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HomeMy WebLinkAbout0143 BEECH LEAF ISLAND ROAD - Health 143 Beech Leaf Island Centerville A= 187-063-003 S M E A D No.2.153LOR UPC 12534 amoad.aom • Made In USA i19U5®NMfiiODUCTINE OFMS9PWUW O—T�-, WWW-IPJQOCRAKOW No. Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLAtion for Ve-po8AY *pstem Construction 3permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. i y3 %Fo(L6�W ►$coWb RIP Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 187 LO6j3c o3 146 B6ACOiJ uV —TtJD(76-Z F:�L Installer's Name,Address,and Tel.No. S02'—((-77--82 Z-j Designer's Name,Address,and Tel.No. CABF�tp� 67N7t51PZk1s65 153 5' 912A,S Type of Building: Dwelling No.of Bedrooms Lot Size + g ( )oZ 7�f `7 DO q.ft. Garbage--� s Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. _ Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ned Date a Application Approved by Date Application Disapproved by Date for the following reasons Permit No. L/ 3 Date Issued - ---------------------------- -------------- Z• s r n� Fee THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS 01ppYication for Misposai 6pstem Construction 3PPrmit Application for a Permit to Construct( ) Repair(0 Upgrade( ) Abandon( ) ❑Complete System [Y Individual Components „ Location Address or Lot No.1 L3 04X<,q LFAp 15u4uU RD Owner's Name,Address,and Tel.No. ,4,F],TMV j,t SO 4N � V j p C-W t J j4 R O LA— Assessor's Map/Parcel SD00 14(c> E _T vv tT6-P_ FC_ Installer's Name,Address,and Tel.No. SOg-K77—$g?'j Designer's Name,Address,and Tel.No. 0-4PL-ujID.66 6707-6tPdtis65 Type of Building: Dwelling No.of Bedrooms Lot Size A21. '700 sq.ft. Garbage Grinder( ) T Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 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) C—? -'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 Board of Health. Signe Date Application Approved byL Date `y Application Disapproved by Date for the following reasons Permit No. /;�)c-) /L/ ^ C- Date Issued ---------- ------------------------------ ------------------------------- - - ------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )'by at 1�— � j�� � R�� 11 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �I�Q�p 1�F ��1 (,L� . Designer &z4A #bedrooms Approved design flow gpd The issuance of this permit shall not be c nystrued as a guarantee that the system will fu c ornasdesi{g4ned. Date ' / Inspector -------------------------------------------------- - - - - ---------------------------------------------------------------- No. -3 f Fee 116 C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal *pstem Construction 3pPrmlt Permission is hereby granted to Construct( ) Repair(X Upgrade( ) Abandon( ) System located at 8 EiEC_Q� 1 c p 1 n Ab (16:30 -moo kh e C z and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with t Title 5 and the following local provisions or special conditions. F Provided:Construction must be complete within three years of the date of this permit. Date L- Approved by I b" a LA TOWN OF BARNSTABLE LOCATION 141 4cEeN Ie.4'r5cAN D P�b SEWAGE# i_ VILLAGE &JtiLo I II e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO: CAPEwiD� Et`°tf=R`P.nS�S i.t C So%-yti1 - 3811 SEPTIC TANK CAPACITY i 5 e 0 LEACHING FACILITY- (type) P►T' (size) NO.OF BEDROOMS 1 OWNER PERMIT DATE: COMPLIANCE DATE: 8-;1-"7 02®i 4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within.200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ca A(?F-WC0 6 A/�!,$'C.(-. I i IFROm 1.w f1 l7 \ A-I = Its° P A-3 26' O Z A-4 =28' R�I 3z ` E] 3 36' Q-3= 31' 44 f AFFIDAVIT OF VIRGINIA D. ROLL Now comes Virginia D. Roll, and upon oath does depose and state the following to be of her own actual knowledge: l. I am the owner of 143 Beech Leaf Island Road, Centerville, Massachusetts 02632 (the "property"), and acquired title to said property on May 4, 1995. See Exhibit 1. 2. The statements made herein are of my personal knowledge, except those statements specifically made upon information and belief and to those statements I believe them to be true. 3. From May 1995 to present, the property has been utilized as a four(4) bedroom residence. 4. I attach hereto a true and accurate depiction of the floor plan of the property, which includes identification of the four(4) bedrooms that have existed at the property since May 1995. See Exhibit 2. Signed under the pains and penalties of perjury this 19`" day of August 2014. v ' Virgin' . Roll COMMONWEALTH OFMASSACHUSETTS Barnstable County, ss. On this 14 day of August, 2014, before me, the undersigned notary public, personally appeared Virginia D. Roll, proved to me through satisfactory evidence of identification, which was personally known, to be the person whose names is signed on the preceding document, and acknowledged to me that she signed it voluntarily for its stated purpose. ael F. Schulz, N&ary Public ....F. My commission expires: 01/15/2021 lei i •�y��B�NjiINE ABb..tt6�v, a���Huaaa��a a EXHIBIT 1 63SS21 137078 1u� -it QUITCLAIM DEED BRIA#Ayr gDA6*2 NliR iTEE of BEECH LEAF NOMINEE TRUST u/d/t dated May 26, 1.Qp�2�.