HomeMy WebLinkAbout0154 KATHERINE ROAD - Health 154 KATHERINE ROAD, CENTERVILLE
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Regulatory Services Department 1 . edcaft
MRNSTA.eM
MASS. Public Health Division
i639. 1�
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geller,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70081830000205008635
10/16/2009
Estate of Regina Hurley
154 Katherine Road
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 154 Katherine Road, Centerville, MA was last inspected
on September 11, 2009, by Robert A. Lannigan, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an 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
• Liquid depth in cesspool is less than 6"below invert or available volume is less
than % day flow.
You are ordered to repair or replace the septic system within Sixty(60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\154 Katherine Road.doc
y r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
E
Owner Owners Name p
information is
required fore i'�
every page. City/Town State Zip Code Date of I nspe ion
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 filling out A. General Information
,
forms to the
computer,use 1. I;�spector: -
only the tab key
to move your Ra�� r), �A)v Ai/ 6104
cursor-do not Name of In sp for
use the return ° /r �^
key. PS ��`I.�j V 61 Y \ ®14
Company Name
Company Address
City/Town State Zip Code
Telephone Number License Number
R. Certification 7
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-mNntenance;of oigite
sewage disposal systems. I am a DEP approved system inspector pursuant4to!)Section'1't.34®oaf
Title 5 (310 CMR 15.000). The system: C)
❑ Passes ❑ Conditionally Passes Is CIO
J4-
',,
❑ Needs Further Evaluation by the Local Approving Authority
fv
6 M
Ins ecto ` i nat ie p g Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or 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.
t5ins-09/08 Title 5 Official Inspection Form:Sebswface Sewage Disposal System-Page 1 of 17
A
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Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Ai 17—
Property Address
F-_7(:3` 1 �RLj�7
Owner Owner's Name
information is
required for C F N �� / L L
every page. City/Town State Zip Code Date of Insp sect on
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:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced.or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration 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):
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name
information is C
required for - 'N
every page. City/Town State Zip Code Date of Inspection r
B. Certification (cont.)
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
IQ
Property Address
S C,i Kj L
Owner Owner's Name
information is ^�
required for C''X"� 1 �� V I L`-
every page. City/Town State Zip Code Date o Inspe tion
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for 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
❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ Discharge or ponding of effluent to the surface of the ground or surface waters
--- / due to an overloaded or clogged SAS or cesspool
❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M i��( �►�`� � � � Ire � ��
J
Property Address
S p r cs w
Owner Owner's Name
information is C F>�� 191 `
required for ��
every page. City/Town State Zip Code Date of I sn pecti n
B. Certification (cont.)
Yes No
❑ [E�, 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.
❑ E< 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.
❑ [2'*' Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ,(d Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes .No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone 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.
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M I 9:671 A D`l\
Property Address 1(�� <
Owner Owner's Name '
information is C f.�c1..� lJ I L 1= M ®k16
required for 1-�- ��
every 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
❑ [�/1 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?
❑ gj� Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
I� ❑ Was the facility or dwelling inspected for signs of sewage back up?
22-' ❑ 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.
El approximation
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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage /Disposal System Form -Not ffor�Voluntary Assessments
�M TIC P'
Property Address
Owner Owner's Name
information is
required for C �:I 0 n( V/ L L O
every page. City/Town c State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
O
Does residence have a garbage grinder? ❑ Yes 2 No
Is laundry on a separate sewage system? [if yes separate inspection required] Ol-yes ❑ No
Laundry system inspected? [ Yes ❑ No
Seasonal use? ❑ Yes 0-�No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? es ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.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:
l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage��Disposal System Form - Not for Voluntary Assessments
fz
Property Address
Owner S% � (N UV.
