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Home My WebLink About0142 FOX HILL ROAD - Health -02 FOX HILL RD ,onterville 189 - 054 - ----------- /// S M E A D No. 2-153LOR UPC 12534 smoad.com • Made In USA am rot sake=ffamomm wyruaDaMll�ooixrt�[ 01F OF IM V PROM" _. �� i fr^`!l v\ `' y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address t3.' _r t Thomas Edwards = Owner Owner's Name m information is MA 02832 6-15-18 required for every Centerville page. Cityrrown State Zip Code Date of Inspection f Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important When A. General Information filling out forms S/# O�—� ��F1�OFIrM�s4i,,��' on the computer, use only the tab 1. Inspector: o key to move your ?�: JA M ES N cursor-do not James D Sears use the return Name of Inspector kVeyQ . Capewide Enterprises lF��:'.�'� r�o• Wiz' 1 F' .. o—. Company Name 5 I�tT 153 Commercial Street yppRrrrtUN,utN�"�` Company Address Mash pee MA 02649 Cityrrown Stale Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16,340 of Titie 5(310 CMR%000f.The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority pectoes 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 151ns.doc-rev.6I16 Title 6 official Inspadion Form:Subsurface sewage Disposal system•Page 1 of 17 66 a5ed xPJ dH 9bZZ 81.02 66 unr Commonwealth of Massachusetts Title 5 official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is Centerville MA 02632 6-15-18 required for every page, City/Town State Zip Code Date of Inspection B. Certification (cont.) inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal Tank D Box and 18 chamber's. System Conditionally B) Sys Y Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old`or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewsp Disposal System•Page 2 of 17 02 a5ed xeH dH LbZZ 9M2 61• unr y Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health). ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ias.doc•rev.6116 Tits 5 otroa Inspection Form:Subsurface Sewage Disposal System•P89e 3 of 17 6Z abed xeJ dH W2Z 81.0Z 61, unr c� Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards owner Owner's Name information is required for every Centerville MA 02632 6-15-18 Page. CitY frown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: AM This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 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 ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in�is less than 6" below invert or available volume is less than '/day flow L.`<./I CX i u G 15ins.doc•rev.6116 Title 5 Official hispection Form,subsurface sewage Disposal System-Page 4 of U ZZ a5ed Yed dH 8b:2Z 860Z 61• unr Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1' 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with,a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. t5ns.doc rev.W6 Title 5 Official Inspection Form-Subsurface Sewage Disposal system•Page 5 or 17 £Z 85ed xed dH 6t,:22 81l•02 61, unr c� Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form Not for Voluntary Assessments y ` 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been Introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrobms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-ray.606 Tills 5 Official Inspection Form'.Subsurface Sewage Disposal System•Paae6 of 17 bZ a5ed xed dH 6t,:ZZ 81.0Z 66 unr Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. CitylTown State Zip Code Date of Inspection D. System Information Description: 1500 Gal. Tank D Box and 18 Charnber's. 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No 2016-110,000Gal Water meter readings, if available(last 2 years usage(gpd)): 2017-48,000Gais Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date Commercia III ndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev,6116 TAIe 5 Dfciat Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 SZ a6ed xed dH 09 ZZ 81.02 61, unr Commonwealth of Massachusetts Title 5 Official Inspection Form 1 `1� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.dx-rev.6116 7i0e 5 Official Inspection form:subsurface sewage Disposal System-Page 8 of 17 gZ a6ed xed dH 05ZZ 8I.02 66 unr Commonwealth of Massachusetts k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 142 Fox Hill Road v, Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02832 6-15-18 page. Cltyrrown State Zip Code Date of Inspectlon D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2011 Permit # 2011 -330, Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade. 30" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on siteplan): 21i 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 Dimensions: 1500 Gal. Precast H-10 Sludge depth: 3 t5ins.doc-rev.6)16 roe 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 LZ a6ed xed dH LSZZ 860Z 66 unf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 142 Fox Hill Road Property Address oP Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 8 1p Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Asbuilt- Plan -TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 21" below grade w/both covers at 4", In and outlet tee. No sign of leakage or over loading. Tank should be pumped. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins.doc-rev.6116 Title 5 official Inspectlon form:Subsurface Sewage Disposal System-Page 10 of 17 92 a5ed xe� dH 69:ZZ 860E 66 unr Commonwealth of Massachusetts u9, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards r- Z-1 Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. City/Town State Zlp Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc,): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No t51n3.doc•rev.6/16 Tolle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 or 17 62 abed YRJ dH 6g2Z 8l•0Z 66 un c Commonwealth of Massachusetts YTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -4 142 Fox Hill Road Property Address Thomas Edwards Oar Owner's Name informationis required fo for Centerville MA 02632 6-15-18 r every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-39" below grade w/cover at 15 Box is clean and solid w/3 line's out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber,condition of pumps and appurtenances,etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: L&ris.doc ray.6/16 Tile 5 Official Inspedlon Form:Subsurface Sewage Disposal System ?age 12 of 17 0£ abed xez! dH 65ZZ 81.0Z 61, unr Commonwealth of Massachusetts Title 5 official Inspection Form ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �L 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required for every Centerville MA 02632 6-15-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont,) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 16 Biodiffusers, Ck D Box and camera out lines. Probed above and next of chambers. No sign of over loading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Mns.dor-rev.WO The 5 Official Inspec ian Form.Subsurface Sewage Disposal System•Page 13 of 17 6£ a5ed xeJ dH 65ZZ 81.02 66 unr c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owner's Name information is required For every Centerville MA 02632 6-15-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.6oc-rev.W6 Titre 5 Official Inspection Form.Subsurface Sewage Disposal System-Pale 14 of 17 a5ed xe un Z£ � dH ZSZZ BIOZ 66 f t Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner owner's Name information Is required for every Centerville MA 02632 6-15-18 Page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins.doc•rev.6116 T He 5 Offxial Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 E£ abed xed dH ZSZZ 860E 66 unf AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION # jjr/ SEWAGE# Z O I I—3 S O i VILLAGE_ n Lc.�t Il. ,—.ASSESSOR'S MAP&PARCEL ,8 9 — sy INSTALLER'S NAME&PHONE NO, (enowe�r j V77 1877 SEPTIC TANK CAPAM Y lro o /fio LEACHING FACILM:(type) 1 F t 3,A1 4)2c 3lol f {size) �'r y -?1. Z NO.OF BEDROOMS .j OWNER Je se k PERMIT DATE: !0—q 2.-11 COMPLIANC DATE: / D -(Z - Z.oI/ Separation Distance Between the: Mwdmum Adjusted Grotuidwatcr Dble to the Bottom of Leachin&Facility A e tl Feet Private Watcr Supply Well and Leaching Facility(If any wells exist oil 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 uc' r � B C y° D y f-G /}f i4,5' cr 4a.6 �} Z SC°.v ayo af � p3 v4.o t3i ABq 9¢ i7•o >31 &t DS 90 Db a3.1 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 89054&:seq=1 6/8/2018 �£ a6ed xed dH 29:22 8602 66 unf i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards Owner Owners Name Information is required for every Centerville MA 02632 6-15-18 per. Cilyfrown state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �N9 10, e° P f� Estimated depth to l h ground water: feett 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: 9-20-11 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design Plan 9-20-11 10' no G.W.. Bottom of leaching at 4' below grade. Bottom of leaching at 6'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspadon Form:Subsurface Sewage Disposal System-Page 16 of 17 5£ a5ed xed dH