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HomeMy WebLinkAbout0067 CROSBY CIRCLE - Health 67 CROSBY C' CENTERVILLE A = 187 029 Ja10CYClFo�yi UPC 12534 ' No.2_ l LpR �. HASTINO9.MN -\ COMMON t FEALTH OF lASSACHUSETTS Y� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIR:ONMENTA.L PROTECTION TITLE 5 }. , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM. PART A CERTIFICATION � F o2_1 r4/10 Property Address: 7 Owners Name: 0 �b `/ � ry Owners Address: O - � U�CD 3� o c Date of Inspeetio O f MIN. :zl_' %�_ C Name of Inspect : (piease rintj .1C71 0 Company Name Mailing Address: 7C9S� �XP Y —�= Telephone Number: CI! C CERTIFICATION STATEMENT -`'' i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience.in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title.5'(3.10 CMR 15:000). :The system: Passes - nditionally Passes N eds Further Evaluation by the.Local Approving Authority Fails Inspector's Signature:. __ Date:. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or. DEP)within 30 days of completing this.inspection.If the system is.a shared system or has a design flow of 10,000 gpd or g eater,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.th.e conditions:of use at-that time..This inspection does not addresslow 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 INS.PECTIONTOR1tiI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'.DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION (continued) Property Address:1 170' � p. .fg Owner•. Date of Inspectio : vUG7 Inspection Summary: Check A,B',C,D or E/ALWAYS complete all of Section D A. System Passes: JI have not found any information which.indicates that any of the failure criteria described in 3.10 CMR 15303 or in 310'CNiR 15304 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 2.0 years:old, or the septic tank(whether metal or not)is structurally unsound, exhibits substantial.infiltration or exfiltration or.iank 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'pipes)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.ofthe.Board of.Health): broken pipe(s),are replaced obstruction is removed ND explain: Paee 3 of 11 ` OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART'.A CERTIFICATION(continued) Property Address: 7 • Owner: Date ofInspectio 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 13.303(l)(b) that the system is not fupctionmI 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 prM,is within 50 feet of a bordering vegetated wetland or a salt marsh Z. 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,safetv.and environment: _ The system has a septic tank and soil absorption system(SAS)and the SASis.within•100 feet of a, surface water supply or tributary to a surface water:supply: _ The system has a septic tank and SAS and the SAS is within-a Zone I of a-public water supply. The system has a septic tank.and SAS and the SAS i's.within 50 feet of private water supply well. The system.has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water suppl_y.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 an-anoma 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: Page 4 of. 11 OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A. CERTIFICATION(continued) Property.Address 7 Owner- Date of Inspec D. System Failure.Criteria applicable to all systems: You must indicate"yes" or"no"to each.of the following for all inspections: Yes N _ 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 levelin the distribution box above..outlet invert due to an overloaded or clogged SAS or cesspool Liquid.depth in cesspool is less.than 6"below invert or available volume is less than %day flow Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the..SAS,cesspool or privy i.s..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 1.00 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..co.pyof the analysis.must-be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15303,tfierefore 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 1.5,000 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. y Page 5 of I OFFICIAL. -NI SPE.CTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 J. Owner: Date of Inspectio Check if the following have.been done..You must indicate`yes"or"no"'as to each of the following, Yes. — Pumping.information was.provided by the owner, occupant, or Board of Health. — Zwere any of the system components pumped out in the previous two weeks ? �s the systen 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 ? " L Was the site inspected for signs of break out ? y LZWere 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 VtheTa--ftles 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 kaintenance of subsurface Y sewage disposal systems.. p 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)J Page 6 of 11. OFFICIAL INSPECTION FORM NOT FOR YOEUNTART ASSESSMENTS SUBSURFACE SEWAGE DISP,OSA I; SI'STEi'rI IrdSPEC I ION FORM PART.C SYSTEM INF.ORiNIATIO'd Property Address: M,a Owner: o Date;of Inspectio -7 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms (actual), DESIGN flow.based on'31 O CMR 15.203 (for example: 11.0 gpd x of bedrooms): 3 Number of current residents:. ,, // Does residence have a garbage grinder(yes or no):INCH Is laundry on a separate:sewaae system(y s or no):)[if yes separate inspection required] Laundry system inspected(yes.or no): Seasonal use: (yes or no): . �./ Water meter readings; if av ilable(last 2 years usage. (irO(gpd)):�,�4� .