Owner's Name
information is C F �Fn 1 L,L �.
required for N '\ V
every page. Cityfrown State Zip Code Date Of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
r
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
WIC4
Property Address
�S'Tf��' �� PF Gt N y QLJF
Owner Owner's Name
information is C'fN k L FN)J L F
required for
every page. City/Town State Zip Code Date of Inspection
D. System information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes Jo V-
Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
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:
Sludge depth:
t5ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5
M l t
Property Address p�,
f J��� 1�"(:31 W ����F )S/
Owner
Owner's Name q information is C F M�IF� V t L vF 1 103
0
required for
every page. City/Town 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
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
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
� �( � 7r�'v►-� �.l�� .� fix'E��v,��
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
tins•09/01, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not
\Jfor Voluntary Assessments
Property Address
s Gi," z
Owner Owner's Name -
information is s � ���
required for �C N`T EN UI LL IF v1
every page. Cityrrown State Zip Code Date of I pe&i n
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
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
f t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
7AT
Owner Owner's Name
information is required for C J3 'k� v J L
J� l
every page. City/Town State Zip Code Date of Inspectio
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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.):
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M C if
Property Address
CS'T A2 F g \ G
Owner Owner's Name
information is
required for
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ 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.):
Wj
N CrSC �
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
ASS ��� c Cr=
Number and configuration d
C p
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
L
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M � Ci
Property Address
S'I�I rn Gi w L)R L n/ °
Owner Owner's Name
information is �^ C /
required for \�dV��� / 9
every page. CitylTown State Zip Code Date o If spection
®. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Y �
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
R0
Property Address
S7 PFCtvj !qjL
Owner Owner's Name
information is I �L �
required for ti'�
every page. CitylTown 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:
❑ h nd-sketch in the area below
drawing attached separately
Fie -OP �OU'Z')
L4136WA1,5w)
V
4 IJ !
138
S
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
N-
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Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Dis osal System Form - Not for Voluntary Assessments
q
Property Address
'F r,-T oF QF-6 k'fjc�, QW,IF
Owner Owner's Name
information is
required for C"�—: I VL 57 lv\f Ct_
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ S rface water
Check cellar
❑ Shallow wells
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation: _
A/0 /�77 C J� Cz J 61
5
. Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
y �
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'-operty Ac H.;6ss _
Owner
Owner
information is ) Z.L
required for —�L�� � _pppp.,��
every page. City/Town State Zip Code Date of'Insp,ctibn
E. Report. Completeness Checklist
Inspection Summary:A, B, C, D, or E checked
Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
ystem Information—Estimated depth to high groundwater
Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
ooNo. 3 Fee (�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
1 ftplitation for Noposal 6pstem Construction 30ermit
l
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System 0 Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. CK
Assessor's Map/Parcel a I
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( )
Other Fixtures
Design Flow(min.required) oZ 2,c, gpd Design flow provided d
gP
Plan Date 0)p Number of sheets Revision Date
Title
Size of Septic Tank ?"o o 49-4 eeoi✓ Type of S.A.S.
Description of Soil �.y�,`jio„„
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued b this Board of Health.
Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
l
Permit No. Date Issued
OLNo. Fee
- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
;PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
. J
I application for Misposal *pstem Construction Permit ,
1 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) `Complete System El Individual Components
Location Address or Lot No. V/.Ia�•RQ• Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel-;t 8 S
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
k
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures j i 1 r
Design Flow(min.required) ca c 16, gpd �I)esign"flow provided d
Plan Date '
Number of sheets 1 Revision Date
__. Title
Size of Septic Tank Type of S.A.S. f—
Cam'
Description of Soil ,Z
c .
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. _
t e a ,Y'-) Date
Application Approved by Date
Application Disapproved by Date
v
for the following reasons
n
a Permit No. � Date Issued
------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed) Repaired( ) Upgraded( )
Abandoned( )by
at X to- G has been constructed in acc dance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer d ,,w I Designer.0,441/jo AV'./,�p.�✓'o'L /�/'
#bedrooms 149 Ei _7611-`lowwaw/4 ,pe J"114=1v Approved dJ�sign flow(� *Jaro gpd
The issuance of this permit shall not be construed as a guarantee that the system will fiio as designer
Date U (� Inspector t, 11 91 5.
---- ------- � /
---- --- --- ------------------------
No.
Fee -�.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Misposal Epstein Construction Permit
Permission is hereby granted to Construct,) Repair( ) Upgrade( ) Abandon( )
System located at � f X Z,1 C mow►,`
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:Cons iction must be completed within three years of the date of this permit.
Date ��(� /� Approved by
Town of Barnstable
N� Regulatory Services
t Thomas F. Geiler, Director
• snEu+si`asLe,
Q a Public Health Division
C7p. i63Q-
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:
Designer:--r)4VI 12 ?2 V' 1A%t0&4 Installer: it�
Address: . C45-T `)lb}4®WtC� Address: l qLe2
On 0 40 was l
issued a permit to install a
da e) (ins alter
septic system at , ` � � - based on a design drawn b
(address) y
�1a1(1 D WJD- YJ dated _.
