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HomeMy WebLinkAbout0159 THE PLAINS ROAD - Health 1 59 THE PLAINS RD., . A= 100 023 i M� I �s goo 0 1-17-2008 a 11 Suva Locus: 159 The Plains Road,West Barnstable, Massachusetts 02668 i 5Z -OZ�T GRANT OF DEED RESTRICTION WHEREAS, Sandra J. Taylor and Philip G. Ellis, of 159 The Plains Road,West Barnstable, MA 02668, are the owners of land, with buildings thereon, in West Barnstable, Barnstable County, Massachusetts,known as and numbered 159 The Plains Road,more particularly described in a deed recorded with the Barnstable County Registry of Deeds in Book 12918, Page 344 (hereinafter,the "Property"), and being shown as Lot 23 on a plan entitled"Plan of Land in Marstons Mills, Barnstable,Mass., for Holly Realty Trust," dated March 24, 1970,by Charles N. Savery, Inc. (surveyors) and recorded in the Barnstable County Registry of Deeds Plan Book 239, Page 137, and also being shown as Lot 23 on a plan filed with the Land Court in Confirmation Case#37368, entitled"Plan of Land in Marstons Mills,"dated January 10, 1972, by Charles N. Savery, Inc. (surveyors); WHEREAS, Sandra J. Taylor and Philip G. Ellis, as the owners of the Property have agreed with the Town of Barnstable Board of Health to a restriction as to the total number of bedrooms which can be included on the Property as a pre-condition to obtaining a building permit; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to authorizing the issuance of a building permit for the construction of a garage addition on this Property, is requiring that the agreement for the restriction on the total number of bedrooms on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, NOW,THEREFORE, Sandra J. Taylor and Philip G. Ellis do hereby place the following restriction on the above-referenced Property in accordance with this agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 159 The Plains Road, West Barnstable,MA 02668 may have constructed upon the lot a house containing no more than three (3) bedrooms. Sandra J. Taylor and Philip G. Ellis agree that this deed restriction affects the Property identified in the Barnstable County Registry of Deeds Book 12918, Page 344, and being shown as Lot 23 on the plan recorded in the Barnstable County Registry of Deeds Plan Book 239, Page 137, and on a plan filed with the Land Court in Confirmation Case# 37368. The foregoing restriction shall not prohibit an increase in the number of bedrooms in the event that the Property's sewage and water system convert to the Town of Barnstable Municipal Water 1 f System,provided that the Property owner shall apply for and receive permission from the Barnstable Board of Health for any such increase in the number of bedrooms. This restriction shall be imposed for the benefit of the Town of Barnstable Board of Health only and is not to be construed as any restriction under any other state or local regulatory scheme. Executed as a sealed instrument this day of.. v ry)Lf Sandra J. Taylor Q . PAip - lis COMMONWEALTH OF MASSACHUSETTS ss �� j�. �' , 2008 On this �s day of November,2008,before me, the undersigned notary public, personally appeared Sandra J. Taylor and Philip G. Ellis,proved to me through satisfactory evidence of identification, which was 09. r ffl! , to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose. No ry lic My Commission Expires: I 2 rn vtr y. 1,60 26' . ie i - — 3.o s �� �C J 5 2000 T0,6{'A°OFg r COMMONWEALTH OF MASACHUSETTS \ , n�°�. " EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION ; ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 159 THE PLAINS RD.WEST BARNSTABLE, MA 02668 0'\C-�) 0 Oib Name of Owner JANE GOULD Address of Owner: SAME Date of Inspection: 1127/00 Name of Inspector: JOHN GRACI I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET MA.02630 Telephone Number: 508-664-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 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 Inspection.The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: _ Passes _ Conditionally Passes Needs Furth)Evaa' ation y the Local Approving Authority X Fails Inspector's Signature: Date:216/00 The System Inspector shall copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,If applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING,THE LIQUID LEVEL IS OVER THE PIPE IN THE SEPTIC TANK.THE LEACH PIT IS IN HYDRAULIC FAILURE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 159 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1/27100 