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Home My WebLink About0077 CONCORD LANE - Health E77ncord Lane 22— 112 tons Mills I I f. i r, 1 I i !�� f i i � l �f �i I _� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for is o l �pstPm (Construction i3rrmit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,71 60WM�P LAt4 Owner's_Nam Addressand Tel.No. ,� t Assessor's Map/Parcel IZ2 I v, I ILA— Installer's Name, ,A Adess,'And Tel.No. Design is Name,Address,and Tel.No. Type of Building: - 1 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Ail gpd Design flow provided Al gpd Plan Date Number of sheets Revision Da e Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alteration (Answer when applicable) c� t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard o lth. igne % Date i J J Application Approved by Date 1 Ll Application Disapproved by Date for the following reasons Permit No. Date Issued 1 --------------------------- ----------- - No. �t. t 4. x Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pphration for bistlos f *pstrm Construction jhrmit Application fora Permit pp to Construct( ) Repair(y! Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessors Map/Parcel t 22 I Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C7ZA Type of Building: Dwelling No.of Bedrooms Ju Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) > (�,! L.0 W �4 . 'tea o 4�. u A-r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in,operation until a Certificate of f Compliance has been issued by this oar lth. , of~ . i ign Date Application Approved by Date Application Disapproved by Date for the following reasons ;o ; Permit NO. Q/ "L/�� Date Issued T_ --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS � � 4 Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Y/),Upgraded( ) Abandoned( )by at JPTj C��_Y2 t 1,3 has been constructed in a,(cr�coordance t with the provisions of Title 5 and the for Disposal System Construction Permit No_n2, dated 1 ( Lf ! Installer C-` 20)WV4,(_. Designer b #bedrooms Approved design'R w /� gpd The issuance o this ermit shallf not be construed as a guarantee that the system will nctio s designed. Date ') Inspector No. c ~ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS is oral *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. ,1 — i Provided:Construction mu t be pleted within three years of the date of this perm. Date �� co' Approved by Stanton, David From: Stanton, David Sent: Friday, July 05, 2019 11:58 AM To: 'Ryan Campbell' Cc: McKean, Thomas; Florence, Brian Subject: RE: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential I am sorry that you may not agree with the regulations, however, please read the e-mail again, specifically the e-mail I sent to you qn Tue Juri 11, 2019 at 9:23 AM which explained the issue. In the future, should you not agree with a decision, it is better to try and resolve any concerns or disagreements before recording a legal document. We will follow up with you in the future regarding how to try and rectify the problem. At this time, the Health Division still cannot sign off on your building permit application. Thank yo'u, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept.:phone: (508) 862-4644 Health Dept. fax (508) 790-6304 From: RyanCampbell [mailto:racampbellenterprisesinc@gmail.com] Sent: Friday, July 05, 2019 10:42 AM To: Stanton; David; Ryan Campbell Cc: McKean,:Thomas; Florence, Brian Subject: Re: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential David, Please see attached septic inspection report. Page six specifies that the system was designed for, and the house currently has, three bedrooms, thus, the deed restriction for same. Joy On Fri, Jul 5, 2019 at 8:52 AM Stanton, David <David.Stanton@town.barnstable.ma.us> wrote: HI Ryan, Thank you;for the update. There is a major problem with the deed restriction, it has the incorrect number of bedrooms listed on it,therefore, I still cannot sign off for the Health Division on the building permit application. I am not an attorney, however with a deed restriction being a legal document, the Town Attorneys may need to review any changes to the deed recording to ensure it is handled properly. You might want to consult an attorney on your own as well to assist you in how to handle rectifying the problem. - 1 li Thank you, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 From: Ryan Campbell [ma i Ito:racampbellenterprisesinc@gmai1.com] Sent: Tuesday, July 02, 2019 6:45 AM To: Stanton, David Subject: Re: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential HI David, See attached recorded deed restriction. Thanks! Joy I On Tue, Jun 11, 2019 at 11:41 AM Ryan Campbell <racampbellenterprisesincggmail.com>wrote: Thank you for the information. I will let Ryan know. Joy On Tue, Jun 11, 2019 at 9:23 AM Stanton, David <David.Stanton cgtown.barnstable.ma.us> wrote: i z i Thank you for the update. I have