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Home My WebLink About0016 COVE ROAD - Health 16 Cove Road Centerville P No. 4210 1/3 ORA Pendaflex 100/.W Emb_ -. I Commonwealth of Massachusetts ,p Title 5 Official Inspection Form r I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �O ' 16 Cove Road Property Address F7 Steven_Grossman Owner Owner's Name information is required for every Centerville _ MA _ 02632 _September 12, 2018 page. City/Town State Zip Code Date of Inspection n e6. 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. Inspector Information Sl# l3 3 Iw filling out forms on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Reader Rooter Excv_atinq _ use the return Company Name key. PO Box 89 r� Company Address Forestdale _ MA _ 02644 City/Town State Zip Code 508-509-0802 S112843 _ Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1.. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails September 17, 2018 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.712EJ2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every - — page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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 determjKi d" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 ye /old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltratloP 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 J❑ ND (Explain below): t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is required for every Centerville MA 02632 September 12, 2018—- - --- — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. / I ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(,$) or due to a broken, settled or uneven distribution box. System will pass inspection if(with ap r'oval of Board of Health): ❑ broken pipe(s)�emoved re replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ / P i ❑ 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 tl�ie Board of Health). ❑ broken pipe(s) are replaced ! ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ��- Title 5 Official Inspection Form io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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.soilIabsorption 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�nd 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: i **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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No El ® 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Cove Road _r Property Address Steven Grossman _ Owner Owner's Name information is required for every Centerville MA 02632 _September 12, 2018 -- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 C.4. Yes No ❑ ❑ the system is rthin 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the syste is located in a nitrogen sensitive area (Interim Wellhead Protection Area—)WPA)or a mapped Zone II of a public water supply well t5insp.Aoc•rev.7/26/2018 / Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 5 of 18 c Commonwealth of Massachusetts lip Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments si 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is required for every Centerville MA 02632 September 12, 2018 _ __- -- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. °° " h following for all inspections: 6. You must indicate yes or no for each of the g p 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 ® El 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)). t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y, 16 Cove Road ` Property;Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September.12, 2018 required for every — — page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 GPD Description: 0 Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No 2016= 671 GPD' Water meter readings, if available (last 2 years usage (gpd)): 2017= 235 GPD' Detail: 'Haigh water usage during summer months due to irrigation. Property has been used part time during summer months for past 2 years. Sump pump? ❑ Yes ® No August 2018 Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts I�� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 16 Cove Road _ Property Address Steven Grossman Owner Owner's Name information is required for every Centerville MA 02632 September 12, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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. /etc.): Grease trap present? / ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges%o: i Industrial waste holding tank present? El Yes El No Non-sanitary waste dj charged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Plumping Records: No previous records found. Source of information: Was system pumped as part of the inspection? ® Yes ❑ No 1000 It yes, volume pumped: gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every page. cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): 1000 alg Ion seetic tank and d-box under deck. Approximate age of all components, date installed (if known) and source of information. 