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HomeMy WebLinkAbout0027 BROKEN DIKE WAY - Health 7 TOWN OF BARNSTABLE LOCATION Z�I �P�C�.I rC SEWAGE#`ZOZZ- OS4 VILLAGE694TU9-VJ UZ- ASSESSOR'S MAP&PARCEL 2`Z7-t lq INSTALLER'S NAME&PHONE NO. �1�2T 6 .�2 (� $)977- 887"7 SEPTIC TANK CAPACITY 1500 OO agnj. LEACHING FACILITY:(type)rjL"n 9A CtFAms (size) Zf3 X 10.$3 )c I NO.OF BEDROOMS 'q OWNER,J —EMAPW PERMIT DATE: I COMPLIANCE DATE: ZZ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ® 0.5 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 ee �T 6 - out (O- c � . 9 5 13.1 32 . jars No: ` d Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatiou for Misposai *pstem Coustrurtion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a1 ,R DIKE Owner's Name,Address,and Tel.No Assessor's Map/Parcel oZ 11 -7 ate B Installer's Name,Address,and Tel.No.. Designer's Name,Address,and Tel.No.T0:9Y,,273—ID 3` 7 1ZObaKr B oaiz C.O :irG eA.Gcfj6_6XtA) C 9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r t�cj}fl 1�-(. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) +46 gpd Design flow provided q—, t gpd Plan Date I`7_-Xg— rt-&o;Xl Number of sheets i Revision Date Title D-7 Size of Septic Tank 1 j UQ Type/of S.A.S. s oo 6-9�- 4se-A—S Description of Soil 11�(G"�lJf�l Jt / pL AA Nature of Repairs or Alterations(Answer when applicable) ( ( `Jj 0 J!&rTj<_ Date last inspected: Agreement: The undersigned agrees to ensure the construction aintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm t ode and not to lace the system in operation until a Certificate of Compliance has been issued by this Bo f a h. Si ned Date �,0 _Z Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 0 2 ! �� Date Issued - '� -r- ,� -- R7',r,7 No. Fee— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:` PUBLIC HEALTH DIVISION - TOWN, BARNSTABLE, MASSACHUSETTS Yes Application for ]Disposal 6-pstem construction Permit Application for a Permit to Construct Repair U ade � Abandon M.• pp ( ) p ( ) pgr. ( ) ❑Complete System Individual Componen�sM. ,� Location Address or Lot No.W7 1?,ROK.OJ DIKE R( Owner's Name,Address;and Tel.No. Assessor's Map/Parcel X) 0AQy WAO_:� a44V 0607R jZ44C Installer's Name,Address,and Tel.No.S'p$a4` 77 $8 7'/ Designer's Name,Address,and Tel.No.570:84 I;—03-717 P•pb 6 6>44 Cp :'G d GtQ1[3s Ct/u i Zara Type of Building: Dwelling No.of Bedrooms Lot Size �L7, Cl5t sq.ft. Garbage Grinder( ) Other Type of Building IL%q<1 F�,`k kf 1!i-L No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow(min.required) 4k4b gpd Design flow provided 3, { gpd Plan Date r ra��Q ,:(, Number of sheets Revision Date Title .al.-1 PtZ.Z)V f=_&1 h 1 k� 1 A,C\4 Size of Septic Tank • 1,500 Type of S.A.S. l�� goo t_Lt),A) 6-64 WG%e S Description of Soil IV& ad 6k0h Q -4u.�i 1.56 Cr Pt All Nature of Repairs or Alterations(Answer when applicable) U C,t=- G,YL<T IV 6r 1 ) 644 0f.) 65FT I / � 1 N.1 &jL a L_-,5441> ?a 4.fi t"rti MAJF 'PiM -PC:r4- _ W Date last inspected: Agreement: .' The undersigned agrees to ensure the construction and maintenance'bf the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environments ode and not to place the system in operation until a_.Certificate of Compliance has been issued by this Board of ealth. �:rt ` Sign I Date L. '°� f02 �. Y Application Approved by �. iY„_ __ z3� Date,�,.,.,� ,/c�ja Application Disapproved by Date x - for the following reasons w x Permit No.* Date Issued �1I ` " -Z THE,.COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS sk - Certificate of Compliante f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( P) " • Abandoned( )by kozoz - N 6 lJ-p- (!I) � at X) A"6'0 6 t,i-4F (A-A V G t V t 4.[.E` has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No:�- j dated Installer Roatu r e look c Designer 74— 1Q6r/1Je77ejLJ& -Zjd~,, #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will(nct of n�as designed. �~ ^� 1 � Date i � �, 3 2�. Inspector - _ _ . _ - - - ----- ---- - - --- -- ------------------------------------- No. �c 0 C, Fee f �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade O Abandon( ) Systemlocated;at 1 tcc' Li AIV CGXX Q�..111��C.� and as described in the above Application for..Disposal System Construction Permit. The applicant recognized his/her duty to comply w_th Title 5 and the following local provisions or special conditions. Provided:Construction must be completed 'thin three years of the date of thiF�b . ��r_ Date / / Approve _ Bk 34895 Pg336 #7387 02-10-2022 @ 09: 10a N 0 T Deed Restriction N 0 T A N A N O F F I C I A L O F F I C I A L C 0 P Y C 0 P Y WHEREAS,James P.Hawkins and Mary P.Hawkins,husband and wife,tenants by entirety of Belmont, Middlesex County,MA areL4ht)ovpners of 27 Broken Dike WayNCWterville,MA 02632(hereinafter referred to as the"Premisesg)"d being shown on a plan entitled gplan of Land in Centerville, Barnstable,Ma.focth$Barnstabbe Deyel¢pment TrusocoleFl IP.€fill WDale:May 15,1970,Charles N. Savery,Inc.Rgistered EnglnGen Surveyors—Hyannis&Sodfh Oarfholdth,"which plan Is duly recorded in Barnstable County Registry of Deeds at Book 239,Page 131. WHEREAS James P.Hawkins and Mary P.Hawkins,as the owners of said lot,have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lots as a pre-condition to obtaining a disposal works construction permit in compliance•with310 CMR-15.000 State Environmental Code,'f'rtle V,Minimum Requirements for-f e Subsurface Disposal of Sanitary Sewage; WHEREAS,the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200,State Environmental Code, Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,and authorizing the Issuance of a building permit for the construction of a single family home on this property,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. Bk 34895 Pg337 #7387 NOW,THEREFORE,James]P.1TWkins and Mary P.Hawkins dit&1effj place the following restriction on the above-referenced land A akordance with their agreementkiA the Town of Barnstable Board of Health,which resb9ciffonFshh&;WA t6 land and Q bFrnd 6glp9n ill s%c&ssors in title: C O P Y C O P Y 1. 27 Broken Dike Way,Centerville,MA 02632 may be constructed upon the lot a house containing no mod*tkrRour(4)bedrooms,James P.111la K$is and Mary P.Hawkins agree that this shall be a permAnAt deed restriction,or until towks&er is available,affecting 27 Broken Dike Way,QociteFd irk CAtJrvAe,IMA and beiQ sum&&fhe�IA rkorded in Plan Book 239, Page 131. C O P Y C O P Y For title of James P.Hawkins and Mary P.Hawkins,see the following deed: Book 22785,Page 193. Executed as a sealed instrument this 3rd day of February,2022. t (Aes P. Hawkins /' �L� — Y MaIIry P.Hawkins Commonwealth of Massachusetts -County of ss e_4 ,ss. On this 3rd day of February,2022,before me,the undersigned notary public,personally appeared James P. Hawkins and Mary P.Hawkins,the above-named and proved to me through satisfactory evidence of identification being Massachusetts Driver's licenses,to be the persons whose names are signed on this document,and acfcnowledged to me that they signed if'voluntarily for its stated purpose and that the foregoing instrument is their free act and deed. Notary Public: My Commission Ex 6i.ENNeOMNSM NOTARY PUBLIC OOMMONWLUTH OF MASSAORNM Iq Comm Expires ML 27,= JOHN F. M ME, REGISTER BARNSTABLE COUNTY REGISTRY OF DEED: RFnMTvF'n c RF.rnRnRn PT.MfrvrPAMTrar.T.v Town of Barnstable Regulatory Services Richard V. Scali, Interim Director RAMSTASM MR �� Public Health Division 039. Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3-25-22 Sewage Permit# '0 Assessor's Map\Parcel 227/79 Designer: JC Engineering, Inc. Installer: Robert B. Our Co., Inc. (RBO) Address: 2854 Cranberry Highway Address: 363 Whites Path East Wareham, MA 02538 South Yarmouth, MA On Z 110 1 ZZ, RBO was issued a permit to install a (date) (installer) septic system at 27 Broken Dike Way based on a desi n drawn by (address) JC Engineering,Inc. dated 12-28-21 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed 1 iance with the terms of the I\A approval letters(if applicable)14 o�� vj„yr Ms�yo c �QHN L e v NRlRCHIl�A U2 (Installer' nature) CML 41 APO (D ner's Signature (Affix De 1 p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D �: SION. CERTIFICATE OF COMPLIANCE WILL NOT. BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepticTesigner Certification Form Rev 8-14-13.doc Town of Barnstable . Board of Health MASEL 200 Main Street, Hyannis MA 02601 039. Office: 508-862-4644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt. March 1, 2022 Mr. (Michael Pimental, EIT, CSE 2854 Cranberry Highway E. Wareham, MA 02538 RE: 27 Broken Dike Way, Centerville A =:22-079 Dear Mr. Pimental, You are granted variances on behalf of your clients, James and Mary Hawkins, to construct an onsite sewage disposal system at 27 Broken Dike Way, Centerville. The variances granted are as follows: 310 CMR 15.211 Setbacks:: To install a soil absorption system seven (7) feet away from the garage slab foundation, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.211 Setbacks:: To install a soil absorption system 6.5 feet away from the front property line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.211:: To install a soil absorption system 3.5 feet below grade, in lieu of the maximum three feet of soil cover allowed Section 360-1 of the Town of Barnstable Code: To install a soil absorption system ninety (90) feet away from a wetland, in lieu of the 100 feet minimum separation distance required. The Board of Health granted these variances with the following conditions: (1) No more than four (4) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\WPFILES\27 Broken D ke Way Centerville VariancesGranted 2022.docx These variances are granted because the physical constraints at the site severely restrict the location of the septic system components due to wetlands and existing private wells in the area. Sincerely yours, J Norman airman Q:\WPFILES\27 Broken Dike Way Centerville VariancesGranted 2022.docx H �1HE DATE: p2 * � $95.00 FEE*: BARNgrABM fotp � Town of BarnstableC.BY: SCHED.DATE: / 1 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 b,��p , FAX: 508-790-6304 14 e� �,'- John T.NormanDonald A.Guadagnoli,M.D. Paul J.Cannif,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION Property Address:_27 Broken Dike Way Assessor's Map and Parcel Number: Map 227,Lot 79 Size of Lot:J27,058 s.f. Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: APPLICANT'S NAME:_Timothy&Grace Pederson . Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name:_James&.Mary Hawkins Name:_Michael Pimentel,EIT,CSE Address: 27 Broken Dike Way,Centerville,MA Address: 2854 Cranberry Highway,E.Wareham,MA 02538 Phone: Phone: 508-273-0377 EMAIL:—mpimentel@iceng.org ore VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) _See attached Appendix A NATURE OF WORK: House Addition House Renovation Repair of Failed Septic System X Checklist (to be completed by office ce staff-person receiving variance request application) Please submit first four on list as S collated packets. — Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans)&one electronic version submitted to email:healthQtown.bamstable.ma.us. Five(5)copies of MA DEP approval letter for Innovative/Alternative septic system(when proposing an I/A system,only). Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu-Five(5)copies of full menu submitted(for grease trap variance requests only). *$95.00 for the following variances: I.)New construction,2.)Septic repairs with increase in flows,and 3.)New owner/new lessee applying for food, pool or body art variances. Exemptions from variance fee: I.) Septic repair without an increase in flow and variances granted at the counter,2.)Monitoring plans,and 3.)Temporary food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. [Type here] MAIL-IN REQUESTS Please mail the required fee amount of $95.00 (if applicable), along with five (5) completed variance application packets to the address below. Checks should be made payable to: Town of Barnstable. Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 For septic system variance requests, each of five packets must include: 1) Variance request form, 2) Letter for the Board with further information on the reason for the septic variance request (Optional), 3) Engineering plans, 4) MA DEP Approval letter for an Innovative Alternative septic system (if an I/A septic system is proposed, only), 5) Floor plans. In additional to five septic packets, must include a copy of the seven (7) page checklist, authorization letter, copy of abutters notice, and fee, if applicable (see checklist below). Please send one electronic submission using a PDF or .jpg of the engineering plan and floor plans to email: health(D_town.barn stable.ma.us. (Total email must be less than 10 megabytes.) For grease trap variance requests, each of five packets must also include a full menu. (see checklist below). Checklist - Please submit first four on list as 5 collated packets. Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans)&one electronic version submitted to email:healthntown.bamstable.ma.us. Five(5)copies of MA DEP approval letter for Innovative/Alternative septic system(when proposing an I/A system,only). Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). *$95.00 for the following variances: 1_)New construction,2.)Septic repairs with increase in flows,and 3.)New owner/new lessee applying for food, pool or body art variances. Exemptions from variance fee: 1.) Septic repair without an increase in flow and variances granted at the counter,2.)Monitoring plans,and 3.)Temporary food(not a"variance"). Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Email: health(-town.barnstable.ma.us Back to Main Public Health Division Page i JC ENGINEERING, Inc. D�Q Civil & Environmental Engineering n 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 APPENDIX A Due to the physical constraints of the property and the existence of a wetland, the following Local Upgrade Approvals and Local Variance are being requested. In accordance with 310 CMR 15.401 - 15.405, the following Local Upgrade Approvals are requested from 310 CMR 15.211 & 15.221(7): 1. A 3.0' waiver(10.0' - 7.0') for the setback from SAS to garage slab. 2. A 3.5' waiver(10.0' - 6.5') for the setback from SAS to front property line. 3. A 0.5' waiver(3.0' - 3.5') for the maximum cover over the H-20 SAS. i t from - The following Local Variances requested om 1, Section 360 1: 1. A 10.0' variance (100.0' - 90.0') for the setback from SAS to the wetland. KITCHEN 13.6' BATH 0"x77' Ova f L 0:� `+ DINING AREA w. 12'7"x 13'6" r i MASTER BEDROOM E I J_1' 6 H 1 v'x17'.3' 10"x5' _ o E HALL 37'2"x..3'9" 4 A\ or t ��- LAUNDRY x 6'11" 1111""x 6'11" { LIVING ROOM 21.'5"x 18'11" FOYER "X'15'11`: 1 1 PORCH GARAGE 9'5"x 6'3" 2'2'1"x 23'2" LIE 1 27 Broken Dike Way Centerville Main Level Z a 0 BAT 3„ x6 EBEDROOM OPEN TO BELOW 14'7" x 11'3" HALL 12'2" x 4,3" BEDROOM 147' x 11'1" € W.1.G. E 7'5".x 51 0" - _-_-..---I-..,_.-----._ 27 Broken Dike Way Centerville Upper Level 12'7`� x 910 RECREATION ROOM BEDROOM 2 6'1" x 13'1" 15'0" x 13'0" ------------- BATH 10'6" x 7'1" ELECTRICAL ROOM 11'6`. x 71" 1 STORAGE 21'5" x HALL 17'3" x 19'81" 27 Broken Dike Way Centerville Lower Level 0 f � Town of Barnstable PT 21-287 Department of Inspectional Services t BARNSI'AB WALE. Public Health Division 'rED MAt a 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Date Scheduled 11/05/21 Time 11:00 AM Soil Suitability Assessment for Sewage Disposal Performed By: Michael Pimentel, EIT, CSE witnessed By: David W. Stanton (BOH) LOCATION & GENERAL INFORMATION Location Address: 27 Broken Dike Way Owner's Name: James & Mary Hawkins Centerville, MA 02632 Owner's Address: 27 Broken Dike Way, Centerville, MA Assessor's Map/Parcel: 227/79 Certified Soil Evaluators Name: Michael Pimentel Certified Soil Evaluators Email: mpimentel@jceng.org New Construction or Repair: Repair Certified Soil Evaluators Telephone# (508) 273-0377 Land Use Single Family Dwelling Slopes(%) 2-3 Surface Stones No Distances from: Open Water Body 96 ft Possible Wet Area 96 ft Drinking Water Well N/A ft Drainage Way N/A ft Property Line 5 ft Other ft n Parent material(geologic) OUtWaSh Depth to Bedrock >120 Depth to Groundwater: Standing Water in Hole: >120" Weeping from Pit Face >120" Estimated Seasonal High Groundwater >120" DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Direct Observation Depth Observed standing in obs.hole: >120 in. Depth to soil mottles: >120 in. Depth to weeping from side of obs.hole: >120 in. Groundwater Adjustment N/A ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level 'PERCOLATION TEST Date 11/5/21 Time 11:00 AM Observation Hole# 1 Time at 9" 11:33 AM - Depth of Perc 6"-24" Time at 6" 11:36 AM - Start Pre-soak Time @ 11:16 AM Time(9"-6',) 3 MINS. - End Pre-soak 11:31 AM Rate Min./Inch 2 Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) N Deep Observation Hole Log Hole#: 1 & 2 Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel 011.- 6" A Loamy Sand 10Yr 3/1 . 6" - 36" B Loamy Sand 10Yr 5/6 36" - 120" C Med. Sand 2.5Y 616 Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) {Structure,Stones,Boulders, Consistency,%Gravel l i7 Flood Insurance Rate May: Above 500 year flood-boundary No Yes X Within 500 year boundary No X Yes Within 100 year flood boundary No X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? N/A Certification I certify that on 10-27-99 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date 12/28/21 SKETCH: (Or you can attach a separate sheet) (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) SEE ATTACHED PROPOSED SEPTIC SYSTEM UPGRADE PLAN DATED DECEMBER 28, 2021. James Hawkins Mary Hawkins 27 Broken Dike Way Centerville, MA 02632 December 9, 2021 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Declaration of Authorization 27 Broken Dike Way, Centerville, MA Dear Members of the Board: Let it be known that we, James and Mary Hawkins (owners of 27 Broken Dike Way), do hereby authorize JC Engineering, Inc. of East Wareham, MA 02538 to represent our and the applicant's interest regarding the upgrade of the septic system located at 27 Broken Dike Way, Centerville, Massachusetts in meetings both public and private. Sincerely, li�tih�nd ames Hawkins May Hawkins The property located at 27 broken dike way will have a 4 bedroom deed restriction placed on it due to the fact the floor plan shows a room in the basement that meets the bedroom definition. With the deed restriction I submit the plan shows maximum feasible compliance from the requested set backs. Don Desmarais s Board of Health Title V Septic Variance Abutter Map for Subject Parcel 227079 Town of Barnstable Direct abutters(no set distance)and the properties located across the street. GIS Unit gis@town.barnstable.ma.us ,,,,� 228081� Legend 2 +`��' 228054 ® Subject Parcel 2281:01' I 8177u 228193 ��� 228152� y [.__� Abutters !1 ' ❑ 228163' 228055 228060 . , 'Parcels 228164 0 Town Boundary 61 r q 228192 228194 Y Railroad Tracks -_.. g ` _ 228058 228056 Buildings } .j J Approx.Buildi NI p 228165,.7 228191 Buildings Parking Lots 228168002 W .�228059 z awed , " m', P ads 228166 `190 �. Unpaved : J 228139002 CI Paved Road n 22816800/ - Unpaved Road ,. `.. Bridge 13 I" 228189 2281 2281t711 : 6T � `s Paved Median r 13 Water Bodies 228169i v 227079 227080 t a f A This map is for illustration 1 -:.. ` t , t '�!„ � purposes only.It,s not adequate 227094002 for legal boundary.4 g determination ry 227081 227073 or regulatory interpretation.This map does not represent an on-the-ground survey.It may be may 227082 � +' — eneralized, not reflect 227078 g Y current conditions,and may 001 , E contain cartographic errors or W ., . omissions. ` 227074 Y Parcel lines shown on this map are k ' 22]Q]] �.y only graphic representations of 227083 227076 Assessor's tax parcels.They are ar - , 227075 not true property boundaries and i do not represent accurate relationships to physical objects on the map such as building locations. 22710033 227084 227104 11_1 1 I 227085° 7086 8 `22 6 0 8 175 ft. 227089' 1 inch=approx. 175 ft. r 227087 227108 -, '" �` P2741 Printed on:12/27/2021 r Board of Health Title V Septic Variance Abutter List for Subject Parcel 227079 - Direct abutters(no set distance)and the properties located across the street. Parcel ID Owner 1 Owner 2 Address Line 1 Address Line 2 City State Zip 227078 CULLIVAN,AMBER 9 BROKEN DIKE WAY CENTERVILLE MA 02632 227079 GILMORE,JEREMY F&SUSAN T %HAWKINS,JAMES P&MARY P 90 RICHARDSON ROAD BELMONT MA 02478 227o8o SIRHAL,REBECCA S 36 BROKEN DIKE WAY CENTERVILLE MA 02632 227o8i DECOSTA,JOSEPH A&DONNA L DECOSTA FAMILY REV TRUST 18 BROKEN DIKE WAY CENTERVILLE MA o2632 TRS 228171 SIRHAL,HUMAM K&REBECCA S THE SIRHAL NOMINEE TRUST 36 BROKEN DIKE WAY CENTERVILLE MA 02632 TRS ........ Page i of i Total Number of Abutters:5 Report Generated On: 12/27/2021 7:05 PM This list by itself does NOT constitute a"Certified List of Abutters"and is provided only as an aid to the determination of abutters. If a Certified Abutter List is required,you must contact the Assessing Division to have this list certified. JC ENGINEERING, Inc. i� Civil & Environmental Engineering °Q 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 MEETING NOTICE Dear Abutter: You are hereby notified that there will be a public meeting on Tuesday,January 25,2022 at 3:00 PM in the James H. Crocker Jr. Hearing Room on the second floor in the Barnstable Town Hall, which is located at 367 Main Street, Hyannis, MA 02601. This meeting is to present a request for Local Upgrade Approvals and a Local Variance with a septic system upgrade project located at 27 Broken Dike Way, Centerville, Massachusetts. Due to the physical constraints of the property and the existence of a wetland, the following Local Upgrade Approvals and Local Variance are being requested. In accordance with 310 CMR 15.401 - 15.405, the following Local Upgrade Approvals are requested from 310 CMR 15.211 & 15.221(7): 1. A 3.0' waiver (10.0' - 7.0') for the setback from SAS to garage slab. 2. A 3.5' waiver(10.0' - 6.5') for the setback from SAS to front property line. 3. A 0.5'waiver(3.0' - 3.5') for the maximum cover over the H-20 SAS. The following Local Variance is requested from Article 1, Section 360-1: 1. A 10.0' variance (100.0' - 90.0') for the setback from SAS to the wetland. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. x T.O.F. EL.= 19.71± FINISH GRADE OVER D-BOX= 17.0't FINISH GRADE OVER CHAMBERS= 18.0' - 16.9' PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2%MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS OUTLET TO WITHIN 6"OFF.G. 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE _ 5" DIA: OUTLET(S) BOX TO F.G. (SEE NOTE 21) CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 18.2 t F.G. OVER TANK EL. = 17.3 t STONE OR GEOTEXTILE FILTER FABRIC ---- - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 4"SCHEDULE 40 PVC � DESIGN ENGINEER. PROPOSED 4" g INIIN• MIN SLOPE 1% 3.5' MAX. TOP OF SAS= 14.50' PLACE H-20 RISERS ON _ FISTI 4'+ 36"MAX. , SEE NOTE 23 ALL CHAMBERS w/ 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL _ _. ... i ._ _..,. . ... --- SCH. 40 PVC 13.50 - 11 ; `' L ',..�..�._.___r _� �-- '.. SEWER PIPE BREAKOUT EL= 14.00� PIPED INLETS TO SYSTEM UNLESS OTHERWISE NOTED. v -( WITHIN 6"OF F.G. 4. TO PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN _ 3 DROP MAX I 1± _j- ry 6 3 2" DROP MIN 3 9 MIN.SLOPE �� PROVIDE WATERTIGHT o ELEVATION = 14.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4" PVC IN FROM JOINTS (TYP-) ��� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 13 „ -- - THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 14" 't.� ¢ �- SEPTIC TANK 4,PVC OUT TO 0 0 0 O 0 0 0 0 CONTRACTOR TO PROVIDE _ - • LEACHING FACILITY o0 0 0 o SPECIFIED DROP BETWEEN + ( oo � � � � � � � � � � 5. SLOPE ALL SOLID PIPE AT 1.0/o MINIMUM. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 4 O, 12" 6" , 2' o0 0° 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. " VERIFY CONDITION OF ? OUTLET TEE 1 .0 MIN. 13.83 � � � 0 � � � � 0 °° 0 0 0 � 0 a o SHALL VERIFY SIZE 48 VE o 0 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK o k� o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS I AND CONDITION OF EXISTING TEES � o � � � 0 0 � � 0 0 0 0 � 0 0 0 GAS BAFFLE 6 CRUSHED STONE EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o _ o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE i 5 VAR. 8 5' (NP) VAR. VAR. VAR. AND DESIGN ENGINEER. OUTLET DISTRIBUTION BOX 4.83 $. ELEVATIONS BASED ON N.A.V.D. 88 DATUM. SEE BENCHMARK ELEVATION SHOWN ON PLAN. I - ---_--- --- -- - -- TO BE INSTALLED ON A LEVEL STABLE VARIES (SEE PLAN) (TYP.} , 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION BASE. FIRST TWO FEET OF OUTLET < 6.5Q PIPES TO BE LAID LEVEL. 11.50, GROUND WATER ELEV.= 10.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES EXISTING 1,500 'GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 4 - 500 GALLON H-20 CHAMBERS 5' MIIN. CHAMBERS END VIEW TO THE DESIGN ENGINEER. *CONTRACTOR TO VIE-RII"Y EXISTI^ � /� CHAMBERS (PROFILE ELEVATION PRIOR TO ANY �VORK SEPTIC T KPROFILE DISTRIBUTION t" X D T 1\ `L _ CHAMBERS DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINE:ER IF DIFFERENT NOT TO SCALE NOT TO SCALE DETAIL t'i NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING ux� REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM I` ,rvo'�, • t". TEST PIT DATA APPROPRIATE AUTHORITY. g • . SWING-TIES V. ! . „�• . PERC NO. 21-287 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED :, '' �* " • ' •ai„ INSPECTOR: David W.Stanton(BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR # r THEY SHALL WITHSTAND H-20 LOADING. DESCRIPTION HC-1 HC-2 1 \ .� � :-- �;..,. ` i r ..� _� TRAVELED WAYS IN WHICH CASE \ .. ,.. EVALUATOR: 'Michael Pimentei, EIT, CSE " F STONE 1 41.9 18.4 \ �r-� • 1 ' ' . - ` 1 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. CORNER O O \ C.S.E.APPROVAL DATE. . -,. :.. V ...::.. �� • +� * • a �1 r, • � " � III� '' a a \\ " 410 CORNER OF STONE 2 15.1' 12.9' 6 , 3 0 * a a " .+ DATE. November 5,2 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ( } ® \ \ `' ''`,. , # .� ; ��; - MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. MAP 227 % '> ':�:: ! CORNER OF STONE(3) 22.3 20.8 0 ,. • ,� ; ZONE TEST PIT#. 1 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, Lq LOT 79 / \ > ¥. ,�* ELEV TOP= 17.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ��7 27,058±S.F. / \1 ` .., ti CORNER OF STONE(4) 41.0 28.2 4 <6-50' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN �'�� ELEV WATER= CORNER OF STONE(5) 49.6 32.3 ��. SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. PERC RATE 2 min lurch y ry - :"' , ' "## a a i • r +� 16. PROPOSED PROJECT IS LOCATED WITHIN: DEPTH OF PERC=: 6"-24 1 I a �' • � All,_ 4.,0"" ASSESSOR'S MAP 227 LOT 79 - . . '.... , TEXTURAL CLASS:,F� � t \ l I // � �`...:. : : � � � §„a . .�► � \+:.. �. _.: � OWNER OF RECORD: JAMES & MARY HAWKINS ADDRESS: 27 BROKEN DIKE WAY CENTERVILLE MA 02632 I ' LOCUS • + � ark-. o,f 17.00' ' � � / 1 0 ( �' `��"�.� +�-r • :"� : A Loamy Sand FEMA FLOOD ZONE X SAS DIMENSIONS ,- • :: 10Yr 3/1 NITY PANEL# 25001C0564J SCALE: 1"=20' .- f s .. ' " •+ Perc COMMU 24" Loamy Sand 15.00' 17 DEED REFERENCE- BOOK 34659, PAGE 199 ! ' ' e` +a ''" ' • B 18. PLAN REFERENCE: PLAN BOOK 432 PAGE 96 10Yr 5/6 36 14.00 ( \ G ".I" ti 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 10 (� 1 1 CENTERVILLE RIVER (TIDAL) 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ( # ( .O fi _..:�r. � .w ' P FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY i F I . . t3 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. r I c. o i . v PLACED IN A ERfiICAL POSITION TO A L 1 21. A 4 PERFORATED SCH. 40 PVC PIPE SHALL BE PLAC O OX w �, _, a • +►+, Y P Benchmark • + P w 5 Medium Sand , O I 1 , , ,. DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3 OF FINISH GRADE. A, Corner of Ste rr C • - ... REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. 3 Elev. 19.66 . • it w , L � X #27 ( 11 1 N.A.V:D. 88 l 3 �' 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL FLOOD ZONE LINE DIVIDING ZONE �y/ A 1 EXISTING ( 1 � ` L.12 BASED , / ` REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. X FROM ZONE AE (E ) 1 ON ACTUAL ON-THE-GROUND r q / P�/ 4-BEDROOM ` e I I \ , FIELD INSTRUMENT SURVEY + / - % DWELLING 1 \ LOCUS PLAN (B.F.E. = 12.0' NAVD 88 BASED ON ��\\ F.1.R.M.#25001C0564J) / % s� \ ( \ "`s SCALE: V= 1000' ' (EFFECTIVE JULY 16, 2014) / , j,�/ 00 �` ( ` \ 126 6.50 No Mottling, Standing or Weeping Observed P T / P� TEST IT DATA LEGEND � t ,\ � M DESIGN DATA \ a�' PERC NO. 21-287 i i ❑ 50xO' EXISTING SPOT GRADE INSPECTOR:. David W. Stanton (BOH) \ < NUMBER OF BEDROOMS(EXISTING) 4 TREE C-1 GARAGE �1 F p �� EVALUATOR: Michael Pimentel, EIT CSE - - 50 - - - EXISTING CONTOUR \ \ DESIGN FLOW 110 GAUDAYBEDROOM �o \ \ + o f �� C.S.E.APPROVAL DATE: Oct. 27, 1999 ./ \ N SLAB=19.0'± \\\ �,':J 1 ro: .'�y TOTAL DESIGN FLOW 440 GAUDAY - 50 - PROPOSED CONTOUR ( \\ ��> tip` Op 6,\ DATE: November 5, 2021 ( _ � \ ► 5 O' DESIGN FLOW x 200 % = 880 GAUDAY 50 PROPOSED SPOT GRADE TOF 19.7± \ � � � �.� ti0 � TEST PIT#. 2 USE EXISTING 1,500 GALLON SEPTIC TANK ` ELEV TOP= 17.20' GAS EXISTING GAS LINE .-�0 I) / \ \ I / \\\ d \ ELEV WATER= <6.70' E/T/C EXISTING UNDERGROUND UTILITIES ��a ' \\ ° , INSTALL 4 - 500 GAL. H-20 CHAMBERS W/ STONE PERC RATE a Z m I �x1' IR I ) VJ W EXISTING WATER LINE f T, -(� \' f DEPTH OF PERC= cn m 15• i \ I / 1 \� SIDEWALL CAPACITY 1 0 �j TEST PIT LOCATION O �r `1 ' \ _ TEXTURAL CLASS: O -r► / \ ' ' ..,. HC-2 r l I (PERIMETER) (2 HIGH) (0.74 GPD/S.F.) GAUDAY G (3)1/ ,L / _ O (96.66) (2 ) (0.74 GPD/S.F.) 143.1 GAUDAY 10 01 EXISTING 1,500 GALLON SEPTIC TANK LOOD ZONE LINE DIVIDING ZONE X FROM ZONE AE 7-G m 1 ` 1 / \ EL.12`BASED ON ACTUAL ON-THE-GROUND FIELD J �y\ m / \ / BOTTOM CAPACITY o„ 17.20' Z \ d INSTRUMENT SURVEY(B.F.E =120' NAVD 88 BASED ON Loam Sand PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE / \ Y rn :: G / F.'I.R.M. #25001C0564J) (EFFECTIVE JULY 16, 2014) (FOOTPRINT AREA) (0.74 GPDlS.F.) = GAUDAY A 10Yr 3/1 / �' , O �� �' / 1 406.1 S.F. 0.74 GPD/S.F. = 300.5 GAUDAY 6" 16.70' PROPOSED DISTRIBUTION BOX O rn c, 1) _ 1 4 r� ALLOI* B Loamy Sand O PROPOSED 500 GALLON H-20 LEACHING CHAMBER -I / \ EXISTING 1.500 G R / L.P. �' w \ SEPTIC TAN'K TO BE TOTALS: 1oYr 5i6 O z� ,` j ti - - ^ 4 USED IN THIS DESIGN -- / TOTAL NUMBER OF CHAMBERS 4 ' r 5 ,,,0 MAP 227 REV. BY APP'D. DESCRIPTION / / 16 � TOTAL LEACHING AREA 599.5 SQ-FT. DATE TO 1 / '`� -EXISTING LEACHING PIT TO BE LOT 78 TOTAL LEACHING CAPACITY 443.E GAL./DAY © , n (4� - �O / cD REMOVED II_I_EI / N/F CULuvAN PROPOSED SEPTIC SYSTEM UPGRADE 17*0 • ,• CLEAN SAND PER 310 CMR 255(3) -- PROPOSED PREPARED FOR: / TP 2 -• DISTRIBUTION BOX PLAN NOTES: Medium Sand JAMES & MARY HAWKINS 17x2' C 2.5Y 6/6 Y �,� • • yo \ 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE Mp OF EACH SEPTIC SYSTEM COMPONENT. / IIt it .• -• F LOCATED AT ~° 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE:LOCATION OF 27 BROKEN DIKE WAY �I,y THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH HAYBALE LINEREQUEST �o LOCAL UPGRADE .APPROVALS CENTERVILLE, MA 02632 '1g O,e TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND ACCORDANCE WITH 310 CMR 15AOI -15.405 THE FOLLOWING LOCAL LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT'WTH TEST S� IN PROPOSED 4"SCH.40 PVC �' UPGRADE APPROVALS ARE REQUESTED FROM 310 CMR 15.211 &15.221(7): PIT DATA. 1 6 70, SCALE: 1 INCH = 10 FT. DATE: DECEMBER 28, 2021 1 \ 1. A 3:0'WAIVER 10.0'- 7.0' FOR THE SETBACK FROM SAS TO GARAGE SLAB. 26 a M 0 5 10 20 40 FEET VENT, EXACT LOCATION ( } No Mottlin ,Standin or Wee in Observed P�j�' qSs PROPOSED FOUR(4) 2. 'A 3.5'WAIVER(10.0 6.5) FOR THE SETBACK FROM SAS TO FRONT 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS g g p g 9cy 500-GALLON H-20 LEACHING PER OWNER `PROPERTY LINE. ONLY. �� JOHN L. °�� PREPARED BY: CHAMBERS w/STONE ` 3. A 0.5'WAIVER(3.0'-3.5') FOR THE MAXIMUM COVER OVER THE H-20 SAS. 6 CHURC HILL JR. JC ENGINEERING, INC. 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONILY AS A N0 41807 p} COURTESY FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE 2$54 CRANBERRY HIGHWAY LOCAL VARIANCE REQUEST MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE.SYSTEM. rs EAST WA S REHAM, MA 02538 VARIANCE IS REQUESTED FROM ARTICLE 1 SECTION 3604: CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMEN'ITS APPEAR.TO p" SITE PLAN THE FOLLOWING LOCAL � � ,•. 