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HomeMy WebLinkAbout0058 JOYCE ANNE ROAD - Health 58 Joyce Anne Road Centerville FIR A = 209 106 I gyI�UlL. C(Fp�o2� ll/t UPC 12543 No.53LOR HASTINGS, L1N -•. ..v i ruu I INGS UNDER TO 4'0"BELOW GRADE. USE SIMPSON ASU66 POST BASE&AC6 POST CAPS l`n 6 o EXIST.11 _ BATH. 6,-0„ W DIII ¢J _ � II i _ Q _I LO I I = w o cn RE-US E I I EXIST. NEW ' ' Jc' � x y x WINDOW �I�? X c° in cv j L'DRY. I I --� a io Z C0 o Y _ 1-3 O 'NJ I o NQ EXIST. I N �C BASEMEN I ao co A W z� 2 � I LO A A2 ANDERSEN EXIST. A21 AWNING BEDROOM T-71/2" T-71/2" T-3 6 7'-3" °P I FLOOR PLAN FOOTING PLAN 26.76 28.23 _ . - -- ---- LOT 7 6 55 o S F \=� , h . sao !?K tyF- 8 NO. 58 •Sp _ . 23)8 7785 JOYCE ANN ROAD MORTGAGE LOAN IN ECTI MLl2407 SAG AMOR E SURVEY..:ASSOCIATES SCALE: 1 ''IN 60 FT. DAT AUGUST 26, 2004 `" F.0 BOX 28 s GAMORE BEACH, MA. 02562 � 08 as :8667 C. ! ;CERTIFY TO � � CHAT THE LOCATION OF THE: BUILDING. SHOWN HEREON :.CONFORMS TO THE ZONING OF THE JOWN, OF BARNSTABLE I CERTCFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD' HAZARD ZONE AS DELLNIATED ON .MAP 0005:C COMMUNITY NO.. 2'50001 PLAN REFERENCE- BARN`STABLE . REGISTRY OF':.:DEEDS REGISTRY OWNER: BOOK/PAGE PLAN BOOK 315; PAGE 022 LOT NO.: . 7 PLAN BY: BARTER AND NYE BUYER: DATED: MAY 3, 19.7.7 - THIS INSPECTION .NOT-MADE FROM AN :FNSTRUME.NT SURVEY AND IS. NOT TO... BE USED FOR FENCES,:NEDGES OR TO STABLISH LOT LINES. FOR USE OF 'BANK ONLY. Ile. A . d 4 � vi ^k t VA �.LL ?.9 ��ze exi�kig slider — 0 ji s >a :. .. . n . ,K �emo�e exisking door and N ;�; ,� ExGep-lion: �/ood skruc-�ural�p G FI��T FLOo� �'LN minimum khiGkness of 7% I`�oJp`f Of ei hk feekro( v„ maximum span permikked for apenpno� prokeG" ± . kwo-skory buildings. p'anels`s I Dover khe glAzed openings wig,,k V a&hm 4 Pimens,ons 11, �o hardware provided. TOWN OF AlDRESS Spa ,u- 6 Qd**p-14"� PERMIT# Zg INSTALLER P'h1� c-tr��� DATE OF ISSUE r; /� (�� DE�IGNERb±LPX lR200-�-t LICENSE# I CERTIFY THE SYSTEM WAS INSTALLED ACCORDING TO THE PLAN SUBMITTED WITH THE PERMIT. I CERTIFY THE SYSTEM WAS INSTALLED ACCORDING TO CHANGES APPROVED BY THE DESIGNER,REVISED PLAN FROM THE DESIGNER WILL BE SUBMITTED TO THE HEA TH DEPT. � � T� ATE INSTALLED INSUeLt&S SIGNATURE HEALTH CERTIFICATION "AS-BUILT"DIAGRAM ON REVERSE DESIGNER'S CERTIFICATION No. a_cr)oq /^ Fee • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplitatiou. for Mitpotal *potem Com6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8 6 Ya #A)A) 1e, Owner's Name,Address and Tel.No. ^ 1 Assessor's Map/Parcel ✓iC" l —� Installer's Name,Andress,and Tel.No. Designer's Name,Addres and Tel.No Ail" Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title of th nvironmental C e and not to place the system in operation until a Certifi- cate of Compliance has been i e this Bo . Sig Date Application Approved b DateL�� Application Disapproved for the following reasons Permit No. QQ,24 —� Date Issued 0 { No. Fee 3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC,HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpprtcaction for �Digpozaf *pgtemc Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .58 o �/�- #AW f Q Cj Owner's Name,Address and Tel.No. 's Map/Parcel Cam+ Assessor 4 �O9 `rQ f. Installer's Name,Address,and Tel.No. �- Designer's Name,Address and:Tel.No Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. - Plan Date NumbeT of sheets Revision Date Title a Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) - Date last inspected: _ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Titjje5 of th- nvironmental C eland not to place the system in operation until a Certifi- cate of Compliance has been i ue this Bo . Sig�ed \ Date Application Approved bye.. Date `a,� Uq Application Disapproved for the following reasons Permit No. dOm Date Issued L) O THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance. THIS IS TO CERTIFY, that the On- � 1 On-site Sewage Dispo System C°�rr cted( ) Repaired (X)Upgraded( ) Abandoned( )by '�t � r) `�C�l S at 11has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this pe shall/not not be construed as a guarantee that he syst i fu ction_as_ esigned. Date y©� Inspector i --------------------------------------- No. �C) Fee 50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSEIIS Diopozar *pgtem Construction Permit Permission is hereby gra ted to Co struct( )Y Re air(OP: r e( ) d t I n ) System located at o C`P 1A AY\ ` � l and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must1he completed within three years of the ate of this e Date:_ L� /1`�')�Q 1 I( Approved by I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION w n r � d ti ti -1,M Sao TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A �.