©W — q Sump-pump (yes or no): 0 Last date of occupancy:, C OMMER CIALIIND USTRIAL A/ 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: Was system pumped as part ofVthe:"!nspec61& yes or no): (� If yes, volume pumped: gallons--How was quantity pumped determined? Reason.for pumping: TYP O F SYSTEM Meptic 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 copyof the DEP approval _.Other(describe): A roximate age of all com nents, date ' stalled(if known) and source of information: Were sewage odors;detected when.arriVing at tfie site (yes or no):141 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM-INFORMATION (continued) Property Address: Owner: Date of Inspecti dS— 77 - BUILDING SEWER(locate on site plan)/, 6 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:Zoocate on site plan) Depth below grade Material of construction:.Z"oncrete.metal_fiberglass polyethylene _other(exp lain) If tank is metal list age:— .Is age:conf`=ed by a Certificate of Compliance(yes or no)'.:._(attach_a copy of certificate). Dimensions: • �' Lj� �C Sludge depth: 3 Distance from top of ludCe to bottom of outlet tee or.baffle: 35 . Scum thickness- Distance from top of scum to top:of outlet tee or baffle`. 01 . N Distance from bottom of scum to bottom of out tee or baffle: _ How were dimensions.determire.di Comments (on pumping recommenkations inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evidence of leakage, etc.): GREASE TRAP--' (locate on site p an. 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 oflast.pumping: Comments(on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,-evidence of leakage, etc.): Page 8 of 1.1 OFFICIAL.INSPECTION FORM—NOTFOR:.V0LUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFOR-MATIOI t(continued) Property AddressAu Owner: Date of nspectio TIGHT or HOLDING TANK: A4(tank must be pumped at time ofinspection)(loc.ate 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: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site.plan) Depth of liquid lever above outlet inveA�outle '�/" _ Comments (note if box is.Ievel and distributionequal;.any evidence of solids carryover, any evidence of aka�e into,or out of box, et . : sr PUMP CHAMBER::/(locate on site plan): ti 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.): 3 Page 9 of 11 OFFICIAL INSPECTION FORM.-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEV AGE:DISPOS:kL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Owner: Date of-ins, ectj (jam SOIL ABSORPTION SYSTEM (SAS): 1/ (locate on site plan, excavation not required) If SAS not located explain why: Type eaching.pits,number:_ Ieaching chambers,number: leaching.galleries, number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: .innovative/alternati.ve system. Type/name of technology: Comments (note condition of soil, signs of hydraulic failure,level of ponding, damp soil;condition of vegetation; etc : , r' CESSPOOLS: (cesspool must be pumped as`part'of inspection)(locate on site plan) Number and coniQuration: Depths—top of liquid to inlet invert: , Depth of solids laver: 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:): 'PRINTA (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.)-. 9 PaQe l 0 of 11 _ OFFICIAL I3 i`SPECTIQN FORIYI=. OT FOR VOLTJ-iNT.ARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR'Y,I. PART-C SYSTEM.INFORMATION(continued). Property Address: 7 &Z2SZ& r Owner: sP.el� Date of Inspecti : � 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.Locatd.where public water supply.enters the building. C s�e. C.D� 33 O �'J K k� s . in 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: 7 a,C.ze l Owner: Date ofins' ect 7 jr SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater, 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: ANecked with.local excavators, installers- (attach documentation) ccessed USGS database-e;;plain: You must describe how you established the high groundwater elevation: 57 11 Permit Number: Date: Completed by: G HIGH GROUND-WATER LEVEL COMPUTATION" Site Location: Lot No. r Owner: Q SAddress: Contractor: C/, Address: �z i r Notes: STEP 1 Measure depth to water table ` to nearest 1/10 ft. .............................................................................. Date '/Z3�7 l month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: r OA Appropriate index well............... .�/ OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to � zZ water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well(STEP 2A), current depth to water level-for index well (STEP 3), and water-level zone (STEP 2B) Z determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. Figure 13.