reviewed the floor plans,there are too many bedrooms at the property. The property'is limited to 2 bedrooms, septic permit 83-868. An information packet with the definition of bedrooms and i ways to rectify issues of too many bedrooms is available at the Health Division counter(it may be available online on the Towns website, but I am not sure.) Thank you, David W.;Stanton, IRS Chief Health Inspector Town of Barnstable 200 Main:Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 i From: Ryan Campbell [mai Ito:racampbellenterprisesincC-agmail.com] Sent: Monday, June 10, 2019 3:48 PM To: Stanton, David Subject:' Re: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential r i i just uploaded the floor plans to the online portal. On ThugJun 6, 2019 at 1:32 PM Stanton, David <David.Stantongtown.barnstable.ma.us>wrote: Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, please include the width of the opening. If the basement is unfinished, please make a note of such. i Thank you, 3 k David W. Stanton, IRS Chief Health Inspector III Town of:Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic Ave. South Yarmouth, MA 02664 I CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! Ryan A. Campbell, President j R A Campbell Enterprises, Inc. 10 Atlantic Ave. 1 South Yarmouth, MA 02664 4 I Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic Ave. South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic Ave. South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 5 r Stanton, David From: Barrows, Debi Sent: Thursday, June 06, 2019 10:46 AM To: Stanton, David; Stepanis, Fred; Hoopes, Edwin Subject: Perm it/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential For your review. Thanks, Debi Barrows Office Manager Town of Barnstable Building Department Nv1 e 1 f Stanton, David From: a Stanton, David Sent: Thursday, June 06, 2019 1:30 PM To: racampbellenterprisesinc@gmail.com' Subject: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, please include the width of the opening.' If the basement is unfinished, please make a note of such. Thank you, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept.;phone: (508) 862-4644 Health Dept.;fax (508) 790-6304 1 Stanton, David From: Stanton, David Sent: Thursday, June 06, 2019 1:31 PM To: Barrows, Debi; Stepanis, Fred; Hoopes, Edwin Subject: RE: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential I have e-mailed the applicant, I did not find floor plans of the whole house. Thanks, David From: Barrows, Debi Sent: Thursday, June 06, 2019 10:46 AM To: Stanton; David; Stepanis, Fred; Hoopes, Edwin Subject: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential For your review. Thanks, Debi Barrows Office Manager Town of Barnstable Building Department 1 Stanton, David From: Ryan Campbell <racampbellenterprisesinc@g mail.com> Sent: Monday, June 10, 2019 3:48 PM To: Stanton, David Subject: Re: Perm it/App I ication: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential i just uploaded the floor plans to the online portal. On Thu, Jun 6, 2019 at 1:32 PM Stanton, David <David.Stanton(a�town.barnstable.ma.us> wrote: Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, please include the width of the opening. If the basement is unfinished, please make a note of such. Thank you, j David W. Stanton, RS i Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic:Ave. South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 r Stanton, David From: Stanton, David Sent: Tuesday, June 11, 2019 9:24 AM To: 'Ryan Campbell' Subject: RE: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential Thank you for the update. I have reviewed the floor plans, there are too many bedrooms at the property. The property is limited to 2 bedrooms, septic permit 83-868. An information packet with the definition of bedrooms and ways to rectify issues of too many bedrooms is available at the Health Division counter(it may be available online on the Towns website, but I am not sure.) Thank you, David W. Stanton, RS Chief Health:Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept.;fax (508) 790-6304 From: Ryan Campbell [ma i Ito:racampbellenterprisesinc(�bgmail.com] Sent: Monday, June 10, 2019 3:48 PM To: Stanton;David Subject: Re:: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential. i just uploaded the floor plans to the online portal. On Thu, Jun 6, 2019 at 1:32 PM Stanton, David <David.Stantongtown.barnstable.ma.us>wrote: Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, please include the width of the opening. If the basement is unfinished, please make a note of such. Thank you, David W. Stanton, IRS Chief Health Inspector Town of Barnstable 200 Main Street 1 ' ,3y Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 Ryan A. C4mpbell,'President R A Campbell Enterprises, Inc. 10 Atlantic Ave. South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! z � } Stanton, David From: Ryan Campbell <racampbellenterprisesinc@g mail.com> Sent: Tuesday, June 11, 2019 11:41 AM To: Stanton, David Subject: Re: Perm it/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential Thank you for the information. I will let Ryan know. Joy On Tue, Jun 11, 2019 at 9:23 AM Stanton, David <David.Stanton(a,town.barnstable.ma.us> wrote: Thank you for the update. I have reviewed the floor plans,there are too many bedrooms at the property. The property is)imited to 2 bedrooms, septic permit 83-868. An information packet with the definition of bedrooms and ways to rectify issues of too many bedrooms is available at the Health Division counter(it may be available online on the Towns website, but I am not sure.) Thank you,: David W. Stanton, RS Chief Health Inspector i Town of Barnstable 200 Main Street Hyannis, MA 02601 i Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 I From: Ryan Campbell [ma i Ito:racampbellenterprisesinc@amail.com] Sent: Monday, June 10, 2019 3:48 PM To: Stanton; David Subject: Re: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential i just uploaded the floor plans to the online portal. i 1 : On Thu, Jun 6, 2019 at 1:32 PM Stanton, David<David.Stantongtown.barnstable.ma.us>wrote: Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, please include the width of the opening. If the basement is unfinished, please make a note of such. Thank you, David W. Stanton, IRS Chief Health Inspector ' Town of Barnstable 200 Main Street Hyannis, MA 02601 ' Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic Ave. i j South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic:Ave. 2 � 2u South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 3 Stanton, David From: Stanton, David Sent: Tuesday, June 11, 2019 1:19 PM To: Barrows, Debi Subject: RE: Perm it/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential Thanks Debi: He did e-mail to let me know, I looked at them and it is denied,too many bedrooms. Thanks, Dave From: Barrows, Debi Sent: Tuesday, June 11, 2019 11:36 AM To: Stantonf-David Subject: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential Floor plans attached 6/10/19. Thanks, Debi Barrows Office Manager Town of Barnstable Building Department Stanton, David From: Barrows, Debi Sent: Tuesday, June 11, 2019 1:27 PM To: Stanton, David Subject: RE: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential Ok Thanks From: Stanton, David Sent: Tuesday, June 11, 2019 1:19 PM To: Barrows; Debi Subject: RE: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential: Thanks Debi: He did e-mail to let me know, I looked at them and it is denied,too many bedrooms. Thanks, Dave From: Barrows, Debi Sent: Tuesday, June 11, 2019 11:36 AM To: Stanton; David Subject: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential Floor plans attached 6/10/19. Thanks, Debi Barrows Office Manager Town of Barnstable Building Department 1 r 1 Stanton David From: Ryan Campbell <racampbellenterprisesinc@g mail.com> Sent: Tuesday, July 02, 2019 6:45 AM To: Stanton, David Subject: Re: Perm it/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building -Addition/Alteration - Residential Attachments: Deed Restriction.pdf HI David, See attached recorded deed restriction. Thanks! Joy On Tue, Jun 11, 2019 at 11:41 AM Ryan Campbell <racampbellenterprisesinc(-,gmail.com>wrote: Thank you for the information. I will let Ryan know. I f Joy d On Tue, Jun 11, 2019 at 9:23 AM Stanton, David <David.Stantongtown.bamstable.ma.us> wrote: . I Thank you for the update. I have reviewed the floor plans, there are too many bedrooms at the property. The � property is limited to 2 bedrooms, septic permit 83-868. An information packet with the definition of bedrooms and ways to rectify issues of too many bedrooms is available at the Health Division counter(it may be available online on the Towns'website, but I am not sure.) i Thank you, i ' David W. Stanton, RS i Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 i Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 + k i { i ; ! d 11 I From: Ryan Campbell [mailto:racampbellenterprisesinc@gmail.com] I Sent: Monday, June 10, 2019 3:48 PM I To: Stanton, David I Subject: Re: Permit/Application: TB-19-1214 at 77 CONCORD LANE, MARSTONS MILLS for Building - Addition/Alteration - Residential 1 i just uploaded the floor plans to the online portal. i 1 On Thu, Jun 6, 2019 at 1:32 PM Stanton, David <David.Stanton(?town.barnstable.ma.us> wrote: i Please provide a full set of house floor plans for 77 concord Lane. It does not have to be architectural, but it does need to have all rooms labeled and be legible. If there are any cased openings going into rooms, ! please include the width of the opening. If the basement is unfinished, please make a note of such. i f Thank you, E David W. Stanton, IRS Chief Health Inspector I Town of Barnstable ! t 200 Main:Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 E Health Dept. fax (508) 790-6304 ii i !I I i