�r� istered as Document 1554,002 with Certificate of Title No.:: 1 6'�. WE, Centerville, Massachusetts for consideration paid of THREE RED TWENTY THOUSAND an d 00/100 ($320,000.00) Dollars grants to JOHN B. ROLL, JR. and VIRGINIA D. ROLL, husband and wife as tenants by the entirety of 146 Beacon Lane, Juniper, FL 33469 with QUITCLAIM COVENANTS the land with the building situated thereon in Barnstable (Centerville) , Barnstable County, Massachusetts, described as follows: LOT 5 as shown on Land Court Subdivision Plan 41630-A. Subject to and with the benefit of the matters set forth in the Decree Certificate entered in Land Court Case No. 42630. said LOT 5 is conveyed with the benefit of a common driveway easement over Lot 4 as shown on said plan to be shared with the owners and their successors in title to Lots 3 and 4, all as set forth in the Easement dated November 3, 1993 recorded as Document No. 598,475. For title, see Certificate of Title No. 126705. For property _,_...., address: 143 Beech Leaf Island Road, Centerville, MA. WITNESS my hand and seal the 4th day of May, 1995. BEECH LEAF NOMINEE TRUST ,tom ' BY: In T. Dac Trustee 4:. COMMONWEALTH OF MASSACHUSETTS �� BNWVTABLE, ss. May 4, 1995 Then personally appeared the above-named Brian T. Dacey, Trustee and acknowledged the foregoing instrument to be his free act and deed, before me. N ry &dbITc My Commission Expi�epl Q? 10 NOTARY a EXPIRES Rrz3128197too RT CT M W N s C V Q x 011 Q F- W C3 t TRUSTEE AFFIDAVIT I, Brian T. Dacey, being the sole Trustee of Beech Leaf Nominee Trust, under a Declaration of Trust dated May 261 1992 and recorded with Barnstable county Registry of Deeds, Land Court Division as Document No. 554,002 and noted on Certificate of Title No. 126705, being under oath do hereby certify as follows: 1. That I am the sole Trustee of the above-mentioned Trust; 2. That said Trust has not been altered, revoked or amended and is in full force and effect; 3. That the beneficiaries of the Trust are of legal age, they are not disabled and have all assented to the transfer. 4. That I am duly authorized on behalf of all of the bene- ficiaries of said Trust to convey the property known as Lot 5 as shown on Land Court Plan 41630-A to John B. Roll, Jr. and Virginia D. Roll for consideration of $320,000.00. WITNESS my hand and seal this 4th day of May, 1995. BEECH LEAF MINEE TRUST BY: an T. y, Trustee COMMONWEALTH OF MASSACHU$ S Barnstable, ss. May 41 1995 Then personally appeared the above-named Brian T. Dacey, Trustee as aforesaid, and made oath that the foregoing statements are true and acknowledged the foregoing to be his free act and deed, Before me, tary Pdblic My commission expires: RY Xp1RE8 g128197 BARNSTABLE REGISTRY OF DEEDS EXHIBIT 2 r 0 J •r "7rva lo J_ ul --— I I.� CO ` tom x J 9 Y. 00 (� oO r d a L4 < J7 14 Ci 1 '— -- - —77 •.�, 7 0 dm 00. ! Ir of 0 i Lp ;0. o T d _ r o N - �o CE x •i 1jI r7_ (� x e n Zj a zj P• \' I - Hrx-t w,�ax r.n 1 _tC:.2Q `\ m v ml o — c W U z2�-ysoL' n�65 nM.og I SC9z O h 14 _ C< �- j -Z770bbZ IJLO 1 k 'n d ' I v o is I -ti dl XI F L= �1 R ( 7 a r Q I ( 1L ( 3 A I n Li e jelly &— •fit _, 15 01 qq � ij r J;11 S �I ® N111 1; ! i S - } i i f +ug 261411:23p P.1 + i Commonwealth of Massachusetts Title 5 Official Inspection Form l'= Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is MA 02632 8-26-14 required for every Centerville page. Cityrrown 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 A. General Information ',. `��q+alfunr���p filling out forms I a \�O�ja OF on the computer, use only the tab (/ �� qC,' 1. Inspector: -i . ;:;- keyto move your t,5' t ��_ JAMES ..rn_ cursor-do not ,lames D.SearS - =� _ -+use the return Name of Inspector key. r"= CapewideEnterprises,LLC _ �* *� Company Name S•�N SP�G��``��\` 153 Commercial Street Company Address Mashpee -- MA 02649 -- CitylTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-26-14 spector's Signature Dale 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 gird 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. ALA t5irs-3113 Title 5 offirjal InspWffF Subsurface Sewage Disposal System•Page 1 of 17 Aug 26 1411:24p p.2 t� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is Centerville MA 02632 B-26-14 required for every tY page. Ci frown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal Tank D Box and Pit. 