508.273.0377 1. A 10.0'VARIANCE(1d00.0''-90.0') FOR THE SETBACK FROM SAS TO THE WETLAND. BE INCORRECT. SCALE: 1"= 10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.5992 27 Broken Dike'Way_ Centerville '. A =. 227 079 I Omrford. , NO. 152 1/3 ORA 1.0% Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Broken Dike k� Dy Via. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name raa P.O.Box 763 Company Address Centerville Ma. 02632 'erom City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/06/2008 Inspector's Signature Date ✓ry 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"s'-ystem�or ,:. has a design flow of 10,000 gpd or greater,the inspector and the system owner'shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. h� This report only describes conditions at the time of inspection and under fhb conditions ofyuse at that time.This inspection does not address how the system will perform I. the future u`�der the same or different conditions of use. , r" •27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as . approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or,uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner thatprotects 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. 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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. r 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 27 Broken Dike Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All System's (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility.with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, ,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Z Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information 1 Residential Flow Conditions: Number of bedrooms (design): 4 ,Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006:98,000 9 ( Y 9 (gpd)): 2007:9,000 Sump pump? ❑ Yes ® No Last date of occupancy: 3/06/2008 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow-(seats/persons/sq.ft., etc:): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter,readings, if available: Last date of occupancy/use: Date Other(describe): 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I . Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Capewide.Enterprises,LLC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume.pumped: 1500 gallon gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No'evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No 9 Y ------------py-------------- ) Dimensions: 1500 Gallon Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? Tank pumped clean 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth'& Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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): 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level-above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No signs of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 Gallon ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Leaching pit was dry at time of inspection.Stain line is 11" below invert pipe. 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Broken Dike Rd. Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Map' Page 1 of 2 Town of Barnstable Geographic Information System r Parcel Viewer Custom Ma Abutters Map Size ® Zoom Out J J'J J J J In p e � �� � / _ f fK jb "Y' k a 1 F 4Y,t 1 y �S �. ,� fir•' � p. � -'Ay � �� ' 9 f� sx ON P 1,f f '� f1C•k-fi , '�-{,;.4y L4 t €rP awl 1 (N. y a4 J - � d t s 20 eet y cc Set Scale 1" = 20 ' I Aerial Photos n^nnvrinhf 9nV1ti9(1f17 Tn... of R.r—f.hle NAA All rinhfc roeenn f- http://www.town.bamstable.ma.us/arciins/appgeoapp/map.aspx?propertyID=227079&mapp... 3/6/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 27 Broken Dike Rd. M Property Address Robert J. Mutrie Owner Owner's Name information is required for Centerville Ma. 02632 3/06/2008 every page. City/Town 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: Bottom of LP 8' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:TechnicalBulletin 92-000-01 plate#2 annual ranges of ground water elevations. 27 Broken Dike Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 THE COMMONWEALTH OF MASSACHUSETTS - - BOARD OF HEALTH .....................................OF......................................................................................... Appliration for Disposal Works Cfonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -...:_... __ -.� ... ..... ;:... •.. ......7----------------------------------------- . Address ? or Lot o. `/JJ/J��a `Ow,n/ey �_(,, o / dress / Installer Address T� U Type of Building Size Lot.... .?�_d S_?F......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (�C) P4 Other—Type of Building ............................ No. of persons--.......................... Showers (2,,) — Cafeteria- ( ) A4 Other fixtures ................................. . W Design Flow..... ......._P..........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity../Y lQgallons Length................ Width................ Diameter.....--......... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.-.z .sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.3.2-9hrq. ft. Z Other Distribution box (>0 Dosing tank ( ) '-' Percolation Test Resul Performed b �... -%. �___.�..��.._-._.... .. ! y--•• p� Test Pit No. 1200-...minutes per inch Depth of Test Pit....l._�c....... Depth to ground water....! .............. Test Pit No. 2_.a.'0_...minutes per inch Depth of Test Pit....:.....?......... Depth to ground water.--.- ITIf........ Description of Soil....... �_...._._. `........ .-Z-.__.._ vz...._.....c....... .-- W ................... ----•---••-••••--••-••-••••••••----------••••••-•-----------------••••--•-•---••--------------------•--------•-•-•......•.......................................................... VNature of Repairs or Alterations—Answer when applicable............................................................................................... ...........................................••• ---•-------...............-----•---•-•---------------------.....-------------------------------------•---•......------......... Agreement: T[-- The undersigned a e to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of AITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued h. Signe -_----- Date Application Approved By•_-•••• • • •••-• -•••-•. ...•...•��W ...... ••-•••••-� 1 -�--- Dat Application Disapproved for t e following reasons:.............................................................................................................. •••-•...........................•.....•••............•••.............••••--...•-••--•-•....._.........••.••----••----•-•-•••••••••-•----••-••-•-••-•---••-•••••-••••••••••-••••••-----•--••-••••-•-•••-- Date PermitNo......................................................... Issued....................................................... Date ------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................OF........................................................................................... z Appfira iun for Disposal Ends Tonstrurti att Errant Application is hereby made for a Permit.to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: t G� �- Loeasion-Addres � ....................... � .Y.. .... .i' ........ Owner. -------•r - . ................................................. .---....- dr ........�..._.....s� q. � Installer Address d Type of Building Size Lot....---.-�./.-�-..........S feet Dwelling—No. of Bedrooms........"`'�..............:....................Expansion Attic ( ) Garbage Grinder Other—Type e of Building .............. No. of ersons_..__._..................... Showers a YP g .............• P (Yf — Cafeteria ( ) a Design Flow_Ot.$.3�tures - _P:::::::-:gallons per person per day. Total daily flow....................................gallons. W. �/ ICI WSeptic Tank—Liquid capacity../.Sl allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.--_--------------- Width.................... Total Length.................... Total leaching area-. sq. ft. Seepage Pit No............:........ Diameter.................... Depth below inlet................... Total leaching area.--!.. - ':..sq. ft. Z Other Distribution box Od Dosing tank ( ) m fed by----- _`_51.��... �.�.� Date.. � Percolation Test Result Perfor .._._. ...._.._ Test Pit No. l.�i .__ inutes;:per inch Depth of Test Pit.....:!_ ....... Depth to ground water........................ rz, Test Pit No. 2.__a..'..D_....minutes'per inch Depth of Test Pit....._...`1i-........ Depth to ground water......F'.Y......... ...................................................................................... 0 Description.of Soil...... .QR±t�,. -�.&�Q{ ------- t -----------•----------------• �'-.if �c'.....aca•r....e .� ................... .........•--......_.......---••........---------_... .. U, Nature of Repairs or Alterations—Answer when applicable............................................................................................... ................................................... ------•----..._y.. ._.........-• . . ----•--•....-----•--............--••........... Agreement: The undersigned agyr!es/ttoo�install the aforedes bed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State,.Sanitar Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by Kie boar ot health. Signed....... -- �:�•------ 7 �y .... ...».... Application Approved By......... ..2. . 1 Date Application Disapproved for towing reasons---------------•-----------------•-•------..............----•---••---•----------------------•------------.---- ..-•-•-••-••.............•-•-•••--•------•-----------.....---•••--•••-•-•......-•------........-•••-...»....---•••••---•-•--•-•--••-----••-••--•---...-------•-•--•-•--•••..........---...•••••--•--••- t,. Date PermitNo....................................................».... ;, Issued::_...............•••--...._........................» Date �.I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ..........................................OF..................................................................................... Tertif rate of Tuntphatt r b THISIS TO CERTIFY, That the In ivi .age Disposal System const ructed- ( Nor Repaired ( ) yL�.-.L.Y�:Q!?a.`. ............ --- -: .. .............................. .......... __....» nn Installer { »� fat...... Ip ?------ .... .. ...-..._...W.. ..... -1��'yt _`_ -......---... ................................................ has been installed in accordance with the provisio s of TITLE 5 of The State Sanitary.Code as`d'e'"scribed in the application for Disposal Works Construction Permit No......................................... dated.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.------... l:�D f.?��~,............................................ Inspector-- -•- - _ �� ....... ... ! ! 'C . THE COMMONWEALTH OF MASSACHUSETTS P ;N -•t I,�r t 1� BOARD OF HEALTH ( No.`.�-5.. ?. .... V"(.^j.............................OF........... ........................-----................ ................... Fix........................ s rn ttl nr , . Tunstrurttan, rr Permission is hereby granted...._ ..!�..'......_. .'.ax. .`r�J F � ......... ........._..,. to Construct ) or Re air �,. ) a ndi idual Sewa a Di osal Sstem atNo....... ' - l? h�.` i4.. .:..__... .............................................................. Street �.+ es'S--Cg as shown on the application for Disposal Works Construction Permit No.............. ... ated._..--..........._........................ .................................. �...........s............... - � B rd of ealth ...................... FORM 1255 A. M. SULKIN, INC., BOSTON i ELLIS & THULIN, INC. LAND SURVEYORS 6� CIVIL ENGINEERS 478 ROUTE 6A-P.O. BOX 159 DAVID C.THULIN, PE EAST SANDWICH, MASS. 02537 JOHN R.ELLIS, RLS TELEPHONE (617) 888-2345 February 6 , 1986 Board of Health Town of Barnstable 367 Main Street Hyannis , Ma . 02601 re . 85-127 , Lot 7 , Broken Dike Way , Centerville Gentlemmen : Enclosed please find three copies of the Certified Plot Plan for the ref . lot indicating as-built condition of the septic system and location of the residence . A table is included which demonstrates that the septic system. was installed in substantial conformance with design set forth in the Proposed Plot Plan . All elevations were measured on the system components prior to backfilling . Ver, rul o , Ellis _& Thulin , Inc . David C . Thulin , P.E &,c c . t Bayview Corporation, -Owner tcE K Z 1 R Cd4 e 5+J 1 _ _ I Z5,OCo \ R-ZO.Gb �i V N 1 • �.� �'at Z O 2 F-S oe �. OFF EOCnE OF / N O SGL�.LE R LEE r PL. 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C .trstl�ll.t_e, MASS., ol&st • GI ICRT' I n� � ,`.�_ �.: l`.^^,�•.r'f1r�f1 <1i r� c..11 ,�.f�Q e. 4 [.O FT, Mtt.1• 0 LEA=1.41W6 Prr hQI MotZS -n4A+-j It C3El, IS PT; M t/.J . -- R+e�-fl�, A 24'DIAI4oTmZ cz= :2a� m CC�� -SHALL BW BR��b�tT �o GQADl= ( �t�WAYS ca.1cReT>= / 4 PAC DtPt=• . .:_. QFr_a�,tQ� Au P-*)"A HEAW (on%cA--";r IQou ccvl= EL-- I8.o mot=RS M IW. PIT<I-1 EL �6 PEQ FT. A / G RAID GO V E Q- _ CLE+4t.1'SA•t.J D USED to MACKFtL.L- -.•, LIG?t,>tD LEVEL- 4.8 . . � ,. .��/ � _ ¢ I • IRGt••+ PIPE .�// (Sp0 GAL. o • �•+�w••,cr wAS�-tED Stau E- �� , M • y4" pea PI'. �Pi-tG TAt�IG MIST. . t . . • • • • • ti o • t • EI=FFGTIVE ' . ' ��4` - I& � MPT14 MD. r I 1-75.9 x' .2.5 439. 8 en ID ' t i • • • • • _.._ PQE�h'ST' SEEpA,61= ; ILJVERT 1=LevATIotJS 153.9 x I.o I S'3.9 v/D ' ' • • ' " PR ��' aL. • - EL• SA I►-NEQ.T AT $ulLDtub 13./L Fr. Arrc-AOActr-f : 59-S.-7 G=/D 4 Pr D/AM. I� � TAL1=T FT DIAM. CgEA- L BcXATOr•�� } ts �'T SE Pn G TA•..I e 12. 8 FT. 2,115.8 [�/D ar L DtsA.� ' t�o7• , JWLVT DRIP-Jno-A 6c-te "L- c" FT• "SELFID..J OF MAX GRciJI-.ID wATre0. T14$L� EL• 3.Co ct1TLffT DtSrajM_Tlc=$j Lcx 1,1. 4. FT• tuLET LEA-4-}w6 PIT I2. 2 PT. .SSWAG1= DISPOSAL S`r'ST�M LEAc=W I W6 PT E nn xAtL : " • I ' o •• 01me►mtou A 4.8 Pr- i DE'51t61•.1 GQITEQ.rA 1/4. 0 rvme j tcm-4 B 4- tJuMP�2 of B�QG�Or.�S '� D I M Eu Slc=%j C 4.Ca FT. ' 6A4 Z&A68 DrsP4=AL LAjrr YE 5 ►�1 L LOG , •5C 1 L. Z��T TOTI%L EST7 M ATED Ft.oW --;N0 Sc t L TEST N= l So I L TE!5T 1J IJu M l3E9- ot= L--A411 rJb P n5 L• I_5�q >=L • 8.0 QhTE of Sot L-Tm5T SIDE LL'Ae--HIu6 PER- PIT 1-75.9 5=. F'1: LcAoA Lo wok Ri uL'TS climb mw BAVS��}E-siege f C04 �6tf�oQp j ociT=m LEAc-It w6 P 9-AT153.q `p. FT. tM2=t.A7U=u I?ATM ra= I LE--V•S n�•u/t uc.-1 -i"C MAL LEA-C441W6 hQ-8A BIC1,8 15=• PT. I N1PbtuM Pena-LA-Moo- L*-re THM-1 M to/ tucr+ vE L!`ACN I Nb Ad E'A 3'L .0 5Q. fT. &_Cno, 9 A.o . Mtn xL -sA*4D i 4- IL, c:VN�SE - �N EP� OF �dq� I•. 1 1-5A``i0 Pt_R t8 wrR. L.c>T -1 13QCY�nt-.I �l Y� WOt�{� ���' �� �, � 3L coMo•s � Ct=tJT� F� 1 L.l_� • �..'` o « p WEFT - EW St_t8./E-,fit u� t V G. zp �1.9 Mtl51aET LA•.1L', �.rrt=aVt tiE, ♦O��E��OQ- ars A p tJo 6.rpvl.•D wR-rt=a N►.rr .rr: (JtaNfoRG •r1=: 3 4&. 64 SUR`t" 44NRA Q' pouuD�rocr�Q.Cl F-L• 3.C_ �4 D e-Q k i LL7 4 C5l,=*jw O wA7t 2'-c:a,u PS .lo F3 We 84 .0 5 L. of 3 Q�oFTMEro�` TOWN OF BARNSTABLE OFFICE OF s seaSTAMAM t BOARD OF HEALTH pp 1639. no k' 367 MAIN STREET HYANNIS, MASS. 02601 May 23, 1985 Mr. Joseph D. Iafrate Bayview Corporation P. O. Box 2048 Centerville, MA. 02632 Re: Variance for Lot 7, Broken Dike Way, Centerville Dear Mr. Iafrate: The variance granted Raymond J. Ratkowski on April 4, 1984, to construct an onsite sewage disposal system on Lot 7, Broken Dike Way, Centerville, is extended to expire May 1, 1986, with the following conditions: (1) The septic system leaching pit must be installed in strict compliance with the approved plan. (2) All other requirements contained in the Town of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be strictly complied with. (3) The designing engineer must be on site to supervise construction of the system and certify in writing to the Board of Health that his design has been complied with before the issuance of a certificate of compliance and an occupancy permit. (4) You must receive approval from the Conservation Commission. The Board reserves the right to deny any further variance time extensions. The variance will not be renewed if the Board feels that installation of an on-site sewage disposal system has the potential to adversely affect the environment. V ell t ly yours, Robert C i ds Chairman BOARD,OF HEALTH TOWN OR BARNSTABLE JMK/mm cc: Conservation Commission T. TOWN OF BARNSTABLE OFFICE OF i Hesa9T rAM BOARD OF HEALTH 1639. �� 367 MAIN STREET HYANNIS, MASS..02601 April 4, 1984 Mr. Raymond J. Ratkowski c/o Bayview Corporation Blantyre Avenue Centerville, Ma. 02632 Re: Lot 7, Broken Dike Way, Centerville Dear Mr. Ratkowski: •fi You are granted a variance to install a septic system leaching pit 90 feet from wetlands and have the reserve area 85 feet from wetlands, in lieu of the required 100 feet, at Lot 7, Broken Dike Way, Centerville,. with the fol- lowing conditions: (1) The septic system leaching pit must be installed in strict compliance with the approved plan. (2) All other requirements contained in the Town of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be strictly complied with. (3) The designing engineer must supervise construction of the system and certify in writing to the Board of Health that his design has been complied with before the issuance of a certificate of compliance and an occupancy permit. The variance expires May 1, 1985. Ve r y yours, R ert L. C i ds, Chairman , . Ann Jane Ishbaugh .�. ..a--In 2 tN1, 17. H. F. Inge, M. Gt�/ BOARD OF HEALTH U TOWN OF BARNSTABLE JMK/mm / � f LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS t / � ea c led ' R U I L D E R OR OWNER DATE PERMIT ISSUED - ._ j _ ram DATE COMPLIANCE ISSUED a _ fu �� 1� Fe rts$— �Ir 04/Z � �s tHE Town of Barnstable �p Tpk Regulatory Services BMM ,,STAB Thomas F. Geiler,Director aTE1639. Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 J This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. May 23, 1985 Lair. Joseph D. Iafrate Bayview Corporation P. O. Box 2048 Centerville, MA. 02632 Re: Variance for Lot 7, Broken Dike Way, Centerville Dear Mr. Iafrate: The variance granted Raymond J. Ratkowski on April 4, 1984, to construct an onsite sewage disposal system on Lot 7, Broken Dike Way, Centerville, is extended to expire May 1, 1986, with the following conditions- (1) The septic system leaching pit must be installed in strict compliance with the approved plan. (2) All other requirements contained in the Town of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be strictly complied with. (3) The designing; engineer must be on site to supervise construction of the system and certify in writing to the Board of Health that his design has been complied with before the issuance of a certificate of compliance and an occupancy permit. (4) You rnust receive approval from the Conservation Commission. The Board reserves the right to deny any further variance time extensions. The variance will not be renewed if the Board feels that installation of an on-site selvage disposal system has the potential to adversely affect the environment. Very truly yours, io rt L. Childs Chairman BOARD OF HEALTH TOWN OF BARNSTABLE JM1K/mm cc: Conservation Commission May 9, 1985 Mr. Joseph D. lafrate, President Bayview Corporation P. U. Box 2048 Centerville, MA. 02632 Dear Mr. lafrate: We are in receipt of your recent letter requesting an extension to a variance granted to Mr. Raymond J. Ratkowski on April 4, 1984. We are enclosing our variance request form. Please return this form to us with the fee of $25.00 and submit at least five days prior to our next Board meeting which will be hiay 21, 1985, at 4:30 P.14. in the Board of Health office. Very truly yours, John M. Kelly Director of Public Health JUK/mm I Bayview Corp. P.O. Box 2048, Centerville, MA 02632 Tel. 775-7637 May 8, 1985 Town of Barnstable Board of Health Hyannis , Mass . Re : Lot 7 Broken Dike Way , Centerville Dear Members of the Board: In preparation of obtaining a foundation permit to- day, I discovered that the variance for the septic system obtained from you last year, for this lot has expired as of May 1 , 1985. The Barnstable Conservation Commission has approved the foundation plan for thid lot, and the Building Inspec- tor the house plans , and there are no changes to be made to the septic system as presented to tou earlier. I would like at this time to request an extension of the variance granted previously, or advice as to how it may be obtained , so that I may acquiue a building permit. Thank you very much for your cooperation in this matter. 6 Of / % Yours truly ; tili� Joseph D. Iafrate , Pres . Enclosure 1 No. g DATE 1-- 03 *THE E TOWN OF BARNSTABLE FEE yp t0 OFFICE OF B�iS MAIL L BOARD OF HEALTH 367 MAIN STREET HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days prior to the scheduled Board of Health meeting. NAME OF APPLICANT Joseph D. Iafrate , Pres . Bayview Corp TEL. NO. 775-7637 ADDRESS OF APPLICANT P 0-Box 2048 Centerville , Mass-. 02632 NAME OF OWNER OF PROPERTY Joseph D. I afrate SUBDIVISION NAME River, s End. DATE APPROVED 1,9- 1 Qom_ Lot 7, Broken Dike Way , Centerville LOCATION OF REQUEST VARIANCE FROM REGULATION (List regulation) Please see attached- - VARIANCE- REQUESTED (Specific request) :R le ase see attached - - f. REASON FOR VARIANCE (May attach letter if .more. space needed) . -t�re,_i-r�U' PLANS- Two copies of plan must be submitted clearly outlining variance requested. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL Robert L. . Childs, Chairman Ann Jane Eshbaugh t Grover C.M.. Farrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE i f ��p�oFTHETo``� TOWN OF BARNSTABLE OFFICE OF . BSSasTmm +00 "639 BOARD OF HEALTH �aYAYk� 367 MAIN STREET HYANNIS, MASS. 02601 May 9, 1985 Mr. Joseph D: Iafrate, President Bayview Corporation P. O. Box 2048 Centerville, MA. 02632 Dear Mr. Iafrate: We are in receipt of your recent letter requesting an extension to a variance granted to Mr. Raymond J. Ratkowski on April 4, 1984. We are enclosing our variance request form. Please return this form to us with the fee of $25.00 and submit at least five days prior to our next Board meeting which will be May 21, 1985, at 4:30 P.M. in the Board of Health office. Very truly yours, tihn M. Kelly rector of Public ealth JMK/mm tr.r �T TOWN OF BARNSTABLE OFFICE OF t Bas NAM T BOARD OF HEALTH 1U ` 367 MAIN STREET HYANNIS. MASS..02601 April 4, 1984 r Mr. Raymond J. Ratkowski c/o Bayview Corporation Blantyre Avenue Centerville, Ma. 02632 Re: Lot 7, Broken Dike Way, Centerville Dear Mr. Ratkowski: You are granted a variance to install a septic system leaching pit 90 feet from wetlands and have the reserve area 85 feet from wetlands, in lieu of the required 100 feet, at Lot 7, Broken Dike Way, Centerville, with the fol- lowing conditions: (1) The septic system leaching pit must be installed in strict compliance with the approved plan. (2) All other requirements contained in the Town of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be strictly complied with. (3) The designing' engineer must supervise construction of the system and certify in writing to the Board of Health that his design has been complied with before the issuance of a certificate of compliance and an occupancy permit. The variance expires May 1, 1985. Ve r y yours, R ert L. Child's, Chairman QAA — S' Ann Jane Ashbaugh H. F. Inge, M. GkAol' BOARD OF HEALTH U TOWN OF BARNSTABLE JMK/mm i Ab April 4, 1984 Mr. Raymond J. Ratkowski C/o Bayview Corporation Blantyre Avenue Centerville, Ma. 02632 Re: Lot 7, Broken Dike Way, Centerville Dear Mr. Ratkowski: You are granted a variance to install a septic system leaching pit 90 feet from wetlands and have the reserve area 85 feet from wetlands, in lieu of the required 100 feet, at Lot 7, Broken Dike Way, Centerville, with the fol- lowing conditions: (1) The septic system leaching pit must be installed in strict compliance with the approved plan. (2) All other requirements contained in the Town of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be strictly complied with. (3) The designing engineer must supervise construction of the system and certify in writing to the Board of Health that his design has been complied with before the issuance of a certificate of compliance and an occupancy permit. The variance May expires 1 1985 P Y � . Ver truly yours, ,; r• " Robert L. Childs, Chairman Ann [Ja e-7E-shbaugh r'T" / H. F. Inge, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm 1 NO. .. / 9' DATE �?-o?7-9-/ FEE ' TOWN OF BARNSTABLE F TN E OFFICE OF i BARI MM NAM BOARD OF. HEALTH 367 MAIN STREET ° cr�t'' HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days .prior to the _scheduled Board of Health meeting. NAME OF APPLICANT BA-ev40-W GoQPoQATno►.1 TELEPHONE NO. -1-1 I - 14S9 ADDRESS OF APPLICANT R,LAWT'.(QE AjE,,Qe Ce64TEiLv►rL.L-E o�1.e.32 NAME. OF OWNER OF PROPERT I!ows,G I LOCATION OF REQUEST LcT '"1 P_oreru �t r�E w�`r ,_�a=uTEQv ► I-L-C VARIANCE IfROM REGULATION (List regulation) LEi+<--H PIT ee-.F- F-- ►COS FM VARIANCE REQUESTED (Specific request) Ta p~T �D�E W E}ftP►'�� � I C� vtr2 1�.rz.E � "la Gcxs3T2�cT �E 2✓E A�-�A t F Q.EQ�►ego $S Fi A N�G•E of WE-" ^U-0 ( l5 v�Q�/k�SLE - vAQ►h�CC PQE.t tdvsW �QRr.,Z'ED E�tP►�� 02 •0l 8S ) REASON FOR VARIANCE (May attach letter if more space needed) 04-A of l� !T A,-jM(CA-bL.c- Foe. Le1kcr+,d?- FAcILtn DUE- To scr IL 2�v�u�na�►s o�s0 cuE�ft,�o� .PLANS - Two copies of plan must be submitted clearly outlining variance requested. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL Rob L. Childs, Chairmat Ann Jane Eshbaugh H. F. Inge, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE GRA-OE Sr,-bT'S� 400A'no�JS A,�D Cc�ouQ�uv - °SITE PIA�b, Lr�cA no�J : Ge,j-mk jL-La, MASS. / J� -nbALVjenA jj) — '. FoQ. RA�fMouD �. 2.AT KOW sCl f3�( � � I P3A-M bE I 14 51. lEO6E wenA,Zs �-re R Pip !S DE n�,e hE�IK PLAt4 o �A � Le �' P Q i v Ai E /100-7 44K14�eJ+c+l.teD�ro0. owi.rEft ate 14 10 A= 19- 13 w •�ILTEST `0 +4 4 LOT / n^ / / `DQAiu,46E. EAS�ffMELIT 0K OF loe VJ 4 �/ — S�RR�RtA� i �. OF n Icry'w I DT}4 P�v 1 ou5 F,L I N 6 : S E 3 eo 4 s� �� F. S .FS c=, IL 19 15"L P spa ti� ao sugiv Vp ts 7 N —— — — €� L'csT PL.4w EX ISn WL/= ELEVATIG�.J �c�rlrcu2- e� Cou-roc�r2 � ^ _ D EL�/A"nC11J �91 L oT -7 - An La J D I L.E: K� 'Ls aS�q APPDc./t=D: b=ARD (= = 4eAL-n-1 C E=-L1TE Kam/ 1 L L E� MATE A6EnI7' � .LE I = ' DA"[t:- 3 2Co 84 CLI�Lrr, f3�vv I.� I waE EBy nR�nFY T144-'THe P2cR--SeD LL.1S sv�EYIN ►-� bEa u� : 84-03 BUILDIU6 Showw o►J I'WIS PLAaJ COuFoQMS TO 7l 4E 1cQ W6 LAWS 4q Mars E�' LAu>= D2.BY: -� OF BAP-WSTABLE, MASS. C�Ulr(cL/IL1L�� MASS., 021032 / G14. t-i 3 16,84 SWEET /QF�r QED LAuD 5Lj!b✓E\/oA VOTE IF:- Ern-aV— Ti-1E —_a PT IC T/4�14- OIL - --- LEAC--"IW6, PIT At12.e mcDRa T1•4A,•-_I I t- r-seuJw 10 FT, WWI .. —_ � � G PA-DE , A 24't,I A A/1i=TAP- R SHA" 2:5E "T -ro GRAD7= ( DPrvI=WAYS ca_Ic Q Esr✓ / 4 P./c P t PC- , R 1 Rs A u l=xTa A H EAvn( Dore CA-t I QCk! coves R r=L= 18. o /�ca��RSi\ `/8 pc-P- FT. I 1: / ) 1 \ � \ �2-/oMW, fauG2Erm; GaAp=- GiFFA"-SAuD uSI=D w..1 1'sAcKFa L-, / \\ 2 8 L IC?J�D L�VEI_- . . . . � •� . 'V LAYER of t per, P"pE i 15 00 wAs+4E-=D fir= mIu. PI7 4 GAL. o o o a e o ° °e /4 PEP- FT. �Rt'lG TAIL FIST. e ° e f' , , ° � e BOX Q °° o B ° a of I ° W PSH E D STa<11= • � � o e o o • � � o 1-75.9 x• 2.5 = 439. 8 ca/D ° ° ° e e • o e e 1 _ PQEcAtsT SEEPn�S1= I-JVEQT 1=LLt/�TIo1-JS 1 53.9 x I•o = 1 53.9 G,1D ° ° o ° ° ° 6 1 — PIT oR F vAL. QT AT BLiILDI /L 1=T. Dvrc.ADA--rr---e 593.-7 L/D to Rr. D/AM. 1.J LET St=PrI G TAu 13.o FT• 5�3-� F-r. D 1 AM• _ C (--gas TA 2 cX ATIou1 Der LET SE PTI G TA+_I'F. A. 8 FT. D I z—.P. 111L�T DIsTQIPxmau Bob 1/L. (� FT• S�rlo►� of nnAx GRauuD wAT>=0. T4,�7-- 1=L -T DrS pjBLrjcxj L2 FT S�wAGE D1SPoS,AL S�(ST1=M I u LET LEA�1 wb PI-r I IL 2 FT. PIT (� DI/�te►:►�Io�, A 4.8 Fr. DE516 r l G�I TE iL-1 A ---cA, ' I/4 I o D l M I=N51 a—J 8 4- FT. �LJ M P. r2 o f PEDQcwxnS 3 D 1 M E u 51 C=xj C 4 FT. Gr�R�A�>= Drst�L uutT YE 5 �t L LOCH T(=Y rA L ESri AAATED Flaw .130 6Al-. 1DA-! 7E5-r tjs l So i L T6T N! I.lu M BE R of LC-A41,{.16 P I'S I •E L= 15.9 1=L - 8. o T� of S�►L SST' Na� I I St DE LEASH lu6 PIE P- PIT 115.9 `�. F`I'. o, 2, LpAM a LcAAA A(. ��,L-1��R'�(Z�D !'S`� �gySI�E 5✓PJFY CclP /61r-Foeo p,�T7?nM LEFKa-11tab PC-:R-AT 153.9 �_q. FT. CEPn=LA-na./ 2A?r-- 1.1O 1 I F=sS nn u / ucr-I Z-a-rA L L�A�"("d= A aQ e A 3 29.8 SG=. FT. PE RmI�aT o� . RATE ti� 2 TH A N nn I u/ 1 UGH 319.E �W. �T �L 8' IV1IvM Q�5�V7= L�AKN 11..16 A�A � . MAD sc �uD �- t/L' E FL L.T OF 1,A OF c s.co moo, c, r C E—== LB EL - c A� ;' WATU--G-. 71_1J5 5c,e.�-11►1� I►.IG. 29874 C � /L=1 AAUc►=c ET L.4A E, ¢s.rrE2VI t iE, MASS: t``.�gTE��vO� �1STEQ` O WATER N� SUiN�y a�lrrtllmu� [� J2ouu0 wA-rEQ a EI_ - p H I/= 4 C-=QavkaD wA 71`Q. Conn 0s ' Permit Number:_ -fir . Date: Completed by HIGH GROUND-WATER LEVEL COMPUTATION Site Location:- g�C>t=ts �l 0:—_ Wh�f C ,rr� t t�.c Lot No. -7 Owner: Address: WA Contractor:. f YYIeW CC)0., -Ilot•.I Address: p.p, 6C% 2048, CC- Ep-*ltu� OIf, Notes: &•C,; 6 f)oF !ilUCTA 0w.o.A rcf b;r n(.'(n• C2) W Sr Gam CO"AA.FLc-ISa sE 5. 604- of Z5• b'L STEP 1 Measure depth to water table g p to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . It/it /8l date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: a�w•1� A) Appropriate index well . . . . . . . . . . . . B) Water-level range zone . . . . . . . . C STEP 3 Using monthly report"Current Water Resources Conditions" � determine current depth to • 1 water level for index well . . . . .. ►2/81 mo yr STEP 4 Using Table of Water-level Adjustments for index well STEP 2A , current depth to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine 3 •L water-level adjustment . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estimate depth to high water by subtracting the water- ; level adjustment (STEP 4) from measured depth to water 4.4 level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �"F k"Anc>u F9onM IVIS. GAF�Q��Ll = r �OiT G.L• D. 4z E. D.G . Gl• IO• B4 e- Pe-L- ri.-E EL = O•O �Qcv..fl c..A•�£ Vc� ® t,..rT� ��As: EL = 'S.V �yviEw Cap•P. of• io. gQ ,r M January 200 1982 Mr. James Crowell 1 Agent for Raymond. J. Ratkowski Bayside Survey Corporation 89 Willow Street ` Yarmouthport,* Ma.0267$ Dear Mr i CrovolI t Youtare granted a variance to have .the reserve sewage 'leaching urea 80 feet .from the wetlands in lieu of- the required 100 feet on Lot 7, Broken Dike Way,, Centerville*:' All other requirements'. contained in the'.Town 'of Bamstable Health` Regulations and'Title 5, of the State Environmental Codes must be complied with. The septic system must be installed in strict compliance with e. the approved plan. The designing engineer must supervise con struction and certify, in writing, that. his design, has bey. complied with prior to :the issuanco of a. certificate of com pliance"and an occupancy permit.. It would.,be. appreciated if: future plans 'sub®itte$ ieted t2�e scale. This variance .expiree. February 1, 19830' Very truly .you ; -� REMIVED : &MMMLA COMMMn� Childs, Cha rmanCowie* Ann Jane E baugh H. F. Inge,'M. . D. , BOARD OF HEALTH TOw'N OP BARNSTABLE JMK/mm cc: Conservation Commission NO. DATE FEE TOWN OF BARNSTABLE OFFICE-OF = BAHISTAHL S ' r►Na BOARD OF.HEALTH °o i679• `e� 367 MAIN STREET '�o►t�Y�' HYANNIS, MASS. 02601 VARIANCE:REQUEST FORM All variance requests must be -submitted five (5) days prior to the scheduled Board of Health meeting. NAME OF. APPLICANT aA,lvtEvA/ GoJ?Pc�P.AT�o� TELEPHONE NO. '1-1 I - 1459 ADDRESS OF APPLICANT I_AWT-QE ACE ►wu1= Ce-►-+Tl=a-vt -Le o�1-(-32 NAME OF OWNER OF PROPERTY 2 A-emc>"D , 4T Y.oW S 4 1 LOCATION OF REQUEST LcT -1 c-►-1Tl=Qy t t_i._C VARIANCE FROM REGULATION (List regulation) UEA--H Prr QsEQe ►e0' FM 'Jertt*-+0 VARIANCE REQUESTED (Specific request) Ta c®,.,sTQvcT LEA{-rh"C- ptT i=fl�E r� � to' vsefZ t o.►rz C- Ta ccxss-rQucT R.esE e� Af-SA t F aE-C ►- e-D gs' FA A. a cF wETt L r I C ( ts' v�2�A-uz-r-- - v t aZ-E PPe1J tayst q Q A#--'rF- E�cPt2Efl o2 •ct• 93 ) . REASON FOR VARIANCE (May attach letter if more space needed) Ariz--A, of 1oT A'\4ML'A-6LC- Foe. PACtLiTr DuE 'z) ScrOAeIL 2l:v Ttot.►s O Et.E��t,�o� PLANS - Two copies of plan must be submitted clearly outlining variance requested. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL Rob L. Childs, Chairmalw Ann Jane Eshbaugh H. F. Inge, M. D. BOARD .OF HEALTH TOWN OF BARNSTABLE s G QA O E -S rJoTS T L.GcAnoN 5 Aw D °S+TE PLAW LaCAT1OLJ ; Gr--Q-mQ.JILLE, JAASS. j J, jn0ALWETLAmjD 3A�5,DE SuQJE�coQP. , 1/AP�noL�Tr+-PoQT, 1. X __ / 1 14 82." - ! E-t6e weT>_A,.