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HomeMy WebLinkAbout3725 MAIN ST./RTE 6A(BARN.) - Health 3725 MAIN ST./R©UTE 6A, BARNSTABLE � v A= 317 082 o r i o i i•: h I QN 7.115 _ SENN t),C;E P RM..IT Q 0. �• F �a IMST-QLLER�S ► W-E AD-DRESS - �� -$-L1lL D E R.5 . 1`t-I&M.E 4-D-QR+-E 5- 5- xl : -' �._ .. .. i_...-- __...�...__._._.._.__..,._ .. __.._......_ 3-11 / I i (70 00671 dzylval 77- L O C_QT_1.O SENNA C,E-RER MIT U-O. 1-U t_l._p ER-6-Q- M E A D-D-R E-SS — sr--g�-icy D L.,T_E_P_E R_tv�1T-1_SSU _3--IW-N j 00 Cf/ d ��. o v i 0 5 ... `, 3 No.. ------------ ...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® ® HE TH 4579'5 Appliration -fair ihnvviitt1 Works Cnonotraartion Vrruift Application is hereby made for a Permit to Construct (/)"'or Repair ( ) an Individual Sewage isposal System at: ' � '`-- --- Locaflon•Address V No. �D ....... Own Address ` Wa.o Insta r I� n Address d Type of Building- Ce 1 //'� Size Lot............................Sq. feet U DwellingKNo. of Bedrooms_______ e ______________Expansio`n-Attic ( ) Garbage Grinder ( ) U - a, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures _...- ------••-------------------- d -- -- _ ----- ______ W Design Flow........................ ._ -•.••----•.• Ions per person per day. Total daily flow____________ ________________ __ ----gallons. 9 Septic T:inkl_Liquid capac it - __..____gallons Length________________ Width-__ _-.-_...-_.. Diameter................ Depth._,__-_-_-_---- x Disposal Trench—No. .................... Wi�dl�._____ _._ . _ tall en _-.......... ----•... Total leaching area------_-------------sq. ft. Seepage Pit No.._____�____________ Diameter._ �i bye let .. n-__.__._ Total leaching area------___________sq. It. Z Other Distribution box ( ) Dosing tank a Percolation Test Results Performed by------------------------------------------------------------------------- ate--------------------------------- Test Pit No. 1..........._----minutes per inch Depth of Test Pit.................... Depth to ground water-----------------....... fiq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ a' ------------------------(---------- a /.........../- ---- -------------- xDescription of.Soil--- ------ --------- �� ' `� Y -- --- ---- •--•-- .- -- --- U ----------------- - —: •••-- -••• ---- Q - --------- '� G xW - ---� �------------ --------••-- - �-- U Nature of Repairs or Alterations—Answer when applicabl --------------____-----------Y---_-_ -________-_______-_--__-__--___-_----___-_-______--- --- -------------•------------- --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu by the board of hea�th gned - ---•- --•------------ ---- ............. -------- --- -------------- D Application Approved BY e Date Application Disapproved for the following reasons-------------------------------- /------------------------------------------------------------------- Date - -- Permit No.. Issued... 1 ;:,ynace..... ....... No....... .......... Fsa...f0 ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD X HEAL TH �� i� Apphration -for Dii laiittl . orki Tomitrurtion Permit Application is hereby made for a Permit to, Construct or Repair ( ) an Individual Sewage isposal System at: .. . ......A........ . . - ,�/n� _ ... J �. . 7d [ P�� Location- ddress . (//7 or Lot Nio. ,_--`�_•_ =•-=-._. ...... ...............•.._...._..._.•......_.................,.......___._..._..__._....._...._.......____ Owne Address a ----------- n 1 s�'s>-° ......... = ----------------•----•------•-------...-........................................ Insta er • Address UType of Buildi Size Lot............................Sq. feet ., Dwelling No. of Bedrooms.-.__-_;, -------- ---------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures d - -------------------- W Design Flow........................ _...... allons per person per day. Total daily flow............_....:_._....._._._:_._..-.---gallons. R� Septic Tank}Liquid capacit.��... gallons Length„ u._..-Width.__ ...._.._.. lliameter----------------- Deptli.-_--...._.._. W Disposal Trench—No. .................... Width........ tal Iaengt ..;..-. 'Total leaching area--------------------sq. ft. Seepage Pit No......../........... Diameter___ t be o' i iet_ ________ ____ _ Total leaching area....