(designer)
3~:certify that the septic system referenced above was installed substantially according to
'T1ie design, which may include minor approved changes such as later6i relocation of the
dUtribution box and/or septic tank.
r.
I cerW-Ahat the septic system referenced above was installed with'major changes
greater th `10' lateral reloeation of the SAS or any vertical:relocafion of any component
of the sepfiC_system)but in accordance with State&Local:Regdlations. Plan revision or,
Ze as-bud i by designer to follow.
s Signature) B• v
�. MASON A
No.1066
SgNlTAR�Pd
(1) er s Signature) (Affix` er,s Stamp Here)
PLEASE RETURN TO BARNSTAAE"PUBLIC.HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL' N r=<BE SSUED a UNTIL BOTH°-'TIIIS aFORM
BUILT CARD ARE RECE WED IiKTHE.BAR;NST,ABL]E PUBLIC SION
THANK YOU.
Q: Healti✓Septic/Designer Certification Form
TOWN OF BARNSTABLE
LOCATION J��//���fi�' SEWAGE#Z ®0,9 o 0,0112
VILLAGE � `��' ASSESSOR'S MAP&PARCEL v2 2
INSTALLERS NAME&PHONE NO. J�r•--7-7
M SEPTIC TANK CAPACITY 9A e-
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: � COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) ea Feet
FURNISHED BY
!4i - 3f7 � o
.Z :r 7
Town of Barnstable P o
� i
Department of Regulatory Services
Public Health Division
�Ar�D MAt�n6� 200 Main StTeet,Hyannis MA 02601 Date
Date Scheduled
Time J&ia-7 Fee Pd.
•
Soil Suitability Ass ssment o
y a7u��11 D �. 1N1 ��e�� Sewage zspos Z
Performed By: y. ✓`
Witnessed B
Location Address�sl� LOCATION & GENE A
fib. c�R I'INFOR. ? MATION
NRMA ame GP c�
/ivy *b/, y .
q �� Address�rs�oT�fiar�,n,�,sZa
Assessor's Map/Parcel: o`
1. Engineer's Name 4n4 O�S'
NEW CONSTRUCTION REPAIR �_
-
Land Use
Slopes(Ro) Surface Stones
Distances from: Open Water Body possible Wet Area
----___ft Drinking Water Well ___ft
Drainage Way ft Property Line
_ ft Other ft
SEETCH:(Street name,dimensions of lot,exact locations of test holes&.pert tests,1 ate wcT ds-rA-p ximity to holes)
lNJ't
w r
rn
21
Parent material(geologic)
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Il`N
Weeping from Pit Pace
Estimated Seasonal High Groundwater T
DETERMINATI
Method Used: ON FOR SEASONAL HIGH WATER TABLE
Depth Observed standing in obs.hole:
Depth to Weeping in. Depth ro soll motth s:
p' g from side of obs.hole: in,
Index Well# Readin Date: In, Groundwater Adjdstment
g In Well level^ Adj.factor �� - ft.
Adj.Groundwater Lcvel
Observation PERCOLATION TEST buc�
Hole#t "_ -^ Time—
Time at 9,,
Depth of Pere -
Time,at G"
Start Pre-soak Time @
Time(9" 6")
_ End Pre-soak
Rate Min./Inch � —
Site Suitability Asscssment Site Passed
Site Failed:_ Additional Testing Needed(Y/N)
Original: Public Health',p;vision 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. Y
Q:\S EPTiCU'ERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# .Depth from Soil Horizon Soil Texture ,Soil Color Soil.
Surface(in.) (USDA) Other
(Munsell) Mottling (Structure,Stones;Boulders.
on istenc % ,rtvel
. �
J lO I 2
Z. -172-
DEEP OBSERVATION
Depth tram HOLE LOG Hole#
P Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
nsistency.%Grave. l) _
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
_ (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
CP115i2tericy,c1 Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Consi ten I
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No— Yes 11Z
Depth of Naturally Occurring Pervious Material
-Does at least four feet of naturally occurring pervi uterial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not, what is the depth*of na urally occurring pervi us material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of,Dnviron ental Protection and that the above analysis was performed by me consistent with
the.required t fining,ex ti n e p 'ence described in 310 CMR 15.017.