ZS:ZZ 860E 66 unr Commonwealth of Massachusetts Title 5 Official Inspection Form 1> Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 142 Fox Hill Road Property Address Thomas Edwards owner Owner's Name information is required for every Centerville MA 02632 6-16-1 B page City(Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information —Estimated depth to high groundwater ® Sketch of Sewage Disposal System either,drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Tile 5 Offdal Inspection Form:Subsurface Sewage Disposal System•I Sae 17 of 17 g£ a6ed xed dH £SZZ 81,02 61, unr Page 1 of 1 Soto, Kathryn From: kennedy3344@cox.net Sent: Monday, November 10, 2014 2:26 PM To: Barnstable Rental R4gistration Subject: 142 Fox Hill Road, Centerville MA Rental Property This is to inform you that our rental property was sold on 1 August 2013, and our tenants had left by July 31, 2013. Since they were only there for the first six months of 2013, we are requesting a rebate of$45.00 for the second half of 2013. Thank you. Joseph and Joyce Kennedy, 3209 Morningside Drive, Chesapeake, VA 23321 i 11/10/2014 /TOWN OF BARNSTABLE LOCATION SEWAGE# Z d l 1 VILLAGE ASSESSOR'S MAP&PARCEL d 9 Sy INSTALLER'S NAME&PHONE NO. (cnpc�t�e �oi/Jrr xs V77 8877 SEPTIC TANK CAPACITY /S"e 0 /t/o LEACHING FACILITY:(type) I F t 3g l (size) p,r V /. NO.OF BEDROOMS J OWNER Jo ese k t Q ce PERMIT DATE: /D - � - Za 1 COMPLIANC DATE: / Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility slid C/ 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 ��- i d y0 - i D y rG cs q8,s 43 a a yo of. D 3 5q,o i31 a8.q �� 7•0 , 60 f� op 1 No. 2011 — 330 Fee w0. THE COMMONWEALTH OF MASSACHUSE'TTS Entered in computer: PUBLIC HEALTH DIVISION a TOWN OF BARNSTABLE, MASSACHUSETTS es 2pplication for Misposal 6pstem Construrtiun Permit Application for a Permit to Construct( ) Repair X6 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 14'L Fu tt 4i 1 l (Lc) "ft X f_ Owner's Name,Address,and Tel.No. Tot 4 So%[t.c, 14en.0 Assessor's Map/Parcel 1 q 3 Zc j jn.Dek•ty S J&c ✓� �' til •t fees_ V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Capew:dt 477H7-7 S; L. ��►k.rta�►;k SoB-1� 3 -037� Type of Building: 2 Dwelling No.of Bedrooms J Lot Size 1 `J�1 Z9 b } sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided 3 3 2, •*--i gpd Plan Date L O — 2 - Z.o l% Number of sheets Revision Date Title 1•-['L lac t3ti Size of Septic Tank l JOD Type of S.A.S. 3 1 • '1- X Ct Description of Soil Nature of Repairs or Alterations(Answer when applicable) 13e4..t7 (,[ LO lfO10 r;' 9 Q h L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of�He Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ?Q/ - �j%0 Date Issued 11 is - •� o No. 30 n 3, Fee �00• THE E COMIyI,Q WEALTH OF MASSACHUSfTTS=- Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Rpplicatiolt_for b'isposal 6pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i l)2 F )t 14;1 (2^�� ( �iti�i 1+.r Owner's Name,Address,and Tel.No. 3-o e d J e y e c k- y Assessor's Map/Parcel I$Cl - 3 2 c� �� 'L' S `� `'� � (n p , ,.�4 v✓3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. -03-7-7 Type of Building: Dwelling No.of Bedrooms Lot Size 1 5 1 2-9 b } sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided -3 3)L . �i gpd Plan Date ( U - 7 Z o 1 Number of sheets P Revision Date Title 1 -1'L 1;0x It, i 1 Size of Septic Tank 1 �J co Type of S.A.S. 3 1 `L Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 e,-J L( - (U t)y c7 ,0 F L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health, i Signed Date Application Approved by 0 Date Application Disapproved by Date for the following reasons Permit No. �O// - -!;3O Date Issued /40- y 70 t t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by /12 ,l u� -,-(�.r t f c t LL - at H 1 VoK 1-L\k yt..�) L �-tl�(k I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No?U"1 33n dated �U- `�' Zo to Installer ( 44tz o,J,<kri On --e-! t_t LPL. Designer S, L • �t2, G�e�:� #bedrooms 3 Approved design flow 33 O gpd The issuance of this permit shall n be construed as a guarantee that the sys wt c i designed. Date 4PA7;1 Inspec ------------ No. Zo I 1 — 33 U Fee '/00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(Y_) Upgrade( ) Abandon( ) System located at l�j -L F u,c I-h 0 IW 4j 0 �E- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Al b. � I "'�,,.,-_.. Approved by [` 10/13/2011 03: 14 5082730367 :0579 P. 002/002 Town of Barnstable Regulatory Services 4 Thomas F.Geiler,Director '• �,aTMB*�B g Public Health Division °+�os� •`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644I Fax; 568-790-6304 Date: I�-13-11 SeWage'Permit# 2-011 ' 3 3 o Assessor's Map&l &reel 10 7 7 8- 1 Installer&Designer Certification Form �. E� ctseS : .Designer: S G 'En`yto eec co� , -r+n C.' Installer: Gu ecw;c!c � P Address: 2854 _C raeMercy.. Address: 153CoYn n�✓c: g'- fps\ Wo�cV►arh MA 02.538 5a6-1�3.6377 dLa On l'o-Y- a•r ; d1 ��y h.t_ was issued a permit to ii.stall a (date) (installer) ]] septic system at 1 H I �O x i I I 00 A. based on a desigt;drawn by (address) -G EYi5ineeccn5 , Tene_ dated OG+&er 2, 2011 (designer) I certify that the septic system referenced above was installed substan.Tally according to the design, which may include minor approved changes such as latent: relocation of the distribution box and/or septic tank. Stripout (if required) was inspc!:ted and the soils were found satisfactory. I.certify that the septic system referenced above was installed with iiajor changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation )f any component of the septic system) but in accordance with State& Local Regulation... Plan revision or certified as-built by designer to follow. Stripout (if required) 'ns cted and the soils were found satisfactory. 14 OF JOHN L. CHURCHILL ( s ler's Sign Cure) ML N 41SO' esigner s Signature {Affix Ue gn �ii' . Here) P ,ASE RETURN TO ARNSTABLE PUBLIC ]3AL; 1)IVLSIOI\T.` CERTIFICATE OF COMPLIANCE WILL i NUT BE ISSUED UNTIL BOTH 'PHIS FORM AND AS- BUILT CARD ARE RECEIVED BME BARNSTABL,E PUBLIC H.EA: Tff DIV "ION-. THANK YOU. Ooffice fonnAdesignarce rtiflcation form.doc Town of Barnstable P# 7 1-5 Department of Regulatory Services Public Health Division DateMAM rEn 39.a 200 Main Street,Hyannis MA 02601 Date Scheduled bo///. Time Fee F Pd. 0'6 Soil Suitability Assessment for S e Disposal Performed By: lJV ad L41 E,r d(I �6 11 OE Witnessed By: LOCATION&GENERAL INFORMATION , Location Address 14 1- �r-0)( HtLL Owner's Name a , F-oye4 mg Address 3a'39 &t.o62kik&s(PS 6t. �p CI S,PE4 f—(\/A 7333Lj Assessor's Map/Parcel: D l 1 Engineer's Name 4�AfQcQ;Cps 4 AWL 4--SC 615((le001-5 NEW CONSTRUCTION REPAIR Telephone# 5,0%-4 71 — itz°'`( . SS06-27 -o377 Land Use: S i eje%-t: fikK- 'p wc'ZI 1&Okmopes(gb) 3 O Surface Stones Distances from: Open Water Body 00 ft Possible Wet Area > >d� ft Drinking Water Well : ft Drainage Way ft Property Line 210 ft Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands fn proximity to holes) Parent material(geologic) 0 os Depth to Bedrock Depth to Groundwater. Standing Water in Hole: a�0�!t'• Weeping from Pit Fnee Estimated Seasonal High Groundwater 4 1 6 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: -0,retk ab smy(k?o y Depth Observed standing in obs.hole: 1 20 In. Depth to soil mottles: In. Depth to weeping from side of obs.hole: _ In, Groundwater Adjustment f. Index Well# Reading Date: Index Well level Adj.iketor� Adj.Groundwater Level, , PERCOLATION TEST Date Umu C'Ow At1 Observation Hole# Time at 9" Depth of Perc Time at 6" 1 Start Pre-soak Time @ '�O 4M Time(9"-6") _ End Pre-soak Rate Min.Rnch / " Site Suitability Assessment: Site Passed !O 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 notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. -ansistenCy.%'Gravel) G-ay I&—5 q 8 LS — Sa- 9 U GI M�c Sund �" !�% I r7'� ��//•krot�6F Fvzs q o-I zo. G2 ► -5 V.j-✓6/3 AIM e' DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sis en gn Gravel) 21-2(0 A LS iOY; 3/2 — 2�_5 y 1 LS S/6 — ��Y-q o c- n- 90-�20 C-2 �.5 2. 5 y" 3 NvHe- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,7g Gravall DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No X, Yes ' Within t00 year flood boundary No L Yes Depth of Naturally Occurring 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? ---I-f-- If not,what is the depth of naturally occurring pervious material? Certification I certify that on a [)cO (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,exper se ar experie ce described in 10 CMR 15.017. Signature Date as l Q:1$EPTI0PERCPORM.DOC I •' TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I U Time: In (Q Out 1015 . Owner Tenant ' Address �L o ` Address P Compl' nce Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities Approv2tii: - - Gtk o 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities J 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed v f (� V PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here f �� l C , TOWN OF BARNSTABLE M �g d MLD Ce d:rt: BOARD OF HEALTH ------�_ ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Z�3 A at Time: In %L>:UO Out t O: I Owner �GS 3u-1 Cc Tenant A L A w<<., Ito CA Address 32o4� �NIUxvjt titi 5koc- VYL Address 2- 'F,,< �-I Ic c- itV2. �l�l� Sias te[ VA Z 33Z1 Ctr..