1st tank and d-box installed 30+ years ago. 2nd 1000 gallon tank, d-box and leach system installed 06/25/2004. Certificate of Compliance on file at Health Sept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Tank#1-2' Tank#2-3' 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.): t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form i� Not for Voluntary Assessments Subsurface Sewage Disposal System Form- 16 Cove Road — `J Property,Address Steven Grossman__ Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every - — page City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): #1- 1.5' #2-2.5' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is,age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 8.5' x 4.5' x 5' 2- 1000 gallons Dimensions: #1= 6" #2= <1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle #1- 10" #2- <1" Scum thickness #1-8" #2-6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle #1-4" #2- 14" Dip tube and tape measure How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):. #1- Inlet(2) PVC tees and outlet concrete baffle in place. Pumped and cleaned after inspection. Located under deck. Access panels in place. Recommend maintenance pumping every 2 years. #2- Inlet and outlet PVC tees in place. Liquid level at outlet invert. Risers bring 24" poly covers within 4" of grade. Recommend maintenance pumping every 6-8 years t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 C� Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4� 16 Cove Road Property!Address Steven Grossman Owner Owner's Name information is _ MA 02632 September 12, 2018 Centerville required for every --- State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ Ierglass El polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top qi outlet tee or baffle Distance from bottom of scum to'bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7t26I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: Yes El 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" in both 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.): #1-One inlet, 1 outlet. No sign of leakage. Under deck with access. Riser brings cover to grade. #2- One inlet(backpitched), three outlets. Equal flow. No solids carryover. No high water staining over outlet inverts. 3' below grade with riser within 6" of grade ,5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 9�1�\� Commonwealth of Massachusetts Title 5 Official Inspection Form tu� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments R4 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville _ MA 02632 September 12, 2018 required for every —page City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Yes No" Pumps in working order. ❑ ❑ Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber/Condition of pumps and appurtenances, etc.): i "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: -- ❑ leaching chambers number: — ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-21' X36' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is MA_ 02632 _ September 12 2018 Centerville required for every --- — -- State Zip Code Date of Inspection page.. Cityrrown D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Camera used to inspect leach field. Lines dry at time of inspection. No ponding. No sign of past h drdraulic failure. 12. 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 i flow ❑ Yes ❑ No Comments (note conditi of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): / t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is required for every Centerville MA 02632 September 12, 2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: / Dimensions / Depth of solids / Comments (note condition of soil, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form Not for Voluntary Assessments rye 16 Cove Road Property Address Steven Owner Owner's Name information is 12, 2018 required for every Centerville ------ MA 02632 _;�e�eTber page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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: M hand-sketch in the area below El drawing attached separately D (31---> rX 01 .... ........ t5insp.dor•rev.7126r2018 Tillp!i official inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Cove Road Property Address Steven Grossman Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every page. City/Town _ State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >5 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: 03/26/2004 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: maps.massgis.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2004 to 120" found no ground water. Base of leach field 4' below grade. Accessed local ground water contours and topo mapping Before filing this Inspection Report, please see Report Completeness Checklist on next page. i5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I i Commonwealth of Massachusetts Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c �- � J� 16 Cove Road Property Address Steven Grossman _ Owner Owner's Name information is Centerville MA 02632 September 12, 2018 required for every — -� page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included -!5insp.doc•rev.7/28/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 18 of 18 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 16 Cove Road Centerville, AM 02632 Owner's Name: Joanna Markham � �� Owner's Address: Date of Inspection: January 13, 2006 Name of Inspector: (Please Print)James M. Ford s i Company Name: James M Ford Mailing Address: P.O.Box 49 M C, rs c� Ostervi[le.MA 02655-0049 _ Telephone Number: (508)862-9400 < CERTIFICATION STATEMENT " uo =—a I certify that I have personally inspected the sewage disposal system at this address and that the info ation reWrted cu below is true,accurate and complete as of the time of the inspection. The inspection was performed ased onLNY training and experience in the proper function and maintenance of on site sewage disposal systems. am a DP rn approved system inspector pursuant to Section 15.340 of Title 5(310 CMR.15.000). The system: ✓ Passes Conditionally Passes Need Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: January 23, 2006 The system inspector shall sub 't 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. 