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HomeMy WebLinkAbout0309 BAY LANE - Health 309 Bay Lane Centerville P A = 186 014 a I No. 4210 1/3 ORA Pendaflex ' �►4 00/0kV Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 309 Bay In ^M s Property Address 1jer Julie Talbott Owner Owner's Name r information is required for every Centerville Ma' 02532'" 2/24/16 page. City/Town. State Zip Code Date of Inspection E.+ lnspiktion results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form: Important:When A. General Information filling out forms on the computer, use only t,a tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 8 Johns path Company Address ' S Yarmouth Ma 02664""' City/Town State Zip Code r 508-364-9587 - S103522 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 MR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the L oal Ap roving Authority _ 2/24/16 Inspector's 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �0 VS Commonwealth of Massachusetts /72 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632 2/24/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon septic tank. All tee's and or baffels are in place. The system also contains a Concrete Dbox as well as 5 Flow diffusers System shows no signs of failure at this 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. Check the box for"yes", .,no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years Gild* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma"` 02632 " 2/24P16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System-Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): brokenpipe(s) are re laced Y N❑ ❑ ❑ ❑ ND (Explain below ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma '0263Z 2/24/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: - .. ❑ The system has a septic tank and soil absorption.system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma -02632 2/24/16 page. CltylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in-the last.:year NOT due.to.clogged or obstructed pipe(s). Number of times pumped: ❑ �I 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. ❑ ® 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 11 of a public water supply well j 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 �. Commonwealth of Massachusetts W Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °� ,•''� 309 Bay In Property Address Julie Talbott Owner Owner's Name information is Centerville Ma 02632 212'4'P1`6"`" required for 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 ❑ ® 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 L15,n. 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632 ""` 2724/16" page. City/Town State Zip Code Date of Inspection D. System Information Description: System contains a 1500 gallon septic tank. All tee's and or baffels are in place. The system also contains a Concrete Dbox as well as 5 Flow diffusers. System shows no signs of failure at this time Number of current residents: Unocupied Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on-a separate sewage system? (Include laundry system inspection "El Yes [I No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 218 Gpd Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: t5ins•3/13 Title 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 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is required for every Centerville' - Ma 02632""`" 2%2'4116" page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown 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 ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5-Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632` ` 2%2411.6. 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: 10/21/94 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: 1.5feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection F®r Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is required for every Centerville M2'" 02632. 2724f16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outletIee--or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? 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.): No evidence of Ieaking,Tees and or baffles in place at time of inspection Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 0263'2' 2/24/1"6 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.): Tees are in place and levels are normal. 