-tc%ev I X Compliance Remarks or Regulation# Yes Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply c w 5. Hot Water Facilities Q, Ev Z S- fg�. &-AZ t-A- 6. Heating Facilities S � 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use ?� a 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal p�c 16. Sewage Disposal A t vA'C C 17. Temporary Housing A/ 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; --` V (� �7p SIT Lb Removal of Occupants; Demolition Number of Bedrooms 3 ;y Number of Vehicles Allowed (max) y Number of Persons Allowed (ma Person(s) Interviewed Inspector — , If Public Building such as Store or Hotel/Motel specify here L TOWN OF BARNSTABLE V40 BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date LO Cl Time: In k0:UU Out 10: 1 Owner �GS �� CC �ENw�h� Tenant A. L 4 A v--. Ito SA � `Address Address '�� t��. �2✓�. Gt.. t,,Cc UA Z 3�)Z1 Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities r 3. Bathroom Facilities Y � 4.Water Supply !rk7-N t �...r 5. Hot Water Facilities 4.a-T c-4- 6. Heating Facilities SN 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits a 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal v 1�12tvA`t t • 17. Temporary Housing Al 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; —� V (� �'�o SZ C b Removal of Occupants; Demolition kto y Number of Bedrooms 3 y Number of Vehicles Allowed (max) Number of Persons Allowed (max I Person(s) Interviewed 1 Inspector - n V If Public Building such as Store or Hotel/Motel specify here f �= FORM30 CHLIWD HOBBS&WARREN TM THE COMMONWEALTH.OFMASSACHUSETTS BOARD OF HE TH CITY/TOWN W ej PARTMENT ADDRESS 'GSM SVO� TELEPHONE Address -1 t _ Occupant_ . Floor Apartment No. of Occupa s___�— No. of Habitable Rooms No.Sleeping Rooms__ No. dwelling or rooming units—_No.Stories Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: `-- BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: SI.Wks, Flues,V ts,Safeties: Kitchen Facilities in ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub-.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.( ee Over) "THIS INSPECTION RE R IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU c INSPECTOR TITLE DATE r� TIME to - �/'l P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential'premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. L Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, � ( ) p 9 g 9 gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482, (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 16-0 0- l3o e I FORM 30 tlw HOBBSB WARREN M THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH CITY/TOWN a DEPARTMENT o ADDRE S C5oo TELEPHONE IN S I ( Address Occupant , Floor Apartment No. No. of Occupants_._,— _ No.of Habitable Rooms _j No.Sleeping Rooms_-3__ No. dwelling or rooming units__ No.Stories__ Name and address of owner ��F_- _ 3 2- pI � � � Remarks Reg. Vio. YARD Out Bld s.: Fences: VA 9 Garbage and Rubbish Containers: Drainage v Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: ff f'j-0 7- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Rooflid Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen. Sanitation: tps Dampness: Dv_cl UV Stairs: Li htin : — STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS LIST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room 6 :� Bedroom 1 1 S Bedroom 2 1V lo, 5 ,1 111 Bedroom 3 S U13 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches Qr Ot er: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT ASIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR �< TITLE DATE 1-7 TIME !p - P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000'not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. , "ri..'+ •..i�„f..r4..`MY.aR'+P�vrw-n...,. - .�... -....-vw -....-._..'r'^'^.�.'N.rt.-.^°y v. 'F RM HoeBSs'WnaBEN e THE COMMONWEALTH OF MASSACHUSETTS ` ORM30 CII&W " BOARD OF jjHEALTH CITY/TOWN �j l ^, DEPARTMENT ADDRESS t 5OY�� 6� � ��44 Ll 5 �' TELEPHONE Address Occupant At 4--. Ate"" Floor...