__.__________sq. ft. z Other Distribu-,.ion box ( ) Dosing tank ( ) Q / � . "` !S/j 1T a Percolation Test Results Performed by----------------------------------------------------------------_------ ate---------------------.---------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-----.---.--..-.----.... f� Test Pit No. 2-___-____-___-minutes per inch Depth of Test Pit____________________ Depth to ground water-_._-.---__-.---_-.---.- a+ ----..... -•' F °.........../ Z--------------- 0 Description of Soil - � ` `'.. - lap .-" - --- x ------- --.4------ V � G W V Nature of Repairs or Alterations—Answer when applicabl ----------------------4---------------------------------------------.------.-_---------. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until,a Certificate of Compliance has been issued by the board of health .. `gned .. D e Application Approved By--------- ----- '` ;�` �/! i'J _- -- �; .._... Date Application Disapproved for the following reasons:........................• --------••----------------•--------------------------------------------------------- Date PermitNo......................................................... Issued...-------- ............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF EALTH ..... ^!............OF.............. "., -ws-.':....................--- 1QffPrfif irate of TAIIiphaurr T IS TO CE IFY, That the Indiv' al Sewage Disposal System constructed ( ) or Repaired ( ) �` -•------•--•-- y ---------------- g j `-I w 4-------/ iJ� :yJ7-A - ----------------------------- Installer (}[ vl �{ '^'i r C [��/a/d/a /7�atV. ' "�'z,Z-:.. . ` ------.... -•--- -- '�..! . ...•----•-•----- has been installed in accordance with the provisions of Article XZ o The • tate ,Sanitary ode as des ribed in the application for Disposal Works Construction Permit No-------------- __-______-.-_- . dated:-.-3/i��7`,(.__....._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.--------•- .. ..�g. � Inspector------ ;----I---- ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD Or HEALTH k % .�?��-.........OF........... . Q(/✓- /d No.....•-- FEE..../ ............ � � vgrk,� �l�n•� r�tr�i>aat, �r-r�ti# 4 y air an Individual Se a e Disposal System t �! Permission is hereby ranted:•. V'-__ ..... . - ..... .__. to Cons ruct ( r,Reap ( ) t fig, p - Y J rr �y /� . �-Street n as shown on the application for Disposal Works Constructio mit N .:,_ _ Dated-- ,/ ,_.. ........._.. Boe.rd of Health DATE................................................................................ FORM 1255 HOB 3S & WARREN. INC.. PUBLISHERS r 1 LOCUS MAP SCALE 1"=2OW ASSESSORS MAP 317 C 1909 Lo. STATE HIGHWAY PARCEL 81 N RO.U'�E ' 6A r S B2' 40' r il'40"E. 192.16 MH8': W10E - 155.16 37 00" co I N � a• LETA L.FULGINITI 2 ALBERT R. ; SK.82t6 PG.27. '� /ic H; �( E I � LAMB LOT 1 E ----_-- •�. _ LC.15659 ° PL.BK.262 PG.28 ,�,?�oS m ' t exist. CB gar. m ® — Q T N3°44'3'-i E �Q�� I i 11 t �•., 0 45AC l w S85°32'40"E � . •. I11. 03• in 40.00-7 •P N 87°24'40"'A 121.03 �' W I• .ROMANIE C 1ASE _ tt Z N�p o5 00 3 BK.3101 P'i 339 j E —-oH �I Q ' w z�• 8 •, � nxistinq-dwe_ling 1 •• s KI K, N85°32'40"%N a to CCt IT THIS PLAN CONFORMS WITH THE _ 40.00 ,h EGULATIONS OF THE REGISTER Z '•` 91.93 106.4. 52.9_�� SB tyt DH. -- ---- - —I 50 W I' • N 87°24'30"W 19,8.34 � S85 039 t� REG.PROF.LAND SURVEYOR LL COUNTY OF BARNSTABLE j Y PL.BK.53 PG. 137 LL' I HEREBY CERTIFY_THAT THE PROPERTY LINES fj'I SHCWN ON THIS PLAN ARE THE LINES DIVIDING I i 'EXISTING OWNERSHIPS, AND THE LINES OF C,J I STREETS AND WAYS SHOWN ARE THOSE OF I PUBIC OR PRIVATE STREETS OR WAYS ALREADY , ESTABLISHED,AND THAT NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR FOR NEW EASEMENT PLAN IN BARNSTA.BLE , MASS. WAYS ARE SHOWN. FO R JULY 7, 1995 REG..PROF. LAND SURVEYOR STANLEY E. AND FRANCES H. ST. PETER cj- - JULY 7, 1995 fti 0 40 80 120 11_i 1 SCALE IN FEET 1"•40' ;` co•. v 1 EDWARD E XELLEY j REG. PROF. LAND SURVEYOR ' •<*fenn, CUMMAOU 10. ud r SEPTIC SYSTEM EASEMENT AGREEMENT made- this :�"� day of �1v �" , .J1998 by and between 1� �y STANLEY E.. ST. PETER and FRANCES H. ST. PETER, hereinafter referred to as "GRANTORS° and ROMANIE' CHASE, hereinafter referred to as "GRANTEE n . 