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0025 LADD ROAD - Health
2- (#19) Ladd Road Centerville A= 186'— 053 J J f c Commonwealth of Massachusetts I a�;3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments MR C t 19 LADD RD 110 Mb Property Address OUTWIN Owner Owner's Name information is :r:• required for CENTERVILLE MA 02632 3-23-17 rv° every page. City/Town State Zip Code Date of Inspection 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: A. General Information When filling out S'/# forms on the computer,use 1. Inspector: only the`tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 5084204534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-23-17 Insrecto4Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board m ' 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"5��.: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-,$bt address how the system will perform in the future under the same or different conditions d1f use. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'� 19 LADD RD Property Address OUTWIN Owner Owners Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town state Zip Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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 MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. THIS REPORT CAN NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE. i 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): I E t5ins•W3 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 2 of 77 1 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owners Name information is required for CENTERVILLE MA 02632 3-23-17 every page. CitylTown ' State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by thel dbTHealth 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 heath, safety and the environment: ❑ Cesspool or privy is within 50 feet:dkwsurface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated weird'or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® 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 El ® Static liquid level in the dislifttion box abovg oretllat invert due to an overloaded or clogged SAS or cesspool ^` l.S less than 6" below invert or available volume is less El ® Liquid depth in cesspoo than'/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owners Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.]. ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 El Elthe system is located in a nitrogen,sensitive area(Interiar=~Head Protection Area—IWPA)or a mapped Zon*-aWoft public water supply well If you have answered"yes"to any question in Secti&VE the system is considered a Siqnificant threat, or answered"yes" in Section D above the large system has failed. The Winer or erator 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.:tact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsiafebe Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not . available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: + ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] st D. System Information { Residential Flow Conditions: 3 PER Number of bedrooms(design): AS-BUILT Number of bedrooms(actual): 3 t DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 . r t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1500/ 1000 TANK P.0 COMBO D-BOX AND 3 BEDROOM C-4 S.A.S Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2016---112GPD 2015--98.6 GPD Sump pump? ❑ Yes ❑ 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: t5ins•3/13 Title 5 'Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town 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): SYSTEM HAS A PUMP AS WELL t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 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: 11/17/11 PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No 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: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500/1000 PER AS BUILT Sludge depth: t5ins-3113 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 M °'r 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Citylrown 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.): THE SEPTIC TANK SIDE HAS A ZABEL FILTER THAT WE CLEANED AT TIME OF INSPECTION. i RECOMMEND PUMPING UPON TRANSFER AND AT LEAST EVERY 2-3 YRS THERE AFTER FOR MAINTENANCE. 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: le Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons , Design Flow: gallons per day Alarm present: ❑ Yes ❑ No t Alarm level: Alarm in workingorder: t El ❑' No; Date of last pumping: Date Comments(condition of alarm and float switches, etc.): J,. •^fir k *Attach copy of current pumping contract(required). Is co attached? Yes �❑!No 1 t5ins-3113 ��` . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 1 „ 19 LADD RD Property Address OUTWIN Owner Owner's Name 02632 3-23-17 information is CENTERVILLE MA required for City/Town State Zip Code Date of Inspection every page. D. System- Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert :r 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.): BOX WAS LEVEL WITH NO SIGNS OF SOLID CARRY OVER OR FAILURE 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.): PUMP AND ALARMS WERE RUN AND WERE IN WORKING ORDER AT TIME OF INSPECTION. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 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 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ROWS OF 3 CULTEC ❑ 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.): OBSERVATION PORT WAS OPENED AND C-4 CHAMBERS WERE DRY AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. Cityrrown State' Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. - City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 3-2017 If checked, date of design plan reviewed: Date 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: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 LADD RD Property Address OUTWIN Owner Owner's Name information is required for CENTERVILLE MA 02632 3-23-17 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION �� L•�D I�t SEWAGE# VILLAGE CEN R-01 t�, ASSESSOR'S MAP&PARCEL 1 •S3 INSTALLER'S NAME&PHONE NO.Xjnz,?�L0—(,j Cdc2t= SEPTIC TANK CAPACrrY�t4A-C_ L SZO ff eW p e. LEACHING FACILITY(type) �r l Lid _ (size).14/t 1.4-k-..L6 NO.OF BEDROOMS 3 ew-3 OF 2 �•. �L OWNER 62.EA�'tJl1.I C'`�"''1 t'C�c� t<e� PERMIT DATE: - I COMPLIANCE DATE: 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 Feet ' Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) _ NC�. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 7 t Feet FURNISHED BY i '.12o-rvTa� +F¢ = 10 I 0 f it 0 ' 0 I �a G zK J10 rt http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=186053&seq=1 4/11/2017 Bk 25343 Po62 ®r15393 43-28-201 1 & 01 = 29P DEED RESTRICTION WHEREAS, CHRISTOPHER M. OUTWIN and GLENNA K. OUTWIN are the owners of the land with buildings thereon located at 25 Ladd Road, Centerville, Barnstable County, Massachusetts, hereinafter referred to as "the 25 Ladd Road, Centerville premises" and being shown as Lots 2, 4 and 5 on a plan entitled "Subdivision of Land in Centerville, Massachusetts, property of John A. Akeson duly recorded in Barnstable County Registry of Deeds in Plan Book 113, Page 123; WHEREAS, CHRISTOPHER M. OUTWIN and 01-ENNA K. OUTWIN as the owners of said lot have agreed with the`town of Bamstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre- condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFOR, CHRISTOPHER M. OU'CWIN and GLENNA K. OUTWIN, hereby place the following restriction on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: I. The 25 Ladd Road, Centerville premises may have constructed upon the lot a house containing no more than three (3) bedrooms. Christopher M. Outwin and Glenna K. Outwin agree that this shall be permanent deed restriction affecting the 25 Ladd Road. Centerville premises and being shown on the plan recorded in Plan Book 113, Page 123. For title of Christopher M. Outwin and Glenna K. Outwin. see deed recorded in Book 24204. Page 176. 2. In the event the 25 Ladd Road, Centerville premises becomes serviced by Town or public sewers in the future, then this Deed Restriction shall become void and of no further force and effect: EXECUTED as a sealed instrument this ' 5 day of M JLJ-C Y L , 2011. CHRISTO ER M. OUTWIN GLENNA K. OUTWIN STATE OF C'OUN"TY OF On this adday of V 2011, before me, the undersigned notary public, personally appeared CHRISTOPHER M. OUTWIN and GLENNA K. OUTWIN, proved to me through satisfactory evidence of identification which was P�- -DL Wjq N(—, / personally known to me to be the persons whose names are signed on the preceding or attached document and acknowledged to me that they signed it voluntarily for its stated se. 'OFFICIAL SEAL" Notary Public COURTNEY A BEVENUTO NOTARY PUSUC,STATE OF IUJNOIS ` ( 1 MY COMMISSION EXPIRES MAY 10,2014 My Commission Expires: Ty 1 V (Putuin I*cd Rectnc OCT-1 R 2011 15:34 From:BORTOLOTTI CONST 084289399 Ti.:15087906304 I� P.1/1 -I QM :CiOwn Cape engineering i na FAX NO. :15083629880 ahCt. 18 2011 03',22PM P1 R "oww of :arIR.s'xa11 Vhoolaq V. Calla, Lhi-e-vior H►k141ia.w91JL}x �� I'AIXfD}Ga h'fe.-Iitll n iTtW011 ?16(1 Main tiErmaC, (lysmw�n,i��.