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 El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Insp ection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632' 2/Z4'f1'6 " page. CitylTown 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 Level and at normal level - 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.): 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official-Inspection 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 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632"" 2'/24/16-- page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑. - leaching pits number: ® leaching chambers number: 5 Galleys ❑ 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.): No signs of failure 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 t5ins•3/13 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 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632` 2/24116'" page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 14 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection F&M-1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is . required for every Centerville, Ma 02632" "'' 2124/16- page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 MR'Y-28-2013 11.40 From:BRRNST HFRLTH 15087906304' To:508,12B9399 P.1/1 TOWN OF SARNST'ABLE VILLAGE 1 sue- i ASSESSOR'S AjjkP a LUTE. z;INSTALLER'S N � , +�liE ra PHONE No. �X . N is .-� �n!�G` ! SEPTIO TANK CAPACITY LEACIUNG PACILr OF BF-DRooma WELL BUILDER II t 0lcPUBQC WATER) DATE I'BR-WIT ISSUED: 'O q v DATE CO92PL[AIdCE ISSUED_ VARIANCE GRANTED... � Yes I IVo 1 eI Az q i • f ` Ie I I • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M ,•• 309 Bay In Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632' 2/24/1G-1 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check.Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: 10/21/94 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: test hole data on plan dated 10/2/94 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forrr, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments n� 309 Bay In M Property Address Julie Talbott Owner Owner's Name information is required for every Centerville Ma 02632 2/24/T6—' page. City/Town 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . �p DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP �0 FARCE(, , Q TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A �tE CENE� CERTIFICATION �UN252004 Property Address: 309 Bay Lane Centerville N OF BARNSTABLE -VOOwner's Name: F. Williams c/o Frank Haddleton, trust e V.AEALTHDEPT. Owner's Address: Date of Inspection: Name of Inspector:(please print) Wi 1 1 i am E_ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (508) 775-8776 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 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 CN'IR 15.000). The system: ec 6Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: � - Date: �1L/�� `J The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanhvr 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.'Ibc original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Bay Lane Centervile Owner. Williams/Hada eton Date of Inspection; Inspection Summary: Check A,B,C,D or E/ALWAYS complete all o[Section D A. Syste 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: ` B. yytem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repair .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer es,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please explain. Th septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, khibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing is replaced with a complying septic tank as approved by the Board of Health. A metal ptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating hat the tank is less than 20 ears old is available.y 1 ble. ND expla' : Ob ervation of sewage backup or break out or high static water level in the distribution box due to-broken or obstructed ipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval o Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND ex p in: e system required pumping more than 4 times a year due.to broken or obsttv�cted pipe(s).The system will pass' spection if(with approval of the Board of Health): broken