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 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,.exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health safety P P y 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 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 form. 3. Other: 3 c- Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 da flow Y ✓ Required pumping more than 4 tunes 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 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 form.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 Cove Road Centerville MA Owner: Joanna Markham Date of Inspection: January 13, 2006 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Added onto in 2004-per as built card Were-sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 BUILDING SEWER(locate on site plan) i Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from.private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 1(2 in series) (locate on site plan) Depth below grade: Under deck 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: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Continents(on pumping recorn mendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be anLsigns of leakage NOTE The second tank in the series contained only liquids. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Continents (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence.of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Corn ments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓(2) (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Corn ments(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.): . The original D-box was under the deck and was unaccessible The newer D box installed in 2004 was level and clean No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ✓ leaching fields,number,dimensions: 21'x 26'(per as built card) overflow cesspool,number: Innovative/alternative system Type/name of technology: Connnents(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): There did not appear to be any suns offailure The bottom to grade was approximately 3' CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Continents(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: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13. 2006 c - 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. --------------- r► 3 a y � O � a� y a� :L� 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: 16 Cove Road Centerville, MA Owner: Joanna Markham Date of Inspection: January 13, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 9+/- 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: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours mans the maps were showing approximately 9'+/-to ground water at this site: No high ground water adiustrnent needs to be taken due to close proximity to a tidal river. This report has been prepared and the system inspected and passed as of the dale of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 Ao No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:le — Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pphration for Digpogar *pgtem Conotruction Permit ,1 Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �. Owner's Name,Address and Tel.No. t�� CaF,3 ,vAh—41m� - Assessor's Map/Parcel v `�� 13—3 G203,2 .O Installer's Name,Address,and Tel.No. Designer's✓Name,Address and Tel.No. y —7 7/ L � / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(140) Other Type of Buildings No. of Persons Showers Cafeteria( ) Other Fixtures Design Flow <Wb f gallons per day. Calculated daily flow gallons. Plan Date .oU tr Number of sheets Revision Date Title Size of Septic Tank /t e0 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) vtg Ca n"_,Pc l .O.S " 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 Certifi- cate of Compliance has been issued by this BO of Health. " Signed l Date Application Approved by r f �W, _ Date Application Disapproved for the following reasons Permit No. a"CU�7 a 7 Date Issued p� No. ��U 7 �� -1 r Fee14 ; •• Entered in computer:t/ t `THE COMMONWEALTH OF MASSACHUSETTS ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ` i. Zippfication for Zio,pozal *pgtem Con!6truction 3permft Application for a Permit to Construct('/Repair( )Upgrade( )Abandon( ) ❑`Complete System ElIndividual Components Location Address or Lot No. I{p C{1\t�i Own is Name,Address and Tel.No. � ,��- wmd� Assessor's MMap/Parcel /3—3 6�O �`/ —U Yz' S