-Apartment No. /U� No.of Occupants ;L U No. of Habitable Rooms__ _5 No.Sleeping Rooms 3 No. dwelling or rooming units-_ No.Stories r Name and address of owner____7ix - 3 2 D 9 `t. c,�1 t�l�,ttl�� Remarks Reg. Vio. YARD Out Bld s.: Fences: VA a 3 31 Garbage and Rubbish ( {j Containers: f f Drainage n Infestation Rats or other: ,a U STRUCTURE EXT. Steps,Stairs, Porches: rvu Dual Egress: and Obst'n.: IVv ❑ B ❑ F ❑ M Doors,Windows: Roof �'� Gutters, Drains: Walls: Foundation: Chimney: a BASEMENT Gen.Sanitation: Dampness: VV Stairs: Li htin : — 0— 0 / STRUCTURE INT. Hall,Stairway: O bst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room I I 1 Bedroom(1) S (0 Bedroom 2 W 10, Bedroom 3 J S Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: off-0 Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:.. Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or.Other: Egress Dual and Obst'n: Q (, General Buildin Posted I ) Locks on Doors: I ' ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE lam' f' � 1;9- i O ' J C `"M DATE ( TIME + P.M. � / A.M. THE NEXT SCHEDULED REINSPECTION �v `T4 P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential 10 endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150 A 1 and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. OL i n� ,. �'� � Parcel Detail Page 1 of 3 Logged In As: Pa rce I Detail Tuesday, Octob� Parcel Lookup Parcel Info Parcel ID 189-054 Developer LOT 28 Lot Location 142 FOX HILL ROAD Pri Frontage 1110 Sec Road Sec I Frontage Village CENTERVILLE _ _I Fire District,C O MM Sewer Acct Road Index j0566 a. Interactive Map Owner Info Owner KENNEDY, JOSEPH D &JOYCE E Co-owner Streets 13209 MORNINGSIDE DR � � Streetz city jCHESAPEAKE State VA zip 1[23321 Country!uS Land Info Acres 10.33 use iSingle Fam MDL-01I zoning IRC Nghbd�0105 Topography Level Road Paved Utilities Public Water,Gas,Septic I Location I Construction Info Building 1 of 1 Year _�� Roof Ext Built 11964 Ll struct Gable/Hip =��__I Wall IWood Shingle Effect 1977____ -- Roof IAsph/F GIs/Cmp AC one Area f cover Type Be Style;Ranch Inall Typical Rooms 3 Bedrooms Int F ..�..—.__ _ ___ Bath Model Residential Floor!- -1 Full + 1 H I Rooms Grade Average HeatTypical� Totai'6 Rooms Type I Rooms i I http://issql/intranet/propdata/PareelDetail.aspx?ID=12977 10/24/2006 Parcel Detail Page 2 of 3 Heat; Found- stories 1 Story I Gas Typical $ Fuels ation i (�_ Permit History __ _ Issue Date Purpose Permit# Amount lnsp Date Comments .- _. ----- - . ............................._...-- _.-- - I- Visit History Date Who Purpose 7/27/2001 12:00:00 AM Paul Talbot Meas/Listed L7 Sales History - Line Sale Date Owner Book/Page Sale P 1 11/15/1987 KENNEDY, JOSEPH D &JOYCE E C112862 2 ALBAN, EARL& MILDRED N C77000 3 SALL, EARL M-792 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2006 $147,500 $2,500 $0 $148,400 2 2005 $135,600 $2,500 $0 $134,500 3 2004 $110,000 $2,500 $0 $114,300 4 2003 $99,500 $2,500 $0 $44,300 5 2002 $99,500 $2,500 $0 $44,300 6 2001 $99,500 $2,500 $0 $44,300 7 2000 $65,000 $2,000 $0 $26,800 8 1999 $65,000 $2,000 $0 $26,800 9 1998 $65,000 $2,000 $0 $26,800 10 1997 $67,500 $0 $0 $20,100 11 1996 $67,500 $0 $0 $20,100 12 1995 $67,500 $0 $0 $20,100 13 1994 $62,600 $0 $0 $24,100 14 1993 $62,600 $0 $0 $24,100 15 1992 $71,400 $0 $0 $26,800 16 1991 $84,800 $0 $0 $46,900 http://issgl/intranct/propdata/ParcelDetail.aspx?ID=12977 10/24/2006 ` Parcel Detail Page 3 of 3 17 1990 $84,800 $0 $0 $46,900 18 1989 $84,800 $0 $0 $46,900 19 1988 $65,500 $0 $0 $18,900 20 1987 $65,500 $0 $0 $18,900 21 1986 $65,500 $0 $0 $18,900 Photos http://issql/Intranet/propdata/ParcelDetail.aspx?ID=12977 10/24/2006 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom MapIF Abutters Map Size ■ Zoom Ou4 1®1 1 1 J I'In R KL n t � ® JPG Map: 189 Location: { c190142 Y h ,I Owner: 44 • _ `- - '" �. > �1 � Location In 190044001 .. � � .�' ._ �:� �- Map & Parce " qi�"" Location t> 189052 #Y158 Acreage 89155F,- Y0 Current Ow -. Mailing Addi 189054 t- #142. w, Appraised I Extra Featur Out Building Land Buildings 18903100,9 189031010 *' Total Apprai x "�.. Assessed V '�, < ►. Extra Featur r ►�'` 189031011 ' # 6+ �;. 'r8 Out Building Feet;_ Land --� ram-- Buildings Total Assess Set Scale 1" =150 I � April 2001 Hi Res . �� Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment: BarnstableMA v0.2.91 [Production] http://www.town.barnstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=189054 1/23/2007 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size . ■ Zoom Out 11 1,In 'Id� Ky ® JPG Map: 189 a +lipu�rr '< Location: Owner: 1900 001 * a Location In Map & Parce Location ► Acreage Current Ow Mailing Addi ~ �,;, Appraised � `189054 Extra Featur 'A ... . # 142 Out Building Land Buildings Total Apprai Assessed V Extra Featur 189031010 20 Feelt Z4h` *., Out Building Land Buildings — I Total Assess Set Scale 1 20 jApril 2001 Hi Res ED Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment: BarnstableMA v0.2.91 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=189054 1/23/2007 ' PROP.VENT WITH CHARCOAL TOP OF FOUNDATION = 61 .8'± FINISH GRADE OVER D-BOX= 57.0 ' 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS= 57,0' - 58,5' GENERAL NOTE S PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2/° MIN. WITH COVER OVER INLET& INSPECTION PORT WITH FINISH GRADE OVER TANK EL.