� ' CERTIFICATION 2,!� Property Address: 58 JOYCE ANN L-A-NE CENTERVILLE 02632 Owner's Name: COSTELLO Owner's Address: 58 JOYCE ANN LANE CENTERVILLE 02632 RECEIVED Date of Inspection: 4/20/04 MAY 1 0 2004 Name of Inspector: (please'print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS TOW ABLE* HEALTH DEPT Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes X Conditionally sses _ Needs Furth valuation by the Local Approving Authority Fails Inspector's Signature: Date: 4/20/04 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti -If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sha 1 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 SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.THE DISTRIBUTION BOX IS ROTTED AND NEEDS TO BE REPLACED.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND MOVING SPRINKLER LINE. RECOMMEND RAISING COVER TO PIT AND D-BOX. ****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. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.THE DISTRIBUTION BOX IS ROTTED AND NEEDS TO BE REPLACED.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.RECOMMEND MOVING SPRINKLER LINE.RECOMMEND RAISING COVER TO PIT AND D-BOX. B. System Conditionally Passes: X 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. n/a 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 i tank as approved b with a complying septic a pp y 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a r Page 4.of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE LAST YEAR PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] . NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period`? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no s X _ Existing information. For example,a plan at the Board of Health. X _ 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)] I 5 r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of inspection: 4/20/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): Oa 02 s 130, Sump pump(yes or no): NO Last date of occupancy: n/a U b'Z4 0 0 V COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1983 PER OWNER Were sewage odors detected when arriving,at the site(yes or no): NO F Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 BUILDING SEWER(locate on site plan) Depth below grade: 54" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 48" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND MOVING SPRINKLER LINE GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 r Page 8'of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 ROTTED AND STRUCTURALLY UNSOUND AND NEEDS TO BE REPLACED.RECOMMEND RAISING COVER TO NEW D-BOX PUMP CHAMBER:_(locate on site plan) i Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9'of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE STAIN LINES INDICATE THE LIQUID LEVEL IN PITHAS BEEN 6" TO PIPE-AT THE TIME OF THE INSPECTION THE PIT HAD 3' IN IT. RECOMMEND RAISING COVER TO PIT.BOTTOM AT 13' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer:n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 9 Page•10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. IJ1� w OpCIL —U- zi AA Ac I�A poi, �ss in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 JOYCE ANN LANE CENTERVILLE 02632 Owner: COSTELLO Date of Inspection: 4/20/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATE DETERMINED FROM HAND AUGER NO WATER AT 12' t , LQCAT 'ON :! SEWA E PERMIT N0. VILLAGE CVO � - Y � a `l � INSTALLER'S NAME L ADDRESS d U I L D E R OR OWNER DATE PERMIT ISSNEQ .� DATE COMPLIANCE ISSUED 1 d co -� J No.. .:g. .- 7 '� Fxs............. y. COMMONWEALTH OF MASSACHUSE�TS BOARD-, OF HEAL I . - - ,, J 0F.:........ -------- --................................ hraition, for Did oii al Mork aastrurtion riimft �@ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage.Disposal S stem at 4f • A� 7.4 ..&..6.... ii 0.. � ess ��`/���a!4ex.g:�a4t � !� or Lo No. V ���J �!/V Owne < aA ss F o C oAa & _. -�� 1f ------------------- 'q Pq Instalte Type of Building4 tr; S'izer Lot..._..4V....Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) G f-bage Grinder aOther—Type of Building ............................ No. of persons............................ Showers O = Cafeteria ( ) Otherfixtures ----------------••---------.._..................----.......------------....._.........----•--------•--•-•-----'`-•-------------••--•------...--.------ W Design Flow............................................gallons per person per day. Total daily flow................ ..........................gallons. 9 Septic Tank—Liquid'capacityZd"...gallons Length................ Width................ Diameter;______.._..... Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... _..-_____.. Diameter......46......... Depth below inlet----�........... Total leaching area..oZ�!p....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by............----------------------------------..... Date........................................ a Test Pit No. I...............minutes per inch Depth of, Test Pit.................... Depth to ground water........................ fi Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -� "Description of Soil__�.... ..... � V -•--•---------------••-----------•-----•-----------.....-----•-------------•--••--•-•----•---•--•----•--....:.--- UW •-------------•---------•-------------=................................................................................................................................................................. Nature of Repairs or Alterations-Answer when applicable..................................................................................:............ ...................................................-...........-........................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTLi: 5 of the State''Sanitary C e The undersigned further agrees not to plac/thhe ystem in operation until a Certificate of Compliance has bee iss d by tSigned-•-•-•. •. --•---.... ....•-•-••••-••....--•-•-----•-...... ..fi Application Approved By........................... ,,- Date Applieation Disapproved for the following reasons:-----•--------••-•--------------•------------------------------------------------------------•------- -•----- .•------••----------------------------------------------------•-----•--•---•------- :....----------•-•••-••-•••-..................-•••••----......------••-•••••••••-••-------••......--••-•---•- Date PermitNo....................•--•--•-----•••-----........---.. . Issued....................................................... ----------•--•--••.................... Date No....: Fmc............................. _ THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH ApplirFation for Bispos al Works Tomil.rurtiun ami# Application is hereby made for a Permit to Construct (t")' or Repair ( ) an Individual Sewage Disposal S stem at ... ....•--- •••....•... -•-•-•--•............... I - j o io Addr ss o Lo No .... p J{ �3 - gi p ---------------- ....... � Owne� 7 (W4 r ✓ i .. 1--1 ............................ - ----•---•.................................. ..........................-------.. _....... --- •------•• •- Iustalter AddresPQ s / UType of Building Size Lot.:_.:_:.�..................Sq. feet %146Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( 6 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ...........................•--------._......--•-•-------------•••---•----•--•-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/Q"..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... .......... Diameter-------8--__-_-__ Depth below inlet-----!!�.......... Total leaching area.. ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-----------.............................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ff •- O Description of SoiLjo..":l.......................... .!!. .-- .............. ........y.. ---------­,"---------- w VNature of Repairs or Alterations—Answer when applicable................................................................................................ •. •--•---••--•--•--------•-•-•-•---••----•--•---•...........•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1,t�. 5 of the State Sanitary Code'I-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss - by t arrd h tkP • Signed........ . ............•---- -----•-• •--•-••• --_=.`.... ... « Application Approved By.............. .............. .... ....