pipe(s)are replaced obsbuction is immovcd ND�xplain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Bay Lane Centerville Owner* Date of Inspection:_ ' = 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 fa ing 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 ystem 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. ystem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst m is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic.tank and SAS and the SAS is within a Zone i of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a pr vale water supply well•• Method used to determine distance •• his system passes if the well water analysis,performed at a DEP certified laboratory,for coliform -ba teria and volatile organic compounds indicates that the well is free from pollution from that facility and LO a nitrogen and nitrate nitrogen is equal to or less than 5 pptn,provided that no other red.A copy of the analysis must be attached to this form. 3. 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Bay Lane P y y Centerville Owner: Williams/Haddleton Date of InsP ection: t — D. •stem Failure Criteria applicable to all systems: You m st indicatc"yes"or"no"to each of the following for all inspections: Yes 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 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 I00.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 xater supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEI certified laboratory.,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma (Yes/No)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 gP You ust indicate either"yes"or"no"to each of the following: (The ollowing criteria apply to large systems in addition to the criteria above) Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a smrface drinking water supply he system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped one 11 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 Se tion D above the large system has faticd.The owner or operator of any large system considered a significant hreat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.Th system owner should contact the appropriate regional office of the Department. '(t1 4 r i r Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 309 -Bay Lane _CPntPrvillP Owner: Willis/Harlrlleto Date of Inspection: Ala, f — `' Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes N✓Puo � Nmping 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? Ll�_ 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: Yes no _ .xisting 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 CRR 15.302(3)(b)) - t 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 309 Bay Lane Centerville Owner: Williams Haddleton Date of Inspection: FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design):. �LNumber of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#ofbe Brooms): Number of current residents:^ Does residence have a garbageg'nder(yes or no):. Is laundry on a separate sewage system(yes or no):A41[if yes separate inspection required) Laundry system inspected(yes or no):A-0 Seasonal use:(yes or no): Water meter readings,if a ilable(last 2 years usage(gpd)): 2003 — 121 , 000 Sump pump(yes or no): 2002 — 114, UUU Last date of occupancy: 6—I ii—� COMMERCIA!/ 7' STRIAL Type of establishment: Design flow(based on 10 Ctvilt 15.203): pd Basis of design flow(se is/persons/sgft,etc.): Grease trap present(yes r no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,it available: Last date of occupanc use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pa of`the inspection(yes or no):,& G If yes,volume pumped:_gallons•-How was quantity pumped determined? Reason for pumping: TYPEPF SYSTEM eptic 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/Altemative 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,(pf kno n)and source of information: Were sewage odors detected when arriving at the site(yes or no):Z-2U 6 Page 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Bay Lane - Centerville Owncrwilliams Haddleton Date of inspection: — c -6 IIUILDIJV SEWER(locate on site plan) Depth below adc: Materials of c nstruction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(o condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: i✓(locate on site plan) Depth below