Signature Date 1� �Z 2v0
Q4S.fl PT1 CAPER C rO R M.D O C
S�; Commonwealth of Massachusetts
Executive Office of Enviroiunental Affairs
Dept. of Environmental Protection
One winter Street,Boston,Ma. 02108 Jolui Gi�ci_
D.E.P. Ti o .Septic it S or
ox2119 ; �
T et, MA O 536
WILLIAM F.WELD O8)56,,
Governor NO /
ARGEO PAUL CELLUCCI V C nn
Lt.Governor SUBSURFACE
�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORvat N
PART A
CERTIFICATION
Q 1
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58 Address of Owner:
Date of Inspection: 10/29/98 (If different)
Name of Inspector: JOHN GRACI MARION E.MEREK;C/O JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000)
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
x Passes This Inspection Is based on criteria defined In Title V
code 310 CMR 16.303.my findings are of how the system is
_ Conditionally Passes performing at the time of the Inspection.My Inspection does
_ Needs rt er Evaluation By the Local Approving Authority not Impyany warranty or guarantee of the longevhyofthe
Falls septic system and any of Its components useful life.
Inspector's Signature: Date: 1imog
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system s a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair,passes inspection.
Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, Is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised W27)97)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
TOWN 13NSTABLE
LOCATIONK0bD4((\1- SEWAGE #
VILLAGE C Yr ASSESSOR'S MAP & LO J 0
INSTALLER'S NAME dt PHONE NO.
SEPTIC TANK CAPACITY a
LEACHING FACMrrY: (type) l (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMrrDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlan s exist
within 300 feet of leaching facility) Feet
Furnished by 4a
. 9 44
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;C10 JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10/29198
_ Sewage backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken.
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
—The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must Indicate either"Yes"or"No"as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an 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
cesspool.
SAS is in hydraulic failure.
(revlsed 04117)971
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;CIO JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10129199
D] SYSTEM FAILS(continued)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revlsed 04127197)
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;CIO JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10/29198
Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following:
,c_ — Pumping information was requested of the owner, occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
— flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this
inspection.
x As built plans have been obtained and examined. Note if they are not available with N/A.
x — The facility or dwelling was inspected for signs of sewage back-up.
x — The system does not receive non-sanitary or industrial waste flow.
_c_ — The site was inspected for signs of breakout.
x All system components, excluding the Soil Absorption System, have been located on the site.
x The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected
for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is
— — unacceptable)(16.302(3)(b)]
(revised 04127197)
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;C10 JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10129199
FLOW CONDITIONS
RESIDENTIAL:
Design flow: o g.p.d./bedroom for S.A.S.
Number of bedrooms: 2
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings, if available:(last two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: 2MONTHSAGo
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:o gallons/day
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: n1a
Last date of occupancy: n1a
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Na
System pumped as part of inspection: (yes or no)Les
If yes,volume pumped: 1300 gallons
Reason for pumping: MAINTENANCE
TYPE OF SYSTEM
Septic tank/distribution box/soil absorptions system
x Single cesspool
x Overflow cesspool
Privy
Shared system(yes or no).( if yes, attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components,date Installed(if known)and source Information:
SYSTEM IS 30 YEARS AGO.
Sewage odors detected when arriving at the site: (yes or no) No
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;CIO JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10129198
SEPTIC TANK:
(locate on site plan)
Depth below grade: Na
Material of construction: concreate metal FRP Polyethylene—other(explain)
If tank is metal, list age nra . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: Na
Sludge depth:Na
Distance from top of sludge to bottom of outlet tee or baffle: Na
Scum thickness:Na
Distance from top of scum to top of outlet tee or baffle:Na
Distance form bottom of scum to bottom of outlet tee or baffle: rda
How dimensions were determined: Na
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
Na
GREASE TRAP:
(locate on site plan)
Depth below grade: Na
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: Na
Scum thickness:Na
Distance from top of scum to top of outlet tee or baffle:Na
Distance from bottom of scum to bottom of outlet tee or baffle: Na
Date of last pumping;,r.
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
Na
BUILDING SEWER:
(Locate on srte plan)
Depth below grade: 2.6"
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction line TOWN
Diameter: Na
Qmments: (conditions of joints,venting,evidence of leakage, etc.)