—Reproducible computation form. 15 �� �.� � � �. ..�� � � ' _ _ �, 1 � � n � \ � � r---� _ ��� � � � ���� ��� � � � - � TOWN-OF BARNSTABLE ` LOCATION 7 CiE'd SG v C //l• SEWAGE # 068— O/ VILLAGE C lEdl R ASSESSOR'S MAP & LOT "'O INSTALLER'S NAME&PHONE NO. 'r P,4AC SEPTIC TANK CAPACITY X.fG D LEACHING FACILITY: (type)I-ALOJd g,�..W (size) S'op NO.OF BEDROOMS BUILDER OR OWNER 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 fv / I TOWN OF BARNSTABLE LOCATION /�"J �/ t® SEWAGE # ti VILLAJGE SS, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ti_ 1! °—+� r ;�) 6 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 4 w bk to � L71\ •G, cn , i b lord �� cr�5by C Lr email I - DATE: 3/30/00 PROPERTY ADDRESS: 67 Crosby Circle ----------------------- Centerville,Mass. ------------------------ 02632 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -6 ' x8 ' block cesspool. Front yard. 2. 1 -6 'x8 ' block cesspool with one 6 'x10 ' overflow cesspool. Based on my inspection, I certify the following conditions: 3. This is not a title Five Septic System 4. This is a sewage system. 1950 ' s 5. Main cesspool on the leftside of house is root bound. The overflow is dry. 6. The front yard cesspool waste water level to the invert is 47 inches. 7. A new septic system should be installed. SIGNATURE: Name:_J_P — Macomber Jr_______ Company: Josej)h_P. Macomber_& Son , Inc . Address: Box 66 Centerville , Ma . 02632-0066 -------------------- Phone: 508-775-3338 --------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY 0 JOSEPH aPksMA COMspoolBER-Leac&hf le ONE INC. f Pumped & Installed 2 5 2000 Town Sewer Connections APR P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 TC`N;j ALBi NST- e HEALTH OEPT. • i i I IWJCOMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COX Secrete ARGEO PAUL CELLUCCI DAVID B. STRUE Governor Commission, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 67 Crosby Circle Nam.ofowr1wMargaret Soltis Centerville,Mass. Newa0rleans886 L0 y via rive Data of Inspection:3/3 0/0 0 Name of Inspector:(Please Print)JOSeph P.Macomber Jr. 1 am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) company Name: J.P.Macomber & Son Inc. T re Number B� — — 3 8 02632 CERTIFICATION STATEMENT 1 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 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: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspe shall submit a copy of this insp lion report to the Approving Authority(Board of Health or DEP)witfdn thirty(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 Department oK-nvironmental Protection. The original should,be sent to-" system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pagel of11 i J Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECnON FORM PART A , r , r CERT1l9CATION (continued) P.op«tyAd&—: 67 Crosby Circle Centerville,Mass. Owner. Margaret Soltis Darts of kupoction. 3/3 0/0 0 INSP£CTtON SUMMARY: check A, B, C, or D. A. SYSTEM PASSES: Ihave not found any information which Indicates that any of the failure conditiom described In 310 CMR H.303 exist Any fa0tue �— —criteria not evaluated are Indicated below. COLUA M: B. SYSTE 61 CONDITIONALLY PASSES: One or more system components s i described In the 'co"dorW Pass'section need to be replaced or repaired. The system, upon completion of the replacement ar repair,as approved by the Board of Health,wW pass. Indicste.yes,no,or not determined(Y,N.or NO). Describe basis of determhution In all Instances. If'not determined',explain why not. ,J1 / The eptle tan is metal, unless the owner or operator has provided the system Wpector 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 a exfiltrstion. or tank failure Is imn-Jnant. The system will pass Inspection If the existing septic tank Is replaced with a complying sspdc tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In th �nap*ctlon Is due to broken or obstrucud pipe(s) or due to a broken, settled or uneven distribution box. The system w If(with approval of tt►a Board of Health). broken pips(s) are replaced obstruction la removed distribution box Is levelled or replaced • The system required pumphigm ore than'lourtftnes,o•yesrdue to broken or obstructed plpe(s)• the rlst*m wW1P6X%-1 Inspection If(with approved of the Board of Heath): broken plps(s) are replaced obstruction Is removed revised 9/2/98 Page 2ofIt i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (con*wed) P►operwAdiress: 67 Crosby Circle Centerville,Mass. Owner: Margaret Soltis Dau of Insp.ctlon: 3/3 0/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �L Conditions exist which require further evaluation by the Board of Health In order to determine If the system Is falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CUR 15.303(1)(b)THAT THE SYSTE IS NOT FUNCTIONING IN A MANNER WHICH AZIM03ECT THE PUBLIC HEALTILAND SAFETY AND THE E