0I. ` 3(p ��f 6 l�( S?, ; IMAMS(ll IT C r- I'�/(j DA G�G M WHEREAS, the GRANTORS and `GRANTEE are the owners of adjoining parcels of land with buildings thereon situated .in Barnstable, Barnstable County, Massachusetts as shown on a - plan of land hereinafter referred to; and ,o . WHEREAS, the Septic' System that services the buildings on the u land of. the GRANTEE is presently located on the land .of the i o GRANTORS; and WHEREAS, the ..GRANTEE and GRANTORS now desire to .formalize the - . location of that .Septic System and show the location of that' Septic System on-a plan; and WHEREAS, the GRANTORS have caused a plan to . be prepared t ) showing the location of-the-Septic System. Nl NOW, THEREFORE,. it is agreed by and between the parties. M hereafter that in consideration- of- the -payment of $1_..00 from the > w GRANTEE to the GRANTORS., the:. GRANTORS hereby grant and convey to J the GRANTEE: 1. An. easement to install, repair, maintain, alter and operate a Septic System, under the land of the ,GRANTORS 'within the Confines' of the "Sewage Easement" as shown on said plan and as hereinafter described. 1 a .i...y;!�( 'd,'Sfi$'bN 41-ya%i i• ;t.. :�vFy 1 8 r_- 8 rr rl 9 •1 2. ' The easement granted in this instrument shall be appurtenant -to the dominate estate. 3. BY acceptance of this easement and the execution of this document, the :GRANTEE agrees that it shall be the GRANTEE'S responsibility to maintain, the Septic System in gogdcondition. The . GRANTEE shall also'be responsible to maintain the surface area of the granted easement in such a condition that it blends with and is indistinguishable -from .the other land "of the' ' GRANTORS. The GRANTEE agrees that it shall be kept as open lawn area . and be . maintained in the''same condition as the remainder of the GRANTORS land. 4. The parties agree that in the - event that it becomes necessary to excavate the .land to. repair or alter the Septic System, it shall, be' the responsibility of the. GRANTEE to restore the land to its previous condition fully equal- to that existing. .before the land was. excavated. 5. The GRANTEE ' agrees that' -following any repair "or � is construction . operations on the site, the land wi.lL be resurfaced and the contours made neat and in agreement with the remaining la' nd'° .. of the GRANTORS. . 6. " The GRANTORS hereby- reserve to -themselves, ' their heirs, successors and assigns, the .'right' to cross and , recross over the surface of 'the sewage ,easement area. They reserve to , themselves the'right to, use that land as 'part of their lawn or garden but they agree, that they shall not place any objects, of. any. kind, on the _ "surface of the sewage easement area. 2 • 1 Ue 2:43 4114-'''�'� r 7• The easement.. rights and priyi instrument shall cease and leges granted under this terminate if and when the Septic is no longer .necessary. for the use and SYstem on Lot en7°yment. 'of the buildings #2. The easement..rights .and privile and if the hous ges .shall terminate when house 'on Lot 02 becomes seaward septic system is . .or when and if a new. located on a portion of Lot #2,..in existing Septic S - place of the Sy now .located within 'the. .grante area.. . d easement 9. The GRANTORS agree this with the land and s grant of easement shall run on _ hall be binding � . and' sh benefit of the all inure :to parties to, this . the. agreement, their respective heirs, successors and assigns, 10.• The parties agree that the sewage -.easement described as follows- area is Beginning at a. point. of land at a - side line between. the land: of and th the Grantor �I! e Grantee; ' I degrees thence North 85 32mi � i. nutes, 40 seconds. ' West a. total distance of 4 0 . •. by "land of , the Grantor to a degrees, 27 . ° . . minutes p lnt; thence North 4 ,, 20 seconds East by other..-land,of Grantor 40 to. .a the Point;* South 85' degrees; 3. minutes, 40 seconds.East, b T.other land to a of the Grantor.40.1 point and the side. line between the. land . of Grantor and the Grantee- then thence South minutes 4 degrees. 27 , .20 seconds West, by land of the Gr distance of . 