grade: Material of construction:_concrete metal - fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed-by a Certificate of Compliance(yes or no):—(attach a copy of certificate) , Dimensions: Sludge depth:_IV—/;Z- ) , 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:,__ Distance from bottom of scum to bottom of outlet tee or baffle: _ How were dimensions determined:_ C C o L, /R c Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(loc' on site plan) Depth below grade:— Material of construction: oncrete._metal fiberglass_polyethylene_other (explain): — Dimensions: Scum thickness: Distance from top of scum top of outlet tee or baffle: Distance from bottom of s m to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping r commendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Bay Lane Centerville Owner: Wi 1 1 i ams/Haddleton Date of Inspection: TIGHT or HOLDIN 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: allons Design Flow: allons/day Alarm present(yes or n : Alarm level. larm in working order(yes or no): Date of last pumping: Comments(condition o alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUHIP CHAMBER: (lo to on site plan) Pumps in working order(ye or no): Alarms in working order(y s or no): Comments(note eonditio of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Bay Lane Centerville. Owner: Williams Haddleton Date of Inspection: 141-0 4-1 SOIL ABSORPTION SYSTEM(SAS): !/ (locate on site plan,eacavatiodnot required) If SAS not located explain why: Type *Ieac ahing pits,number: ching chambers,number: y'� eaching galleries,number: „tom leaching trenches,number,length: &)I — & leaching fields,number,dimensions:/ , overflow cesspool,number: ovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): .000 �? --- 6 ,ores CESSPOOLS: (cc ool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inle invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspolow Materials of construc Indication of groundw (yes or no): Comments(note condsoil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site pl ) Materials of construction: ---. Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Bay Lane Centerville Owner: Williams/Haddleton Date of Inspection: G SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. I � 6� i 70 h 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Bay Lane Centerville Owner. Williams Haddleton Date.of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water X 3 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: Ioio it 11 let TOWN OF BARNSTABLE LOCATION 209 6,* �--pjwL- SEWAGE VILLAGE ASSESSOR'S MAP & LOT/ '#,�`- 0 INSTALLER'S NAME & PHONE NO. t4iCr SEPTIC TANK CAPACITY LEACHING FACILITY:(type) lr-Lowblc�-vusorL- (size) S NO. OF BEDROOMS PRIVA1TE WELL PUBLIC WATER .:)_ BUILDER OWNER DATE PERMIT ISSUE 19114 DATE COMPLIANCE ISSUED: 10I Z r)) Q -r VARIANCE GRANTED: Yes No fit -5 � o ex,-z-, ri61 PAX % r No............il Fss..... - _..........— HE COMMONWEALTH OF MASSACHUSETTS T i4= BOARD OF HEALTH RM TOWN OF BARNSTABLE . pphratioit for Divj-Vo,!3tt1 lVark.6 Tonitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ....r.........%........... ....................................................... ........` ..-------------•----•-----•----.............................................................. n 0. io��e\�i ess C or Lot No....... Owner Address Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I________________minutes per inch Depth of Test Pit____________________ Depth to ground water-_-__________________-_- . rZo Test Pit No. 2................minutes per inch Depth of Test Pit__-______.__________ Depth to ground water........................ a ......................... •---------•-------•-----••--••-------••-------•-•••---•------•--------•_........................................................... 0 Description of Soil......................................................................................................................................................................... x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-..--.. U Nature of Repairs or AterationAnswer when applicable._._ vl'� -..._. _��J_� ___..... �.........I.►!� `E30 C. c.u+ -•-•-•--- ' • ice' ........