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HomeMy WebLinkAbout0036 LAKEVIEW DRIVE - Health '36 Lakeview Drive a Centerville l I, Commonwealth of Massachusetts 5 Official I�nslpection Form Title L Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r ( G e yr e' ✓ y� n , Property Address Owner owners Name :��:Jc�— information is C � ✓!/r l�Q State Co Date in ection required for Cityrrown every page. not be altered in any Inspection results must be submitted'�t at theis oend of the form. Important: may way. Please see completeness c Important: A. General Information When filling out I � 3 fortes on the , computer,use Inspector: only the tab key to move your cursor-do not Name of Inspector✓ use the return /0 LG key. Company Nam Company Address /0 ------- Zip Code State Town � °YQ- Number License Number Telephone Num r B. Certification sposal sstem at this address d that the I certify that I have personally inspected,th accun�te and sewaged condplete as of the time of the inspection.titon.The inspe tiion U.An site �� information reported below is true, stem inspector pursuant to Section 15.340 of s erformed based on my training andl experience in the proper function and maintenance o 0 Iwa P rove y g= rT!itle wage disposal systems. I am a DEP alp 5(310 CMR 15.000). The system: Conditionally Passes ❑ Fails Passes ' the!Local Approving Authority ❑ Needs Further Evaluation by 4a Date Inspe6sigre Approving Authority(Board of this report to the App 9 The system inspector shall submit a copy of i stem is a shared system or l t this inspection. If the system of Health or DEP)within 30 days of comp 9m owner shall flow of 1t the 0,000 gpd or greater, the inspector oan and should be sent to the system owner has a design report to the appropriate regional offQ bl f th and the approving authority. and copies sent to the buyer, if app . er **** only describes conditi' ns at the time of in ps stem wil and ) perform n the future undeconditions of r This report Y at that time.This inspection does of address how the same or different conditions o use. { 1 of 17 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page tsins•MOS Commonwealth of Massachuse#s • • ect�on Form lugTitle 5 official �n� orm .Not for Voluntary Assessments Subsurface Sewage Disposal System 3 G Property Address I✓`'►OG Owner owner's Name 1_ 0o� information is �e✓t t2✓117 l��` State Zip Code Date f I pection required for Cityrrown every page. B. Certification (cont.) CD or E I always complete all of Section D Inspection Summary: Check A,B, A) System sses: I have not found any information which indicate tthnat any of the eaaunotcevaluated areriteria a in 310 CMR 15.303 or in 310 CMR 15.304 exis Y indicated below. Comments: B) System Conditionally Passes: completion of the replacement or repair, as approved by ❑ One or more system components as described in the"Conditional Pass" section need to e replaced or repaired. The system, upon p the Board of Health, will pass. " "no" or"not determined" (Y, N, ND)for the following statements. If"not Check the box for"yes . determined," please explain. hether metal or not)is The septic tank is metal and over 20 years old' or t tion or exfitVat on or septic tank v tank failure its imminent. System structurally unsound, exhibits substa6tlal infiltration roved by the will pass inspection if the existing tank is replaced with a complying septic tank as approved Board of Health. ection if it is structurally sound, is avai atbleaking and if a Certificate of A metal septic tank will pass insp Compliance indicating that the tank is less than 20 y ❑ Y ❑ N ❑ ND(explain below): i Title 5 official inspection Form:Subsurface Sewage Dispo�System.Pageof t7 (sins•OW8 Commonwealth of Massachusetts Title Official InsPoection Form lugSubsurface Sewage Disposal System'; m • Not for Voluntary Assessments Property Address �, ✓t'10 v/ / Owner Owner's Name I 3a T /l information is Cevi ✓V6& Zip Code Dat of j spection State required-for City/Town every page. B. Certification (cont.) B) System Conditionally Passes,(font.): ❑ Observat ion of sewage backup n, settle or of break out or high static water neven distribution box. System will to broken or obstructed pipe(s)or; due to a broke pass inspection if (with approval ibf Board of Health): ❑ Y ❑ N ❑ ND (Explain below): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed '. or replaced ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled, n m6re than 4 times a year due to broken or obstructed pipe(s).The ❑ The system required pumping of the Board of Health): system will pass inspection if(with approval ❑ Y ❑ N ❑ ND (Explain below): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed C) Further Evaluation is Required'by the Board of Health: Health in order to determine if ❑ Conditions exist which require futther evaluation by the Board onment. of the system is failing to protect public health, safety or the enviro 1. System will pass unless Board of Health determines manner which will protect1public health, 15.303(1)(b)that the system is►not functioning 9 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 p Pa 3of17 Title 5 official Inspection form:Subsurface sewage Disposal System• 9e t5ins•OW08 Commonwealth of Massachusetgts Title 5 official Int ection Form Subsurface Sewage Disposal System is -Not for Voluntary Assessments ,r Property Address / / DI w)p�GY l Owner Owner's Name Da 3 information is ,��e✓v7`le- required for State Zip Code ]ate o In ec'on every page. Cityrrown B. certification (cont.) 2. System will fail unless thel8oard 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 suppl�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�sA�and the SAS is less than 100 feet but 50 feet or more from a private water supply) Method used to determine distanbe: **This system passes if the well water analysis, performed at a D nd certified nitrogen ory,for equal oior� bacteria indicates absent and the presence of ammonia nitrogen a of the analysiseq must r less than 5 ppm, provided that no other failure criteria are triggered. A copy 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 L"J clogged SAS of cesspool Discharge or pbnding of effluent to the surface of the ground or surface waters ❑ u due to an