WEIONMENT. Cesspool or privy Is within 50 feet of surface water Cesspool or privy is within 60 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)DETERMWES THAT THE SYSTEM t; FUNCTIONING IN A MANNER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENVIRONMENT: Na The system has a septic tank and soli absorption system(SAS)and the SAS Is within 100 feet of a surface water supply or tributary to a surface water supply. ND The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. .R0 The system has a septic tank and soli absorption system and the SAS is within 50 feet of a private water supply well. DIO The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds Indicates that tt well is free from pollution from that facility and the NA of*mmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance NA (approx)mstion not valid).- 3) OTHER X Thi 1 -6 'x8 ' block cesspool in the tront yard. 1 -6 x block cesspool with one 6 x10 block cesspool aG an nvPrflnw ThP main npccpo01 heavily rooted.A new septic system should be installed. The house has been lightly used for the past two years. revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTiON FORM PART A CERTIFICATION(eon*wedll Property Address: 67 Crosby Circle Centerville,Mass. owns: Margaret Soltis Dow of lnspectkm:3/3 0/0 0 D. SYSTEM FAILS: Y0y must Indicate either"Yes" or "No" to each of the following: �)'ip`f-',- 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 fallurs. Yes No/ Backup of**wage IrrtofeciNty-er-syeterr+cornponent due qo an overloaded orv{egpadSAS-oreesspool. 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 th distributlon bo above outlet Invert due to an overloaded or clogged SAS or cesspool. Y Liquid depth in cesspool Is less than 6" below Invent or available volume Is less than 1/2 day flow. V Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). / Number of times pumped_. _ y Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surfaca water supply. v Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. ILI 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. 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 publi health and safety and the environment because one or more of the following conditions exist: Yes No / the system Is within 400 feet of a surface drinking water supply the system•ia•vvitWo 200 4etof-*4«IwtarV40-*aurfWs drinkial we 'au►PIY• '• " 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infognstion. Main cesspool on the leftside is heavily rooted. A new septic system should be installed. House has been lightly used for the past two years. revised 9/2/98 Pagt4orti i f t j� SUBSURFACE SEWAGE DISPOSAL SYSTEM, INSPEC?lON FORM PART B CHECKLIST PropertyAddress:67 Crosby Circle Centerville,Mass. Owner: Margaret Soltis Date of inspection: 3/3 0/0 0 Check if the following have been done: You must indicate either"Yes" or "No" as to each of the following: Yea N Pumping information was provided by the owner,occupant, or Board of Health. None of the system-cornpoAanis kawbean puaNwd4*r,@tJeast two. weww and-thewystem h"Ambeaamcaiaiaywawwal flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. As built plans have been obtained and examined. Note If they are not available withO _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,'if&ding the Soil Absorption System, have been located on the site. The se tic tank anholes 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 orrthe site has been determined based on:- Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] _ The facility owner.(and.^^^._._Lpaats.Jf difieract froaLzAwsr).war&4wawidad with lnformatiomon*s.rcp_r walat f SubSurface Disposal Systems. 1 I i revised 9/2/98 Page 5of11 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTION FORM PART C SYSTEM INFORMATION ProWtyAddress: 67 Crosby Circle Centerville,Mass. Ownw: Margaret Soltis Data of Inspection:3/3 0/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: Ild g.p.d./bedro m. Number of bedrooms(design), Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) ( a oro:_; If yes, separat Impection.required _ Laundry System Inspected yor no) Seasonal use(yes or no): p �� ��ro Water meter readings,it av ilable(last two year's usage(gpd): /I` �1,0,W ..f/<,�amr�'',JO.76Aw Sump Pump(yes or no):�0Last date of occupancy: COMMERCIALANDUSTRIAL: Type of establishment: Design flow: d 1 Based on 15.203) Basis of design flow w 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)AY Water meter readings,if available: / 9 Last date of occupancy:�i OTHER:(Describe) '00 Last date of occupancy:Z� 1 GENERAL INFORMATION PUMPING RE O RD.S�and s ur c f information: �1'r -2 System pumped as part of ins action: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool INAW d64, ,1 Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) !' 