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 old"`or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration orexfiltration 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'3113 Tille 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 i Aug 26 1411:24p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is MA 02632 8-26-14 required for every Centerville page. City(rown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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): ❑ broken pipe(s)are replaced ❑ 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 tames 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 ❑ NO(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 bins 3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Aug 26 1411:24p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is Centerville MA 02632 8-26-14 required for every page. CityrFown 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 0 ® 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 pal is less than 6° below invert or available volume is less than '/Z day flow P17— t5irt8.3113 Title 5 Official Inspacllan Form:Subsurface Sewage Disposal System•Page 4 of 17 Aug 261411:25p p,5 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owners Name information is Centerville MA 02632 8-26-14 required for every Page. Cityr'own State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 It of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Wins•3113 Tide 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 5 or 17 Aug 261411:25p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is Centerville MA 02632 8-26-14 required for every page. Citylrown 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)1310 CMR 15.302(5)J D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 15ins-3,113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Aug 26 1411:25p p.7 Commonwealth of Massachusetts Title 5 official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is required for every Centerville MA 02632 B-26-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection [] Yes ® No information in this report.) Laundry system inspected? ❑ Yes Z. No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-67,000Gais g ( y g (gp »' 2013-76,000Gal's Detail: Sump pump? ❑, Yes ® No Last date of occupancy: NA Date Commerciallindustrial Flow Conditions: Type of Establishment: Design Flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No M Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ias-3113 Title 5 OHicia:inspection Form.Subsarlace Sewage Disposal System-Page 7 or 17 Aug 26 1411:26p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form '_l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owners Name information required for every Centerville MA 02632 8-26-14 page. Cityrrown 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: 6-19-14 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: galtons 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-3113 Title 5 Orfidel Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Aug 26 1411:26p p.9 ' Commonwealth of Massachusetts Title 5 Official Inspection Form i. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is required for every Centerville MA 02632 8-26-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: 1994 Permit # 94 - 511. New D Box 6-14. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 25"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: iyears Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast. H-10 lotSludge depth: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Aug 26 1411:26p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form '1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 143 Beech Leaf Island Road Property Address Virginia Roll Owner owner's Name information is Centerville MA 02632 B-26-14 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 12" 18" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? asbuilt tape-sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank and inlet cover at 25" below grade,outiet cover at 1'. Note: Inlet cover under brick walk way. Inlet tee,outlet baffle. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins-N,3 Tide 5 Dfriciel inspection Farm:SubsuReco Sewage Disposal System-Page W of 17 Aug 26 1411:27p p.11 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 143 Beech Leaf Island Road _ Property Address Virginia Roll Owner Owner's Name intor. -df is Centerville MA _02632 8-26-14 required for every page. Citylrown 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: Date Comments (condition of alarm and float switches, etc_): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-3113 Title 5 Official Inspection Form:Subsrsface Sewage Disposal System-Page 11 of 17 Aug 26 1411:27p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is required for every Centerville MA 02632 8-26-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 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.): D Box is 16"x16"•15" Below grade w/cover at 6". Box is new B-14 wlone line out 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 7IVe 5 Official tnspedon Form:Subsurface Sewage Disposal System•Page 12 of 17 Aug 261411:27p p.13 Commonwealth of Massachusetts v Title 5 official Inspection. Form 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is required for every Centerville MA 02632 8-26-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 600 Gal. Precast Pit w/4' stone. Pit at 32" below grade w/cover at 15". Inlet line is piped into risor 8" stain line. Wall's clean. No sign of over loading or high stain line. 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•3113 Title 5 Official inspection Form Subsurface Sewage Disposal System•Page 13 of t: k Aug 26 1411:28p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is required for every Centerville MA 02632 8-26-14 page. Cityrrown 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.): 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.): 15ins 3(13 Title 5 Official"ection Form:Subsurface Sewage Disposal System-Page 14 of 17 Aug 261411:28p p.15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name Information is Centerville MA 02632 8-26-14 required for every _.. page. Citylrown 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 rp cK 14 _ t51ns•3H 3: Tithe 5 Official Inspection Form:Subsurface Sewage Disposal posal System-Page 15 of'17 Aug 26 1411:28p p.16 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name informarequired for is Centerville MA 02632 8-26-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells jt/0 11'+ Estimated depth to high ground water: 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: Hand Auger T_H.4' Below Bottom of pit . No G.W.found. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5irs•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systen-Page 16 of 17 Aug 26 14 11:29p p.17 -4c�x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 143 Beech Leaf Island Road Property Address Virginia Roll Owner Owner's Name information is MA 02632 8-26-14 required for every Centerville 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 fie t5irs-3.113 Title 5 Official Inspection Fotm:Subsurface Sewage Disposal System•Page 17 of i 7 1A , .��G�d-AXQCN OF BARNSTABLE LCCATION L ©� @ec,�, ^'� �5� � R,� SEWAGE # it-tV 7 l VI; .LAGE_ �H--ZCJ�`�Q ASSESSOR'S MAP & LOTO INSTALLER'S NAME & PHONE NO. I gc,5tb\\ -7-71- (MO SEPTIC TANK CAPACITY I ,�_&) -jAbows LEACHING FACILITY:(type) LeOLGL= �'4 (size) COOQ 6.11` � NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER ����11,,C� BUILDER OR OWNER ba JS ��+`a��s Cv 7-7) y�'7 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Zz— VARIANCE GRANTED: Yes No I I W-1-21ge 5 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH StlBJECTTO APPROVAL OF BAR NSTABLE CONSERVATION ®.�i�R---------------OF....... ..�t`�!4�- ..... ........................ COMMISSION for Disposal Works Towitrnrtion Permit Application is hereby made for a Permit to Construct '( or Repair ( ) an Individual Sewage Disposal IV•••.stem at: Cgfi, Location-Address or Lot o. ......................... • �� VLw lf �N ... ---------- Owner �. ................•. -- .......... .... Installer Address Type of Building r Size LotV.52vP_E ....Sq. feet Dwelling—No. of Bedrooms.......3.................................Expansion Attic Garbage Grinder � PL4Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures -- ..........................................•--------------------------------------------*.....................----------...........------.•--- W Design Flow......b�. -T.5 .Y..._......gallons per person er day Total daily pw.._....;Ai .��'--.......................gallon e'�' WSeptic Tank—Liquid"capacity���allons Length..N ._:'G. Width..5.S.. Diametep- Depth ..' _.. x Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area....................sq. ft. � ,Seepage Pit No................ Diameter.....1... ..._ Depth below inlet. �.,S_ Total leaching area. ---- � ----- P � - •---• gM. B....sq. ft. Z Other Distribution box (116e5 Dosi tank � � ��l _ `" Percolation Test Results Performed by%M.TES...4 6.c:_- � ._...._... Date.�`---� .:.. -- ....... W 4 Test Pit No. ___minutes per inch Depth of Test Pit---- ......... Depth to ground water..,_t__:5_.....__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-••---•--••----------------•------------•--------•-----........•....._......... ..---- -------- O Description of Soi1..Q_". .�-4��!!5. ,. V�3;a�?.l(.....Z_-. .5} 17 _ �.G L.. °`.N_6..�. Q ! +y� W V ... ---------------•-----------. .