v� ; Installer's Name,Address,and Tel-No. l0 Designer's,Name,Address and Tel.No. >5�� wig�w sr �•z��s � - � °� Type of Building: Dwelling -No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other'- Type of Building aN.v(ti No. of Persons Showers Cafeteria( ) Other Fixtures Design Flow O G X? gallons per day. Calculated daily flow gallons. Plan Date 5 1712.ov ` Number of sheets Revision Date Title Size of Septic Tank oo0 _ Type of S.A.S. I, Description of Soil �n� s Nature of Repaiis.orAlterations(Answerwhen'applicable) v tv � Sn� �•�.. v Date last inspected:71 f Agreement:,/ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the,provision$of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has}een issued b is o of Health. Signed ' Date Application Approved by - Date c��Lf Application Disapproved for the following reasons Permit No. a 60 Date Issued' V l 1 THE COMMONWEALTH OF MASSACHUSETTS �,A) ! /� BARNSTABLE, MASSACHUSETTS y (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sew ige Disposal System Constructed ( ) Repaired ( Upgraded( ) Abandoned( )by . f� CS /v t u C�_X Q a,-- at 6 O se te d, b 0/L, I1P has been constructed i accordance with the provisions of Title 5 and the-for Disposal System Construction Permit No. a L/-d 3�dated ��y�� Installer uI 11, M -r MCAT -Designer �"q ) 'n2Pf, V The issua ce ,f this permit shall not be construed as a guarantee that t efs�tem ' c-tibn as designed. r Date � � Inspector-��' r' —————————— -- No. av�� a � f ---------------- Feet/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Of 6pogai *p!tem Congtructfou Permit f Permission is hereby granted to Construct( )Repair)O Upgrade( )Abandon( ) System located at I b u✓D �1�, CR A sr and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to . comply with Title 5 and the following local provisions or special conditions. Provided: Co7() ton must be completed within three years of the date of thisper ,i it. Date:_ � _ Approved by _I - 1 J t TOWN OF BARNSTABLE LOCATION GO .R D SEWAGE � ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 4�1-lXrl %7 t::X,1— SEPTIC TANK CAPACITY /Q DO LEACHING FACILITY: (type) Z-!�;Ar/,111 G Z 2 4E't2 (size) NO.OF BEDROOMS l BUILDER OR OWNER WO& S PERMITDATE: COMPLIANCE DATE: 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 PQ Db Town of Barnstable 0E1"E Regulatory Services Thomas F. Geiler,Director * BARNSTABLE,p* 9 MASS. 0 Public Health Division 1634.q. �0 ATEo '�°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form r Date: Aq 16!�l Designer: = Installer: Address: 7 Address: � ,¢� �jl On s issued a permit to install a date) (costal er septic system at�Z4�44F__ based on a design drawn by (address) Dr' ated �_/iv, (designer) I certify that the septic system referenced above wad installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Certifythat the se tics stem referenced above'v�as installed with major char es i.e. p Y J g ( greater than 10' lateral relocation of the SAS or anyertical relocation of any component of the septic system)but in accordance with State &'Local Regulations. Plan revision or certified as-built by designer to follow. (Installer' Signat I CIVSL (Design ignature) (Affix 67 w p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE .ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form Town of Barnstable P# �oFtr+e rpwy Nov o� Department of Regulatory Services sanrisTnsre. Public Health Division Date dd d v MASS.s639. e� 200 Main Street,Hyannis MA 02601 9• ArED MAt A L b Time D .4A4 Fee Pd. �� ^ Date Scheduled Soil Suitability Assessment for Sewage Disposal .®o ��^e&L?l Witnessed By: bpv�J.W, 54f. Performed By: rris LOCATION & GENERAL INFORMATION Location Address / �� Owner's Name D/p&/ to AXj b l Address A/, c."al ,2-D ' Assessor's Map/Parcel: �p 3? / Telephone Engineer's Name 1,4 &e,&e i// Tele # ��Z NEW CONSTRUCTION REPAIR p �cpiS/z2e^"7.n Slopes(%) L3 Surface Stones /I/o Land Use .wen.3 Distances from: Open Water Body 7/0 a ft Possible Wet Area 7/yU ti Drinking Water Well yt/owPIft Drainage Way 7Z ft Property Line x Z b ft Other �r ft SKETCH:(Street name,dimensions of lot,exact locations of test(toles&perc tests,locate wetlands in proximity to.holes) / SI Gv�� Parent material(geologic)/mac A f}^' Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /✓b Weeping from Pit Face A/b Estimated Seasonal High Groundwater rVcs X. ,0 J�fD(/�~ e z S/rcf�ir✓ t7A '✓� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: —� to soil mottles: in. Depth Observed standing in obs.hole: in. Depth ft Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date �-/—T(*Time1—� Observation dI Time at 9" Hole# ��•�y 6 Depth of Perc Time at 6" Start Pre-soak Time a "d d Time(9"-6") a End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first no the Barnstable Conservation Division at least one(1)week prior to beginning- Q:HEALTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. tvoilslstencv.0%Gravel).. . ! --ZZ �6A�y �p 6V� zz �2 a C- �pN0 - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Gravel) Flood Insurance Rate Map: / Above 500 year flood boundary No `� Yes Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes IT Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious snaterlal? Certificationproved by the c C 6 I certify that on (date)1 