(revisedO 27M)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;CIO JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10129199
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: Na
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: n1a
Capacity: Na gallons
Design flow: Na gallons/day
Alarm level:_nla Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Na
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
Na
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)_vaa
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
Na
(revlsad 04f1T)971
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
Owner: MARION E.MEREK;CIO JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
Date of Inspection:10f29198
SOIL ABSORPTION SYSTEM (SAS):x
(locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Na
Type:
leaching pits,number: rva
leaching chambers, number:Na
leaching galleries, number: Na
leaching trenches, number,length: Na
leaching fields,number, dimensions:Na
overflow cesspool,number:5'xs'BLOCK
Alternate system: Na Name of Technology._Na
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT HAD 2'OF LEACHING LEFT AT THE TIME OF THE INSPECTION.RECOMMEND PUMPING EVER YEAR.
CESSPOOLS:x
(locate on site plan)
Number and configuration: ONE
Depth-top of liquid to inlet invert: 6"
Depth of solids layer: 2"
Depth of scum layer: 3"
Dimensions of cesspool: 5'x5'
Materials of construction: BLOCK
Indication of groundwater: Na
inflow(cesspool must be pumped as part of inspection)
Na
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
MAIN CESSPOOLS AND ALL COMPONENTS ARE STRUCTURALL SOUND.RECOMMEND PUMPING SYSTEM EVERYYEAR.
PRIVY:
(locate on site plan)
Materials of construction: Na Dimensions: Na
Depth of solids: Na
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Na
(revlaed 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
154 KATHERINE RD.CENTERVILLE MAP 228 PAR 58
MARION E.MEREK;CIO JANET HILDEBRANDT;240 N.MAIN ST.S.YARMOUTH
10129/99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
ov 3%
(rev1eed04)2719T) Page f of 10
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
154 KATHERINE RD.CENTERVILLE MAP 229 PAR 58
MARION E.MEREK;C/O JANET HILDEBRANDT;246 N.MAIN ST.S.YARMOUTH
10129199
Depth of groundwater 12
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS MAPS AND CHARTS
(revleedGMT19T) page 10 of 10
EXISTING BASEMENT PLAN 4u — 1 FT.
TOWN OF- B,41NISTABLE
4,—rJa
UP
'-3°
6'-4d
1 CRAWL SPACE
I r,-4a r/—Aa
'-102` T-4a
24 GARAGE SLAB - - - �
ABOVE
I
/ a P
26 —4 I 2 '
3'—10 a—�--4,_4 d
- -- - 2
BASEMENT
1 '
El
EXISTING
C) WATER
HEATER AND
FURNACE
4
36'
EXISTING BASEMENT PLAN, DWG.NO. 1 54KAT -1 A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST.■ CENTERVILLE, MA n ARCHITECTURE AND CUSTOM BUILDING
SCALE = 1 FT.(1 :4B) DATE : 27TH OCT 201 1
3282 MAIN 5T. BARN 6TAB LE. MAaencHuSETre 02630 TEL. 508 362 9500
EXISTING FIRST FLOOR PLAN q l) - 1 FT.
33'-4° 3'
EXISTING 32X52 EXISTING 32X52
DOUBLE HUNG
DOUBLE HUNG
WINDOW WINDOW
a TM
KITCHEN r n-� ET
�j DINING AREA BEDROOM 2
11' EXISTING 32X52
DOUBLE HUNG
WINDOW
-6# GARAGE
2# EXISTING N T
32X52 DOUBLE
HUNG WINDOW LIP E E 2 '
IA7
EXISTING 32X52
DOUBLE
CLOSET WINDOW HUNG
LIVING ROOM
BEDRODM 1
C OSE
14'
EXISTING 914 EXISTING 614 lil
X52 DOUBLE X52 DOUBLE 3
HUNG WINDOW HUNG WINDOW
EXISTING FIRST FLOOR PLAN, DWG.NO. 1 54KAT - 2A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA SCALE 4n = 1 F-T.(1 :48) DATE : 27TH 0CT 201 1 ARCHITECTURE AND CUSTOM BUILDING
32B2 MAIN ST, BARNSTABLE, MASSACHUSETTS 02630 TEL. SOB 362 9500
EXISTING SECOND FLOOR PLAN q — 1 FT.