----------------------------------------------- ....------•-•-•------------------•----------------------------------------•---•------.....---------..._._..-------------- W UNature 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 TITU 5 of the State Sanitar ode—T undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued b t boa f health. Signed----- ....--•---. ..•. ... ................................... Date Application Approved By---------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ...................................•------------------------------------••----------......-•-----------•---•••-••.._._......----•--------------•--•-•------•--------------------------•--••-------..... Date —�' Permit No------- .. ..-_.. ---�`--------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ( '7 BOARD OF HEALTH �c, tic....------.....OF...��-�s'��t � � Appliration for Disposal Works Tonotrurtion thrutit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal System at: ............................ ,.- ....( Location-Address or Lot o. W ......................tom.. ............... .............................................. .•---..............••-------••-••--........------.............._......-•----. Owner _ Addresusr C r Installer Address U Type of Building ,., �� Size Lot_Z-_�J_2 -:�._..Sq. feet Dwelling—No. of Bedrooms......_.��.................................Expansion Attic (�1�j Garbage Grinder O �j PL44 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ........................... . _ ,t,,� -- ----••..........*.••--•••-------------------------------------------- Design Flow.._...SJ.:�__ l .......................................... per person per day., Total daily flow............ !T.....................gallons. WSeptic Tank—Liquid*capac>tyA_`-7 allons Length-_- Width... ..__ .. Diameter-.---':.... x Disposal Trench—No..................... Width.................... Total Length...._^...�.... Total leaching area.___ � y`...sq. ft. Seepage Pit No--------- Diameter-----__'�......... Depth+ below inlet___ ___ _______ Total leaching area..,�:-_.._�._.sq. ft. Z Other Distribution box Dosirig4ank '-' Percolation Test Results Performed by.. :. :--._ _ L...�_ C-_._______ Date__ \___` �.._63 N _: a Test Pit No. 1---L_�r...minutes per inch Depth of Test Pit----- 3........ Depth to ground water___ 1.'_.: _....._.. Gr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ---•--------•--•--• ...........................................5..------------. -. ..... •• . Description of Soil_....-.::. - '�v G �G 6 7 - �� . x V .......................-•-•-•-•-••-•-••--•-•-•---••-•••••-•-•-•---------------•----•-•-•--•-•-----•-----•---••••-•-••-•--•••--•----------------. W -•-•-•-•--------------------•--••--•••--•---•-•---•-•-----------------------------------•-••-••-••-•----•-•---•--•----------------------•----•--•---•-----------------------•---••••••••........._------ UNature 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 TITHE 5 of the State Sanitary Code— The undersigned further agr s not to place the system in operation until a Certificate of Compliance has en issued b he bo of healt �✓�� �B Signed..... _ _ --•-..._.. -• -•----------- ---•---- . ........................ ----------------------------•- - — Date Application Approved B ........... ��. ��C*..... �?t------- Application Disapproved for the following reasons-----------------•--•-- ---------------------------------•-----------------------....................... r Date Permit No....... ......- -. Issued. 47/ 0, ?'01 f Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ...........OF......... ®r e:.o< .c�„c �r.-I�................................. (Entifiratr of Tootpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �) or Repaired. ( ) .----------------------------------- ---------------------------------------------------------------------------------------------- 1 (� Installer has been installed in accordance li the provisions of fiITIE 5 of The State Sanitary C as d scribed in the application for Disposal Works Construction Permit No..___._. �7 dated_...._ _ ?________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BId CO CONSTED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ^ i� Inspecto THE COMMONWEALTH OF MASSACHUSETTS 1 �� a BOARD y�OF HEALTH ..........OF.......... ,, ° .... No = .d FEi..:;7 r.. Disposal Works T-Ponstrurtion amit ��� �� Permission is hereby granted Q>2. :.__...0'4- -,-----------------------------•----•-------- I-.._.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System v.E�@=•� 6�r•....__ Street O�/ /+,X-Z as shown on the application for Disposal Works Construction Pe ' N I.