�__----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. Signed . -- ------------------------------------------------------- .................................:------ I Dace ApplicationApproved By .....................e( ----- ................................................... -------�r....�.. Dace Application Disapproved for the following reasons- ------------------------------------------------------------------------ .... ............. ... - - - - .........-.. ............... .......-------------------------------------------------------------.----------- - ....--.....-..........--... Dat Permit No. ---- Cf-L,--"--1 ...-......._-....-- Issued -------------------------- Dace No.......................... � FEB..........5.!.2.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uinpnial Wor1w Tunitrur#tun ramit Application is hereby made for a Permit to Construct ( ) or Repair, an Individual Sewage Disposal System at: Location- \ dress or or Lot No. ................ .. ...........lial�-� k - Rrv. L,',.............................................................. Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) al Other fixtures _______________________________ _ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter....-------------Depth____-__--___---- W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ; •-----------------------------------------------------------------------------••-•-•--•-•-•--------......................................................... 0 Description of Soil........................................................................................................................................................................ x V ....•••••-•-•---•--....••••-•-•-••••••---•--•••--•------•-•--------•--•-•----•••••--•--•-•••••••••••---•••••----•--••--•-•-••-•••-•••---•--------------••----•-•---•-•---•-•...........----------•------ UNature of Repairs or Alteration Answer when applicable.--. v. ._....<_rat-N1_W „ ,MTh l� b..._..G-A c_�o+...------------------�------------�,`...?.... ....._... �-�.��-------`- ' -------- .►??. 'S�------••--•--••---. Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. Signed - - -`� ........................................................ ......................................... Dare ^ ApplicationApproved By .............. � J U... ".----,^------------------------------------....----------------------------- ------- Application Disapproved for the following reafonf- -------------------------------------------------------------------------------------------------- ------------------------ ----------------------------------------------------...-----.............------------.......--------------------------------.............--------....-..........-...-----------------....---------.. ........................................ _ Date Permit No. ..... i-�.Lr �� ------------- Issued Dare --------------------------------------------------------------------- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C'lez#tftca e of Clamplia ><ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) by .. c-L to"e k � w o se - - --- - --------------------------.........----------------......--------------------------- Installer at . - _l3 `' / .� - - f ,r u ...------------ --------------------------------------------------------------- ------ -------_---- has been installed in accordance with the provisions of TITLE 5 of The State t Environmental Code as described in the application for Disposal Works Construction Permit No. ---_7_y -- .._..._ dated .........._......------_---------------_... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COND AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - ',- ...- Ins ector" -� / `"------.7---------- DATE ... ... - r p G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p��^ TOWN OF BARNSTABLE No........ FEE.....��1............. Owpo,oat Worbi Tunitrutiun "amit Permission is hereby granted--- (-A�C 't-....... y ------....--•--•-----••-•--•-•...--•-------••--••---•-•--•-•--.....•••.............. to Construct ( ) or Repair ( an Individual Sewage Disposal Sstem at No.- Q`�.....--.....7 ....... E-`-`------r-------------------------------------- Street l as shown on the application for Disposal Works Construction Permit o :� ( lG/ _; ..... - j . - / ........ q, .....................