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.if"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exfiltration,or tank failure is Imminent.The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Ida Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced nla The system required pumping more than four times a year due to broen or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2J98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1/27100 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 the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS Is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,Method used to determine distance n(a(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1127100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: x i have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No x Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. x _ Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Il. . x Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. x Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ x Any portion of a cesspool or privy Is within a Zone I of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well, x Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.if the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must Indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No x the system is within 400 feet of a surface drinking water supply x the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further Information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSI-ECTION FORM PART B CHECKLIST Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner: JANE GOULD Date of Inspection: 1/27100 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note If they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the Interior of the septic tank eras inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X - Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1/27/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d.lbedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate Inspection required Laundry system Inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n1a gpd Sump Pump(yes or no): NO Last date of occupancy: 1/1/00 COM MERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:1/1100 OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: THE SYSTEM HAS NOT BEEN PUMPED IN THE LAST TWO YEA System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous Inspection records,If any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date Installed(if known)and source of Information: 1984 A NEW SYSTEM WAS INSTALLED Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1127100 BUILDING SEWER:X (Locate on site plan) Depth below grade: nla Material of construction: _ cast iron X 40'Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) n/a SEPTIC TANK: X (locate on site plan) Depth below grade: 0" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: L 8'6"H 5'7"W 4'10"" Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert,structural integrity,evidence of leakage, etc.) THE LIQUID LEVEL IN THE SEPTIC TANK IS UP OVER THE PIPE,THE LEACH PIT IS PAS THE EFFECTIVE DEPHT OF LEACHING. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n1a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: 1/1/00 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet Invert,structural integrity,evidence of leakage, etc.) n/a revised 9098 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 159 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1/27100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n1a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:WA Alarm in working order:NO Date of previous pumping: 1/1/00 Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet Invert: THE LIQUID LEVEL WAS OVER THE PIPE" Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2198 Page 8 of 11 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 159 THE PLAINS RD.WEST BARNSTABLE MA 02668 P Y + Name of Owner JANE GOULD Date of Inspection: 1127100 SOIL.ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000G H fi XD 6 leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Aftemative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING,THE LIQUID LEVEL WAS OVER THE PIPE. CESSPOOLS: _ (locate on site plan) Number and configuration: n1a Depth-top of liquid to Inlet Invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of Inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 159 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1/27/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) C 6 D R QA 13 Ar- �4 83 3� 6� �S OF revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 169 THE PLAINS RD.WEST BARNSTABLE, MA 02668 Name of Owner JANE GOULD Date of Inspection: 1127100 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: 1/1/00 Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please Indicate all the methods used to determ'Ine High Groundwater Elevation: NQ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) NQ Determined from local conditions NQ Checked with local Board of health No Checked FEMA Maps NQ Checked pumping records NQ Checked local excavators,Installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 TOWN OPBAP-NSTAi'3LE . �oGo S 9 P46/4l.S' ��ni'� � SEWAGE # � VIL:L_ AGF ASSESSOR'S ;nAP & LOT INSTALLER'S NA OD NO. ,SEPTIC TANK CAPACr1 r6 e v LE HI ACNG FACIL=: (ty , 4 �= (size) X`� NO. OF BEDROOMS BUILDER OR OWNER PERMIITDATE:. COMPL1ANCE DATE: Separation Distance Between the: - ' -Maximum us.,d Groundwater Table and Bottom of Leaching Facilityy Feet , Private Water Supply Well acid Leaching Facility (if any wells e.kist �-,, ;-. Feet on site or within 200 feet of lea�l�Ing faciLty')` 1 Edge of Wetland and Leaching Facility(If any wetlands exist within'300 feet of leaching facility) ` ' Feet Furnished by �2 /3.2 F .4 � No. A Fee_y.?_ n THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pprication for Migpool *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(VrAbandon( ) ❑Complete System gindividual Components Location Address or Lot No.,5 g(h/-5 Owner's Name,Address and Tel o. Assessor's Map/Parcel Z `✓C��` Installer's.I_ame,Address,and Tel.No. Designer's Name,Address and Tel.No. r Type of Building: Lot Size sq.ft. Garbage Grinder Dwelling No.of Bedrooms ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -5750 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title - Size of Septic Tank SSJ!R�A--- LOq12 Type of S.A.S. 60 t�- q� '4) �✓z�G� Description of Soil d?0 0 f=e- V e 4 1���1 �, UJ Nature of Repairs or Alterations(Answer when applicable) O EE � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance hag-been-issn alb _---- Signed Date Application Approved by Date 2 2 7— ;Lakyo Application Disapproved for t follo g reasons Permit No. a.GOk,51 — g Date Issued g' TOWN OF BARNSTABLE . j C LOCATION S 64AI t.S 7Z'c� SEWAGE # VIL,LAG ASSESSOR'S MAP & LOT t i Lv't fA_ INSTALLER'S NAIO NO. /71 i a Cd,12 =2e,42LI r SEPTIC TANK CAPACITY /6 6 LEACHING FACILITY: (ty ) s (size) � NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 0- - r Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 J Furnished by i -;Z7�� -97z :g lei - ,( ! d No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., M,�SSACHUSETTS 01pprication for ;Di.5pogar *p!6tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( ^radon( ) ❑Complete System k Individual Components Location Address or Lot No./ �] Owner's Name,Address and Tel.No. Assessor's Map/Parcel tN'3�""^ �t " Golu\u Installer's Name,Address,'and Tel.No. Designer's Name,Address and Tel.No. 5-f Type df Building: J Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) `Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures :.<. Design Flow -C`Z gallons per day. Calculated daily flow '��« gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank e of S.A.S. �.. ---Type 1 Description of Soil Nature of Repairs or Alterations(Answer'wheh'applicable) c rt n 't Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of H alt . Signed r Date Application Approved by ' Date Application Disapproved for t e folio i g re o s``"'t'�1 Permit No. Date Issued —7— .——————----------------------------- THE COMMONWEALTH OF MASSACHUSETTS ,r BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by _ at - t ._... has been constructed in accordance the provisions of TitlA and the for Disposal ystem Construction Permit No. dated Installer Designer The issuance of this enru/shall not be construed as a guarantee that the s st will function as deg i n 6.1 O n� Date p � 'I ,r't�� g Inspector y ,r-t,4 /lr� g1!1 --------------------------------------- No. r Fee THE COMMONWEALTH OF MASSACHUSETTS V r PUBLIC.HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS 'Wi0po5al *pgtem Construction Permit $ermission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 5 t ��. ,n/o d and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: _'1 „Ma Approved by F 4i '► 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated Z516 Q , concerning the property located at l:52 i9ou nn VQa_A, VU f2 Lmdrib))—meets all bf the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system r • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be loc ted less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] 4\0 • If the S.A.S.will be located with 250 feet of any ve,etated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevatio , Please complete the fohowing: / A) To f Ground Surface Elevation(using GIS information) /,;(9 G.W. Elevation +the MAX.High G.W.Adjustment 3,� _ `1 �v DIFFERENCE BETWEEN A and B SIGNED DATE: �� O [Please Sketch proposed an of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �l/"N!1� � � ' � � l��� ��U� V�`''� L 0 C A..,T INN 1@ ''``�P lip S E W A G E P E R IN 1 T M Q� K. 3, /00 VILLAGE IDSTA LLER'S NAME 6 ADDRESS � e U I L D E R , AOR OWNER s DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I L i t3eX . 1 No...'..... �-:.� • TIE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �r ........../..Ow• oF2c. f?!1! 'T ........................................ Xv,pliratiun for Moposal Works Tonstrurtiun ramit Application is hereby made for a Permit to Construct ()<) or Repair ( ) an Individual Sewage Disposal System at: ..........................................' ' 4-----..... r1 ........... /nl_�.��" Locyy-��n� -Address or Lot No. /100 w caner - Address a .......................... ......................... ------- ---------•----........... -................. er Installer Address Type of Building Size Lot ,0_'fJ._Sq. feet Dwelling—No. of Bedrooms....________________________________Expansion Attic ( ) Garbage Grinder (� aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .......................... - Design Flow.........&W__________________________gallons per er day. Total daily, flow.............�. �10_...............gallons. W Septic Tank—Liquid capacity�OODgallons Length_.J�"'__ Width._ --'.... Diameter________________ Depth___11__._._. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No----------- Diameter._____AT!.... Depth below inlet._._�.......... Total leaching area___!Ova.sa. ft. &Db Z Other Distribution box ()(g[j Dosing tank ( ) a Percolation Test Results Performed by.....•-----------••--•••-•-••••--•....-•••-••-•-•-•-•----•-•-•••••-•----• Date........................................ 1.4 Test Pit No. 1___.__4Z._minutes per inch Depth of Test Pit____________________ Depth to ground water-----!lfQ.___S...... 44 Test Pit No. 2................minutes r inch Depth of Test Pit__.____..._________. Depth to ground water...... P P a f --i- -----•-•------------------ O Description o --•-5 Soil �t_.'f.......'._....0-----.e** ?n�Ql�--''-"09�--� J�... G11- c.� •-•------••••._...••-•-••-••--••-----•••••••---•---•••--•-•-••••-•-•-••-•--••-••••....-•-•------•-••...-•-•---•-- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------------------------------------------------•--------........-•-•--•-•---•---------------------------.._..------...--------------------------------....-•--------•----••- Agreement: The undersigned agrees to install the a scribe ivi a Sewage Disposal System in accordance with the provisions of TITLS 5 of the State u ders ned further agrees not to place the system in operation until a Certificate of Compliance ha e s y e bo d of health. d SinC . Date Application Approved By--•- ` - •- •--••- .................................. ........... �4------- ate Application Disapproved for the following re on ----•• - °--•••-•••••••-•-••--••-•---•---•••-•.=•-••••-•••-•••••--••.................................. ........................................................ - •-....•-•---••--•-••••-......•-••---_------••-•-----------------------------•-------•- ----------•--- Date PermitNo......................................--------------•--- Issued....................................................... Date {� s No.........U._. =.,r..©S FE$...... �.�............ THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH «gip ---.�I.OHJrll.............OF. -°11< e ----------------------------••---•••••••-•.------ Appliration for Disposal Works Tonstrurtiun Vrrmit ;, Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 07- e,�?�� �►f i ................»"". .............. -- .........I._-_...- -•1.............. _ ..------- ---------..........._.._... -••••--•--..........................••.... Loc 'on-Address +-K,, '�/I�'��//► or/�?t No. .