� ..... Dat _ �� 1..1............... .._ ................................. ---------------- Board of Health DATE. 2 ` 711•---•-------•--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS DEC-21-1994 13:39 FROM TO 7753344 P.01 B k , ` ER► & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 420.9131 FAX (508) 428-3750 WILLIAM C.NYE,P.L.S.- President PETER SUL.UVAN, P.E.-Vice President-Engineering RICHARD A.BAXTER,P.L.S. -Vice President i December 21 , 1994 Town of Barnstable Board of Health 367 Main Street Hyannis , Ma 02601 Re: Lot 30 Beech Leaf I�land Road Assessors Map 187 Pircel 63-3 Dear Board : In accordance with your requirement as set forth on the r. septic permit , Baxter & Nye has provided engineering inspection for the installation of the septic for Lot 30 .. The system has been installed as per the design plan . I trust that this masts your present needs . Very truly yours , er & Inc 0 eter Sullivan . . E . V. P. Engineering cc : Sayside Building ,:J Post-It-brand fax transmittal memo 70 ges► R: FranV #of p® CO.• A Dept. Phone# Fat(# Fax 0 _.._ - M&WERS OF 01 5 Nw. vo 'v THE COMMONWEALTH OF MASSAC SETTS BOARD OF HEALT"H SUBJECT TO BARNSTABLE CONSERVAT11311,1 ...................................... .... ........... COM. Appliration for Di"oiial Worka Tomitrurtion Frrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal IS stem at sti—eOr-t i..� T_.. e! .....(Z2.......... .........uE........................... ........................................... Location Address i t No. ............. ...............ST �j Tee\)%L.L.........................................._.Q............ Owner 4 5 1 0'1 . ..... ....... ........... ........ .........g .................. --------- ...... Ad ...k.. ..........A(................. InstallerAddress Type of Building Size Lot-44F16ZA......Sq.. filet U Dwelling—No. of Bedrooms__3.................................. xpan - n Attic (� Garbage Grinder a Other—Type of Building ............................ No. ersons.......... ................ Showers Cafeteria Other fixtures -----------_----- .....................................................I..................................................................... < "'�-flqw------45 5........................gallons. W Design Flow... ...........gallons per erson per Total daiI3 Ions. 1:4 Septic Tank—Liquid capacity.EM-gallons ength.kO�—V. tf W — .......... Width.5:-B....))-iaijj�ter............. Depth. Disposal Trench—No......... ..... Width................... Total Length......_.. ... Total leaching area....................sq. ft. Seepage Pit No-------A------------ Diameter....1 ............. Depth below inlet.—S... .... Total leaching area..:3Q�..sq. ft. Z Other Distribution box (Yels /Dosin tank A P Percolation Test Results Performed by-IA&X15,?_4�...LIS j;i:..\"4 C— .... D ate ........ Test Pit No. I----4a...minutesperinch Depth of Test Pit to ground water..'Wt_J............ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit..._............_... Depth to ground water........................ P4 ...*-------------------------------------------"-- ------------------------------------------------------------*-----­----- ------- ---------- 0 Description of Soil.... ...AA �4 ...................................................... -------------------------------------- ------------------*------------------------------------------------------------- .......................... .................................................................... ------------------------------------------------------------!:------------ U Nature of Repairs or Alterations—Answer when app 1cab gr : _E�:I:Wwn .....=........... OJ9i MA� .. ....... ......... . --)Agreement: ------------- r—_—F—_/rt I _ YvE�w 7 m.L.L_� -r, pr�> /V ia�> , 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 board of health. Signed----- ..... . ... Date Application Approved By. ... �. ... ..e ............. Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................w................................................................................ Date PermitNo................................ ............... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " =X............. ............OF....... ...... . � TwWrtifiratr of Tontpliattrr THIS 0 CERTIFY, That the Individual Sewage Disposal System constructed Repaired by................ ------- ................ Installer ................................. at........... ...0 T-------------­-----""......... has been instilled in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------�& .... dated-.. ---�/.!ka.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.....................0.............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -2sil tt:ww...........OF.......... ......................... No........................ Raposal Workii %T11mitrudion "prrmit Permissionis her y granted...k �.TL!'