1/A Technology etc.Attach copy of up to date operation and maintenance contract _/j,f� Tight Tank Copy of DEP Approval Other �d APPR X1MA AGE of all components, date Jnstage {if known) nd source of4nformation: \ '� Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P►opertyAddresa:67 Crosby Circle Centerville,Mass. Owner: Margaret Soltis Data of h$P--dOn' 3/3 0/0 0 BUILDING SEWER: (Locate on site plan) ,�/ Depth below grade: X/ Material of construction cast ironNd 40 PVC Zther(explain) 0 Distance h p ate w ter supply well or suction line 054 Diameter Comments: (condition of joints, venting,evidence of foak o,-etc.) -• Joints System is vented rou the house vents. - SEPTIC TANK: P (locate on site plan) Depth below grader Material of construction oncreteN,tmetal4,6LFiberglassA4 Polyethylene4lother(explain) In If tank Is[natal,list age_ 1s.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: • Sludge 4111 Distance from top of sludge to bottom of outlet tee orbaffla•. AO Scum tNckness:_ M Distance from top of scum to top of outlet tee or baffle: 4M Distance from bottom of scum to bottom of outlet tee or baffle:-/1 How dimensions were determined: A4 Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles,depth of liquid level In relation to outlet Invert, structuroHntegrity, evidence of leakage,etc.) Septic tank is not j)respnt GREASE TRAP: (locate on site plan) Depth below grade: A/A Material of construction:4M concretetkmetaW4 Fiberglass4.�4 Polyethylene*A other(expiain) AA Dimensions: 414 Scum thickness: Distance from top of scum to top of outlet tee or baffle: 1111 Distance from bottom of scum to bottom of outlet tee or baffler Date of last pumping:_-t//? 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.) Grease trap is not =rpcpnt revised 9/2/98 Page 7ofII i SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPFVCTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Crosby Circle Centerville,mass. own«: Margaret Soltis Dote 0flnspectfon:3/3 0/0 0 TIGHT OR HOLDWG TANK:(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:—& Material of construction LiJ concrete.Jametal aFiberglasW_,Oolyethylens l,other(explaln) z14 AM Dimensions: A14 Capacity: a gallons Design flow:_gallons/day Alarm present Alarm level: Alarm in working order:Yeti/00 Nod�0 Date of previous pumping:q Comments: (condition of Inlet tee, condition of alarm and float switches,etc.) Tight or hnl Hi nq tanks are nn+- Present. DISTRIBUTION BOX:Agl (locate on site plan) Depth of liquid level above outlet Invert: Comments: (note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — Distrihu inn hnx ig nntTlQSBnt. PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) 17 Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) umD chamber i g not =rPgPnf- revised 9/2/98 Page Ior11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropenyAddress: 67 Crosby Circle Centerville,Mass. Owner: Margaret Soltis Data of Inspection: 3/3 0/0 0 SOIL ABSORPTION SYSTEM(SAS)y (locate on site plan,if possible:excavation not required,location may be approximated by non intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dime sions overflow cesspool,number: Alternative system: AA A Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) Loamy sand to medium Main cesspool on 1pftside of house ess oo ron yard. Waste water is or y seven inches below the invPri- pp A new sim tic system should CESSPOOLS y in the past two ;years. (locate on site plan) '+� '� , r>d�� !!r G � Number and configuration:S Depth-top of liquid to inlet invert: � Depth of solids layer: �/ Depth of scum layer: .� , , Dimensions of cesspool: ! Vyb Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as pan of Inspection) Did not pump in flow ow cesspanI S overflow cesspi 1L11 1 aftcj_AQ of house ; s dry No sign,sigzas of water_} s e mii s eesspeel is on the low side of lot. Comments: (note condition of soil,signs of hydraulic failure,level of pending,condition of.vegetation, etc.) Same as above PRIVY: (locate on site plan) Materials of constru li Dimensions: /11i Depth of solids:, t Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Prime is not prPGent revised 9/2/98 Page 9or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a • PART 49 e .. SYSTDA INFORMAnoN(can*w.d) Prop.nyAd&.": 67 Crosby Circle Centerville,Mass. Owrw: Margaret Soltis D`t'of In'°."fon: 3/3 0/0 0 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) OT o � 6 bxq revised 9/2/98 hge10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C If a ►..s SYSTEM INFORMATION(continued) PropertyAddrass: 67 Crosby Circle Centerville,Mass. own«: Margaret Soltis Dew of hupactkm: 3/3 0/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Dote wobsite visited Observation Wells chocked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Z Obtained from Design Plans on record Observed Site(Abutting propert baervation hole, basomeat sump etc.) Determined from local conditions Checked with local Board of health _Checked FEMA Maps zChocked pumping records Chocked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map. Gahrety & Miller Model 1 2/1 6/94 revised 9/2/98 Page norit i >'n.tt1T�A tTt/."�TT'1TR.-JAf I.TIRTTII i1R.lTlf1:?rTTw►IT.RRIIT ARI{�t 1.l�tt/1 tit. TRTT.