I Ryan A. Campbell, President i R A Campbell Enterprises, Inc. i i 10 Atlantic Ave. f South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 I I I i Ryan A. Campbell, President E R A Campbell Enterprises, Inc. 10 Atlantic Ave. South Yarmouth, MA 02664 Ryan A. Campbell, President R A Campbell Enterprises, Inc. 10 Atlantic:Ave. South Yarmouth, MA 02664 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 3 I 6k 32122 Ps69 T343C)6 06-27-2019 a 032410 DEED RESTRICTION WHEREAS, Kurt G.Warms and Deborah A.Warms(hereinafter referred to as The Warms)of 77 Concord Laney Osterville, MA are the owners of a single family home located at 77 Concord Lane.in Osterville, MA, (hereinafter referred to as 77 Concord Lane)and being shown on a plan entitled "Subdivisibn-bf Land in Osterville, Marstons Mills Village, duly recorded in Barnstable County Registry of Deeds as: �L�1nl dcx�tea 2.Ca ►�Ar �t MWBook/Page: 27358/223 ` Map/Block/Lot: 122/ 112/ ,.a Property Address: 77 CONCORD LANE Village: Marstons Mills WHEREAS,The Warms as owners of said lot 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 lot as a pre- condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the 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 Out on record with the Barnstable County Registry of Deeds by recording this document,NOW, THEREFORE,The Warms do hereby place the following restriction on the above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1.77 Concord Lane may have constructed upon the lot a house containing no more than three ( bedrooms.The Warms agree that this shall be permanent deed restriction affecting 77 Concord Lane, in Osterville, Marstons Mills Village, in MA and being shown on the plan recorded in Plan Book 27358,Page '223: - - For title of 77 Concord Lane in Osterville, see the fo lowing deed:Book 27358,Page 223 Executed as a sealed instrument��y of 2019 04Vner' tg ature : Kurt G.Warms Owner's signature : Deborah A. Warms E THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM7E DATA 06--27-2019a a 03: 411'p DEED RESTRICTION WHEREAS,Kurt G.Warms and Deborah A.Warms(hereinafter referred to as The Warms)of 77 Concord — Lane.Osterville.MA are the owners of a single family home located at 77 Concord Lane in Osterville, 'Concord Lane)and being shown on a plan entitled"Subdivision of 'illage, duly recorded in Barnstable County Registry of Deeds as: i RECEIPT Pi 'nted: June 27, 2019 Q 15:43:01 BARN ABLE C0VNTY REGISTRY OF DEEDS p LANE JOHN F.;MEADE. REGISTER Transg: 160717 Oper:CMACNEILL JOY if said lot agreed with the Town of Barnstable Board of Health to a Book: 32122 Page:-69- Insth: 30306 - 4rooms which can be included in any home built on said lot as a pre- Ct l4: 1159 Ree:6-27-2019 ® 3:41:45p orks construction permit in compliance with 310 CMR 15.000 State BARN 77 CONCORD LN 1um Requirements for the Subsurface Disposal of Sanitary Sewage; DOC DESCRIPTION TRANS AMT - 1 WARMS, KURT G --------- Board of Health,as a pre-condition to granting a disposal works RESTRICTION ;tem in compliance with 310 CMR 15.200,State Environmental Code, County Fee $ 10.00 10.00 r the Subsurface Disposal of Sanitary Sewage,and authorizing the Surcharge CPA 020.00 40.00 a construction of a single family home on this property,is requiring State Fee $40.00 40.00 g y p p y, q g Surcharge Tech:$5.00 5.00 ion on the number of bedrooms in any house constructed on the lot Total fees: 75.00 ile County Registry of Deeds by recording this document,NOW, ■•x Total charges: 75,00 place the following restriction on the above-referenced land in :h the Town of Barnstable Board of Health,which restriction shall run CASH PMT PAYMENT -CASH 30.00 all successors in title: Overpayment amount: 5.00 REF CASH REFUND -CASH 5.00 ructed upon the lot a house containing no more than three his shall be permanent deed restriction affecting 77 Concord Lane,in n MA and being shown on the plan recorded in Plan Book 27358,Page 223. Far title of 77 Concord Lane in Osterville,see the fo lowing deed:Book 27358,Page 223 Executed as a sealed lnstrumentG�y of 2019 Owner' ature : Kurt G.Warms 1)4 Owner's signature : Deborah A.Warms ! a �x i Bk 32122 Ps69 W30306 06-27--2019 a 03 a 41P DEED RESTRICTION WHEREAS,Kurt G.Warms and Deborah A.Warms(hereinafter referred to as The Warms)of 77 Concord Lane,Osterville, MA are the owners of a single family home located at 77 Concord Lane in Osterville, MA, (hereinafter referred to as 77 Concord Lane)and being shown on a plan entitled"Subdivision of Land in Osterville,Marstons Mills Village, duly recorded in Barnstable County Registry of Deeds as: VLAN a-x,I, 1,L<,o 0A(6. -7 :WzwBook/Page:27358/223 61 Map/Block/Lot: 122/ 112/ Property Address: 77 CONCORD LANE Tillage: Marstons Mills WHEREAS,The Warms as owners of said lot 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 lot as a pre- condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Title V,Minimum Requirements for the 