40� to- the--point antee a total to the point of beginning, ' 3 BP:i-9819-0168 95-08 29 :43 #0 2 i 3 This .area .is`more ,-parti-cularly.,shown on a plan of land entitled "Easement Plan*-in. .Barnstable, Mass. for Stanley E.. and Frances .H. St., .Pete-r,: July _.7, 1995' -scale . '1" 40�-, Edward E. Kelley, Registered Professional Land Surveyor, Cummaquid, MA" and is shown on _said ; Plan as "Sewage. Easement"-. Said .plan is to be recorded at the Barnstable County Registry of Deeds. 6,06 P/• F&Z- IN. WITNESS WHEREOF, we have set our hands and seals this o�kc� day. of 1995. ' �L�1011C ( Romanie .Chase, now known as Stanley . St. Peter Romanie Abraham '�t��7•iCt,f-u.� �b Frances H. St. Peter. CONIA40NWEALTH OF MASSACHUSETTS a Barnstable, ss: Date: _ Then personally appeared before me the-above-named.Stanley E, St. Peter and �.. Frances H. St. Peter, who separately acknowledged the foregoing to be their free act ..,,deed;. <, i Not PublicA. , ' My commission expires:. STATE OF 'MASSACHUSEi'i'S ��. County of Barnstable. , ' Date: a S * Then personally appeared before me the above-named'Romanie Chase, who acknowledged the foregoing to be her free act and deed. *now )mown as Romanie .#A dham. . Nota Public •- '� : :.. My commission q pires: c� 4 ,: •: 7 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO 1ti Address of property 371,5 Main Barnstable Owner's name Stan ST. Peter p Date of Inspection 7-1 1 -95 �, 100 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. t� The site was inspected for signs of breakout. i/ All system components, excluding the SAS, have been located on the site. k/ The 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 SAS 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 SSDS. r 1 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential _ number of bedrooms D number of current residents / garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Typg 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. Source of information: jam z 7A-, 6 T 2&01 ° S 13v.1d 0 J� Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART B / SYSTEM INFORMATION continued SEPTIC TANK: ,, (locate on site plan) depth below grader material of construction: concrete metal FRP other(explain) dimensions: t — T i a' 1 7 _L sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness „ distance from top of scum to, top of outlet tee or baffle io= distance from bottom of scum to bottom of outlet tee or baffle 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 recommendations for repairs, etc. ) DISTRIBUTION BOX: (locate on site p an) ;y depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc: ) 04zd K. PUMP CHAMBER: LZ (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps -and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued . 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 and number j D b !> leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) � y 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, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs,etc. ) ' 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' a Cz DEPTH TO GROUNDWATER depth to groundwater method 'of determination or approximation: C-t j �f/6 i L'' tl�f•��- f 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) Backup of sewage into facility? yv Discharge or ponding of effluent to the surface of the ground or surface waters? A" Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? (/ within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? 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 analysi' . for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Barnstable TOWN OF BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION — II -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 37J5 Main Barnstable ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Stan St.Peter PART D - CERTIFICATION NAME OF INSPECTOR W.E. Robinson Sr COMPANY NAME W.E. Robinson Septic Service COMPANY ADDRESS P.U. Box 1089 Centerville MA 02632 Street Town or City State ZIP COMPANY TELEPHONE ( 508 ) 775-8776 FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : —,/-- System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . . v Inspector Signature z Date One copy of this certification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc f 3.I• 1 . . 1 Ir CN c - X� 6. l .t , r •r �t ;. F' • a• i I I i h I ` I i - 1 I 71 9. Q e 'l. ! I ! Csi izz _ „5 • j 1 1. r t rl - i..