•... Board of Health DATE........... �-•-�-----�•--'`--(-�-- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS I ., TOWN OF BARNSTABLE r L'OC TXI)N SEWAGE # VILLAGF: 2�(Vt Q ASSESSOR'S MAP &-kOT INSTALLER'S NAME PHONE NO. —p� SEPTIC TANK CAPACITY A LEACHING FACILITY:(type) LjAcL ftiJ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER a ire DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I f r J ' SLL17-kl,)o h- ¢F1 i i ' ,1 GE I�R 309' 6 -LANE TI ;:11 G , . ......... ,._._.... _...._—.................. ...-..__-_......_.__.._.�.. .Wetland F7dg (Typ/aal). _ CA Scale- •=2083' . Locus Mao. ~ .Assessors Map 186 Parcel 14 Elevations Shown Are.Based-On M.LW. Datum L.� AIL 'DESCRIAT1 OF'SIT DRAI G .:MANAGE ENT SYSTEM: A. 2092,SF+/-ROO AREA -1 V X 101RECHA, E"CRAIWBER /(6) ULiTEC MODEL"1Ob U llrs 8"MANIFOLD:@ '-0"BELOW GRADE,I W SLOPE,W/`INVERT @ V-8" • PVC or NiDPE?IP CONNECTIONS YARD DRAIN`:OV FLOW FOR 25 YEA EVENTS' CHRMSER LID ED DOWNSLOPE TOWARDS,BAY LANE • i/ // / / / :/./ rya \I AL 10/4/2016 i o-iao7 r*ffjR0N , QFnfa�vr \�\ APPRE .VED' AL STIH AFF \ Po Utz y •llr /e CONSERVATION COMMISSION SITE IMPROVEMI .A�ArtyE nuJal� / / �� •. \ \ LA AL / / f t 1 01 \ \\ �'` // / 1 - tflvECT wlvs�ours /fl./l I J I s 11 I o C. r we RECIl / / I ( III < \ ,1 .1 0 PtPrNC3 LR COLDo C \\ I/ l I \0� ,-O Mav ldetd Area; l m Lo{NATERandll? GEDRA/N/a I l\� m t°iVe• , e l ,l I I l 1l�\?0 ` o k •`C \` t .�_ o I a a.s Q / nYl I (� < < �� `\\\` b \\\ I` .. �. \� y _... _ -_ as SO O� \ I III \\ � s� � � q \ \ \ 1 3 0 0 / I �LLIVAN ENGINEERIN JOHN C.O DEA P.E. 7 PARKER ROAD ur.I I �ll�� �� ��\� �` �� �\\' \\ (r u\ ` �•w� I \ \ \ �2 OSTERVILL.E MA02655 \ \ � 508-428 3344 -lam` V \ i .-0.9 ¢ -Oxe -0x6 -Ox1 \ —�.. : ��... :\�.�\` • •�. \ \ QY '\ �\ i - �\\ yl• \\\ o„ \ w � PERMIT SET t �'�+' ,VI� ---- \ _I.o cG 9 oxs ?i�� row \, \ . ���,.. \ \\ r \ v° 90 , ` OeTOBER 26 20' \ \ " \\ \ \\ \ riCr wOy\ spell \ 1 11 ..\\\ \ \\. �� ad ° -110 KEY TO PROPOSED SITE IMPROVEME 5� 1 \ ��� \\\\ \\ ''�� 24--- �' \ \ 1 \ �Rwiow," ES61A 2. ENCLOSED-BREEZEWAY � ; i i I � LR E E R V EJ 3a EXISTING RINSING STATION / . �/ ; I El ctric°; wrr sio.a ew sells).cells 3b; PROPOSED RINSING STATION a /J PROPERTY LINE 4. EXISTING VISTA PRUNING yr/illy.pore 5. . NEW VISTA PRUNING , UUl,ty Pale \ 7 CLIPPING OF VIPIES.._.-..I 6. :_ _ HAND -- �� RAY LA j _E, TER�ILLE r ------ - -.� RECHARGE CHAMBER" B ;`� �� �' _Y 1 Watergate !NOTE:" SITE IMPROVEMENTS SHOWN ON'THIS PLAN HAVE BEEN I PREPARED BY RF BERNSTEIN ARCHITECT AND DRAWN ON THE SEPTEMBER 15TH 20'16 •`'^`e PUBLIC RECORD SITE SURVEY PLAN PREPARED FOR THE PROPERTY - .p - RF BERNSTEIN ARCHITECT ON SEPTEMBER 28'"1984 FOR THE INSTALLATION OF THE CURRENT Seale Y=20 ,r�A Hydrant I w, �.,,,,•„' SEPTIC SYSTEM. ALL EXISTING CONDITONS HAVE BEEN CONFIRMED _ ,- a� .o T t . - 'EXISTING RINSkG. - EXISTINGRIN SING:ST I4q' TO 8E REMOVED i BASEMENT ROAM. ....... . j S — 'SITE'. K FOR NEW BASEMENT,ROOM,. -- - R/N /NG STATION i �f CRAWL SPACE 0AWSPi0.f`E_ MEM IGAL CRAWLSPAOE EXCAVATEFORNEtiV.' ,.' DERO dAETER FOUl7DATlON: artdFOU/UDATIEN+I -• i _. WATE HPROOFMG:' for_." > EXCAVATE FOR A$SBCITS EY s : NEW FOOTINGS' ON GRADE`fXISTIAQ f7GfAlDh191!➢ TO REHIAIN Mt PL9C,E � _ INAERMAiNAGEMEN7''; `SYSTEM �3(IST-VG 9� e�fV1ENT PLAN SLAB ON'WDE _ . . -- — - R 26 i�OCTOB�___..�-- YV.kG��c;�TA�. TQIIIk L »aV•.r~r, OUTWM E�F1Sk6ADl.III•L _ ,. RES.Ip:ENC 30,0 BAY LANI 'CENTERVfLLE�I 4 I I T 1... J I afNlNf34fJ(1 ;.. i i -1 EXISTING APPLIANCES and CABINETS TO BE REMOVED. I r i II' i : I . 1ST FLOOR LEVEL Ii II _-- EXISTING CONDI° i f And.DEM©�ITION ' KFECHEN. --.- i {t I _SUNF3QQI1tL_�___-- REMOVE: ISH•'iT0 EXPO RAFTERS i TO INS T FOAM INSULAT N _ I ENTRY 4AL L I I REMOVE INTERIOR WINDOWS.__ t And DEMO OF tyA(4S JJ I. 1 FIXTURES and FURNITURE L.. TO BE REMOVED I NOTE.O AFTER DEMOL&M AND EXl5TI1VG CONDITIONS 't ARE STRUCTURALENGINEER. �e .. �`• j WRL VISITSYTEAND�IDETL°RM/NE�FINAL STRUGTURALEE .. - i • '.. BREEZEWAY DECK and �DETA&S.AND SZ�OIF�AFK2NS - REMOVE EX/STI(YG f -' WASHER/DRYER O \t:,• "- ; s _ . SCUTS FOR • � .: N.._-_FOOTINGS_ PERMIT SEl - G �T .......-....._......_ OCTOBE�t 26t" �ISTO�t LR RLA�1 --REMav�aa"1=scrs"r>le� - - } FINISHES OIV CEILING " AND WALLS' TA TONk B f 172 E.FA!-Wq MHHI EAST• FALMOUTH. k,Q 33_mltlaldo®eatWd.01 i RF BERNSTEiH ARc $88 WASHINOTON sn GLOUCESTER;MA 01 _xt s 8-2ei-886 Nnara - MASSACHUSEf.78�R0_No. V. .. l ff ,. '- 'a RESIDE C] ` . 