35'-3d
— — _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ p�g�O la� __ EXISTING 32X52
-£7-E DOUBLE HUNG
A WINDOW
GARAGE SLAB EXISTING DOUBLE 13'-4Z"
ABOVE HUNG WINDOW
ExISTING 32x52
DOUBLE HUNG
W WINDOW
s
EXISTING SECOND FLOOR PLAN, DWG.NO. 1 54KAT -3A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE. MA n — ARCHITECTURE AND CUSTOM BUILDING
SCALE — 1 FTA 1 :46) DATE : 27TH OCT 201 1
3282 MAIN ST, BARN STABLE, MA96A6NU SETTS 02630 TEL. SOB 362 9500
F
a
_ _ - _ _ _ _ _ _ - _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ __ _ _ __ _ _ _ _ __ _ _ _ _ __ -_
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- - - - -- - - - - -- - - - - - �
I II II
II II
L - - - - - - -- - - - - - - - - I I
II II
II II
EXISTING FRONT ELEVATION - 1 FT. I L - - - - - - - - - - -- - - - - - -- - - - - -- -- - - -- -- - - -- - - -- -- -- J I
4 L- - - - -- - - - - - - - - - - - - -- - - - - - - -- - - - - - - - -- - - - - - - - - - - J
EXISTING FRONT ELEVATION PLAN. DWG.N0. 1 54KAT -4A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA SCALE 4n = 1 FT.(1 :4B) DATE : 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST. BARNSTABLE, MASSACHUSETTS 02630 TEL. 50B 362 9500
. ,..,,ter...
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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f- - - - - - - - - - - - - - - - �
EXISTING REAR ELEVATION - 1 FT.
EXISTING REAR ELEVATION, DWG.NO. 1 54KAT -5A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA SCALE = 1 F'T.(1 :4B) DATE 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST, BARNSTASLE, MA55ACHUSETTS 02630 TEL. 508 362 9500
( 1
PROPOSED BASEMENT PLAN 4 — 1 FT.
6'-416a
/-61516a I�/— Z�
� ( � I EXISTING
32/—1'7a BASEMENT 4/—5tl
ACCESS STAIRS
REMOVED D
3'-3 9 3'-4111 AREA SACKFILLED
7/ /7/;f
EXISTING DOOR T-4'
OPENING INFILLED 8
WITH 1 O° BLOCKWORK
/-3tl
6'-4a
EXISTING DOORS
RELOCATED WITH NEW
34'-4p STAIR AND OPENING rf /
IN EXISTING C
1 f C RAWL SPACE BASEMENT
NEW 4° WASTE i,•
CONECTS TO EXISTI Jr. `•
—4a I 6/-4a
/// •r'':
NEW 4' X 1 B° ACCtSS
CUT INTO EXISTI W BASEMENT 2
FOUNDATION Wp(LL
�_ 4/ z" 7'-4p
— �
GARAGE SLAB - � � -- -
ABOVE NO /
EXCAVA ION//
/ NEW CRA DEEP . G' 26'-4° P I I 8� 2 '
WIDE BY 3 10 —I---4 4
I I_ 9 /_ tl /I— a
1 / / 2
/ NEW 2X4 WALLS
NO WITH 1n SHEETROCK
EXCAVATION TO OUTSIDE TO .