���itl1 0 Or& 1tA IVa 4544 .'nx iqJ;' l9Q.b�I7A f atuber g,.Dexipa,ner Ctoii<icmio L sewomp PermjM �/l- © Asuess l"s .Mg0l'al,cei /00,/�z=3 A&9! 'fnsl aAfirom: 13o v /0 f)A 3 x$'�I ►J��dv X� / was is;LOd a c.'CrO t to inIlWl a (Llal�) (ir19. rl 9erfic:y3tGm a1 bAsed on a doign,drawn by M `flCl� G3B d t //3) /lk (�bx�IL y' curlitY.tlsgt+hr wpliu ,sy:sWw ediuvo.-d ooC,vr.was insUllcA 3nbstantleIly amor(4 ts) ,llc dcsip, whiull nzy iac-ITIde minoT APPTI.)\;Vj 4 iviRtcs mah sts Ider4l xNOPatjDnl Of the.. di 9t!17LUilj:L b(lX Fa 11d/cy]':ep 61L' (tittJl.C. _ I ovirity that the uopTic: ST.gtcm rufcremaed abuva wAs ao,Jif'�cd weal.wjfar efiorg04 ;a.r iy7:;Wt-r thar 1 G'la!•ovil re-Ricat i,of 1I1c SAS' or any wilical.rolooaliut of hiLY c,nm,lxmotal of tly�;,;�r�fLG BYMM)bUt w.r1rrar O.r,.rr,with�wtc T.auti.l,Rr.;ni,atimy- T"_t1u ro-Vis.o.a nT rtl0ied a- b;I,L t by dm- ipttcr 1,631Lm �AN I151- OJALA (1ltisttL 1 ;i Sigio'gPirp.) civil_ Na 40602 f' lohl/l, e� 4AIG�CT�s 8 mttsral (A Ilx�.r.-':,r(amp Hun.) —pl"I'�9l✓'.' , :n.r,l. TQ- ii I►IS.T, IIL, . FUnuc IDIVI q,�N,_.. s�� �,r.>�r:;ate . fm.-. ► -f7j TTj 00TR' klq-LLoA'ff_!o.-M U AUL Q, Cr.rdtirmtjon,P'ixin 3-26 04-dor, N 0 THIS COMMONWEALTH OF MASSACHUSETTS FEE ARD OF,, HEALTH O F ��>s I APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade (Abandon ( ) - []Complete System []Individual Components Loc ' wner's Name ��P 1 soy J Map/Parcel# 5—:5 / .. Q0 Address, �` l s Lot# Telepho e# Installer' ame / , , /� n is Name .'67 Telephone# Telephone# Type of Building: "CX / Lot Size 3-s Sq.feet Dwelling—No.of Bedrooms Garbage Grinder Other—Type of Building No.of persons Showers ( ), Cafeteria (Al) Other fixtures Design Flow( 'n.re uired)393y gpd Calculated design flow35&-9 gpd Design flow Plan: Date Number of sheets Revision Date ! / / Title Description of Soil(s) , _S Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation hl&loq DESCRIPTION OF REPAIRS OR ALTERATIONS C011 5,d1V),dOl The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe not to place the system in operation until a Certificate of Compliance has been'ssuedby the Board of Health. Signe at spections FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 2 No,. Dl/ r THE COMMONWEALTH OF MASSACHUSETTS �FEE rf) 0IDA,i v' BOARD OF H EA�LT�H CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) 3]Amplete System The undersigned hereby certify that t e Sewage Disposal System;Constructed( ),Repaired( ),Upgraded(V)Abandoned( ) t by: �(jU1644-1 at has been installed in accordance witt the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating..tplication No. dated Approved Design Flow (gpd) Installer DesignerC�A UD A. 0�` t Inspector The issuance of this certificate shall noube construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 I No.A � THE COMMONWEALTH OF MASSACHUSETTS FEE ":X� BOARD OF HEALTH ; • ;9 4 � DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby anted_rho Constru t Repair (U "pgrade (�/ ) Abandon ( ) an individual sewage disposal system at drI tr t �P1 si ��. ` / as described in the application for Disposal System Construction Permit No. / / dated Provided: Cons ruc i Ishall be completed within three years of the date of this p rrhti AJ 0c ` conditions must be met. Date Board of Health ���� . . � � FORM 2 - DSCP DEP APPROVED FORM 5/96 4 FORM 1255 (REV 5/96) H&W HORRSB WARREN'" PUBLISHERS- BOSTON k -../, 'M:y ••-l. 5 .� �T AT'.i a�T s L,,�..jM1,,�.a /J//jtf�)� //q/^r'�'.. y//_/{Js�//{(/,fir///,r��'')j. _ .' .Y`�,._�\''//A�./"`'.ti . - i No., �O 4TH�GOMM ONWEALTH OF MASSACHUSETTS FEe AR OF HEALTH r r APPLICATION FOR DISPOSAL SYSTEM, CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repairll!( ) Lz grade (4,�bandon ( `) - 0 Complete System ❑Individual Components + A41J --E�IU(� �ir!/ CJ, 1�t��`�rl!/r ��f' L; 7.� �. ( ../OL7i�a _ 01, Location .a Owner's Name '57 Aj Map/Parcel# v ddress / Telephone# f�'�)r�c�l<��•�i (_ �13_64 t 9�y)..Y3'�< , ''1rvn C,.oe, rA (YV._-tw /Installer's-Name�� I D si ner/)?0 1/�gress J Telephone# Telephone# Type of Building: P�/ C�C' iF( / Lot Size 4i3.0-40 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder Other—Type of Building No.of persons Showers ( ), Cafeteria �) Other fixtures "r Design Flow( 'n.rewired)330 gpd Calculated design flow3�• 9 gpd Design flow .rovided3�gpd Plan: Date / /9//U Number of sheets Revision Date / j /b�/� Title, t^� Description of Soil(s) GNOSIS S �1 Soil Evaluator Form /No. nl �V Name of Soil Evaluator;QQ^ P A6WG It Date of Evaluation �6 oq U?. : ' . r ( I 'I %•- j I r DESCRIPTION OF REPAIRS OR ALTERATIONS Q0/10.60 e,E. 1s,di' ?4 )/)5)o/l/ 05GO GG//Ui) ,SNP)Vtfg0,'4 C_�G`2 zt)-A ".'fir(60/) -The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. ,/ ,� / i Signed;' (� at �l /�� /� r n l q Inspections d )all FORM t - APPLICATION FOR DSCP DEP /� 'Rt©VED FORM 5/96 f ,, �' Town of Barnstable Barn Board of Health j ultaC j BARNSraaLE, m Mass. g 200 Main Street,Hyannis MA 02601 1639. �m 2007 ATFp �p OFFICE: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING RESULTS Tuesday, February 10, 2011 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing — Underground Storage Tank CONTINUED TO Jeffrey Lowery, owner— 88 Bay Road, Cotuit, MA. MARCH 8, 2011 Underground storage tank. II. Variances — Septic (Cont.): A. Linda Pinto, engineer, representing Kevin McCrea, owner— 97 Sterling Road, Hyannis, Map/Parcel 268-204, 0.23 acre lot, multiple variances, septic repair. GRANTED WITH CONDITIONS. The Board voted to approve the variances with the following condition: A) must record a four (4) bedroom deed restriction with the Barnstable County Registry of Deeds, and (2) must supply a proper copy of the recording with the Barnstable Health Division. B. Joe Henderson, Horsley Witten Group representing Town of Barnstable, owner—425 Sandy Neck Road, West Barnstable, revised plan (prior Board of Health meeting was July 2010). GRANTED WITH CONDITIONS. The Board voted to approve the revised plan dated 1/27/11 with the following conditions: 1) the building usage will not be changed to a higher use, and 2) the water use will be monitored monthly for the first two years and during the Fall of 2012, the Board will review the water use and may consider imposing parking/use restrictions. III. Variances — Septic (New): A Down Cape Engineering representing Chris and Glenna Outwin, owner— 25 Ladd Road, Centerville, Map/Parcel 186-053, 41,782 square feet lot, setback variances to wetlands. Page 1 of 3 BOH 2/10/2011 GRANTED WITH CONDITIONS. The Board voted to approve the variances with the following condition: A) must record a three (3) bedroom deed restriction with the Barnstable County Registry of Deeds, and (2) must supply a proper copy of the recording with the Barnstable Health Division. B. John O'Dea, Sullivan Engineering, representing Nathan Rudman, owner— Lot 31, portion of 40 Waterman Farm Rd, Centerville, M/P portion of 207- 091-002, 88,280 square feet lot (buildable space), actual lot size is 5.2 acres, setbacks to water bodies. GRANTED WITH CONDITIONS. The Board voted to approve with the following conditions: 1) two additional test holes will be done — one in the reserve area and one in the SAS area. 2) one new percolation test will be conducted to ensure it meets the standard criteria, 3) revise the plan to state that one foot of fill will be brought in to bring up to the five foot mark to groundwater mark, 4) a six (6) bedroom deed restriction will be recorded at the Barnstable County Registry of Deeds, and 5) a proper copy will be submitted to the Health Division. IV. Modification of Comprehensive 40B Pe rmit#2003-090 : Peter Freeman, Freeman Law Group, representing JDJ Housing Development, LLC—'The Village Green', 0 Independence Drive (formerly 770), Barnstable, Comprehensive Plan # 2003-90 Map/Parcel 332-010-001, (previously discussed Aug 2010). RECOMMENDATIONS TO BE MADE. The Board voted to approve the same letter as was sent 8/25/2010 recommending 1) the management office be constructed during the first phase of the project, 2) the office be occupied by an onsite manager during the occupancy of any rental units, 3) consider the earlier proposed elevator(s) be included back into the plan in at least one or more buildings, and (4) the refuse storage be screened from the public view with lids kept closed, and the dumpsters emptied on a frequent and regular basis. Mr. McKean said there are 60 units in each of the two phases. He said the staff recommended with such a large project, the owner should begin the rental registration process early. V. License: Disposal Works (Septic Installer): A. Warren Pena, West Falmouth, MA APPROVED. Page 2 of 3 BOH 2/10/2011 0..1 _ �� Town of Barnstable P#— l u �TW Department of Regulatory Services / BAnN6rAB1.E, ; Public Health Division Date (/ AE& a 200 Main Street,Hyannis MA 02601 Da te Scheduled 09 Time 1U r Fee Pd.)f Soil Suitability Assessment for S°eivage isposal Perfonned By:C0 r Witnessed By: Vr LOCATION& GENERAL INFORMATION Location Address /JU Owner's Name O�tw I ✓1 ��(/� Address Assessor's Map/Parcel: Engineer's Namc �Otjvl NEW CONSTRUCTION REPAIR Telephone# �_ . _ 9 N J Land Use. �` Q'N� ''� Slopes(%) v Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft r Drainage Way � ft Property Line J ft Other /w M ft SEETCHt(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) t Qftl a3 � -2 a rA Vj Parent material(geologic) ,A li Depth to Be(Iroc Depth to Groundwater: Standing Water in Hole: -Pm IN/Y4t Weeping I'r0111 Pit Face Estimated Seasonal High Groundwater _ - DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: �� -�^ S Dep Observed standing in obs.hole- a_M`f V!