>m......... ........................................................................................... to Construct or Repair (_ ew Disposal S St L+..An lividual S age Dispos at I:n No.. An:r.?- ....... .. .... ..... . ...................................................... Street as shown on the application for Disposal Works Construction Permit ....... ----------------- -- ---------- --------- Board of Health DATE................................................................................ !1q .51 f" FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS No... �..- --'.. � ` Fes$..'..�a............... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR®�OF HEALTH - ------------------OF....... ' Apptiration for Disposal Works Toustrurtiun Frrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S stem at: �SL_P3,"0 l� ..' tir�?vICL Location-tAddress _ r! t_�J' h• ll�C l�\A, (__tiNkks-\�IE.VI t—L Cj ---...-•------------------..... .....- .............................. ?--•--•••-•------ -•--------•------------•-•---•-••---.....---------•--•-----. -•------------•-•-...._....- Owner Address �y ............................................................................. •........._._._.. ----- ---- -- ....... .................................. Installer Address �Z.I J Type of Building , � Size Lot___.=__._�__________________Sq. f t Dwelling—No. of Bedrooms__ _____________________________________Expansion Attic ( `K:)ca Garbage Grinder Other—T e of BuildingNo. of ersons____________________________ Showers a � -------------------------------•-------------P-�----- ( ) — Cafeteria ( ) Other fixtures _ ---------------------------------- - Design Flow_____________TS____'_._:_______�C�___________gallons per person per day. Total daily flow______._.____.________________ ...... Ions. 04 Septic Tank—Liquid'capacity_3_' -_cgallons Length Width....:_ '�__.. Diameter... ........ Depth... __-'i_," Disposal Trench—No_____________________ Width._.____.__.__._._._ Total Length__________,__...... Total leaching area............ _ sq. ft. Seepage Pit No_______________ Diameter.___1`___.___..._ Depth below inlet_ 2:_�__....._. Total leaching area__ -P_�_....sq. ft. Z Other Distribution box (Y'.X-Z�; Dosing-tank 0R p _ Percolation Test Results , Performed by.._'!¢�'ff _�_._�::�`._..'__."'_t�-. t-\'sa�5 a Date - 4 Test Pit No. I................minutes per inch Depth of Test Pit... '?_............ Depth to ground water__N�.'._.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ ---•----------•--•--•--------•---•-------------- -- ... ..: O Description of Soils `' !�q_�t �E3<s�� �- r e i !�( C:�t2rat;1 aT - \ Z'�l t i� U ---•-----••-•-•--•----•---•-••--------- " ------•----------------------•••-••-•----._......--••••_.---------•----------•-•--••-----------_--•--•-----•--_....----------••-----••- W ( r U Nature of Repairs or Alterations—Answer when applicable. ,, NIN1. .��--- '7------- Agreement: TG_M S -5"�r�t �. 7 . N _ 7V I e.-r 01 CC The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 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 board of health. Signed ------------------------------ ••--------- ------------------------------- ---------------- ------ ------ °^=:_. - Date Application Approved By____.___...... y.C :_ `---'_ Date Application Disapproved for the following reasons:-----•--------•---------------••-----------------------•------•-------•--------•----------......•-----••--•-•--- ...............•---------------•-----------------...--------....-----------••--------•-----•---------------•--•-----•-•----••---..__.__-----••••----•-••--•----•---•-••-•-----•••---•••••-•---•--------- Date Permit No--------- ---- - ----�`"�-----A---------..... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS- N� BOARD OF HEALTH L .- ..'..t.•C. !N...........OF......... 's.i .w"L=l^� :............... (9rdifiratr of TI-Impliunrr THIS I6�-W CERTIFY, That the Individual Sewage Disposal System constructed ( �')_or Repaired ( ) by......................... ......... ....._ _.._..__... (`-•- -Installer at = .. ► ----- --------------- has been installed in accordance with the provisions of TITIE 5 of The Sanitary Code s described in the application for Disposal Works Construction Permit No------- "i"____________ ____ dated_---- "`' ' o ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................. THE COMMONWEALTH OF MASSACHUSETTS ,/ /1J►fly �'� ¢ BOARD OF HEALTH `v'? t.a:I-.1N44............OF....... .......................... No......................... FEES c�......... Disposal Works TwAanstrt inn Uprrutit Permission is hereby granted.__ -©_' : . ....... + .��':._ to Construct( " or Repair ( ; Cn I dividual Sewn Disposal S sti --, at No... -----�-....._. •...`�= � -----•-- '`'` ��Sewage- .. ..