SURROUND STAIR
AND SUPPORT WALLSNEW
ABOVE
NOTE:
� T/,� / ADJACENT
EXCAVATION
TO CHIMNEY
/ WIDTH SCARE E EXISTIN S El V\
CHIMNE r
B G -E)
/ ABOVE
EXISTING N W
WATER
HEATER AND STAI TO
FURNACE FI ST
Yw
12.•/ 1 a
—4
14 J
ADDITION FOUNDATION, 5' DEEP,1 0° R/C
WALLS WITH 24" X 1 0° STRIP FOOTING PROVIDE
2003 CONT. HORIZ. BARS, FOOTING WITH NOTE: GAS METER
KEYWAY. LAP TOP BARS TO MAIN WALLS BARS ABOVE HERE
PROVIDE ANCHOR BOLTS AT OA1 ❑.D. MAx. PROPOSED BASEMENT PLAN,
DWG.NO. 1 54KAT -1 1 B MACKENZIE BETTY ASSOCIATES
154 KATHERINE ST., CENTERVILLE, MA SCALE q� = 1 FT.(1 :48) DATE : 1 OTH N OV 20 1 1 ARCHITECTURE AND CUSTOM BUILDING
32B2 MAIN ST, BARN STAB LE. MA69A13HL19ET79 02630 TEL. 506 362 9500
NEW DECK, RAIL
D STEPS FROM
FT'113'LUMBER, 2#SONOTUBES P RQ PO S E D FIRST FLOOR PLAN 41I _ 1 FT
I - �-1116
NEW DECK, RAIL
AND STEPS FROM 1 3"
.3 EXISTING 2X5 _5 EXISTING BAY NEW DOWN EXISTING 32X52
PT LUMBER, 2# v WINDOW PIPE FROM DOUBLE HUNG
n DOUBLE HUNG
1 0 5ONOTUBES WINDOW REMOV EXISTING DOOR NEW DOUBLE / REMOVED 2ND TO WINDOW
REMOVED HUNG WINDOWS N W PATIO DOORS I I BASEMENT
rn
Q TACKIN
'VPAS HISH ER � m XI WALL,
I J DRYE
WABHEcl
\A
NEW 20 MIN. I W EMOVED) I EXISTING
32 x 70 ooDR -
Z I 1 S'-lp SHOWER
_ CUP'()
3' 7
KITCHEN I I I NEW Z BAT ROO EXISTIN
LAUNDRY CLOSET NEW BASEMEN
RAISED CEILING I DIMING AREA A CESS, WITH
NEW BULKHEA
BETWEEN D ORS
DORMERS
EXISTING X
I EXI5 NG DOUBLE HUNG
CL❑ T WINDOW
tVE14'-11�-"I 7
Z 11 BEDROOM Z
1 1 1 �\REhYODVED?
FRIDG
FREEZE
GARAGE —I— 1 1 EXISTING_ WALLREMOVED
- -_ NEW BEAM -
1 EXISTING WALL REMOVED 12/-5 l4"
NEW 20 MIN. 1 1 1 I '
32x70 DOOR I 1F/C7,3n I 1
NEW OAK FLOOR TO /
MIATCH EXISTING OVER I INIrW
NEW CRAWL SPACE o REMOVED STAI TO
ST
AIRS T^,A, S MOVED BASE ENT
rAND NEW BEAM ADDED,
FLOOR FILLED IN
m — — — —
D
2" I I Z * I EXISTING 3Zx52
7'-3 0 f CHIMNEY LIVING ROOM EXISTINGDOUBLE HUNG
P WDE EN RANG = a i CLOSET WINDOW
J U Z o N w BEDROOM 1
ROOM STAIR TO
Z p SE ND
pm 1
F/C 7'3"
1
VOID OVE 1
�L1�J C L L1�J I ENTRANC I EXISTIN
. 3" �-�'� " I CLOSET
8^ GAs
1 A i METER -
't EXISTING B'4 " EXISTING 8'4 "
X52 DOUBLE
X52 DOUBLE
HUNG WINDOW NEW PORCH HUNG WINDOW
cl
PROPOSED FIRST FLOOR PLAN, DWG.NO. 1 54KAT -1 2C MACKENZIE BETTY ASSOCIATES
154 KATHERINE ST., CENTERVILLE, MA SCALE 1" = 1FT.(1 :4e) ARCHITECTURE AND CUSTOM BUILDING
q DATE : 1 OTH N OV 20 1 1
3282 MAIN ST, BARN 6TAB LE. MAfi SACNLI5ETT5 02630 TEL. 508 362 9500
PROPOSED SECOND FLOOR PLAN _III _ 1 FT.