�TtTI ..t..r•TOWN OF Barnstable BOARD OF HEALTH -V SUI)SU[tFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION "•TTI�T••.'•.:f-T.t1►�.TTT.T1"111'R.7tItTZTICiTfiTRT1:7-.5'i r'1VlRR 7ITTTnRI�T Rl1�.tRt'IRt 7�T •fnrT'T!'�1••�..� -TYPE OR PRINT CI.EARLI'- PROPERTY INSPECTED STREET ADDRESS 67 Crosby Circle Centerville,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' S NAME Margaret Soltis PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sb'fi' Inc. COMPANY ADDRESS , Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 -3338 FAX ( 508 ) 790 - 1578 w CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent witli my training and experience in the proper function and maintenance of on- site sewage disposal systems . i �IIiCt, Check one: Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System._FNI_LEll___.- The inspection which I have con acted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ne copy of this rtification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner ors"op operator shall u P pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 Cmn 16 . 306 . partd .doc Fee 5 0. 0 0/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �es Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopogal *p5tem Construction Verna Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XXComplete System El Individual Components Location Address or Lot No. 6 7 Crosby C i r c le Owner's Name,Address and Tel.No. Centerville,Mass. 02632 Soltis Assessor's Map/Parcel /J OF 17 0 Installer's Name,Address,and Tel.No. 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XXXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 500 + Box Type of S.A.S. 2-500 gallon leaching chambers. packed in 4 of stone. Description of Soil Loamy sand to medium fine sand. Nature of Repairs or Alterations(Answer when applicable) Om i t t i ng c e s s poo 1 s, I n s t a 11 i ng 1 - 1500 gallon septic tank. 1 -Distribution box.2-500 gallon leaching chambers packed in 4 ' of 1 " stone. 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' d by thi ar of alth. Signe o Date 7 0 Application Approved by y Date 00 Application Disapproved the following reasons Permit No. Date Issued o' - . oi� � , - % Fee $ 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,' MASSACHUSETTS - 01pprication for Migpooal 6potem (Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) }CXComplete System ❑Individual Components Location Address or Lot No. 67 Crosby Circle Owner's Name,Address and Tel.No. Centerville,Mass. 02632 Soltis Assessor's Map/Parcel / 17 0 9 1 Just ler' Name, ddress,and Tel.No% 7 7 cj—3 3 3$ Designer's Name,Address and Tel.No. 7 7 5—3 3 3$ .�". .Macomber & Son Inc,. J.P.Macomber & Son Vic. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Tpe of Building: Dwelling XXXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fiktures Design Flow 3 5 5 gallons per day. Calculated daily flow 3 X 110=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 + Box Type of S.A.S. 2-500 gallon leaching chambers. packed in 4 of stone. Description of Soil Loamy sand to medium fine sand. N re of R airs or Alterations(Answer when applicable) Omitting cesspools,Installing 1 — 1 (�'U ga��.on septic tank. 1-Distribution box.2-500 gallon leaching' chambers packed in 4 ' of 11" stone. 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 beAthe by thi o of ealth. Signe Date 7/51/0 0 Application Approved by /�1 Date"WA 09 Application Disapprovedllowing reasons v Permit No._ Date Issued 19C) THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal'System Constructed( )Repaired( )TUpgraded)(XX) Abandoned( )by J.P.Macomber & Son Inc. r at 67 Crosby Circle Centerville Mass. ` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated J.P.Macomber, & Son Inc. ` —Designer—J�,.-R.N acomb(r & Son Inc.Installer g � I The issuance of this perTit sNill not be construed as-'a guarantee that the/ystidm IIJfunc/tio as designed Date / / / / �t Inspector ` �/��/�, No. C/ Fee$ 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migooar *potem (Conotruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade%�X�Abandon( ) System located 4497 Crosby Circle Centerville,Mass. and as described in the above Application for Disposal System Construction Permit. Th pp p y e applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio ust b completed within three years of the date of th' e t. q Date: Approved by i a %/� ` z l/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) Joseph P.Macomber Jr., hereby certify that the application for disposal works construction permit signed by me dated 7/5/0 0 concerning the property located at 67 Crosby Circle Centerville,Mass. meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. The bottom of the proposed leaching facility will not located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation /_+the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B . SIGNED DATE: 7/5/0 0 (Sketc roposed plan of system on back]. Q:health folder cat I ��. _ _ `,. 