have passed the soil evaluator examination ap Department of Environs ental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 1.5.017. s Date G Signature / -�'`�` l Q:HEALTH/W P/PERCFORM Sent By: RESOURCE; 15088336383; Dec-26-00 11 :04AM; Page 212 'gym. E. Robinson, Jr. S ptic Inspections 43 Tomahawk Drive `tentervi]1e, MA 02632 (508) 775-7986 Pager 97.8-622-8700 Location 16 COVE ROAD C.EN'TERVILLE , MA 02632 12/16/00 Systems leach pit was dug up and inspected to determine the amount of stone around the pit. ( 2.5 to 3 ` ) With less than 12 " of liquid in pit. No stain line above. ]Leach pit is in like new condition .at time of inspection. William E Robinson Jr. RECE199/�D NO V 0 4 2000 TOWN OF ggRNST yEALTy DES LE COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Address of Owner: BOX 590 N.EASTON MA.02396 Date of Inspection: 10/24/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluatio By the Local Approving Authority Fails Inspector's Signature: Date:10/24/00 The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is arshared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS 'The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M; inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Paoe 1 of 11 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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 o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced rn/a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2/98 Paoe 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I; NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a,septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, t �Wi IY[ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance Na (approximation not valid). 3) OTHER nla tu2;4ti 1 Y� revised 0/2168 Paoe 3 of 11 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 110/24/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n&. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. r E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a.facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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) c}n . The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. r ;i •� r revised 9/2/98 Paoe 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner: MR.BOYD Date of Inspection: 10/24/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: r; Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water.have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. F;�tt revised 9/2/98 Paae 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 FLOW CONDITIONS RESIDENTIAL Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): n/a Total DESIGN flow: 220 gpd Number of current residents:0 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a . OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons ' Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,-date installed(if known)and source of information: 1989 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/7./98 Pane 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by'Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 5'7"W 4'10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet-tee or baffle: 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet-t'ee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a ` Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a i revised 9/2/98 Paoe 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 COVE`RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) r, Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level: N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a 1r, revised 9/2/98 Paae 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 1'OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN V OF WATER IN IT. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic,failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions:,;n/a Depth of solids: n/a k,•, Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Pape 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) B � 6 A O :r;rr 6D 26 6A 1F1 .fi revised 9/2/98 Paae 10 of 11 A • J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 COVE RD CENTERVILLE, MA 02632 M186 P032 LA4L Name of Owner MR.BOYD Date of Inspection: 10/24/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2/98 Paae 11 of 11 r Barnstable Assessing Search Results Page 1 of 2 2 IKE Home: Departments:Assessors Division. Property Assessment Search Results 16 CHIVE ROAD r� Owner: WOOD, DANIEL C Property Sketch Legend Map/Parcel/Parcel Extension � Yly 186 /032/ yil,i Mailing Address WOOD, DANIEL C 3 j I 33 I3�3 4l �, P 16 COVE RD CENTERVILLE, MA.02632 i , 2004 Assessed Values: Appraised Value Assessed Value Building Value: $236,100 $236,100 Extra Features: $2,800 $2,800 Outbuildings: $0 $0 Land Value: $321,400 $321,400 Interactive Property Map: ap requires Plug in: Totals:$560,300 $560,300 I have visited the maps before � �„� Show Me The Map ' . �:.