= RISER TO WITHIN 6"OF FINISHED GRADE 1• UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 60•8�+ ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FI FOUNDATION = 60.8''� F5" F.G. (ONE PER OUTER ROW) DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS 9"MIN. I 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 36"MAX. DESIGN ENGINEER. PROP. PVC PROP. PVC 36"MIAX. SEE NOTE 21 TOP OF SAS/B.O. = 52.93' 1.2'COUPLING 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SEWER PIPE (TYP OF 3) SYSTEM UNLESS OTHERWISE NOTED. 'IPA MIN.s�oPE �% 6�3" 2„' DROP MIN. 3�� 9" _ '+ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 3 DROP MAX. MIN.SLOPE @,% L 63 _ JOINTS(TYP.) ELEVATION =52.93' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4" PVC IN FROM EAHMHH 1.33' rO7 16" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" 57.75' SEPTIC TANK 4" PVC OUT TO 0.90' (TYP.) P) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. *58.4'± O LEACHING FACILITY CLEAN SAND 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 58'00� 48" OUTLET TEE 53.77' MIN. 6" 53.60' S2.50' �-- 51 .60' laid flat 2.875'(34.5") I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. ( ) � (STONELESS SYSTEM) � 5.0' (TYP.) I 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6"CRUSHED STONE (TYP.) 8.625' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY 5' IN. NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 10.0'TO FND COMPACTED BASE 31 2' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON AN APPROXIMATE M.S.L. DATUM OF 60.00' 6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE OVER MECHANICALLY GROUND WATER ELEV.= < 46.00' J ESTABLISHED ON A NAIL SET IN A FENCE POST AS SHOWN ON PLAN. COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET I 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS PROFILE BIODIFFUSER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6' WIDTH 5'-8" DEPTH 5�-8" (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE Precast Corp., Pocasset, MA) DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) H-20 BIODIFFUSERS TO THE DESIGN ENGINEER. CONTRACTOR TO VERIFY THIS ELEVATION 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. & REPORT TO ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE T D 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT I-,/AT� REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM HC-4 N + • • • " 13415 APPROPRIATE AUTHORITY. ,► . PERC NO. 6 W 11 : •• ' : •• f INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 0 / ••�• * ,' • • • + . { EVALUATOR: Bradley M. Bertolo, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE « ,o +► THEY SHALL WITHSTAND H-20 LOADING. Off, N ' " • • • ' C.S.E.APPROVAL DATE: 7-29-03 Q Off • ,* • • . 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ��, / • • • . � • : # � DATE: September 20, 2011 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE (4 " • • • f ra '� . • • ELEV TOP 56.00' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. •s' �' +s • • � = \ / • • • .• ,• • REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 3 e ` •• +• • •` • • ELEV WATER= <46.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). #142 •�' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN i • „• •; ,. ' w PERC RATE _ <2 min./inch U HC-3 EXISTING SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. •J��` �� • • • • • � . '• co 3-BEDROOM 00 • ` • • • • • + • �' '� I DEPTH OF PERC = 54"-72" 16. PROPOSED PROJECT IS LOCATED WITHIN: C0 DWELLING - �` «• * + • ce) - „ • +.• • • , TEXTURAL CLASS: 1 j ASSESSOR'S MAP 189 PARCEL 54 J .• • + . •' ' - OWNER OF RECORD: JOSEPH D. &JOYCE E. KENNEDY U \ HC-2 $h + ` M 60 • 0" ADDRESS: 3209 MORNINGSIDE DRIVE J 0 ^�O Hatc � . - a �, 56.00 CHESAPEAKE,VA 23321 4� (2 O •• LOCUS • E Fill ( HC-1 , • o A24 Loamy Sand '00 FEMA FLOOD ZONE C O ` '� • • ti� - - - ' • • -,.' ••• 26" 10Yr 3/2 53.83' COMMUNITY PANEL# 250001 0015 C SWING-TIES SCALE: 1"=20' 1f81 _ • o a; B Loamy Sand 17. DEED REFERENCE: LANDCOURT CERTIFICATE#112862 - 10Yr 5/6 ( 18. PLAN REFERENCE: 1.) L.C. PLAN#33466-C MAP 190 DESCRIPTION HC1 HC2 HC3 HC4 yaw- . = = • � p • 54" 51.50' 2.) PLAN BOOK 185, PAGE 117 Ilk PARCEL 44-01 #13o BIT. DRIVE tC` h� \ SEPTIC COVER IN (1) 20.7' 26.5' -- -- Y • 8D @rfy • • • .