^- In, Depth tv spit rncottles: Depth to weeping from side of obs.hole: ..._,lm Groundwater Adjustment„_,m.,, ft. Index Well# Reading Date: Index Well level �r Adj,faetor_ Atu.(lrt�undwater Leval PERCOLATION TEST uate 6 '!<'lltte ��i9'► Observation / Hole# Tor /J Tittle it(4" Depth of Pere ✓ Time at 6" Start Pre-soak Time @ O� _ Time:(9"-V) End Pre-soak kU/ /1 Rate Min./Inch Z Site Suitability Assessment: Site Passel!— SitpFailed: Additional Testing Needed(YIN) . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) weelc prior to beginning. QaSEPTICIPERCFORM.DOC DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) (USDA Soil Color Soil Other (Munsell) Mottling (Structure,Stones;Boulders. Con istency,% ravel �EEP,OBSERVATION HOLT; t L Depth from Soil HorizonO�' Hole# Surface(in.) Soil Texture Soil Color Soil (USDA) Other (Munsell) Mottling (Structure,Stones,Boulders. Consis eUCY,%Gravel Z_ 3 d -2 - -- -e. tug- ,t , rfcd eACCL DEEP OBSER VATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Text Surface(in.) Soil Color Soil Other r (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ A p Co iste c O vel S L try l23`Z z Sy s�9 — Lvov DEEP OBSERVATION IIOLE LOG hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Sol)(USDA) (Munsell Other Mottling (Structure,Stones;Boulders, Consi ten ,v a -------------- I+lood Insurance Rate IVIaK Above 500 year flood boundary No— Yes - Within 500 year bourdary No_ Yes Within 100 year flood boundary No Yes Depth of f Naturally Occurrine]Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material's Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and ex a 'enee described in 10 CMR 15.017. Signature Q:SEPTICNPERCFORM.DOC i ` 1 4 y Town of Barnstable Barnstable r IKE T A9-AmmicaCO �AR Regulatory Services Department A L . "ASs. 11.Public Health Division �ArfD MA�° . 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 6, 2008 Christopher Outwin 1133 North Dearborn Street#2701 Chicago, IL 60610 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 19 (#25) Ladd Road, Centerville MA was inspected on December 28, 2007, by Patrick O'Connell,certified Title V Septic Inspector for the State of Massachusetts. t The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V(310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool • Liquid depth in cesspool is less than 6" below invert or available volume is less then t/2 day flow. • Any portion of the SAS, cesspool or privy is below high ground water elevation. You are-ordered to repair or replace the septic system within Sixty(60) days from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH McKean, R.S., CHO Agent of the Board of Health [ ce-r '1rs aiSo Oo0-a 103g LoSZ -;t Q:\SEPTIC\Letters Septic Inspection Failures\19 Ladd Road.doc Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 19 Ladd Road Centerville MA 02632 411� Property Address b )3 Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information 1 When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 � City/Town State Zip Code 508-428-1779 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authorityt t December 28, 2007 �In§ ector's Signature Date t, The system inspector shall submit a copy of this inspection report to the Approving uthority0oardr" of Health or DEP)within 30 days of completing this inspection. If the system is a sha d 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. 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 07.290 Outwin.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is g required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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. 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 NorthDearborn g Db St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 NorthDearborn Db St#2701, g Chica o IL 60610 December 28, 2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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. 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is g required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. CityFrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 07-290 Outwin.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, g Chica o IL 60610 December 28, 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Unknown Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 36,000 gal. _ g ( Y 9 (gpd)): 50 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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: Last date of occupancy/use: Date Other(describe): 07.290 Outwin.