•• April 2001 photos available Sales history: Owner: Sale Date Book/Page: Sale Price: BOYD, BEECHER C&ALMA V C87664 $0 WOOD, DANIEL C&GINA F 10/31/2000 C159578 $268,000 WOOD, DANIEL C 1/14/2002 #857379 $100 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $3,703.58 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax C.O.M.M. FD Tax $616.33 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $ 111.11 Hyannis 2.03 West Barnstable 1.36 Total: $4,431.02 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 7/6/2004 Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.46 Year Built 1957 Appraised Value $321,400 Living Area 3048 Assessed Value $321,400 Replacement Cost$253,842 Depreciation 7 Building Value 236,100 Construction Details Style Ranch Interior Floors Pine/Soft WoodCarpet Model Residential Interior Walls Knotty PineDrywall Grade Average Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Wood Shingle AC Type Central Roof Structure Gable/Hip Bedrooms 5 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 3 Bathrooms Total Rooms 11 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,800 $2,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 7/6/2004 +`Ci y a Ilk t� ,t w?�, �E�t�J�� *'i,�hf��f � a3 E�°,f' i •��r�^° L e,d t ,f� J` �� is y', .,� + � i i,.g� •�f �4 *r��,y.t xi:.��"• ��}« i�'� {��• ! M,,. .. ,y. ''� �,�. .F} •! ,wy t fit. s, y � ��':t�`` �`c ..�.�*�:* t ... 1♦9 • i t v, 7d r r 1�y, �, � _�'.R �. �15i„��i try. t ) "•"" f} All t i •* i ',y;? '`' r max�_��.�'� � ��q� ' $* ,C �� { Oro � .{(:..• - i, II 0 �.•' ` .14. �" F.ws�'�'.,f,- �:.�;" %br'jt'd,��r W �� ,i.t�{,.t. "�. �+. i. = �. .. � �! '.+ �a 33'1'y�i?.r:•";— r E ,' a c .«.i ae. r� •_yt y.,..�, !.. . , • + r . .•.� s .. �� v '� `� a'��' r fir' -�a}, . '��, '.�. i •ate , p f},� � � !y�r �4 Y. ,.• \ y "� f r �-•_ J Y.j>. i�F„ .z `t Wn •, 1 J� y r h u �K � �,• �r t, 1 +a J� � hya r.•- _° + `a' i � .,�` tea'" � fi,� '}aT. -rF \ may* ;�'.�� r,�° t '"iSL 6!�tY~°i � • ..\i�q §y .�l �i • I �� . ,. .. ,� + 1 rt r ii � i�`yFr\ a ;rtf�y�•f, iJ.:.�; �r%< v �, t r . ,. �,.�. � ,{�•e'i r' f F .T �' 7,"77• ,,�" I St fa a .'� . E t. ,,,J y =. ,,,� ! 4 .J ��:.a}' /_ A ��•r I,s'{"t i,�i'K+=#i i{. �, `di 1 vJ S ( - y�,I ♦ ` � t m .+ 7' ' S"•,j fovea AC 4, .' �' e^\\�� TOWN OF BAR NSTABLEf ' LOCATION I_,} Q C�oo,ls1__Q RO_ SEWAGE VII:'s.AGE ASSESSOR'S MAP & LOT,! INSTALLER'S NAME & PHONE NOJ ya,B I S SEPTIC TANK CAPACITY i Sn® LEACHING FACILITY:(type) (size) X(o QNO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER c- BUILDER OR OWNERC0..nc DATE PERMIT ISSUED: 12-1 q e,(, DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ' W _ ;� � � � � � t F `�� /p n f tom' � / / $ 20.00 No.. . Fxs............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town OF ................ . .......................-----------------........----------...---...---- Appliratio' n for Biopooal Works Tonstrnrtion unfit Application is hereby made for a Permit to Construct ( ) or Repair )(X ) an Individual Sewage Disposal System at: 16 Cove Road Centerville ................................•...................................---•-•-•----.................. .......----•-•-----•---•-•---••---...-------•-•-----......._......-------•----.................... Boyd Location-Address - or Lot No. ...........................------••----.......__........---•-...._................-•-•••--------• -•--..........-•-.._._....... ............................................................... w � w J.P.Macomber Jr O ner Address. ,.a ....................................................-•-••---•••------•--•-•-•--•--•--............. Installer Address UType of Buildin Size Lot............................Sq. feet DwellingyNo. of Bedrooms........... ..................:............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of per-sons............................ Showers a YP g --••--•----------------•---- P ---(----)_.— Cafeteria.(_.._>. dOther 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_-_____-_-_-_..____- 44 Test Pit No. 2................minutes per inch Depth of Test Pit::"_.__....._...._.. Depth to ground water........................ W ................................................... -• ...._.- 0 Description of Soil.................. Sand & Grravel ----------------.--------------------------------........••••.--------------- ----------------------------••-----...............---------...--------------------------------------•------------------•--•---•••-----............---- V .----------- --------------•----•-•••••-••-•--•--.......--•••---•••-•...--•------•-••-••......••--•----•---•-•-••-••••.......-•-----•-----•••-....•---•••--••--•••••••-----•-•••-•----......---••---••-- W --------- --------------------------------•--••--•••--•- ---- -------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._.-__--I-I0-00 gallon tank 1-IC3C)�3---gallori•'•leacYiirig--pig............. -----------------------------------------------------------------------------------•--------........----••-------------------------- ----------------------------------------------------•--•-••-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L!L- 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 b the b and of he th. 10/24/89 Signed s.._ Date Application Approved By............ •-•--- .........../n_ 5_ -.I?. Date Application Disapproved for the following reasons------------------------------------------•----=--------•---------•-------•--•-------------------------•---•-•--- a .....................•-----•-------•--------------------------------------------•--------------.................................