�: • Perc j 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. EXISTING � �. F� O SEPTIC COVER OUT(2) 27.2' 18.8' -- -- ♦ • • 72�� 50.00' 9 G' ti • Med.to Coarse Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY DWELLING _ c, BIODIFFUSER CORNER(3) -- -- 21.6' 46.9' 0 * . ,_ C-1 Traces of Fines FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY °�6�' .o \ O - t• ' . ' -- • • (15%gravel) FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PROPOSED ARC 36HC #3616BD H-20 <� 5� gig �' 9L O ��0' BIODIFFUSER CORNER(4) -- 30.0 50.1 2.5Y 6/6 BIODIFFUSERS COUPLING (TYP OF 3) �� ti� ,o,�i�'S'�Z` 90" 48.50' 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE BIODIFFUSER CORNER(5) 46.1 26.0 \ '9�. APPROVAL IS REQUESTED FROM 310 CMR 15.221 7 ' �o `>:. / cc 0 LOCUS PLAN Medium Sand ( )' a r�.o PROP. PVC \�1,0 \ �-q� BIODIFFUSER CORNER(6) -- -- 41.0' :1:9�2' C-2 (1.) A 2.57 WAIVER(3.00-5.57) FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. -? VENT 2.5Y 6/3 PROPOSED INSPECTIONGT SCALE: 1"= 1000' 120" 46.00' f PORT (TYP OF 2) ,�' � '� � \, 0� TP 1 �� pf, No Mottling, Standing or Weeping Observed 56 --�, sL �0, � O DESIGN DATA TEST PIT DATA LEGEND �p / ----- PERC NO. 13415 Q Q INSPECTOR: Donald Desmarais, R.S. �p 6 TP 2' row O� 8 �'` 50x0 EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 E.I.T. - - 50 - - EXISTING CONTOUR 0 i EVALUATOR: Bradley M. Bertolo, \ h 10" 12" I \ /� "`'`� \' - DESIGN FLOW 110 GAUDAY/BEDROOM 7-29-03 PROPOSED TOTAL 18 ARC 36HC (#3616BD) H-20 ho TOTAL DESIGN FLOW 330 GAUDAY C.S.E.APPROVAL DATE: BIODIFFUSERS IN FIELD CONFIGURATION / / V ` " D 447'. " 50 PROPOSED CONTOUR / 6� R`?� DATE: September20, 2011 �!H!w EXISTING OVERHEAD UTILITIES \ S� 1 �sS 88• DESIGN FLOW X 200 % = 660 GAUDAY TEST PIT#: 2 co 00 PROP. DISTRIBUTION BOX \\ �tij #142 0l� USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV TOP= 56.00' W W-- EXISTING WATER LINE 45 O� EXISTING j O 3-BEDROOM _ - ' ELEV WATER= <46.00 DWELLING OINIr1 °� GAS ----- EXISTING GAS LINE TOF = 61.8'± A PERC RATE _ INV.=58.5't S INSTALL 18 ARC 36HC (#3616BD) H-20 BIODIFFUSERS DEPTH OF PERC TEST PIT LOCATION 89°16'10"E ! = & 3 COUPLINGS Benchmark 16.20' TEXTURAL CLASS: 1 Nail in Fence o o PROPOSED 1,500 GALLON SEPTIC TANK Elev. =60.00, \ SYSTEM CAPACITY _. Approx. M.S.L. 1 c °n, PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE (TOTAL L.F. OF BIOS&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD 0" 56.00' �21 93.6')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 332.4 GAL. LEACHING/DAY PROPOSED DISTRIBUTION BOX j -�- �� w MAP 189 ( Fill PROPOSED 1,500 O� ,moo a, PARCEL 53 24" Loam Sand 54.00' PROPOSED ARC 36HC (#3616BD)BIODIFFUSER(H-20) GALLON SEPTIC TANK �OG� co M °r y C:) � TOTALS: A26" 10Yr 3/2 MAP 189 53.83' PROPOSED ARC 36HC(#3616BD)COUPLING EXIST. CESSPOOL TO ,c PARCEL 54 Z tc TOTAL NUMBER OF BIODIFFUSERS: 18 B Loamy Sand BE PUMPED & FILLED ti�,� 15,296 S.F.± TOTAL NUMBER OF COUPLINGS: 3 10Yr 5/6 WITH CLEAN SAND REV. DATE BY APP'D. DESCRIPTION �j TOTAL LEACHING AREA: 449.3 SQ.FT. TOTAL LEACHING CAPACITY: 332.4 GAL./DAY `A" 51.50' PROPOSED SEPTIC SYSTEM UPGRADE }/+ PREPARED FOR: Med. to Coarse Sand CAPEWIDE ENTERPRISES ?p ` g0 _W I NOTE: C-1 Traces of Fines EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE (15%gravel) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 2.5Y 6/6 LOCATED AT MAP 189 N "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO 90" 48.50' 142 FOX HILL ROAD z ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST PARCEL 31-10 ! MODIFIED JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. C-2 Medium Sand CENTERVILLE, MA 02632 2.5Y 6/3 SCALE: 1 INCH = 20 FT. DATE: OCTOBER 2, 2011 120" 46.00' 0 10 20 40 80 FEET NOTES: No Mottling, Standing or Weeping Observed -. < 1 o 'S�� 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM - OHN L. n ' PREPARED BY: L J COMPONENT. RESERVED FOR BOARD OF HEALTH USE c" CIviL JC ENGINEERING, INC. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING ).41807 2854 CRANBERRY HIGHWAY SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO c s EAST WAREHAM, MA 02538 ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. SITE PLAN , 508.273.0377 3.) ENTIRE LOCUS PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. SCALE: 1" =20' Drawn By: MCP Designed By: MCP Checked By:JLC JOB No. 2078