0 Q � � V'r. � 7 y l c •E rZ p t3 €'�' �t,;y��f---J(ABLE 9: 02 s I � x I II •I� IIII I11 ! I IIII -TI >. I I III ••� (�,I . — ' I (IIII I I I C I I I I it�I ��j I (IIII [I I I!IFANFII (I I !I ! • � .�I_I�I -- --� ---- I ,!I.. II,I'I,II' ''i Ii .l,i I ': , _ '.1{: I w_...11_��__�, ! I'',I I' � il�,!I I!it I �N ,�J�II tl f i I !I ' �II G �l-jl II III l�ll I I IEEE Ii II. I� I IIII III r— ` III IitTO I I iilll� I I it i�li .. 7 I II �i DIIII �Li ail I I FU0 F0 0 III III!!I!I!lilll!!IIIIIIII! ,� j II I,. I �I I � III' I 0000 — II!II!IIi119U11!II!IIl'I'! ','�II' II J I I ' i� 0� �II ! I III H, ------------------------ out- D ro MARGARET S®L>,TIS RESIDENCE 2, ff 1 LJ? Ec =, (IJ1 LM,I11 FiI! I c ry r 67 CROSBY CIRCLE ry 9 ELEVATIONS ry I� I ly I f I I I I �� i ! P; � I I''II�II, gill l i• III ! � � I�1 ! ,1. !11,. II I, , I ( r 1 � � •I 'I IIII ,I it l 11 i I -I l'ilil I �`II III I ' I I!I) i mill T II iI( il �I i � II I. �i Ij I II,II(IIIIO I <!I.;illl - '!iiLl�ll i Illllil j j )I j ill l I, i Ilj,� —� iI' I I il'I! I Illi�;!ili�: 'IIII . �.II:IIII� i MARGARET SOLTIS RESIDENCE L ` I.I �'I ��lil II U) T 67 CROSBY CIRCLE 1 �( o cTUT `C' a '\I�� o - 1- G+` tJEG�G?U 9QL1� Imo, rUa LFE� 1CL_. o o ELEVATION D FHvK, E. 51�,L=7 f J4"L G D SJ V fl J 14'-0• 12'-0' 14'-0• p 31.-0• 3r_6. 7r_O' 3r_b. •b'-0• br_0. 7r-01 7'-0' iv-2° 9 _)1 ib'-r:° 1� i + + r I 0�1 vp SILL MIST as m °ABOVE I (nil 5 FOR SPX, �� Jill x EP a v G w1 m m m is f r—I o =7 Ir THEDRAL LI aDECK NG DEC Q Des 7282 cr7 ® I DFs 2x 10'-b" �/ Iing pfc)) 9 72°x82" B OAK FLOOR t=tI IF RAIL o 0 61 _l ° a e v+� I i m < 6 MASTER EATH ��, oc Q Is � � TILE® C) x �JII ~ L— W8m24 STEEL BEAM ABOVE -3' 2� CT 1—l LI In F— -- - 3-2xI0 HEADER s lJ ) h 22 3-2z10 HEADER I rnFLu \ 3L / ��, = �3-2x10 NEAC'ER 31 Z REF. CC ®ih s�9HALF < 0 0 U rp 2>z S I uG I IuGFrii I __ iCITGNEN I I �= (off I 6po-VEJ - -------l5TO T.C. cq r . -- -------------- - -I Q I I WALK-IN CLOSET al F o FJ-2 CATHEDRAL CEILING I (jr��l`� ® �o I I`�i 3/ 3/4 ; n BEDROOM #2 0 GAS 2z10s , Q I I zq v FMI 4=0 I I . ` Col 2'-1 ur CARPET FLOOR 'h z4E I/E yw I 'oI ISLAND I 2.4 TRAY CL°IL1NG I w tn) _ I I ac - -------'� x 23 3/S a m = __ . I MASTER I -- - - CUM � Is�y E\1` t4'-o• CATHEDRAL CaUNG RAI I I WINE , I BEDRCCIM I W ib r2l, n rn heol L I W® �u / CARPET FLOOR -- Cjj� 0 ni- z GREAT ROCM ® )--------- -� o COAK FLOORPAN.2� -Lol ---TV v 2-9 1/4' LVL`5 PAN --- r JPKT x2q 4 20'-4' ABOVE a w WALK-IN CL03ET m -—- - W12x= •RIDGE- -—- , - --VVV v eATP 1 201 '�sq 3/4 TILE FLCOR - UP CN CL ro 11 it T 4S I I AE'LVE PKT 21 s OOD 2� A2 �o o STAIRS i I FR r-- --� I--- - V ABOVE J II I I Z II . sN;LVEs s'=o�C.O. s i OAK F I I I I I I� td n l I I I m I I m Io c N� I I ® I I I dA�IL7LU ED CEIrI.ING I I I Q[ I I I i I ININ PTD I I ?AK FLOO1 e '�I 3/a°x59 4PTD I I I I I I o 2 o I GARAGE Z v 29 4'x66 3/4• ' '-I-Zx•o 41FADR e 4 m *13I-2' CATHEDRAL fSILiN6 a ni PITCH TOWARD DOORS 11I o I 2-arlaa® I6•o-c. 'D F m 1 tLl OFFICEI I PTD 2966 COVERED e I WI JOIST3 ABOVE m I�R>'>= FLOOR ` '�4'> 3/4' ' I f FRAME o PORGi 4 r canP I ® IFCR 3' '�� 2 g BRICK ,o 241:5 cv PTD I I 17- 29 4 1/4' 3 i RUBLE JOISTS STEP 3/4°tt69 4 v �UNDER DORMER m e 7'x9' O.H. DOCK 7'x V O.H. DOCK SHEET e F I S T FLOOR PLAN N 3-2xI2 HEADER I 3-2xf2 HEADER SCALE: 1/4' - 1'-0" AB 8'-0" D'-O' 3'-9. 7'-0' T-O° 3'-10' T-b° 14'-0° 8'-b" 24'-O" CS: 0714 DRAWN BY: KW 74'-0' DATE: 7/02/07 ov I -- \ I \\ // I � �)� �I lIs \AI ------------ 306 toe r——---I FV r— —I SKT +CAT 5 I SKY n ,r Lam' - am' TRAY CMUW. BELOW 61-61 cmuw. LOFT I I _ I ® ����� L 1�s� =T IL IL cARpVr Ibi j] L/ MATH #3 FCC 2WA L-2 nLE S-nmL BEAM 0 # AIM 11 111"T 22 2 2A"211 j 21t CARPET WALL 7P 4— I I CIO LU 2fz 21k 21fi_�/�,1216 6'-0 CEILING c I �_ ,� TV BEDROOM 1* I cApp--r (a z 4- to M4CW* 2-2x10's4. VWO.C. III -4 WE (L Im I'm I x 10 1 —�FL=R�=STS 100 314'X25 3140 UNDER DORMER 21 t; e! I IIIi �Ii��I I!Ili � � R � I � ! . II � II� i�ililp , 4--0- 41-01 5WEET L ME %SIECOND FLOOR PLAN V-0. 2v-0. JOB: 071A SCALE: 114" DRAWN BY: K I DATE: 7/;-;Wl qo, 33'-2- 3'-0' 3'-6' 7'-0. 3'-b' 12'-0' _ 14'-01 ' (0) -77 1—— I�—II 0�1 / / (3) PDN2947 2 In \ \ In 29 3140x47 3/4° \ \ __ (i) $ I I e 6°O.c Q //I (III «J I J h a I 96 � � a � I I I I I I I � J I `r�� cs�� -F- ------------------------- / I I I I If I L-- --------J I - --------- - 1 -------- / wroxtq sTgn—BEArt ------ --- �I I (��� �) I ------ � 11; BEAM 0 lu — ------- --- In IT1 Wroxiq STEEL BEAM 20'-6' '-4" J 25'-8° I FROST WALL Jsp► �( (n) I ps I FROST WALL }�7 n, gill1 BEAM 4 i txz,:ET � I I �� niil iUl I k ----------� I wroxw BJeArI III ---- I —I-- --- — I — 1 o b I I t. lJ Ll nn STUD MEAMr4 WAIL I 1 0 0 rig') P.T. swcE PLAT- —— ———— ———— 1 3 1/2' LALLY=.umms I U I 36'x36"xt2° Ca C. PADS TYP. L L J UP I I o I I I FULL BA5E`1ENT �i 13'-4• ICS, o I I v DROP to" PCR I 3 1/2' CCNGRhTE SLAB R1 F / v r -- I DC�P j I t I t _m L--- It 1 --------- m 1 cv 1jr —_—__ I Z O lu 3 1/2' LALLY COLUMNAR— `�' q Wx 3'w-W CONCRETE WALLS I 9'-8° ( I I 30"x3Wz2' CGPIC. PADS TYP. -2x1O GIRT 