-•------------••--••-••-••---•••------•---------••-----------•-•••---- Date Permit No.- S -•�-----•---...----•-.. Issued Date No.... .......`....... FFz............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tn...., OF........................................................................................ . ppliration for Disposal Works Tonstrurtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair -XX ) an Individual Sewage Disposal System at: 1 Core Rond Center i 11 ........... _......................••-•-------------.....-• .,--••---.............---------.---- ----....••---"---•-••-•-......----""-"•-----------•---------•-•---•---------------------....----•- Location-Address or Lot No. U ......................_.......................................................................... ......,--"------------"•---"---------"...-----------------•-•-""-"-----...................._...... Owner_ Address a ......' ...........• ..:.. .. E-r ..... ....... ..........•.................--••------•"-•---""---................................ Installer Address Q Type of Building Size Lot............................Sq. feet U DwellingM No. of Bedrooms........... ...............................Expansion Attic ( ) Garbage Grinder ( ) 44 Other—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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,_� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.---..._--.--------.--- G=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. - a ..........T.................................................................................................................................................. , O Description of Soil.........................................Sand t� Grp'.-C 1 " . "•................••"•---"-•--•---------•"-------"-"-------••----•--•-••--•--•-•-•-•-•-•---•--•--"--...-"---"-"----. x V --•----"•---"••----•----"•"--•-"-----------"---"•-----•""-"-"•---"-"-"----"--"•-•---•----...----••-•--•---•-"-----------"-"--•••----•"•----•---•"--•--•"-----"--------"------•---•••--"-•-•---••--...... W ------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------•--...... U Nature of Repairs or Alterations—Answer when applicable...--.--. .1 .. ) :^.la Oe� L�t l . - ----=----------------- ------- �— 1 1 11O`: l = r.i �1 r .� t. .. ........ -•- ---•-•----------------------------•-•"-"-•".....-------•......------•-••---•--...----""----•-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Al TiE 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. 1 ff 1•, 21 ., . ................................ Date Application Approved By---. ,-�. .. ._.. ...... te— Application Disapproved for the f ollowa g reasons--------------------"--------•----•-------------------------------------------------•"" •-"•••"--•-•"•--"--"--- ........._-.....................................................................................--------...----•---------------------...----------------------------------...------------••--••---...... Date •--- Permit No.._ .._...r.._ � _ '..�..2.�...�. Issued.----------•---•-------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........Tnr ....................OF................?:.:::..:.'. sl :'.:!:r'........................................ ver#ifiratr of TnntpfiFanrr -THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (A;) Jr. by --"•-•----•"••----•--••---•--..........•------•-----"------•-•.................""•"....."----•------------""--------"-•••"-•"--"•--•------..................-"----........-""-...._ Installer at 1-=•-.--- = 1' 1`i� 1' t=n-t r=r _?.;:�.5:............ --- ----------------•------------------------"-----------.....----•---•••--------------•••-•---••- has been installed in accordance with the provisions of TI'":11-, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.- ��F...__✓,--_..... _..... dated..... ._....._-....._-- --- ------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE C UED AS A ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ,. `' �:�.-.. .�.............................•--.....---...-"----- Inspector.... --• k --�=---- !�>.l`-�- THE COMMONWEALTH OF MASSACHUSETTS I50ARD OF HEALTH No......................... ............71.0.Atrl.................OF......... ............................................. FEE---.8 20.Cri .................... Disposal Works 0-rnnitnr#ion Vrrutit Permission is hereby granted.............�.. _......�r,�..� Jr to Construct ( ) or Repair (X) an Individual_Sewage Disposal System at No. It, Cove Road Center-4.+1^ -•-•-----------------•-----"-........-•"-"-""---••---------•--"--.....•--•--"-.••••-••---....--•-•--------•--"---•-•--•----------............................................ Street > r as shown on the application for Disposal Works Construction Permit �;o� ....... Dated.......................................... " -- -------------------------------- � oard of Health DATE = .................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN ,OF BARNSTABLE�. ` LOCATION Lf� 4..29ldLL`� I�L SEWAGE I VILLAGE C' yg�P „�/]�_ ASSESS,OR'S MAP & LOTS " INSTALLER'S NAME PHONE NO. �• �� 6,�y,g�� -; j�G_ SEPTIC TANK CAPACITY 1 P' I LEACHING FACILITY:(type) (size). . 1,�(�c�,�� NO. OF BEDROOMS. PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No I r{ ✓ / t A