��r`y ......................... wner Address Installer Address U Type of Building rr Size Lo :f4...Sq. feet Dwelling—No. of Bedrooms.........#.-)...........................Expansion Attic ( ) Garbage Grinder 4j p, + `other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -----•------------------------------------- ••---- --•--•---•--............... W Design Flow ..... ��------...... -•-•--...gallons per a day. Total y flow •- .4� gallons. 7i ►, ,.. WSeptic Tank—Liquid ca.pacltyl0d0.gallons _: Length_ ___ __..___ Width.:_ ....... Dia��tleter________________ Depth._�...___-_ x Disposal Trench—No......... ..... Width .... Total Length......... i-------- Totahleaching area....................t� sq. ft. Seepage Pit No________ _________ Diameter ...�e4....... Depth below inlet.... Total leaching area:..'!• ..sq. ft.6Pb Z Other Distribution box ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W minutes per inch Depth of Test Pit. Depth to ground water-__-..1�4N.______.___ Test Pit No. 1.__..*��.,t�.. ................... e ,r• -_ 44 Test Pit No. 2................minutes r inch Depth of Test Pit.................... Depth to ground water. .................. i t Description o S4 5`----'--Q��..' ...`---..0.....+, ..... v�... ��� ' ...... ...................................` .... • U �d ......•-••--......----••....r.!'l-' ' -•------------------------••---------:.....------------------------... W •-•-•-••---•.............•-••----•••••••------••-•--•-•-•-•-••-••••......--•-•--•---•......•----•----••--•••-••-----•---•-•••-•••••....-----•......-----•-•-----••-•--•---•-••---......-•---•-----•-•-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•-------------------•----------•-------•-------•--------.....--------------.......------------------••---------------------•----------------------------•••••-----•---••••-- Agreement: The undersigned agrees to install th ore escribe div' Sewage Disposal System in accordance with the provisions of TITLE 5 of the Stat de der 'gned further agrees not to place the system in operation until a Certificate of Compliance h b iss e bo rd of health. �p U !. Date Application Approved BY -'---........... . ................................................. ate Application Disapproved for the following re ons:••••----------•-••---•••---•--•--------•-••---•--•••----•--•----••......---••-•-•---........................... ---••-•-------=------•--•-•-------•------...........---------.....--------------•••-••-------...-•--•---------------------•-•------•-----•-•--------•------•-•---••----•-•---•••-•--•---•-••--•....----- Date PermitNo........................................... -. Issued....................................................... Date x 4� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................... ......... TnrtifirFate of f ompli attrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY-------•-........ .....£ ''"� : =inst ii _, y at............... I � ` + ' ' --------------•-----------•-----------•-------------._ has been installed in accordance with the provisions of TITL' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit 1No.' --------- dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE-SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S TISF °CT RY. DATE................:.................(�'. ../�. ...� ....--------- Inspector--•=----•� ............................................................. THE COMMONWEALTH OF MASSACHUSETTS BARD OF HEALTH C ...........................................OF...................................................................................... Disposal Works �ianutrmlivit rrutit . Permission • hereby granted.....-- -. .!.. ..---••-----•-----------------------------------------------------------•--•------.--------•-------- to Constru or Repair ( a Ind�vi. al Sev�ra a Disppsal System atNo..... Z.> ..... ....................------------ r street., tsy" cr as shown on the application for Disposal Works Construction Permit No'................ ated---------................................. y ✓- oard of Health DATE....----------------•--•-----•--••-- jam FORM 1255 A. M. SULKIN, INC.. BOSTON ,� + Massachusetts Water.Resources Commission/Division of Water Resources WATER WELL COMPLETION REPORT ' D _._WEL� ATIbN � z Address O _. p'V /��/�11 d City/Town 21%)& / 4M7 . �r 4 G.S.Quadrangle Map r Grid Location Owner Address 130, 16UM � WELL USE ONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water aring Rock Other ///��� Water-bearing Zon METHOD DRILLED �� 1) From To Rotary(type) CableJ�V 2) From TO Other �� 3) From 4) From To CASING �� Depth to Bedrock Lengt 9S ameter�= Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet.-below land surfs Sand: fine❑ medium❑ coarseX ,Date measured A Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: '4 Slot�O length_fro m�to9 Yes ❑ No Split Screen(or 2nd screen) WATER ALITY TESTS MA E Slot# length from to Chemical Biological Depth To Bedrock PUMP TEST, Drawdown feet after pumping days- hours at GPM. How measured ecovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) aterials From To 0 o' m IL Firm a� Address— City Registration No. F6i era ors Signature Please print um It 10M-8/81-164843 1 Log Number: 3699 Bottle # B050 Date: . 5/22/84 Of sAR� A r �•i s� BARNSTABLE COUNTY HEALTH.,DEPARTMENT SUPERIOR COURT HOUSE V BARNSTABLE, MASSACHUSETTS 02630 ° AS$ ' DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Client: -Ted Galll d Collector: R_ R Clough Mailing Address:Yj p_ 0_ Bnx 724 Affiliation: Clough & Cahoon Well Drill 'g. Barnstable, MA 02630 Time & Date of Collection: 5/2.1/84, 11 :30 a.m. Telephone: 362-6990 Type of Supply: well water Sample Location: Lot 23 Plains Rd. Well Depth: 95' W. Barnstable Date of Analysis: 5/21/84 Parameter Sample Result Recommended Limits Total Coliform-Bacteria/100 ml 0 0 PH 5.9 Conductivity (micromhos/cm) 78. 500.0 Iron (ppm) 0.12 0.3 Nitrate-Nitrogen (ppm) <0.04 10.0 Sodium (ppm) __ 20. XX Water sample meets the recommended limits of all above tested parameters. Water sample has higher than average levels of nitrate. Future monitoring is recommended (2-3 times per year). . The low pH of the water may shorten the useful life of the house's plumbing. Water sample may present aesthetic problems due to Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. Water sample is not recommended for human consumption due to Retesting is suggested. REMARKS: CC: Barnstable Board of Health / CC: Clough & Cahoon Well Drilling Lab Dire or - 11/7/83 I N I . Q �O as /Q LO r 2S � z Q \ -' t y .,. ^..4 >Mrs,T'=�'�'""?�"3;s $"�q"sr ".".°.*"'�Y'Y'h�.tY':��'� 'a^-' °�y"»'�'C^�di�. '` "3•'.R' z '' '�; �-'!�e �...'�''!"`yn,}�y"�^'7;Rr°?e�'' +"it'- �c r,x..-,i^ .M.'^"n t TE r yoL�A'9 \ .p.r -� wE[c z TOP OF FOUNDATION /' CONCRETE' COVER icon',�•as-�✓r� /_ _ _ �,. CONCRETE COVERSs, Y " 4'�CAST IRON :12"MAX. Gqz .Sd�fie _ s �.✓.0 -- 67� '\ sGQa'° PIPE (OR 4"-ORAN 12"MAX. EOU1V.)- MIN. GEBURG(OR EQUIV.) PITCH 1/4"PER. PIPE- MIN: LEACH PITCH I/4"PER.FT.' PIT •.• •• PRECAST NVERT ° + - o PIT G / E1.r10:E1c�... INVE T INVERT ! . s w SEPTIC TANK DIST w 1• OExisr.✓� �,o INVERT BOX �.. • E UI ; - o• EL..Z.4.. /4Q:O, GAL. ( INVERT . 9Gc�ia �i' 3/4"TO Ile {'+ s �': EL �..7' o Eta? was H ED �•gl .r� LO 2.3 STONE �. CA \\p v TES/°'� 3S 443 rT rt ax f •• /9 6�DIA.l /2' DIA.-----►�s.►�r ` FROFI LE OFOUND WATER TABLE Y SEWAGE DISPOSAL SYSTEM w NO SCALE / 794 y / •^ 4 ¢_ ' /S0,00' PLAINS 40AD SOIL LOG WITNESSED BY : ' �.RS?FI GSG BOARD OF HEALTH E-t.?9,72 ' E-t 34.82' �l•.�.3, z T-. �:.r�� 9.•0�, -ate f DATE .:'9��'��.'. TIME.�.3.0.� c7.JR�n.8�. ,.; /iLoTE - ELF✓.�TGi✓�S B/,�SF� nn/ � , .�J/9%� c// / �'?�_e ) 1 JfiM�,3 !L?Tv/✓I \. B /✓c �+, M TEST HOLE I TEST HOLE . tS��.IJJGN• .,4444 A'S.ENGINEER �L f� 1 ELEV.:9.Q>.3!v' ELEV. .4'0.22.'. . Yv rnvso.� ✓ �?.:G•FFa,c�. /.�t�e�9, R�'C7 9Ae- ego A/ a �' I �q�o• resg.s ' Y �a DESIGN DATA : >, NUMBER OF BEDROOMS ,.3. L3J�3 ' -L5 3 Z2 TOTAL ESTIMATED FLOW . . '�9.Q . GALLONS/DAY I .S<�✓s� ' ; BOTTOM LEACHING AREA ./i 3 1D . SO.FT. /PIT SIDE LEACHING "AREA.. . . .��O.B SO:FT./ PIT �. vG GARBAGE DISPOSAL eVO. . .(50% AREA INCREASE) TOTAL LEACHING AREA : .2�3>� SO.FT MILLS t S I T E PLAN -�-� M A R S T O TES , V I / L_ L f ct 3i PERCOLATION RATE . . . . . . . :�'.� . MIN/INCH CYO ceo LEACHING AREA PER PERCOLATION RATE ..'I'94. SO.F7 s r AJ WATER ENCOUNTERED FOR NUMBER OF LEACHING PITS .cS .13%✓lip->.� �?r,1 ..�,r ,.✓, � APPROVED . . . . . . 190AR0 OF HEALTH . . . . � TED GOULD DATE . . : . . . AGENT OR INSPECTOR /�J�/QL� // /�g9 tSC.9LE /'' . ,QO • �,:� EDWARD 9 r �' �p IVAI OF KEJtEY f L�JN .�ErE'R��cd .�Cs)ni &0,o AC' e-79 f' /.97 � i��p y Lfl7` c'3 f7 '9 . .Src';�o.,i .4 ,�/�L�, /✓�ia�s�-c�,✓� NJ�L�.t- M� •,✓►�.9�7.s.�-cvJ,�.!''�r�� •,n?r9 - � '� " PETITIONER x �+ � Y•�' #s« � ,"a-7�`�" 'may` '� � ...x.m y� r ,-t`r j^ w'` '�k ,r^ x r` d ;; � 3 �;,i i .., .t 4 f s. �:..• +y .';'�.gyyti+�`ii�ii���GiiYP'.�riit�. Y3'iai:_s".w•%.r-rSa...,w.c.-«�.,,..... :. � ? `+. .c'" 'yam +._..< r_i �a.i„.�. �n ::."x!r�-a'*'.r :"n"�,t,_,,,.,:M l