f2'-21 1
7
RAIL, AND SHELF
0
- - - I I WALK THROUGH
- - - - -- - - -E3-AM I.BQt71- -- - - -
-- rt' �G'L-oS-Er- - - -- -
- - - - - - - - - - - - - - - - - -- - - - - - - -
KNEE WALL REMOVED
NEW DORMER � EXISTING
IN XISTING ROOF I RAIL AND SHELF Z KNEE
IL
J _ WALL
O TUB SH ER S AT 0 W J
H NGI G N G I
—_
— —— —— — — —— — —ram— — — — — —— — — — — — — —— — — — — — EXISTIN 32X52
BEDROOM WNUDO HUNG
3
EXISTING DOUBLE
HUNG WINDOW
OLD STA IRS REMOVED EXISTING 32X52
AN — — — — —— — — —— — — —
D NEW EAM ADDED, DOUBLE dUNG
— � --rL TT- T'LT.€13 fIT WINDOW
\ - \ OFFICE
\ ( CL SET p I E EXISTING SLOPING
\\
NEW IV ROOF \
EXISTING SLOPING STAIRS \
CEILING ABOVE
CEILING ABOVE / \
NEW D RMER
EXISTING KNEE WALL EXISTING KNEE WALL
iff===4
CHIMNEY ATTIC ATTIC
Vol1. OVER STAIRS SHELF
i
i
PROPOSED SECOND FLOOR PLAN, DWG.NO. 1 54KAT -1 3C MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA II ARCHITECTURE AND CUSTOM BUILDING
SCALE = 1 Ff.(1 :48) DATE : 1 5TH NOV ZO 1 1
2282 MAIN 5T, BARN STABLE. MA6 BACHIl9ETTS 026313 TEL. 508 362 9500
ASSESSORS MAP : ����
TEST HOLE LOGS
PARCEL: 519 NOTES:
FLOOD ZONE: �o% / �1C� � SO I L EVALUATOR -'
VALUATOR :
WITNES��Ayl REFERENCE: e a77 /5I 717� 7 C }- DATE : jLY'.�� - 1) The installation shall comply with Title V and Town of Barnstable Board of
Health Regulations.
`p ,ofZe L-f �► 1 ' i>l�y PERCOLATION RATE: 2) The installer shall verify the location of utilities, sewer inverts and septic
components prior to installation and setting base elevations.
TH- I TH-2 3 All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"
) g' Y P p P g per foot. The first
W b 3149 two feet out of the d-box to the leaching shall be level.
_ l 4) This plan is not to be utilized for property line determination nor any other
purpose other than the proposed system installation.
�►�.,1�t � � ��� � � F� 5 Alimse tic components must Y
) p p st meet Title V specifications.
LOCATION MAP 32� 6) Parking shall not be constructed over H 10 septic components.
7) The property is bounded by property corners and property lines.
�11 6INA 8) The property owner shall review design considerations to approve of total
` design flow and number of bedrooms to be considered for design. Receipt
t
d of payment for the plan and installation based on the plan shall be deemed
C-7/Z
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with
g p clean sand per
Title V specs.
I Z_7 10)System components to be 10 feet from water line. Sewer lines crossing the
SEPTIC SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
/ applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
_ FLOW ESTIMATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the
��??
owner to ensure such.
d
BEDROOMS AT j GAL/DAY/BEDROOM - ZZD GAL/DAY 12)The installer is to take caution in excavation around the gas line if such
exists.
f/D,0 SEPTIC TANK 13)The installer shall verify the location, quantity and elevation of the sewer
lines exiting the dwelling prior to the installation.
2ZOGAL/DAY x 2 DAYS - 41-0 GAL ___
USE ( GALLON SEPTIC TANK
�4,wff-pc,
r /��'' 1 D IL ABSORPTION SYSTEM
ja 'Ix e>
-. 'r' I 1 -1A P.( �--✓-y,/a"`7 / �. l F L �^..f � � �,�{�. � �.ar" .I).- J'jjJJ/pJJ _��'�..1 l 1 9 i✓`aE..V�... �t!./✓,i�� �Z„��. ��w��.. Y OF--j—t
S I DE AREA: 2- �( 2�I -i" ra Z X 0 ,`7
f BOTTOM AREA: 2 r Y� C,�,'T - s 06P itsc'
LAR_
IC SYSTEM SECT1.ON ;c Z_ i 0q- n L
H o,, o,vO ice"
ff\6_R(O
W
�,Z
L.�-sraa b � a1'-._I_���_'y�bvi$L 4ta6MV �I
L
IL GAL
C SEPTIC TANK �
5,�1tLa_� ._. � r �c� ____ ' .Zo' _ - � ' '2 '� 11 �I► SITE AND SEWAGE PLAN
LOCATION :
(fEc^..,rr ��oC.�t..�
PREPARED FOR g C5
M
0
14t%J 15 r414
SCALE:
DAV I D B . MASON TZ5 DATE:I0 'Z
DBC ENVIRONMENTAL DESIGNS
EAST SANDWICH . MA
3 DATE HEALTH AGENT ( SOS ) 833- 2177
Z