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1958 Were sewage odors detected when arriving at the site? ❑ Yes ® No 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 15 r Commonwealth of Massachusetts r. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 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: 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? 07-290 Outwin.doc-08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 Northg Dearborn St# 2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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): 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r— Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 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 07-290 Outwin.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 �• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: One ❑ 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.): Full to top, pit in hydraulic failure. 07-290 Outwin.doc-08/06 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection, D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One w/overflow pit. Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Block Indication of groundwater inflow ® Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Full to top. 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.): L07-290,Outwin.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 r • Commonwealth of Massachusetts Title, 5 Of-Id: Inspe{ctian o�rm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher O.utwin Owner Owner's Name information is . 1133 North Dearborn St# 2701, Chicago IL 60610 December 28, 2007 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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. \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ♦ \ \ ♦ \ ♦ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 26 Ladd Road v Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Ladd Road, Centerville MA 02632 Property Address Christopher Outwin -- Owner Owner's Name information is required for 1133 North Dearborn St#2701, Chicago IL 60610 December 28, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 4-5 feet Estimated depth to 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: Elevation of marsh abutting property. 07-290 Outwin.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF 1HE l Regulatory Services BARNSTABLE ; Thomas F. Geiler,Director MMASSM ArfD�,�p Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private,inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system.in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the``Disposal Work Construction Permit". N� If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. r TOWN OF BARNSTABLE LOCATION � b 1�. SEWAGE# J-* i- 0-7+ / VILLAGE l4_--e�( �e.LA L.L `�ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NOJ3d 2: )L� Cj�qq=1 SO Ste- "17 t SEPTIC TANK CAPACITY.=�!>eZ__4A-L• CGuf A. L S Asti/[cY� G LEACHING FACILITY: (type) `ri L cro,_ (size),"k-i-Y ._Q� NO.OF BEDROOMS OWNERCu�Ih� G'`� ctyt a���voPtc=s PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the:. _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY lo 9:0► d Dr. Christopher M. Outwin 1133 No. Dearborn St., Apt. 2701 Chicago, IL 60610 312-787-7411 "fF A rI Mr:'Thomas McKean RCS.` CHO Town of Barnstable" Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 Re: 19 (25) Ladd Road Centerville Dear Mr. McKean: We have received the order to comply relative to the Title 5 inspection conducted by Mr. Patrick M. O'Connell, as part of our preparation to place our old family cottage on the real estate market this month. The house is currently part of an estate, and when the house is sold the Septic system will be redesigned and reconstructed as necessary. In the interim it is our=undersfanding'from Mr. O'Connell that with regular pumping and cleaning the system is safe and represents no negative health or environmental impact. In addition it is our understanding that the State of Massachusetts allows two years from the date of the inspection to complete the work bringing the septic system into compliance which will be done. Sincerely, Christopher M. Outwin, Ed.D. _ Jf Administrator of the Estate of Mary M. Outwin iL r7 ^"1 G:`r cn c� FLOODZONE FNDN. DESIGN BY OTHERS � SYSTEM PROFILE PROP. FF 0 MIN. ELEVATION 12.5' PROVIDE WATERTIGHT 20" MIN. DIAM. ALL SYSTEM COMPONENTS SHALL BE 0(1` 5 Rood X / COVER TO WITHIN 6" OF FIN. GRADE MARKED WITH MAGNETIC TAPE OR �e1 x i/ (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. Rt �� ° x PROVIDE WATERTIGHT 20" MIN. DIAM. � ACCESS COVERS TO FIN. GRADE TOP FOUND. EL. 11.5' PROVIDE INSPECTION PORTS TO 2% SLOPE REQUIRED OVER SYSTEM WITHIN 3 OF FINISH GRADE 0 7'8' MINIMUM .75' OF COVER OVER PRECAST 9.5 MIN coo Q PRECAST H-10 RISERS (TYP.) MIN. 8' DIAM, PROP. TEE CULTEC #410 GEOSYNTHETIC COVER o or oe Ln 3 4"SCH40 Pvc 4"0SCH4o PVC FILTER FABRIC COVER ��r locus ._ \ PIPES LEVEL 1ST 2' OVER UNITS o .d� oy /ood * 8.7 0 7.0' 10" 2500 GAL H-20 TEE �� ch 5.75 TEE a O o� ea MONO-POUR 5 5, �aln [,on SEPTIC TANK/PC COMBO 8 2rj' St 4' LIQ. LEVEL ogo0 000Oo°° o° MIN 6" SUMP ACME OR EQUAL 000000o c 0°000°0°0°0° °c 12" MIN. INT. DIM. 0.25' 6t 0 0 0„0 0 0 ° a SEE DETAIL 8.44' 8.27' 8.0' ' '? �wo o u• •ou ..': 0• CULTEC C4 UNITS, 9 TOTAL 600 .00 OOOOOOC Nantucket 00oo00000000°o°0°O°000°c OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 24' X 12' O�O�O�OrO�o 0�0�0�0�0,,0, 6" CRUSHED STONE OR MECHANICAL (NO STONE PROPOSED) Sound COMPACTION. (15.221 [21) 5.0' FOUNDATION 19, SEPTIC TANK PUMP 96' D' BOX 4' LEACHING VARIANCES REQUESTED UNDER TOWN OF FACILITY BARNSTABLE REGULATIONS SECTION 360-1: LOCUS MAP ( 2 % SLOPE CHAMBER REDUCTION IN SETBACK, SAS TO COASTAL "MIN SCALE 1 =2000 f min. ( 1 % SLOPE) USE •G-W AT EL. 3.0 BANK (100' TO 68'), TO BVW (100' TO 79'); *ADJUST ELEV. AS NEC. TO PROVIDE PROPER COVER (TIDALLY INFLUENCED) ST/PC TO COASTAL BANK (100' TO 50'), To ASSESSORS MAP 186 PARCEL 53 OVER EXIT PIPING • BVW (100' TO 59') LOCUS IS WITHIN FEMA FLOOD ZONE A13 ELEV. 11 AS SHOWN ON COMMUNITY PANEL SYSTEM DES IGN: NOTES TEST HOLE LOGS #250001 0016D DATED 7/2/1992 GARBAGE DISPOSER IS NOT ALLOWED 1. DATUM IS NGVD 2. MUNICIPAL WATER IS EXISTING ENGINEER: ARNE H. OJALA, PE, SE DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 110 GPD 3. MINIMUM PIPE PITCH TO BE 1/8" PER Fool. WITNESS: DAVID STANTON, IRS USE A 330 GPD DESIGN ' FLOW • (HOUSE TO REMAIN 3 BEDROOMS) 4. DESIGN LOADING FOR PROPOSED PRECAST UNITS TO BE DATE: JUNE 26, 2009 ZONING SUMMARY AASHo H-22 (sT/Pc COMBINATION) PERC. RATE _ < 2 MIN/INCH SEPTIC TANK: 330 GPD (2) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. I ZONING DISTRICT: RD-1 CLASS SOILS P# 12604 USE A 1500 GAL. H=10 SEPTIC TANK s. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MIN. LOT SIZE 43,560 SF 310 CMR 15.000 (TITLE"5.) MIN. LOT FRONTAGE 20' LEACHING: 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 1 ELEV. [2 ELEV. MIN. LOT WIDTH 125 BE USED FOR LOT LINE STAKING OR ANY OTHER v MIN. FRONT SETBACK 30'. (9) CULTEC C4 UNITS IN FIELD CONFIGURATION p" 7.25 0" 7.25' MIN. SIDE', SETBACK 10' OF 3 ROWS OF 3 UNITS, FOR TOTAL OF 7?_ PURPOSE. AP Ap , MIN. REAR'SETBACK 10 LINEAL FEET. 72 L.F. x 6.7 SF/LF = 482.4 SF x 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. SL SL 0.74 = 356.9 GPD. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 10YR 3/2 10YR 3/2 WITHOUT INSPECTION BY BOARD OF HEALTH AND 12" 12" SITE IS LOCATED WITHIN RESOURCE PERMISSION OBTAINED FROM BOARD OF HEALTH. B B PROTECTION OVERLAY DISTRICT, ESTUARINE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LS LS PROTECTION DISTRICT, AP DISTRICT, AND DCPC MA DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES APPROVED DATE BOARD OF HEALTH PRIOR TO COMMENCEMENT OF WORK. 30„ 2.5Y 6/4 4 75' 30„ 2.5Y 6/4 4 75' SITE IS NOT WITHIN MESA JURISDICTION 11. ANY UNSUITABLE MATERIAL ENCOUNTERED.SHALL BE EXISTING IMPERVIOUS FOOTPRINT: 1973 SF REMOVED 5' BENEATH AND AROUND THE PROPOSED 25% MAX. ADDITIONAL = 493.25 SF LEACHING FACILITY. PERc C C TOTAL MAX. FOOTPRINT ALLOWED = 2466.25 SF BUOYANCY CALL: 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND TOTAL REMODEL FOOTPRINT 2440 SF 2500 GAL H-20 TANK. WGT: 28,000 LBS ) REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. (OK) 13. WATER FRONTAGE: 142' AT MHW; RIVER WIDTH = 54." OBS WATER 2•75' 54" OBS WATER 2.75' 11 x 6 x 62.4 x 4.58' = 18,862 LBS UP (OKAY) 225 t• AMOUNT OF NEW CONSTRUCTION WITHIN OUTER RIPARIAN ZONE: 448 SF (NONE WITHIN INNER RIPARIAN ZONE) 14. FLOODZONE FOUNDATION DESIGN AND FINAL GRADING MS MS TO BE IN ACCORDANCE WITH FEMA FLOODZONE REGULATIONS. OWNER OF RECORD 2.5Y 6/4 ,\`N. 7 02 1 3.61 BENCHMARK: USE CORNER CONC. 2.5Y 6/4 CHRIS & GLENNA OUTWIN `x�5 � APRON AT EL 7.3' x 7.39 96" 0.75 96" 0.75' Existing 3 BR � \�� �� #7'� .20 . Dwelling REFERENCES Top Fndn. = e.4' DEED BOOK 24204 PAGE 176 .46 � x 7.22 � � " First Floor = 9.5 �� �� 3.57 Provide required cover over 2 pressure line - must drain back to pump chamber (To be removed) I �!