� t14 _.__ Street as shown on the application-for Disposal Works Construction Permit No. -'.__2_'_�Dat d.._ .......... c_ .� G DATE_ -----•...............•--•-----------...------....••------••-•-• Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y G _ I � CEILING TO JOIST 891' - IFS UP UNFINISHED SPACE App—mately:4905F TO BULKHEAD HEIGHT FLOOR TO BEAM SW' 33 266 23' — s ca 24 X FURNACE - BOILER NEW LIVING SPACE _ Approximately:G96 5F BREAKER BOX WH ,B EXISTING BASEMENT �r Cape CAD Design NEW BASEMENT RENOVATION FOR: GENERA' OTES NOTE SCALE: DWG. NO.: 1. SOME OF THE MEASUREMENTS ARE APPROXIMATE THE PLANS 5HOWN ARE THE SOLE PROPERTY OF CONTRACTOR,15 TO VERIFY EXISTING CONDRIONS THE DESIGNER AND CANNOT BE COPIED, I/L�11 — I I AND DIMENSIONS IN THE FIELD PRIOR TO START OF REPRODUCED AND/OR ALTERED,USED FOR PERMIT F.O. BOX 80 6 B ETSY WARD D E LA N EY WORK AND/OR FILING E DESI T THE EXPRESS WRITTEN NGT 2. ALL WORK SHALL CONFORM TO THE CONSENT OF THE DESIGNER,PATRICK RIMINGTON, MASSACHUSETTS STATE BUILDING CODE(LATEST UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION DATE: /- EDITION)AND ALL OTHER APPLICABLE CODES. ACT OF 1990. OS/OV/2O 1 G M A R5T O N 5 M I L L5 143 BEECH LEAF 15 LA N D ROAD O ANY DISCREPANCIES,ERRORS AND/OR OMISSIONS Approved IN THE NOTES,SHALL BE BROUGHT TO THE ATTENTION OF THE DESIGNER PRIOR TO COMMENCEMENT OF 508-280-7074 CENTSRVI LLE MA 0263 2 AO I CONSTRUCTION PROCEED RROR5AND/OP RUCTION CON5TITUTES ACCEPTANCE OF THESE DOCUMENTS for filingAND ANY REV: 'J OMISSIONS BECOME THE RES ON5IBIDTY OF THE 1 PLAN BUILDING CONTRACTOR OO�OO�OOOO Patrick - Rimington 23'-2', 2--3' r NAILING SCHEDULE JOINT DESCRIPTION NO.OF COMMON NAILS NOOF BOX NAI(S NAILSPACING R-21 BATT INSULATION ROOF FRAMJ.NG: R—W.—WENBILE.) I Eno RIM BOAR B 1 0 4AFTEN(END NAILE 0 1 ........ "I CEILING TO JOIST 89A" AT4CHNIS� UNFINISHED SPACE STAIRS UP LUD F�0 rVuR I FACE NIBLED)_O� O.JE TO BUMMEAD L12"FBI,,NaaeolA—C-11 HEIGHT FLOOR TO BEAM 6N JCVTTO SILL,TOP PLATE ORGINCER(I.F.-P[T) 4m!Cd PER TOM 11OCKINO TO 11151S(WE NAILED) I-RA 1-11B FACH END ILECK111 11 51LL 11 WP PLATE OOC NAIIF1) 1AC,,F- 2'Ll" LFD.1B SIATPFO REAM 01 GIRUER FALL.NAILED) 21 i LET IETIFT. ICISTOILECTE1 10 81AIIII-ALLED) TAd j*ITd 'ER-S, BAND JOIST TO JOLST TEND NAILED)RODE 1�111; 1-1. �-d PE A POO I A�;iAr"�F 2 PROPOSED ERV SYSTEM WOOD STRUCTURAL PANELS—000) ST L. t.�D2 t:F:E 2 02 A—HIS OR IFWSSESSP.CED OVER 1A— L. I. �11. —---------- —--------- 'A U 01 WALL PIKE OR MKE IRUSS W/SIRTIOURAL"'ITTIMS tl EN IDGE/V FIELD A THAI 01 TIMESSIACED U1 10 IV Ad INnD A11E ENDWALL RAPE e 11111—EATIND 2 WPSO1 1AUDDA11 ..LT. I'EFLAEOA-OPOT WAIT SITAITTING' A02 W-1-11—RAL 1ETSOLM =DC.11AN PAT IN 6w EDGE1120 FIELD TAT'.IW�-OTTEIRLITTAID W.- SO ID.Fil�11. U11 1111511111 MECHANICALq ROOM Apr—n-1y;372 5F TAT GYPSU M WALLBOARDrFDC�F/100 FIELD IIEVA WOD STRUCTURAL PANELS 0 T'WOOD) 1'..L111 TN1CFF-1 RV I. I ITTGU.-11 TOO E.LAIDR TIIAN I INCITTISS 1. 1. TEGI/I 111L. IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS R-21 BATT INSULATION CLIMATE ZONE SA(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) IINE�I.A1111 5"LLO".1. C.F'1L,1'1',C;j 11,111RAILITTIAL111 LVIALl., MIAFMF'NOWAII A A 0'AC A A L' 1 IT DS:, D'S F- 1 , 7 NEW LIVING SPACE G98 5r BREAKER BOX WATER TREATMENT WITH EXPANDED TANK (2)2X4 TOP PLATES R-21 BATT INSULATION SEPTIC VALVE (2)2x4 TOP PLATES (2)2A6 HEADER ............... J 2x4 STUDS@ 16 D.C. (4)2x4 KING STUDS�IJ02 �12 R-21 BATT INSULATION R-21 BATT INSULATION (4)2x4 JACK STUDS 20 BOTTOM PLATE PROPOSED BASEMENT 2x4 B0170M PLATE LEGEND NEW 2,4 WALLS TYPICAL EXTERIOR WALL FRAME TYPICAL DOOR FRAME EY15TING BEAM AND LAULYCOLUMN G NERALNOTI!5: NOTE: SCALE: DWG. NO.: 1.SOME OF THE MEASUREMENTS ARE APPROXIMATE THE PLANS SHOW ARE THE SOLE PROPERTY OF Cape CAD De,51cj, n NEW BASEMENT RENOVATION fOR: CONTRACTOR 15 TO VERIFY EXISTING CONDMONS THE DESIGNER AND CANNOT BE COPIED, 114 1 AND DIMENSIONS IN THE FIELD PRIOR START OF REPRODUCED AND/OR ALTERED,USED FOR PERMIT WORK AND/OR FILING WITHOUT THE EXPRE5 S WRITTEN 2.ALL WORK SHALL CONFORM TO THE CON51214T Of THE DESIGNER.PATRICK RIMINGTON, P.O. E30X (50(S BET5Y * WARD DELANEY MASSACHUSETTS STATE BUILDING CODE(LATEST UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION DATE: EDITION)AND ALL OTHER APPUCABL!CODES. ACT Of 1990. 3. ANY DISCREPANCIES,ERRORS AND/OR OMISSIONS 05/0(5/201 G IN TME MAR5TON5 MILLS 143 BEECH LEAF ISLAND ROAD OF THEOTES,5 ALL BE BOPOUGHTTO THE ATTOENF O Approved DESIGNER PRIOR T COMMENCEMENT AO CONSTRUCTION. PPOCCEDING WITH CONSTRUCTION CONSTITUTES ACCEPTANCE OF THESE DOCUMENTS for filing REV: AND ANY DISCREPANCIES,ERRORS ANDIOR. 508-280-7074 CENTERVILLE, MA 02G32 OMISSIONS BECOME THE RE5PONSIBIUTY OF THE 00/00/0000 BUILDING CONTRACTOR Patrick PLAN Rimington