--,,.......... .. . ... ........................... ............... Date Application Disapproved for the following reasons----------------------------•-------•---------------•------------------------------------------------•----••---- .............................•------•-------•---------------••--•------------------------•-•-------------•••••--••-••--••----••--•-••----•-•••-••--•--••-------........................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ........................ ................ Trrfifirate of TomptiFanrr TH 1, TO ERTIFJ That the Individual Sewage Disposal System constructed ( "'")Jor Repaired ( ) by �...,:. --- C -. ............................ ----------- .. ..._.... w�J ,�c -- , -- at 7-.` A taller ,t. / +''d//All has been installed in accordance with the provisions of TI'" ,-. 5 of Xe S-tate Sanitary Code as described in the application for Disposal Works Construction Permit No ..... dated................................................ THE ISSUAN E 9F THIS CERTIFICATE SHALL NOT BE CONSTRII AS A GUARANTEE THAT THE SYSTEM WILL NgTION SATISFACTORY. DATE.......... -(.--•... ................................................. Inspector......... ...`--•--•••-----••------••••-----••----•••--•..............-•-.••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT .........OF..._... ....+.'. ................... ,�,2 " No.--- �..........� FEE... ............... Disposal Works 0-Fonstr ion Vprrmit Permissionis hereby granted.............................................................................................................................................. to Constr�tt (# epair ( ) an div'du 1 eve . Dispoal System "" at No..-•-. ` .. i s '`-.-. .}�t,�.l Street as shown on the applicatio for Disposal Works Construction Permit No..................... Dated............................................ - ° -•-------••------•---...---••---•-----...--•--------................. Board of Health DATE--------- 1' ............................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS V J FAMtt_Y :5 BE oRoom IIWO GAR.BAG6 6Q'P1DER. o�att_•� F1-0W Ito A 3 = `3� G.P. o. z SEPTIC *A►JK = 330x15�%:9 �95G,P. v Ico•/, 015Po5AL PIT v5E 1000 GAL_. 9 15o b.F X 2.5.E 3?5 G.Pq G '7 l 50TTOM AREA= jO 5,F• �N 50 5.1= x I 'ToTA I-. c)E516N = 4Z5 'TOTAL. DA t t-Y FI-C>W = 330 PE2COLATtDIJ RATE ] MIN 2MIN OPLLS55/ �`y 16. OF �� DODO ` / HICHARD ALAN Cyr�� S vFti' W. �7 `S A. BAXTER �' 1� JON S y No. 240484 1 S1UO�Q iJ t d �G/STERN Q' P / Q>1 4N� SUR��y ` UN A E / Q� ?� _ 1 fro �� �'S .. / • 'T6�-T I(IG TOP FNDrtoo. ' NoLt= I3.o.t4• s �r INV. 1• Ioou INV. DIST. IN./ GAL. 9✓�..3 Bp?( 5SPTIG IppO INY; /45•/ ••TANK [,tGaFT' Gc�t.. 9KS SAND`( LP Tu INV. INV. W lT4I 9s' 7 9519 1'/3/9•IYL WASNtaQ 6Tv NE 1•ZI B(E.S C1=RTI FIGD pLoT P1_AN W t� PR.OFILC= L0 A.-T►oN G�i1�r��1//L Lam- I Wo• 5 CA.I.E SCA E I' Vol .._.. A-T p L.p.t•� REF r= t4 GE I CERTIFY THAT THE �ov►��`r►0t.1 5NOww N6R6o1.1 GOMPU- j YJITN"THE S I DV--L1N G A W E SET eACK -TOWN OF SARNSYA3l-L' ANC ►S ��T 8C.3/.5•P� Z Z LOCp.TED •WITH tJ THE G DOD Pv L .tN DT AE S IG 1� SAXTsze Wye: INC. 1,5-T r--Qsry I.Au o'S u eV F- Tu15 PL&KI 15 WaT p►d AM O6TE2VILL6- � MASS• Iu5-I-R,uMEWT Su2vEY �--TNE 0Fr F-7r5 6u0vL3) ' ►.Io T D� 'v 5 E D To �ET E.�V'^I N E �.oT V 11-I E.�j �4 P P L 1 G A►-1.T.. ,C/1/Et�S�� '��Y. GO' d eed� J� Phln�e GreO ZONING SUMMARY Rd. ZONING DISTRICT: RC DISTRICT S w 01d P°5 MIN. LOT SIZE 43,560 S.F. MIN. LOT FRONTAGE 20' L MIN. LOT WIDTH 100' MIN. FRONT SETBACK 20' MIN. SIDE SETBACK 10' MIN. REAR SETBACK .10' 5° SITE IS LOCATED WITHIN ESTUARINE PROTECTION, RESOURCE PROTECTION OVERLAY AND AP DISTRICTS LOCUS S MAP /� P SCALE 1 22000'�± ASSESSORS MAP 209 PARCEL 106 LOCUS IS WITHIN FEMA FLOOD ZONE X MAP 209 PARCEL 105 PROPOSED STAKE SET (TYP) ADDITION 155. 11 ' N rn MAP 209 AC . PARCEL 106 GAS ��� 0.34 AC. MTR. h ELEC. c' ``� NMTR. ��• ��' ��_�� � v A I �Z. A pO rp Clq o N CP PJ�� MAP 209 PARCEL 107 EX o a A �N o PROPOSED ADDITION SITE PLAN OF 58 JOYCE ANNE ROAD \ZHOFMgss�c CENTERVILLE a� DANIEL yes 0� A r oJa.L,a N PREPARED FOR a No. 40980 off 508-362-4541 I �Op oar EDWARD MROCZKA S fax 508-362-9880 URVE�� Q downcape.com © qN� UR down cape engiaeermr, me. JUNE 4, 2015 REV: NOVEMBER 3, 2016 (ADDITION FOOTPRINT) Civil engineers land surveyors 1 Scale:1"= 20' 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.L.S. 15-112