&us -r r -�Q hele PLn E A� T•8en• / j3 Q EL: 13.98 M•S.L. �A,; n I LE Leo' PQ,vA � (vAR�A*+�Qg��,Pr�)Q_3S.00 � /I DRo+b� pQ,,,E;wn-! t0 c.r3. �='LO•� to 8 I�S.oCo A= 19.-13 LOT 10 � L / V- � y, ` '/�/ / / MAIWAc,E EAS�ffN F-QT' x OF ca /STE.� of �L�D 2�..1ti5 A � 9 Y/� �o�>= ILG ��►� . Rp Imo' wIbT" i� W PP�VIOUS. F+LINC� : SC 3 804 '��, F. 5 .f3. /Lo sm (RAT s Ic I ) a I 'Ls • 19 5,L ° 4 s at.- 2 . r3. - I o o�ar�P o4` i P spa 7Ap on . sXrsnQG ELEVA-now cc TcuR-. oQ. Vol 9 PAD PLr-T PLAN! D EL�1/ATIdJ eL CL�u'TocV2 4� LoT -7 - BV�K��I D+Lra D,-,4D 25 Po4 COTE A6EN7' `aC'A I R: I = 4c=>' DA'T'E% 3 2Cc 84 GLI raUT BY eaEP--n FY TWAT THE Pkc)R$ 'EELL1S JOg jjS 84-a3 BUlLDIU6 Sflowu cJ "T>-4IS PLAaJ COUFo2MS TO T41= 2o►JIN6 LAWS 2�t MUSK ET LAu>= DR.BY: -� IQ� pF B,AawsTABLE, MASS• M �' 5. K. G�uTEQv1►..LE., ASS., o2b32. (�yY• -4 _.l 3 26.84 L SUEET I of 3 naTF-- lQErpIS'TERED LAUD 50aJE`ina 20 RT. M 164, LcSTE i F E ITH a2 T.-I E. '5E PT I V- oGL LFAG t•- i w b P►T Aar-- MoRB Tn-I A" f 2" (3e1=�W 10 f-T, .MIW . _ GRhflE , A 24-DIAku=-r1=2 GATE CGSP- /� �-1ALL e3 E R4LC �r4T � GQAD� ( DQrl./i=WAYS C�c Qa-r� / 4" . P t PE- o QFca��I Q� ALj swrP-A HEAVY D�CA�r I Qa! ca/1=R M 11.1. PITcI-1� FT. ) A GRAB cov�R- A�SA►JD/ i — US>=D I" f?1�GKFi L /- _ LA`!--R-OF IS t PIPE- 150o An R mIN. PITc4-1 GAL. FIST. a t o e e e o e o• t/4" PEJ0- Fr. TA"IL ♦, nX v ° 1 e 5/4" ° ° 1 ' Ct=P I-I ' ' WP6HED SroLl� e • � I I e e o p . � e e (�75.9 x L,5 = 4��. 8 U/D ° ° e p p e e ° o p p + _e_ PRECftST 5EEPAba t LJ�/E QT 1=�- /ATfO1JS 153.9 x 1. O 153.9 C•=/D PlT aQ Ip)�/ERT AT BLAL0i"C= 13./L F=T. F1' DiAM. FT• 5�3-I FT. D I A M. C t�g� TA J �AT(:>-I) �r"L�T SE PrIG TA+JL' 12. 8 FT. plsp, = .0 v/D I Solo I u L'ET D I I f3�tnot-► Bob 11. (� FT• S�,C r I�t-I o F= nn A x G 9-CLJ W D wATE 0- 7,4BLT-- I=.L = cx-rn-a-r D`��1 (3ox 12. 4 FT• Sz-:wAGa D ISPcvsAL SYSTEM ►t l LET LaA,:fH, 16 PIT I2. 2 FT. L_EAc►4106 PIT DES16tJ GRITI=iLrA �cAL= 1. I/a" I ' o Dlanel.,�te� A 4.8 pr. B4- _ F-=1". w1uMR2 of PD�c�xn5 3 D I M Eu Slo&j C 4.Cp FT. 6,4RBAG>= L1SLuuIT. YEStL LOG '`��tL 7l-=15T TEAL ESn Ail ATED F-Low - 0 6A1.. /DA-( So I L TEST N= t So I L TeST ►J 2'L 1JUMBS7P- cF LI=A44tii6 PrtS I EL= 15.9 ML . 8. o C>A7T--- of L--T1=ST 1bc l 1 I` s I SIDE If=-A---Htub PEP- AIT 1-15.9 . Fr. Ld,A+ a LoAn+ ac R1='SvLrS� I2. b r: `( BA`ItE S,jPyti Fo CoPP /CwFQD @aT-toM I E (�A,--H 1 w6 Q-AT 155,9 FT. C�ZeoLA no•r P-_ATE I.]* I L>=55 m r u /I ue-" TOTAL A-P-Z:-A 329.8 SCE. FT. Q/1�1uM P--P,=LaTto+ RATE �je iL lT-IA-N M Iu / Iuc.-+ R 75E=P-V1= LeACN(IJ6 AAA 31.9.8 S5�. fT. 2 8' ec.CCsnC-2�= 2. IVIt=-t gc sAuD /L- I/L' c:z:=thP-SE T • `� 4 e I U D t �2R ® wrfL (-oT -1 OF EL= o.o Al -+I H WATfC � P► ► IS Sc�i�-ll►.1� I�IG. 2W4 C �� 451 MV5►CE.cSE=r LAI.iE, rE2VILLE, NIASE F 0 a O ISTE I.l 0 6 Qo��1 a D WATER��c� I�D 11 �8T>E ,gyp ❑ cl.Ircl.tr: PIAq�f�li=w�oRP D�4'i� . 3 /L(-.e>q. SURV� uffA kw C3- G 2ovuD wA-ra=R.to EL• 3•Ce 84 Permit Number:_ Date: Completed by' : HIGH GROUND-WATER LEVEL COMPUTATION.. Site Location: �►hl Lot No. �7 Owner: CIA Address:-- Contractor: r AYYtew CCWNOPA-1_1CtJ Address: p.6, &OX W48, CC—NTF;4LoE 0111ZI2 Notes: C�+r i i i vv �c �1r� Qw.•o.AkrriE b7t 0(.in. A2 (2ATYnwS%r_t - Ct P LSr Gam Cau nn Fi Lc-tS'- 5E 5. 804- of Z5 �2 C P-� l) STEP l Measure depth to water table . g p to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . /81 date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A�w•1� A) Appropriate index well . . . . . . . . . . . . B) Water-level range zone C STEP 3 Using monthly report"Current Water Resources Condit-ions" �e determine current depth to • 1 water level for index well . . . . .. !'L/81 mo yr STEP 4 Using Table of Water-level Adjustments for index well STEP 2A , current depth to . water level for index well (STEP 3) , and water-level 444 zone (STEP 2B) determine 3 •� water-level adJustment . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estinate depth to high water 0 by subtracting the water- ; level adjustment (STEP 4) from measured depth to water 4.4 level at site (STEP 1) ,►,l Fc:1"A-nC>U . FPOM /l/IS. 6 A i3 K��LI E Lt=i G.L P. eL E• D.G •4 c l• l O B 4 GKcuuD wP�Ti'Q. Di={- 'r�ST t•1o�-E El. = a•o ��owD c.�A-re4. Pe£ ® �� C�tys: EL = 3•(� �y�IEw �P-P• 0110• SA 7r�C�ET 3 c� 3 3 ' .—�- A. January 20,.. 1982 y Hr. James Crowell Agent for Raymond. J. Ratkowski Bayside Survey Corporation ti 89 Willow Street ` Yarn►outhport Ma.0267$ ` 2 :Dear Mr Crovoll= You are granted a variance .to have the reserve, sevage leaching area 80 feet from the wetlands in lieu of- the required 100 feet on Lot 70 Broken Dike Way, Centerville. All other .requirements`•contained .in the .Town' "of Barnstable Health` Regulations and'Title 5, of the State Environmental Code, must be complied with. :The septic system must:be installed in strict compliance the approved plan. The designing engineer. m"t -supervise cony struction and certify, in writing, that his 'design: haa'beea';; complied with prior to :the issuanco of a certificate of com- • plianceland an occupancy permit,, It would.:ba� appre edciated if future plans: submittlisted the scale. This variance expires February I 1983. Very truly .you 1lp . Childs, Cha Haan /- .09 , Ann Jai!j aug H. F. Inge,'M. D. HOARD OF HEALTH TOWN OF BARNSTABLE . JMK/mm cc: Conservation Commission✓ January 20, 1982 Mr. James Crowell Agent for Raymond J. Ratkowski Bayside Survey Corporation 89 Willow Street Yarmouthport, Ma.02675 Dear Mr. Crowell : You are granted a variance to have the reserve sewage leaching area 80 feet from the wetlands in lieu of the required 100 feet on Lot 7, Broken Dike Way, Centerville. All other requirements contained in the Town. of Barnstable Health Regulations and Title 5, of the State Environmental Code, must be complied with. The septic system must be installed in. strict compliance with the approved plan. The designing engineer must supervise con- struction and certify, in writing, that his design has been complied with prior to the issuance of a certificate of com- pliance and an occupancy permit. It would be appreciated if future plans submitted listed the scale. This variance expires February 1, 1983. vVery truly you , �! 4 . Childs, Chairman Ann Jane baugh H. F. Inge, 'M. D. BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm cc: Conservation Commission atri o t u� Published on Cape Cod since 1830 A community newspaper published every Thursday at 24 Pleasant St.,Hyannis,Mass.Tel.771-1427 7� 1830 1982 } TEL. 853-2620 � S t SvnL)C/ 06� . CROWELL & TAYLOR CORPORATION Land Development & Engineering 89 WILLOW STREET YARMOUTHPORT, MASS. 02675 CIF �n- -� Iso-VI- s'L�-r J7 ftEaC(5y lW -QUOST A U/-6,\,t -4t\jc6 FYI Gy si • 1 E-A uE /-�-r� } 5 �- v�.r� c�� COT &n& I )t& WAY rz, . Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Wlillam F.Wald clower+or Trudy Core Arpeo Paul Cellucel S---ry U.Governor David B. Struhs . CamnMeriorwr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 7 CERTIFICATION /I Property Address:- d [ Zc O Ke,'l `V`��'�C� KJ Eby/ E i! l� ddee•s of Owneriir�o I�C'�•G�4t.c/l .St y t Date of Ins 6 i �L'► h , Name of Inspector. �l t. I( / : (If different) �aV:cL J :, �; ^ ` R Company Name,Address and Teleppone Number. �v- 5 M� VO e.-h tt- SA, CERTIFICATION STATEMENT Pt"5 k`I-1`� '�'� c d_,C, I certify that I have personallyins SO�� " �� S petted the sewage disposal t system at this address ankat 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 Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatu .0- — \���..f''"'``"—t 1 Date: lvZ The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY. Check A, B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as de Any failure criteria not evaluated are indicated below. fined in 310 CMR 15.303. B1 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired The system, upon completion of the replacement or repair, passes inspection. 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, cracked, structurally unsound, shown substantial infiltration or enfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)5WJ049 • Telephone(617)292-5W w `J Pnnied on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address- V10 Kt,,� �.)K L' �0 Owner. v�o '►1 e,I O G ►O✓1 •� J V 4 L C.. Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) 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 The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 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 a 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT The system has a septic.tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The evstem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is leis than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for ooliform 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 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: V�� �J c��c'.� /.(— Lo A�_1 Owner. Dvf v^+ 2Ll VC-.4 kk opt, SWt/+c_ Date of Inspection: zk— D) SYSTEM FAILS: I have determined that the system.violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. — Static liquid level in the distribution box above outlet invert due to an overloaded.or clogged SAS or cesspool. — Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. — Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design now of 10,000 gpd or greater(Large System)and the system is a a health and safety and the environment because one or more of the following conditions exist: significant threat to public, — the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:-'. 1 ZV`O K{c�---� Owner. �J v, �.'% Date of Inspection: r��t ' , Check if the following have been done: (Pumping information was requested of the owner, occupant, and Board of Health. _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. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of bates 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 existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. 1�Co c-C_ ��<—A -Ir- t S dV d+ r 4&4 V V" 0 A. L (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7�,ro .W N y Owner. rv?r- Z Date of Inspection: RFSroENTIAi- FLOW CONDITIONS Design flow:_-L-jQ_galons Number of bedrooms::_ Number of current residents: O Garbage grinder(yes or no): Q.,S Laundry connected to system or no): . 5 Seasonal use(,yes or no): Jl p Water meter readings, if available: Last date of occupancy: 0✓L ^p-_.,—.% COMMERCLAL/INDUSTRIA-- Type of establishment: Design flow:_gRUons/day Grease trap present: (,yea or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: A"0✓L t— System pumped as part of inspection: (yea or no)1lJo If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: V Sewage odors detected when arriving at the site: (yea or no) V40 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �., sp K e.