� `N I \ 9\ PLAN BOOK 113 PAGE 123 6,27.. ` °o x 6.75 TITLE 5 INSPECTION REPORT (FOR AS-BUILT OF SEPTIC \��� 9 \���\ `�� 3 x z.2s SYSTEM), DATED DECEMBER 28, 2007 Prop.ST/PC .74 \ 53 �^� } 4 `��\ x 6.35 ��\ \ 0�°ring DATUM: NGVD Exist ` \ _ _ . . _ . . _ . . _ . . _ . . � • Ex N. 75 200' off River _ ---6.10 (Outer Riparian Zone) �Ip 0 Ew t. � oqk ova ow \ e t a d / x�'67' x • �/ e 5.O�ranse ek o 7. � � \`� `•�� \�� #4x 4 PROVIDE APPROX. 84' OF 40 MIL LINER AT 5' OFF SAS 16 71+ 7 f!0. ` N, x 5.94 � \ IN AREA SHOWN (SURROUNDING PERIMETER OF SAS). x •31 TOP AT EL 8.7, BOTTOM AT EL 4.7'. ENGINEER TO �,70 ♦ 6.9 / i� ¢, Qq SUPERVISE INSTALLATION AND CERTIFY SAME. � 6 / \ ry 87 N \O.0 5' REMOVAL OF UNSUITABLE SOq REQUIRED 5 371 Prop. / Ex. Dirt \ `� 3 �.\ AROUND PERIMETER OF LEACHING FACILITY, , Parking/ \ DONM TO SUITABLE SOIL LAYER. REPLACE Ems. \ 19 / 0 , \ Add n. x 5.89re9/ \ \\ .86 3 W7HSPE CLEAN SAND, TO MEET 15.255(3) /� , Etos remain e Z7- � 5.63 `� ��\ D 7 6.48 x 6.77�, 7.47 ( \ Tran�t'15 ♦♦ ry .30 / C7 �� / x 1 �� \ . cJ' 3.26 sTCB 14 _Via• ._ .�./__.. - /_ _ \ _ �' 04 \ , - .29 Transact r� "� Prop. Sc. Porch jDR�♦, / 6.51 I \ 4.99 \ 14 ' kqP�♦,\\ Prop. dri way / \ ♦ \\ 1 90 S+ x 7.02 ° Propo ad privacy fence, elevated min. 6", 411 \� / 6.32 <1 ♦ \ �� x 6.28 �5.42 9io along estarly property line this area (or F %\ \ 6. #0 alterna ve: closely spaced evergreen plantings) �, \\ 0 \� 66 3 \ TH2 / 0 \ 5 5 x 51 j Prop vent with charcoal�il _(final placement in consultation • h Transact 13B 4.2 ♦ I homeowner) � 0 (Note: tie together all ends to vent \ TCB $2 1 7.33 1 � pipe)- 10 off Riv / .50 -7 '- Inner Riparian Zone? _ A .60 7. 5 7.11 ♦ - I x 6.24 ' ♦ J# Septic area is in area of garden Transact 12 ' .9 �' � • ' ♦ ,� ..���.r► B (5) Pasture 14 ♦�, .� 7.03 PROVIDE ACCESS COVERS TO FINISH 2 / ' Rose (Rosa GRADE 210 Carolina) Allow wide path within existing ACCESS FOR ROUTINE MAINTENANCE 6.39 1 Gal, 4' o.c. x 6.54 1 ar9a, switch to 4' outside MUST BE PROVIDED FOR ZABEL FILTER. / # .4.2 1 of lawn. Provide edging either INSTALLER MUST FOLLOW ALL � 6.5 side. MANUFACTURER'S SPECIFICATIONS FOR �. (4.33 5.73 (3) Norther PROPER FILTER INSTALLATION Transact 10 9 \C8 9 bayberry (M)rica \ \ O T NOTE: ED I GAL. RESERVE .,,, / �• pensylvanea), 3 gal, _ x 3.23 .OS \\ //////� 4' O,C. PROVIDED IN PC - - ALARM AND CONTROL PANEL / Exist. 2.93 \ \ 7 / // // // // � \TCB 8 / / // \ TO BE INSTALLED INSIDE 6" Plastic // /j / / �� BUILDING. ALARM TO BE ON Culvert . 5:20 // / / / o INV. IN 5.75' Pipe/ # \9 \ ?/Q/j////////j // °' p SEPARATE CIRCUIT FROM PUMP 2" PRESSURE LINE ° FLOAT SWITCH ALARM ON (AlOO)ABEL TER 14" TEE SLOPE TO DRAIN BACK OUTLET TEE W/EXTENSION WEEP HOLE PROP. 1T X 2' KAYAK SETTINGS: 1500 GAL. MI . PUMP ON \TCB 7 /// // /j�///���/� 57g Upland Lot Area: 5" WORKING RANGE 6" THIS SIDE OF BAFFLE CHECK MYERS SRM 4 _ \1C\0 3 /� / � 0 Wetland s of A 5„ - s.a' SUBMERSIBLE 4/10 HP PUMP Prop 4' w' Wetland Lot Area: SYSTEM (OR EQUAL) 3 PUMP OFF 12" / / /• path 4,727 sf+/- o. 0 900 sf area / / i , .(ON BLOCK) \' to remain /� 24 1 I 4 DOSES PER DAY, AT 110 GAL. PER o0 000 0 00 0 0000 unmowed 5 10 11 DOSE (5" WORKING RANGE) 6" BAFFLE . o�824C6 6 { 4 4 11��SS THIS I I 2 2500 G SEPTIC TANK/PUMP CHAMBER COMBINATION Wetland 4 ���) _ _ _ (MONO-POUR) 2.g � ���\ �== �� - - -x�i 3.s7 \ \\ x 4.1 4 �ToP ost�e ban 1 Bordering Transect5` rn # (NOT TO SCALE) 3 .P Transect 2 f -•-x 3.76 #5 -54 ag MHW - ' 2.4' . -4 . _ _ X ED�QF.R R 4 U6 PT DECKING, ?8 1.9,E Transect t 1' SPACING 2.16 ( YP) Transect i4ondWard Edge o Morsh x 72 Transact 1 1.91 TOWN LANDING/PARKING / x 2 PROP. U4 PT POSTS MARSH (TYP) I /x0.69 x1.53 x2.10 x�29 Salt Marsh Sea ar dq@ n4 Af K>f8r5s�v: (`W20 ML 4 0.06 x -0.45 x -0.39 W x 0.51 x -0.40 Proposed X-0.96 (1) 6' x 4' Float & (1) 4' y. 12' Float X-1.00 ("Dinghy Dock") X-1. x-1.08 x-1.28 - x -11.52 x-1.49 x -1.65 Prop. 10" piling (typ.) . x-1.65 x -2.12 x -1.59 x-1.83 x -2.19 x-1.85 x-2.06 x-2.32 x--i2.39 tJ EXISTING x-2.39 Ln MOORING HAULING fkLST RIG �04 T fEOp,'( E�US� EXIST. BOATS (TYP) LOCATED 8/28/09 �°P� EXOAT l0 aSITE FLAN P OF CENTERVILLE RIVER Q�P (TIDAL) 25 LADD ROAD o��° EBB FLOOD CENTERVILLE `POPS /� PREPARED FOR CHRIS & GLENNA OUTWIN off 508-362-4541 Q�'P SNOFM fax 508-362-9880 III �zNOFMAssq o�� DANIR�s9CyGpFti9ySS �� �AS� JANUARY 19, 2010 downcope.com © o`' DANiEL �� N� �` q� a� ��y REV. 1/7/11 DWELLING, GRADING . a OJ;aLA o fJANIEL yam ': o DANIELA. Gi� o A. �� CIVIL N �� m � R r; REV. 1/10/11 (PLANTINGS) A. t,�, OJALA 1-- owa Cope engineering, /TIC. OJALA ,�' q No.46502 OJALA CIVIL i t y REV. 1131/1 1 ( OH NOTES) civil engineers ND.40980 / P o �, o, _ No.40980P °� No.46502 Ion surveyors sst .s ; o F Scale: 1 = 20' 939 Main Street ( Rte 6A) }- �\ allo u vEyOg gNo�uRVEI°.; � N YARMOU THPOR T MA 02675 I-� 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. tw SHEET 1 OF 2