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,NOW, THEREFORE,The Warms do hereby place the following restriction on the above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1.77 Concord Lane may have constructed upon the lot a house containing no more than three bedrooms.The Warms agree that this shall be permanent deed restriction affecting 77 Concord Lane, in Osterville, Marstons Mills Village,in MA and being shown on the plan recorded in Plan Book 27358,Page .223. for title of 77 Concord Lane in Osterville,see the fc lowing deed:Book 27358,Page 223 Executed as a sealed instrument��y of 2019 Owner' sig ature : Kurt G.Warms :Owner's signature:Deborah A.Warms 1 s : 1 a COMMONWEALTH OF MASSACHUSETTS ss 20jt Then personally appeared the above-named Uri" nown to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed,before me, ' SANDRAJ.YOCHUM Notary Public Commonwealth of WSSUhuselts otary Ablic MY Commission Ex Tres February 4,2022 My commission expires: !� r BARNSTABLE REGISTRY OF DEEDS Jahn F. Meade, Register a Ot A,p .E,.� r3 - 1"- 6, 4-- 2rd' ry STAIRS 7, 13n, s- IT-4- STORAG 16- LOX RFO STORAGE UTIU—"RKROOm SE—GIOUILMG In v 793 w Ull, 6.2' Z.r eouveEI!. Yr 2 7-r 41� V. 15`6511M,- 1 6.7 Y4 0 7- - - -----—---------—----- L fb 7 - ----- - ---- ry........... 7-4. "1 7� 7-1 ol—c 11 23—11-- 20 ftl 157W EXCAVATEDiv 4i 3`1 27,- 70*IX BASEMENT 77 Con=Id 78i -.s- 31- 8.r s— 2�4' T-2- 7 2'-0' 12— Sun Room � i 5'8'.—W 2114' yea rf Z, it 31 ft' L I 114* 1--.12-4- 220 omm1R"&,;Rom 6'4 15"'.lo- 74 W ...............— zol —5TFLOOR 77�-- -———————————— ''r a 2-2' 2+ � i1i N;16 ]. )Yf j 7 's.— d N - _ W toz O Z W qx 0 uj > w 0 3 w w 0 w 0 0 N Ul i TME: .W - - N ki FLOOR PLAN .till - . r,Vcstous z EX15T. M / GARAGE i CCturtG,751'Icat — r - O � O Te O t i a tl/i z Q o Q . . � - xis ec•.rr r<t n.n. --� Zz LUw 6� 7a u > 1 In x z GUI. 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NEW emr sruN(ar ro AUTen e2hn5T. r 12 'Mv xo W5.R!.-PAPER 2 71tiv a3.570 ,�n,,12•)C'rml)31tEAniWC � Afw 2.6 GCILInL J015T'5 9 16• -, Nii 2.810CA1NG¢u.TKEn RAfitY3.Tt1'. f V nPft AL.'1,+M.E GUTTER b "yY NtW i.SCWflT ts7 C.tM'T.VENT' Q i ��OVEK t�3 CI1RLk'Ci Cl fv r NEW EATT MOAA M COM NEW O ; wNi.17:AMtVC. f�!✓ r LD Q. 4 � BEDROOM � O t3P A^JMAi PELT �- O aiN:'a ADvAK TEO FL wom, YI114tX10 Ii V�•'� Z W ^L, u 9eCGT;3 YLOC#R GUJEO#>AIIFO TO THE TOP Of 1 2 "l E X,*5T5 W bd QNG�5P1AAr NAas i z z 9T Le Q 6.O.C. a Q _.-ftub iC" _— 5`:;. F.G.ww5tA...TO coot - 121 = Q' 4Pd'GYPSUM WAH.E50. (� Z �L { _h'"W?r.PSStX1JPtG-011ork U W I.2...23sy5la FRQ&D Al DKO ! Ts�aJ� n'Aty,'frilG.Rt Z" Y O t LC3 ~/1 'Nf?xr w t410R wAGtL w ifo"2 G { jX RMW.TO REN;rN--A. cz O W � o � �z " G%�� PJ m1� M1p: AIZA6E ",IT ii OOR NttY S'"u-W'�'+t'ft�fKCOF f'�� 11 TmE _ raP; K snrr�wocxc .uLwpu:5 BUIIUI�G. Rfv6x"s y W I ND !1 w[ CA '\I�# NEW GARAGE SECTION �5 t � f: Ia = -O- � 1 .----- G cn S3�-t 's2c "�p s2 2c10Cp Gip w o 0Q W 3ou z 6 u > zQ Mom uj Z ;� fio SCLLt AsT�o� Httb. �at.q ........- .. .......... .. .. .... ...... ........._ .. .. .. ... - ..... ,..__.... .. .... ..... ..... ....... .... .. ... .. .. ..... .... ...... .... ..... .. ... .. ... .. .. ..... ..... ..... wt 57 d ............ ...... n• v K, A-4 i ru .ral sz a1,9o-:e .o-z .als u:r�}I•o-z g19 Pa ra! sgz z-r .rz .me A:a .01-z .ea a15 s.c uu st mI S.Z .ova .m:a .nu,m ul o-al v ---------------- g = I • ! -4, XOH -fi-9.OZ w 1 v e yb9 to e m�7v9 a .OL-.ZL X.S:LZ e , r � 4 4I ` 1 lvsvYJ 1 lasron AI! PZ 1 z g w .0-st x,P6L w°apeea'gsy9 �6 .O:S :Z{ _ A.SL x.O'.SL , s .—ZO 9 it I I I 4 3 f wva b vuvJS l410 �II a v e u .m'bv IZZ 1 \ � t ax,aaPPS \ ; 6 ry 11 \\• ,06 `` a C 11 •\ d 1 _�.... .....( 6S\ \• 11 \ \ Vl �q aS woa a6 E 1 .z-urn Alcz .u:zZ 9.rz .z,c g.rz A✓.z-9 0!l.P.z, �l9tz ,z-.z oY r.9 .rm .o-.9 �t .o-,! .Pz .o-z az l.o-z J—z s su W 1 q9 xog 0 :l i I 1 Aemuew oa uogepuno/ w0ji m >luel b Bwyoea� i AsBuilt Page 1 of 1 I '7- LC4A T I0N/7 S E W A G E . PE RMIT NO. to r- L.o n C'o✓c� 1,�-t ? �� -- VILLAGE INSTA L.LER'S NAME i ADDRESS cc BUILDER IIOR OWM R 4Y1 Ln, bo-r�6 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / Al y ^� I 0 3 . http://issgl2/intranet/propdata/prebuilt.aspx?mappar=122112&seq=1 5/30/2013 Commonwealth of Massachusetts Title 5 Official Inspection Fora • — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments «„ 77 Concord Lane Property Address John Lombardo Owner Owner's Name —' information is � � � �� Ma_ 02655 3/8/2013 required for _._ 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.Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your _Scott Campbell cursor-do not use the return Name of Inspector -•__ _ �______ ____ _ �� key. Cardinal Construction Company Name r� 32 Ridgetop Rd. Company Address Cotuit Ma - - 02635 - re'� Cityrrown State Zip Code 508-420-1295 S 1388 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 F rther Evaluation by the Local•Approving Authority r' /w 3/8/2013 In,pector. Signature Date The system inspector shall submit a copy of this inspection.report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000.gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i • i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i I 3 Commonwealth of Massachusetts Title 5 official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address — John Lombardo Owner Owner's Name information is Osterville Ma 02655 3/8/2013 required for — every page. CityrTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file • • 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sex-age Disposal System•Page 17 or 17 f <L\ Commonwealth of Massachusetts Title a Official Inspection Form • - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 77 Concord Lane _ Property Address John Lombardo Owner Owner's Name information is Osterville Ma 02655 3/8/2013 required for � _._.._._.__. __._.__ every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record • If checked, date of design plan reviewed: 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: • Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins•11/10 Title 5 Otrxial Inspection form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address — John Lombardo Owner Owner's Name information is required for Osterville Ma 02655 3/8/2013 ____._. every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �� II OW • t 1 L/ i • 15ins-11/10 Title 5 Official I nspection Fwm SubsuAace Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t - 77 Concord Lane Property Address John Lombardo Owner Owner's Name — information is Osterville Ma 02655_ 3l812013 required for -_-- _ every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): • t5 ns•1 tl10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address John Lombardo _ Owner Owners Name information is Osterville Ma 02655 3/8/2013 required for __.._ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) Type: ® leaching pits number. - - ❑ 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.): Course sand gavel. No signs of hydraulic.failure,no ponding or damp soil, normal vegetation,..(grass) 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 tSins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address John Lombardo Owner Owner's Name _.-----.-_-__-- -- T information is Osterville Ma 02655 3/8/2013 required for _ __. every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): Box is level. Single line out of box to pit No evidence of solids carryover, no evidence 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 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: t5ins-11110 Title 5 Official I `nspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 77 Concord Lane Property Address -~_ --- John Lombardo Owner Owner's Name information is Osterville Ma 02655 3/8/2013 required far every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: - Material of construction: • ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: -------- -- Capacity: gallons Design Flow: -- - - - --- gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: -- ---m-Date ---- -- Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewege f?sposal System•Page 11 or 17 Commonwealth of Massachusetts Title 5 official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane _— Property Address John Lombardo Owner Owner's Name information is required for Osterville Ma 02655 3/8/2013 __— ._ -- - --- ------- every page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 463 Scum thickness 0 - Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 - -- Now were dimensions determined? sludge stick,tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Both tees in place at time of inspection. Structural integrity of tank is good. Liquid levels at proper working height at time of inspection. No evidence of leakage into or out of tank. Grease Trap(locate on site plan): Depth below grade: feed Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: — - Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle -- • Date of last pumping: Date t5ins-11110 Title 5 Official Irupedion Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address John Lombardo Owner Owner's Name information is O_steryille Ma _02656 3/8/2013 _ required for _ _- — _.... every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: compliance date 10/4/1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): - - Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): • Septic Tank(locate on site plan): Depth below grade: feet — Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, fist age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) , ❑ Yes ❑ No Dimensions: • Sludge depth: ----- t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address John Lombardo Owner information is Owners Name required for Osterville Ma 02655 3/8/2013 every page. City/Town state Zip Code Date of Inspection D. System Information (cons.) Last date of occupancy/use: Date -- Other(describe below): General Information Pumping Records: Source of information: -- - • Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: - - — gallons How was quantity pumped determined? -- - - Reason for pumping: -- --- --- Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool El Overflow cesspool El Privy El Shared system (yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts WOMEN Title 5 Official Inspection Form . - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane _ Property Address John Lombardo Owner Owner's Name information is Osterville Ma 02655 3/8/2013 required for every page, Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 • Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail. 2011 =69,000 gallons 2012= 104,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: 2013 _— Date Commercial/Industrial Flow Conditions: Type of Establishment: — Design flow(based on 310 CMR 15.203): Gallons per day(ypa) 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: l5ins•11110 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts - Title 5 official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Concord Lane Property Address John Lombardo Owner Owner's Name information is required for Osterville M ----- every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3_-- — Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•I I/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of V L C T ION SEWAGE PERMIT NO. .4 VILLAGE INST ALL ER'S NAIVE A ADDRESS G� 8 U I L D E R OR Owq R DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ell No... j.`.�7. t } Fss.... ..... THE COMMONWEALTH OF MASSACHUSETLS BOARD OF HEALTH _...�4.. .(. ............0F.......................................................................................... ppliratiun for Biupuual Works Tonutrnrtiun Prrutit Application Tihe.;eby�madde for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: A.;, I °1a— tr �... ...------•---------.....----...... .................................... ........................................................... Loca��:'`on-Adf.ress or Lot No. Cl...!..!Z..!........^P!z?,�SC !f...................................... ...........•---........------..............................---•--................................. ner Address Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.... .. ..............................Expansion Attic ( ) Garbage Grinder (�l No Other—T e of Buildin �' a yp g g e p ( ) — Cafeteria (� )__ 1P ..__/".�!`llI- . of ersons....... .............. Showers a Other fixtures ........... ................. d ..... . •--••--------- W Design Flow............................................gallons per person per day. Total daily flow..................._........................gallons. WSeptic Tank—Liquid capacityJP7!?R.gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_----- ...... Diameter........6........ Depth below inlet...... ........... Total leaching area..Z.......sq. ft. Other Distribution box ( ) Dosing tank ( ) Z Percolation Test Results Performed by............. . ..... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....JV/A-------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ................. ........ ..........12�=../.L z.....Ate`PA........�'� d----------------------- 0 Description of Soil......................................................................................................................................................................... x c., --------------- •-- -------••------••••-......•-------•-•---•-•----- •-•----- .................. W - -•-•- --•--------•--•-•---••-...-••-•-••••-------•••------••-•--•••-•-•--•-••----•--•-----------•-•---------•--------------- VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeji is ued by the b�hlth�Signed . . . .�. ..... . ........ Application Approved ........................................ ------ /. a te ......---- e Application Disapproved for the following reasons-------------------------••-•---•----•--•----------------------•------------.....----------:..---............--- ---------------•-•--........---------••-.............•-•-...............•---•---------................-------------•......_..---••--•--••---•----•---•••-----•--------•----••-----------•---•------•---- Date PermitNo......................................................... Issued_.......................................... Date ..---.. ... FES..... THE COMMONWEALTH OF MASSACHUSET-,S BOARD OF HEALTH ...................OF.......................................................................................... Appliration for Diopoottl Workii Tonlitrnr#inn amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n r i. l...e?. ....6.0 C../".C. +o� u'/�F.....-•.......... ............•-f:J.l..M..+. l_.1.------•--•- .....------------..........-------•--•---- / / LocatJ'on-Address or Lot No. i7.-- :..hla1P?.�?.fd/1,,?6.,r...................................... W A.