309 t3AY LhF CENTER�fiLJ �A J i f AE1tOW ALL.A,i t 3Y60EI3 GER INO FwisH T01 — ML$TALL SPRAY FOAM'INSU.ATION I f FLOOR EXISTING CONDIT s BEQROOM. 1 ---- -- OLITtt?td I i _RfiWPVEEXI5rNG TUB: T1 IC . I. E3ATFtRM' I _ QSFIRE 4i/ALLS :9 5- f i KITCHEN �. ... _-_BEDRQpAIr \ EX{STIN .ta2: FLOOR'RLA'N '/a 1 -Q- -- _—- ---'---- - T►+ . -.•. .GUES,TAPARTMENT,: - --- - -— --- ----' --- - ----- -- - _.._ ..-- fSCTOBER 2 2 \\ .11klNiiROORl1 CA+AL\\ 172 E.FALMOUTH HW i \ EAST FALMOU`fH.MA, (5W)548 113T rcatoldo!Ppa " j y SIT BERNSTEtN.AbtOk 988 WR$HlNQ',MN SCR OLOWE8 TER,MA 011 dbaFGh- 3; ..,` •''' • ';,;MAS9ACRIUS@T(S Nc:A r : p f n I ZX3.INBULA D PANEL ) j 7 (' = r sTf?NETREAD6 ��+s*,Nv rr wa y'V Lit"i t. _._. { PLYM10OI BOOTH SIDES ...�.' 1 ( FND WALL _ �IIIlII 'II�NII l - is7rNgc. I ( FHxVBErro6OI T{SPACE • ..._.... _..._...._.. 2X4 RAM/NO I EXLSFNtKi PI �, li I'I ... _ ` .. ........ CIILA ION LL .. !_ NS T S N E RE MC .. t(� e'd .: BCEDAR BOARDS 'I - �.lLi •G/. I i.1y! � ''� 'Ci.A-MOISwRri voA enRRI 3U9 SAY LANE - X B'P.T.EDGE W. .. .-... •i•; r-. = WOOD BASE .. - ,.. .. "—� y A �'�%t 'I d A XB.P.T.dOIBTS 6 l 4. 6' .l, 4, a RUSHED STONE ._._.._..._._ _........_ �, TILE INSTALLED OVER CENTERVILLE, ti •' ,,.� 0 `;Q. d A ND...._......_._...... a,.g�°3 e • Ap._IED TO CONCRETE '.. 4' SLAB.' WOOD BOARDS ON GRA__E__ KAYAK STORAGE SECTfON nKAYAK-STORAGE PANEL ELEVATION 4 AREAWAY_an I CONCRETE STEP DETAIL (eZBASEMENT WALL SECTION 1 -- _- _.. - I - _ �- 1 Yi REMOVEmW EX,JW RMLS[`;3TAT�N �^ / ...... .,. r', I _ A r 'BASEMENT LEVE CRAIWL:BPACE' _ _ PROPOSED i S v ;IMPROVEMENT P -- 7 ;KA.YAK4.' / ' < CONF#W CLEA"JCES REQUIRED FOR NEW I - NOTIF ARC CT W MEC!IANICAL EQUIPMENT AND. Y HRE OF ANY CONFWCTS WfTH THIS PLAN ; CHANIC� NEW DUCTWORK TO SE LOCATED ALONG PERIMETER 'f WALLS W BASEMENT RAOMSAND SHALL-BE CONFIGURED M4WTAW A MMgMUM`OF T-Or CLEAR FROM SLAB TO . f i TO R -- 7t { 'DUCT TO ALLOW A MINIMUM,OF 6'-8-REQUIRED FINISHED CRAW L_SPACE,- , ;l �i!. CEILING HEIGHT MI HABITABLE'SPACES.. .• i I EXISTAW P.OtMIDATM WALE. ————--————---'} ---- rosuvwvlaT�wuvDows •r.. �\ ,':' ---------------y PERMIT SE1 v BASEMENT FL4 R PLAN /a t -0 . I TXN/OFNEW OCTOBER 28TH 2 ` WllYCONCRETE FIGS- LOCNB T I N O FNE _. � i I _ W17H STEEL BASE^PLATES -- FORHSSCOLUMAIS _ — -� r &"OW CONCRETE .! j 80N07UBE PMR FND. 4'OEEVORTYjEXI$TMMi I I 1.ATALDO CUSTOM Bkl r F00I7NO i I I 172 E.FALMOLITH HW MEMBRANE and STONE.--_ EAST FALMOUrH,MA 0: SNOWEl9 BASE I I Il.i I (5W)54&1133 mataldoQcwWdob I I� NOTE.- I I. rtl— ALL WORK TO CONFORM TWE-8C 2m WITH MASSAcHUSETT'S AMENDEMENTS`. I RF BERNSTEIN ARC F And 780 CMR MASSACHUESTTS a EDITION RESIDENTIAL BULDWG CODE. i II 1 gas WASHING7ON STR - - .-... R,MA 011 I II GLgFIGESTE rl . - I t � 878.281-96Qa: r16la+G,Os� ,.,_MAS§ACFHISE7TS Ae�_Plo_, �1_SHOWER:DttINAGE DETAIL._..-.--------..____. y— 01 2 34, 8 18 ' RESIDENC 309 BAY LANE ._0EN_TER.ftLE,_l 'kVW—TO 11VCL.UDE INSA LM 5"CLOSED-CELL SPRAY ,FOAM&WAATION WALL R0dFXAFIERS INCLUDING EXPOSED ATTIC SPACES AND R&JOVWG CEILING FINISHES #V SLOPED CEX#W AREAS. ALL:EXPVSED EXTERIORtNALLS TO HAVE MIN.3"CLOSED-CELL - --—._. SPRAY FOAM INSL ILATdOV i ALL EXPI(7SED/NTERIOR WALLS VO HAVE ROXUL FIBERGLASS _ ..._.__...... I 1 MEWTE E II i j QFFIGE... 'DOORS '' I NEW FRENCH DOORS:AY ST r i — °ars i I i I - y FLOOR LEVEL r _ — : PROPOSED XISTINCat CASED '_ IMPROVEMENT PI Dlr�k Rs !!rA_andQEN - . --- Donn ,: �, •.,. '\, '::; -• .. _ ;. _. .. ._. .�.1....L14!1NG_ROOM,_-I-�--_,____...__ _ _. 8. � �" 1 O'... 1 EBBING R - DO�DF't T - I I ,: \ O _ ?; _HALL I I O/IiTT&TQ_R�GE •/% :�� �./. I 1 , i �. .. �i � 1 METERr : k � i f" J SYSTEM GRADE..' t \. . f NS97�:P�t16@1?ECFfObN i�a@• } - 4 _ , COMwmTm Rvmr \y ..: - IIitOAAfJXIOED TEOMASAS-RE—OL1REQ._.; C ' x; s 11p �`CIJf#lit�JT LY7ClE A7�b P'tRE DE'PART)k0VT REGULATI&M, - \ \ E2T Wf7H C?NMtER FOR ALL E NERw LODV VOI TALE NgiiMAQ RECW/REMENTS INCLUDING SOUND SYSTEM;ALARMS,VO CE. \ , ELECTRCAI:'UPGRADES ALL EXLSTWO DEVICES TO BE REPLACED - \\\ IMTKARC FAULT OUTLE"TS.VVWWEX-167 �'2-WfRECIRW—ITSr©SE, PER 1T SET • , ; .. rN�rAei NEW WIHDf)DtS m1d � , PROTECTED BY acl CIRCUIT BREWRS:ALL NEW WmM AND CIRCUITS 71D RtEET COD'S AND REOUIREMtFN1'S, DOOR TO ENCLOSE EXRSTIN6 i & HARD-WIRED CO dATIM E aW CO MTECTOR \X \ BR WAY,sUPr�RrEDoAr i a'-o-. OCTOBER 2e 21 \\\ / EXJSTffMFOUNDATION WALL.-- _ tiFTEAC()NMEGIED iNC1UQiP1C3(3l1ESTAPARTMEN end_A�1Md.i�Ok!