--� ��� k( •��{ Owner. Date of Inspection: SEPTIC TANlr:_Z, (locate on site plan) Depth below grade: !a - Material of construction:_2Sooncrete_metal_FRP—other(explain) Dimensions:!4O Jbk J >I I U )Too Shulge depth: � - Distance from top of sludge to bottom of outlet tee or baffle:3-, Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Of Distance from bottom of scum to bottom of outlet tee or baffle: `f 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.) GREASE TRAP._ (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(e:plain) 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle*, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 02 cU✓c; c.n )j t\_ w A Owner. � �c.`G4�4�'lCi-� S `vj.,c� Date of Inspection: TIGHT OR HOLDING TANK_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(e:plain) Dimensions: Capacity:- gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX_X (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal dence of solids carryover, evidence of leakage into or out of box, etc.) , PUMP CHAMBER_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc,) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -7 ? SYSTEM INFORMATION(continued) Property Address: l u rr� K�n,.� �y kL 1�l�y Owner. 2t.�pGl�� io-1 Surl���C� Date of Inspection: Ja4 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:Oil t. leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: eats: (note condition of soil, signs Of hydraulic failure, level of ponding, Condit' n o vege tion,etc.l 9 .Alin:n 1 -� c 7 ,i o r CESSPOOLS:_ (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(cesspool must be pumped as part of inspection) 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.) (revised 11/03/95) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9-1 `3 Mi k w Dy k4 LA-)-'k.� Owner.Date of Inspection: SENMR OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �5 Ouj ,J DEPTH TO GROUNDWATER Depth to vwndwater. 1 X"_feet Of determination or approximation: y S 'f o WL/i l 1_ ` L -. i ["i I (revised 11/03/95) 9 r t Page of Commonwealth of Massachusetts ` Executive Office of Environmental Affairs a° e Department of Environmental Protection ii 19 , ' 1 '96 WlUlam F.Weld Governor Trudy Coxe S:!',y,EOEA David B. Struhs Comminioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 1 �rO key 7 D 1 �AG�I'I S TR T _ Property Address: �� •� ��1Ad ress of Owner:&e Q r e � ��� v p In Q.� Date of Inspection: 46C �� /f � (If different) 97 k-m U k WC.-4 Name of Inspector: Kevin H. Powell Cl-_f1i eal Ile Powell Construction Company 7 �J a(� Company Name, Address and Telephone Number: 3� 1495 Ocean Street Marshfield,Ma 02050 617-837-6633 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-sites wage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ FaLiltInspector's Signature: �1 Date: Kevin H. Powell J ` The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 authoritN. INSPECTION SUMMARY: Check A, B, C, or D: A] 7Any M PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. 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, 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 conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a TWephoee(617)M-5500 �ieT Primed on ttactoded Paper Page A of s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: a. / 171D k� h Owner: —,-!TO G-PG y j e Date of Inspection: a- 1,57 (qs 8]SYSTEM CONDITIONALLY PASSES (continued) _ 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 _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 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 a 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.APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The cvstem has a septic tank ano soli absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil.absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and 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. D] SYSTEM FAILS: 1 have determined that the system violates one or more of the following failure criteria as defined 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. _ Backup of sewage into facility or system component due to an overloaded or dogged 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. (revised 8/15/95) 2 f r� 1Page 3 of SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFIJ/CATION//,(continued) Property Address: Owner. 6&or ?P Date of Inspection: /.�/1s—A5— D] SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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: The following criteria apply to large systems in addition to the criteria above: The design floe,- of system is 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: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 Page / of SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: / /3-ro Owner: 6�eo✓ -e Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. t/None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates durin that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. he facility or dwelling was inspected for signs of sewage back-up. he system does not receive non-sanitary or industrial waste flow he site was inspected for signs of breakout. system components, excluding the Soil Absorption System, have been located on the site. he septic tank manholes were uncovered, opened, and the interior of the septic tank was 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 existing information or approximated by non-intrusive methods. he facility o-,%nc' lard occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 Y, Page � of t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR_M PART C SYSTEM INFORMATION , Property Address: ro P h / d Owner: &t,p r of t -70 YI f s Date of Inspection: `.;L/�S—/�� FLOW CONDITIONS RESIDENTIAL- 4lo Design flow:��itallons �9�%9/'� A �QS/� ` s Number of bedrooms:-yjO Number of current residents: Garbage grinder (yes or no): c. eS Laundry connected to system yes or no): LIe-S Seasonal use (yes or no): a c�_ ���yf,�f Water meter readings, if available: ��r�O /J J��� / Last date of occupancy: retie n COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION /a, PUMPING RECOR 5 an sours of informal1n:a /�O017� �O J �7S Pr oc.5/7 K System pumped as part of inspection: (yes or now Wt s R"f rrt 00E0 p n Abc k t91i If yes, volume pumped. gallons iDke,r +e ow rteY Reason for pumping: TYPE O SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date in lled (if known) and source of information: (sr►1a//�l/IC-e ( r��t/�QT� eel Sewage odors detected when arriving at the site: (yes or no)&:5 (revised 8/15/951 S Page 60 of I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6 eo r5 e Uo o-e Owner: AtP-17 vnnl Date of Inspection: /d//S/�S'_ SEPTIC TANK:_/.-40 (locate on site plan) Depth below grade: / Material of construction: Aconcrete _metal _FRP—other(explain) 4Z of Dimensions: O r Sludge depth: it Distance from top of slud$� to bottom of outlet tee or baffle: 3oZ 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: �S j[ Comments: ,�p�'�j � �E h 1 !'!r,.� S'f ou!G� ��4L'� T��e CO U e!"•� (recommendation for pumping, condition of inlet and outlet tees or baffles, pth of liquid I vel ' relation too let invert, ictural integrity, evidence�lof I akage, etc.) !/ .'S -fit O �G /7 /F n Grp / ,S P o ve !� Pd L GREASE TRAP: `UNL� (locate on site a Depth below grade: Material of construction: _concrete _,metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom n` <rU^ 1- r)0110n! Ot 011!le! iee Or 132111r 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.) (revised 8/IS/95) 6 r Page '7 of---L/ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ,)? 131101 e A7 " / Owner: 45eo/Z 7 e 0, n eS' Date of Inspection: 14 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:Comments: / s ?o e� (note ii level ano istribution a�js/-ir/ c! !,<1 al, e\ide ce of so cajjr)o% r, evi ence of le kage into or out of o3 etch �'d 0 Lo o , �P IS T'�'r �u�d .007CS�acc�(�' O uI � L,4)-cl c rai e!2 us P�7G/,p c e L,*-►-V t I e e 1 -q-z, e- \ti '�o c�cD C 6 nc9 V ion , n e of l/ yr /pe'G /'V/0�� A& PUMP CHAMBER: 10 A/6�: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 6/15/95) 7 Page of I ' ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SY'SSTTEM INFORMATION (continued) Property Address: d 7 T� Owner: G 'eU� e ', G ✓1-PS Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:��1 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comm n s: (note ndition of soil, of hydraulic ailure, level of ponding, cond' ion pf v tation,etc.) r� dv w'r3 L�1'4QcC� G S Ctin C� 11� 1-a►:�cA�C co P ]cc CP i 1 S 7 r o F -P C-0 ' CESSPOOLS: _ (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 ground�%ater. inflow (cesspool must be pumped as part of inspection) 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.) (revised 8/15/95) B I {� 1 Page of 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Prope Address: rd/C /� 1CP Owner: G?'e c e-i-e Sr,Y1 f 5 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' D k� �`kLl 0 CO t CAP >L FG= t_It 1 t � oil � _ Di5�1 Du�tU61 L 1 3g,3 BF: a4 ql / g is 391 13 D 181 DEPTH TO GROUNDWATER Depth to groundwater: 473feet o r Ice- method of determination or approximation: B jfr C v vh A Ll _ 77 a ;av 1, WuS � 7� r 0�v VKtvl d (il.9 QV GO Yn(?S,1tV-7 4 u V( mid (revised 8/15/95) 9 Page- / y of ! 1 t: me„4 In the certification state the inspector is certifying that the conditions existing at the time of the inspection are accurately presented in the inspection report. The inspector is not certifying that the system is adequate for the current use of the system nor for the future use of the system. This inspection is not a warranty that the system if functioning properly, or appears to be functioning properly, will continue to do so. The septic system inspector, Kevin H. Powell , is representing the interest of the Commonwealth of Massachusett on this inspection. If any party who has an interest in this septic system being inspected and does not fully understand the contents of the septic system inspection form should seek professional consultation from a Professional Engineer,Registered Sanitarian or Certified Tittle V system inspector to protect his or her interest in this septic system. C,4�a'-Oj Kevin H. Powell Certified Tittle V System Inspector L s S� 1'ti 7 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Kevin H. Powell Has satisfied the q q Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. February 27, 1995 Acting Director of the ' -ion of Water Pol1ution Control l� 5 3267 �j 7G3 1 n ' Gj Q G & . 3 9 1 ' 7000 �. iZ A/T ¢ _ c�'S 4-1 EN/ DfD vEutq 9 i. to r .'94e.113.9 GF`l S ptsr Zt cLE'✓. . 1��O TJ x / , .' /T<�/� JvG, �� a--�r.Aa D M E/Nv. ✓__�f r 24"VIA.0o��� � � � > BcX /EPJT, inJlr-` 4-n^4 MrN. .�,N C12 �._ /sT�' =�✓E �k)AbE_/ rnJ f T,CjA Tin ✓ j--p--- t i' , ,<�-•- . � ;�r.;r- ..��:�rv-r�c�ST.%"r-�t \O,�S�N.40P✓C _�FLOW� L/�/E � � -A _i��aCS �jq z / �J) / DDT ;. C�GnA.) ! 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