�f't2�3cr Address .tf rG +° ---------------- --•------ .- .--•---............ ------------• �Installer Add ------- -....... ------- --........ *...... ... � l � ress UType of Building , Size Lot............................Sq. feet Dwelling—No. of Bedrooms...._..................................Expansion Attic ( .) Garbage Grinder p, Other—Type of Building No. of persons.....2.................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./P.%.-'Q.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.._......./------ Diameter-------46........ Depth below inlet.....467........... Total leaching area..2,zm. ....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..............S.--....&A L4....--•-----•-•................ Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water....IV-1—A---.__.. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................:....... �+ ................. ....... Z ......44.6==-!)......... ----••-•----------•-•--- ODescription of Soil.................................................._...................................................................................................................... U -----------------------------------•--......._.......-•---------------.............--------...------.........--•---=i........_...---•-----------------........---....---.........---•-------............ --------------------------------------------------------------------------------------------•-...-•----•--------�...------...........................................:.......-...................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•--••-----------------------------------------------...............---•-•----...------------...-----....•--......••-----------•-------•---................----•-•...---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b and of health. Signed. • .: lA D,1-.J---- - ^�"'1 Date Application Approved By.._.......... •�i, .... �1`" ,� ....._._ I,ate Application Disapproved for the following reasons:............................................................................................................... - •---•-------------------------------------•-----••••-----••-•-------------------------...._._....._......-----•--•--•-•-•---•----•-•-------•---------•-•--•••-•---...••-------••---------------•-------- . Date PermitNo-------------------------------------------------------- Issued--•--••-----•--------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tompliantr THIS IS TO CERTIFY, T the Individua Sq 'age Disposal System constructed ( ) or Repaired ( ) by--------------------------------------------------- .f ...................----•---•-•----•-•----•------•--...........----.............--••-•------_-- at.............6,� -------� 1...---•--• •Gx ,........ ' t=`�---- ---------------------------...------•---.................. . has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----e_?I_$11�.I_........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ 1 v: `1-.A-.AL4 ......... Inspector--------------�.�r..�_........•........----•-.................-----...........-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... ---� No.�•�.:�G�� FEE....... ��..r--•- Diopooal rkg ('15o tr ion ;Irrmit Permission i her y granted. ------•_..._ �s. to Construct ( 1>4 Repair �an Individual Sewage Dispo System atNo. ----•-------C_v...........^....... .......................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ............................ ........................... .J_ .. _ -.-.----.---------•-------------^ DATE---•-------...../ _... Board It FORM 1255 A. M. SULKIN, INC., BOSTON ��•E•�FAM1�-`! - 3 B�ORooM i� p/>ILY FLOW a I1vx 3 -3 PP 99r8 - - - - - -/4zo II SEPTIG TA►JK = 33ox15�% = ,49i6'.p0 _ - u5E- l000 GAL-. I pi5Po5nL PIT �5E IooO GAL.. a /oa.g /03 g 5 t DCWALL A1z.CA - 150 5.r /62. Z L 5 o 5.>= X �2-•5 - 37 5 6.P o 25:t gOTTC>M AREA= •II 50 5.r.5 o s.V- x 1• o 5.o G.P o 2�f / .�?/o/- - /03.7 l •TOTA 1- 0ES1GN - 42-5 G-P. D. A ,cis:. 7-w I� -TOTAL DAIL". F�--C>W - 33OG.PC) R� +3 N II PE2COLAT1oN RATE : AT : 1"0J ZMIN o1;LE55' \ s, tti �G /0Z•Z /o ./ IILE,4GN it o 11A OF 1,1 'p�tti OF WILLIAM 4Lr,N" c w 3� ' j N Y f , IU JONE.S C ems- R3).�3 A No. I!+334 251 ay spa✓.e ,��/,e.s. � 'Top FNu= loXo /a/ 3 ,�G• r, y ^ ' � 1� INv. /00.3 . INV. DUST. GAL. Z I 000 i 99'7 -TANK INV. Gay.. 99.3 f LG. PIT INV. INV. WITW 99•5 99.7 I SANV ► 3/q I VL l WASUGD 67v N �3 /2 . GESLTIFIGD PLOT PLAID /o�✓,o � p R-U F I L. &9 3 L O C A-r 10 N /vf q�5`Tail,/✓� /y/�L s I NO SCALE 5cALG jp • VATS p t-A N REF E KE rN C, I GE R'f 1FY TNAT IµEmoP06a> �5E.5,Aoµ(N � F{EREOW COMPL`(5 WtTN U-T- 2� AuP 5ET5AGK R-GQu12EMENT> C)r- -Tc>W►•i o I~ BA2N5TA3L-E- A N-0 ►S No-r' 7/ LOCP.T D. �)/7 N o4D PLbQl — p.I� �/L B A XT E�Z. E26,D' u�.v EYoeS -Tull P L&ti 1 '5 W C)rT B t"5 r p o A r j U ST E 2-V I L LA lu'5TR.uMENT' Su2vC-`( r -TAE 01=F•SI~T5 6WOUL,D NoT DE u5EDTO pETE�ZI^I►�E L.o-r �_ ►NE5 APPLICAr-IT