>�E. ! `� CATALDO CUSTOM E3UI OOR Pl.�l 172 E.FALMOUTH HW ( ti EAST FALMOUTH,MA 02 00 •.\ ; ,. ... , - i(598)548.1133 mala"CaUddoN : I , :RF BERNSTEMI ARCHI 988 WASHINGTON'3 STRE GLOUCESTER,MA o19; ±. 978.281-BW9 A6acch6.:aob " .—MASSACI4USERSReg_Mo_AR I 1 N1=Ud R{N�ulNi3 STATION ELAN:... Ye,-1,'-ON _1_ — - - li LJ V'Ei t'`'f�:t RESIDENC N 309 BAY LANI CENTERVILLE, _...__._.-...__...__..._... i BED - i � � I i I I � I I I . I I C COED CELL YFOAMfMVLATION . COVER S 'IXB REgtleoaltD PLANK A7TC 8 CiE STORE Ld>ALITIQN '2Np F i 1 i OOR LEVEI I L �I a._ I PROPOSED • I Ii I MP ROVEME►VT F _;.. I ?@N7CY`VN1tl.RQ TA/R 14— Tv ORS -`. --- - S ' t`7' SPIRAL-S i TO ATT(C ST i , I y: � I OFMAS7�ER8ATH' I 1 I I I r ATTIC STOR/YG i I i I Oy y , Fr , PERMIT SET �xl�Tnva Gu�S. OCTOBER 26TH 2( APARTIv�ENT__ n G OOR PLAN- s , : CATALDO CUSTOM BU \ I 172 E.FALMOUTH.HW EAST FALMOUTH,,MA 02 (508)548.1133 mataklo,C c9Wdob \ (i ff BEMSTEM ARCH 9M wASMNGTON:sTRI GLCQUCE$TE T MA 'S . i 8T8•.281.580g rfbWch aiaod. I � � neassncHusErrs_L1a�ivn.a I _ — 2' 3 4'. 8 fs :� .T-� Tiislons: -� M E DESC IPMON �. OAT R To Of FaSdJndt�tiac� ��.'� 4 PVC 1 4 ft To Beaid �. �$ Fist 2Finished Grand Min. 2? e e e e e e ..e e 27.6 A -o / 4 PVC 1 E ft. ' ,� ,� Riper '� Case�r To - , C, der a Within 1 Of Fin. Grade �p tc Tank Leaching Galleys a�ox � h ia� 1,500 Gal. 25.1 24.9 24a.? 21.4 26.5 1N26.3 M.H.W. Et.=2.4' Foundation - Taan — — Wetland Flag (Typical) ✓"� Design now. . �� References: 5 BDR 0 110 GAL. AY — 550 GPD Sacs�ie.1 —20 3 . Unless otherwise noted all cons!ructlora ��., 9 Land Court Certificate 127425 methods and materials shall conform to 7 Land Court Flan 21863A Tltfe V of the state environmental 'code Assessors Map 186 Parcel 1� Septic Tank Re ulrements. crud do applicable local re�crfaatiaarr 550 GAL. 1.5 = 825 GAL. y' pP � + ,�, 2 Precast.concrete septic tank, d box, Elevations Shown Are Based On M.L.W. Datum and leaching facility to lthstaand P--1a� loading unless under pavement, dK es, or travelled ways where H--20 loacd ng Leaching Facility Pequirem n ts. sh all apply: Assumed perc <2 min./inch I All pipes In the system shall he schedule Infiltration Rates: .Sidewall 2.5 Gal. s.f. 40 or equal � Bottom 1.0 Gal. s.f. 4. No field modlffcatfons to the se'rage disposal sotem shall be made without prior written approval of the eng�lnfr er end the focal board of health. LeaacfAlyds� aca:lfl , P�-o o'ed. 5 This systern Is not designed for,as � � a---- 5 Galheys Stone / n m Side: 2.5 Gal.ls.f x (24+24-f-5-; 8) x 3.3 — 528 GPD garbage disposal unit > / /i ® Project llfie: Bottom 1.0 Gal./s.f. x �24 x 82 -- 192 GPD 6, Engineer to verify perc at thane of Total = 720 GPD 7 Utfllftles sha tyn are aapproxlmate only. ,� / / Exact locations to be �venfied try c,an traaa:for / prior try the start of work Ml . 2 ' SLOPE' OVER / � / / \ F309- nNIS,H' asRAOF LEA�'HWO FACILITY �/ ti 1?a' MIN 48 LA> OF I PEASTME AL AL Lane AL WASHED p STO)VE �\30 Utility Pole *to I Z ,� - I --1- 1-1 - -, ,- / / / ,- I--,AL Ba ms table 24 CEN TER CROSS SCTfa ! (Cen ter Ole) / \\ .�. ..�.�. LEACHING GALLEY "'TAIL a*o RIOT' TO SCALE / / /�� � % �/� / � ��/ � l � - — - -" Wire F`qn ce / / 1 / _ o / / ; / cra#I \ \\\ Mn tained Area; \ 1 Ox9 l I { i C �� \ \ aiEe2a. Ces y �ol TO \ (� ® La ai Lawn / ( i I l I \ \ S \ hJ� \ PREPARED FOR: Be um`ped \ck tlla�d 30 a� , Z3 . __I I I O clStI g ��Lin C \ j ' ` ToBe 7�andon�d Richard Chit tb \ \ e \\ � a 33 / 31 —Ox8 —Ox6 —Ox# 911 loan strelaet a� N. a� pp \\ \ �O V)( I \ I it �.^fa,"!� �,w".' ..�i.• —Ox �rx an . \ \ A. M. ion Associates Inc. —Ox9 —Ox5 —Ox2 ,Ta. Or„ �- \ •,,�.•.- \�\ ti�\ \\\\ �' �\�, \ \\ � \ � \ Q �^ \\ -q8 >t8 14.. � \ \: \1 \ \ \ ' '•per cep a r 'J j/ �A3 420 1$56 —1xO \ JIL DrawIng Title - --,, � ' 1� \ \ \ \\ \ .\ —Cx8 \ �\ \ \ \ \ 3 I Dr'v� AlL \ l \ \\ \\� \ \ \ o ed ell \ \� Foof\Drain C► / \ l \ —1 xO —Ox \ \ J�) \ \\ $optic Td4 \ 1 �„---- 2�° . —1x0 —Ox7 l . . —Ox9 \ l� \ \ \ \ T, �; \ ata \ septic i 22 \ ' �-i' I Ps6aad 11�e RE E R V \ \ \ ) I Rept9ir D—Brix — —_ \ t \ II Undergrognd Plan / 1�1 1 Electric Proposed 5 4`XI° Galled W,/V Stolle ILI � ,.-- J CW PROPERTY LINE J \ \' �� � P., Utility Pole Utility Pole Watergate 0 Scale 1*= 20' i (Date. 10/20/94 Dwg No: Hydrae t Field: J.V.B.' .ToA. Design:C.P.J. Check: C.P.J. l Drayin: `J.V.B. ' ob No: 0726.1 Sheet 1 of 1