16"xto• COl1TINucus FOO'nNG I I POCxEr I 2 CM 3� I I 3Ean POCKc'T� I 9J19 - ®�--- I ---F 7 F F-/--, F DROP t0" FOR I I 6 4t� L3 I L J L+J L J L J L+J F- --1 DOOR 1 b'-2' 6'-O' b'-O• 5'-0° b'-6" 6'-b• 1 = I I 1 nf� 0 1 I I � I I I = � ►u Z 1 _�i ------- -------------J j j I GARAGE I I t!1 I -- i 4' CONCREM SLAB I I ccl 1 1 V 1 -- ——————————————-- I I PITCH TOWARD DOORS I CL I o 0 1 I I I I JU I I ® 1 1 o al 0 i I i a LINE OF 3RICK PORW—\ o L---------------J ------------------ I I DROP IOC 5,x 3'-q° CONG3E7E WALES— I I 6 I i I6'xIO" C04TINUOU3 FOOTING / i 1 FOUNDA71ON PLAN SCALE: 1/4" m 1'-0' I I / I 5t-IEET —L---------------------- A5 ,L 4'-0' 16'-O" T-6° 14'-O' 8'-6° 24'-O' 2'-W JOB: 0714 76'-0° DRAWN BY: KW DATE: 71,-- L ---------- �' �� it j f � : .. Tr Vol 0 z m > r mZf NEE",I 1 11777 F L-1 > m -------------------------- A3 7777 Z 7-K P. - 3- �o F 9'-4" 113 MARGARET 501-TIS RESIDENCE F5 z EJ) 0, UJ 11 L Eo 11 Tln� 67 CROSBY CIRCLE 3 Ff� S E R,FRY S Q,U �E= SEE HI TF E F-Fe,0 L L S22, 7,5,2 g SECTIONS PHICUFE." E-TC018-7/ 77/ fl fl a4lic" F-- ? Z'Zji US LOCUS INFORMATION Kalrn,4� ` REVISIONS: dy Henry PI NO. DATE DESC. CURRENT OWNER: MARGARET HARKINS SOLTIS C*nterville TITLE REFERENCE: DEED BOOK 13120, PAGE 13 PLAN REFERENCE: PLAN 99/13 & 303/61 V. ASSESSORS MAP: 187 v < _ \ \ \ PARCEL: 29 N/F ZONING DISTRICT: RD-1 ` \ SETBACKS: FRONT 30' - \ \ WILLIAM & DORIS LIEN SIDE 10' z V\ o J ASSESSORS MAP 188 REAR 10' PARCEL 62 MINIMUM LOT SIZE: 87,120± S.F. ( f I Orchard Rd \ \ I I EXISTING TOTAL LOT AREA: 27,004± S.F. 10j ¢p, 552. I ,�� r;� I I I FEMA FLOOD LOCUS MAP: NOT TO SCALE Op " \ ? \ 5¢ f + � + ZONE DISTRICT: "C", 7/2/92, #250001 0016 D \ I I I OVERLAY DISTRICT: RPOD �''e OF'�'�rs�.j GROUNDWATER OVERLAY DISTRICT: APCRAI aA . NITROGEN SENSITIVE No.FIELD 9 I ' r^j 0 ZONE: NOT A ZONE II )2" OAK \ A H NE 12" PINE 1 02 Q2' \ \ 2 BE C \ \ AC 0 S5 , N/F \ \ \ \ 12" OAK \ K \ 12" `PINE ' 2 3 30"f HOWARD & KAREN ONIK �•. \ 1 \ J \ 20 OAK / 1 PROFE SIONAL LAND SURVEYOR DATE \\ \ \ \ / ASSESSORS MAP 188 `, ° PARCEL 154 ` \ \ ' \ \ � \ \ / I I Z � I . � PLAN WOODE #436/4 � \\ D 1 1 ' ( LAWN/AREA m o / OF 15" MAPLE \ \\ LAND W 1 \ / N PROPOSED \ .o \� � 1312.1' o ,Cd RESERVE/ /X. Q o (� / AREA 2 OAK V 67 CROSBY CIRCLE Z ARGARET HARKINS VILTIS I I I / ell � o PROPOSED -4Z OAK / ASSESSOR MAP 187 �: ` I 14" OAK J LAVjtf�l AREA I/ / IN o r PARC�L 29 \ WOODED I / GAS ,� 0 '� ,. 15" OA / O 27,004 S.F. ' ( W • ME tK CHIMN EL W 12 OA / S z/ N � � O I ' J � � ���' M C E R �,,,� REE (/ / � ° I l \ ` 1 N o ( w \ / , �— CENTERVILLE ` M I / 1� / \ ? i �" I , I I �` j EXISTING \ mo w o c G / 12 PINE o I 106 1, \ \ ' °� I ` WOOD FRAME 1 a' � w ROPOS I C/ MASSAC H U S ETTS �n i� HOUSE #67 I z L y� EA CL14 OAK TOF=43.2 / '' "�% I I 3 � C BRICK I I z� GRASS o W (BARNSTABLE COUNTY) PATIO PROPOSED ��, I I N Q I r WOOD FRAME ��_� rn ' HOUSE #67 `\''j� P ANTE \ ! a \ TOF=45.0 L 1 — AREA W WG / + - � \ FIRST FLOOR 46.0 " \`, � \ �� 12 OAK 12 A \ \ I BASEMENT ELEV. 36.0 ' ' ' / o � ' / ' " I I I o I ' 12 OA \ I PORCH/ \ / ' oo ' � I \ \\ 12" MAPLE ' "' f ' \ GRASS OVERH ��� / a- ,i PROPOSED t,0 ,3' — \� I CONDITIONS \ / 12 0 CEDAR 1 2 OAK I / 112 OAK ' �� BI MIN I / DR) ous \ / 42.3' � VEWgY PROPOSED , T L — 7 — (LAWN AREA I rn / JULY 169 2007 �! PROPO D 1 0 I AN REq \ I STAIRSI 1 R =� i — j TREE WELLS 2 0 I Q , r 1_ T -4 2 , e ` L L 1 T %� LAMP \ 1 \ \ V��DIN � � � BRIG 1 T//T -�- �--�e�- \\` G SftBgCK \ WOOD D ' STAI S PLANTED 1 I -VIAPROXIMATE 4p-nC\ 2" OAK AREA 1 1 I \ \ 2" /OA LOCTION COMRILED U I I I PREPARED FOR: \ ; 12 OA I \ \ \ \� FROM TOWN`OF� 11 �I Mr. JAMES BOW ES \ \ BARNSTABLE HEALTH \ \ 1 I E ` 1O0.00. DEPT. INFORMATION 1 �\ 12 HOLLY 1 BAYSIDE BUILDING, INC. c� / I `\ o —�/¢g•pss¢"W 0 RASS� � / 32 \ \ � \ ' �\ � / � 1 P.O. BOX 95, 3 BAYBERRY SQUARE \ 0 CENTERVILLE MA 02632 \ r21' GA4<- — _ \ \ (508) 771 -1040PROPOSED \ � � $ / \\ LAW AREA Q0 N 12 OAK 12" AK / BSC GRO U r LEGEND _ _ , I � I � \ 1 Nf \ / I ' � ( I � 1 / � / 349 Main Street, Unit D 4 �� o 2" OAK 5.0 PROPOSED ELEVATION 1 �— \ { o W. Yarmouth Massachusetts 50.9 X SPOT ELEVATION 12 OAKI 1 1 / C.B. ® CATCH BASIN I I I I a \ /�� 02673 DMH ® DRAINAGE MANHOLE 15" MAPLE I I I I ,� ' V/ // 508 778 8919 SMH QS SEWER MANHOLE I I I �y //Q / C 2007 The BSC Group, Inc. OU DRAIN I 01 5 OODED t N IQ O TLET PIPE TMH 8 TELEPHONE MANHOLE 5 1 I , ,r, I / \ �• ��� LP LIGHT POLE I I �¢�58 / " UPL UTILITY POLE LIGHT I 0 W I 1 ^ I / �, \� / 0 1.2 1 = 10 / I 1 ` O / p I / 0 .25 2.5 5 MRs UPLT-* UTILITY POLE / LIGHT & TRANSFORMER N/F UPT UTILITY POLE / TRANSFORMER TOWN OF BARNSTABLE 0 5 10 20 FEET I / \ UP , PROJ. MGR.: C. FIELD / O i W — UTILITY POLE ASSESSORS MAP 187 OVERHEAD ELECTRIC LINE PARCEL 30 ' I I / \ FIELD: D. GAZZOLO / P. HAGIST o EHH ELECTRIC HANDHOLE O GMET GAS METER I / CALC./DESIGN: K. HEALY — G— GAS LINE 0 I I I / / g DRAWN: K. HEALY cv I G GAS GATE 12" OAK I 4tj / CHECK: C. FIELD I / / FILE: 8869-EXC.DWG WG ® WATER GATE I / \ / U DWG. N0: 5655-02 — W— WATER LINE SHEET 1 OF 1 JOB. NO: 4-8869.00