overibaded or clogged SAS or cesspool Static liquid levl in the distribution box above outlet invert due to an overloaded Cl 3/ or clogged SA$ or cesspool Liquid depth in cesspool is less than 9" below invert or available volume is less ❑ LJLU than '/z day flo,, Tale 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 t5 ns•owe Commonwealth of MassachUS005 0=12 Titl e 5 official Ins Pection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments property Address Owner Owner's Name Ce / _r�l//�information is o /-� State Zip Code 0 e o Inspection required for city/Town every page. B. Certification (cont.) Yes No `. Required pumoing more than 4 times in the last year NOT due to clogged or ❑ obstructed pipell(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of'desspool or privy is within 100 feet of a surface water supply or ❑ tributary to a surface water supply. ❑ [vj� Any portion ofj cesspool or privy is within a Zone 1 of a public well ithin 50 feet of a private water supply well. Any portion of cesspool or privy is w [] [� 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 acceptableat at a Der ty nal led his system passes if the well water analysis, performed laboratory,for!fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less t provided that ho 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 20009pd- ❑ u 10,000gpd. ermined that The system fa is. I have det one or more of the systemabove 3, therefore the fails The ❑ criteria exist asidescribed in 310 CMR 15lure .30ealth to determine what will be system owner'!4hould contact the Board of H necessary to correct the failure. E Large Systems: To be considered]a large system the system must serve a facility with a g y design flow of 10,000 gpd to 15,060 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 Wwe11 ad Protection ❑ ❑ Area- IWPA)dr a mapped Zone II of a public water supply 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 er section large system E oas faile . Th owner or opertor of an fa led undeeSecfon D shalaupgrade therge system considered a significant thret under with 310 CMR 15.304.The system owner should contact the appropriate system in accordance regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage oisposaI System'Page 5 of» t5ins•09108 Commonwealth of Massachuse>,ts Title 5 Official IM ection ntar Assessments Subsurface Sewage Disposal Sy stem Form -Not for Voluntafry As Property Address ✓'�t4(i Owner Owner s Name information is t��e✓✓r I l� 1 Code Date f In pec'on state ZiP required for cityrrown every page• C. Checklist You must indicate"yes" or"no" as to each of the following: Check if the following have been dons. Yes No Pumping information was provided by the owner, occupant, or Board of Health ❑ of the system components pumped out in the previous two weeks? Were an ❑ � Y Has the system,received normal flows in the previous two week period? ❑ Have large voluml es of water been introduced to the system recently or as part of ❑ this inspection? Were as built plates of the system obtained and examined? (If they were not available note as N/A) Was the facility a 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,baffles or tees, matey al of cotns'tructior f otn the tank inspected for the!condition of the dimensions, depth of liquid, depth of sludge and depth of scum? Was the facilitydwner(and occupants if different from owner)provided with ff--�❑ information on this proper maintenance of subsurface sewage disposal systems? The size and Iodation 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 oti distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: ------- Number of bedrooms (actual): --- Number of bedrooms (design): � V DESIGN flow based on 310 CMR 15�203 (for example: 110 gpd x#of bedrooms): rMe s Official Mspection Form:Subsurface Sewage DiWOS t System•ta0e 6 of 17 tsins•0"s Commonwealth of Massachusei s Title 5 Official l�n peCtion Form Subsurface Sewage Disposal System orm -Not for Voluntary Assessments vie t-/ ��- Property Address / Owner Owner's Name 4 information isOa of nspection required for State Zip Code every page. City/rown D. System Information Description: l G llo �o �IL 1 1✓ ZDy 0 6x 1,45 Number o current residents: ❑ Yes o Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes No ❑ Yes No Laundry system inspected? es ❑ No Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: ❑ Yes No Sump pump? Date Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 1503): Gallons per day(gpd) Basis of design flow (seats/persons/§q.ft., etc.): ❑ Yes ❑ No Grease trap present? ❑ Yes ❑ No Industrial waste holding tank presenth Yes No Non-sanitary waste discharged to th'd Title 5 system? ❑ ❑ Water meter readings, if available: Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i5ins•09" Commonwealth of Massachuset`ls Title Official Inspection Form Tit is Subsurface Sewage Disposal System) orm Not for Voluntary Assessments �� a�e pieU9 Property Address ( ✓"IO G� Owner owners Name / information is vl�e✓V,!/ Dat of ction required for State Zip Code every page. City/Town 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 ifilspection? ❑ Yes No ❑ If yes, volume pumped: gallons How was quantity pumped determineld? Reason for pumping: Type of S m Septic tank, distributiibn'box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternativ6 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 dopy of the DEP approval. ❑ Other (describe): Title s official Inspection form:Subsurface Sewage asposai System-Page 8 of 17 t5ins-M08 Commonwealth of Massachuseits official 1`4ns►pection Form Title 5 -Not for Voluntary Assessments Subsurface Sewage Disposal System Form vrt_�✓ property Address Owner Owner's Name information is CQ�'7�✓v�G l� State Zip Code Date of ction required for City/Town lug every page. D. System Information (cont;) Approximate age of all omponents, gate 'nsta ed (if known) and source of information: d� ' in at the site? ❑ Yes Ly' No Were sewage odors detected when arriving 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, verhting, evidence of leakage, etc.): Septic Tank (locate on site plan): 3 Depth below grade: feet �e,aconstruction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years � of certificate) ❑ Yes ❑ No is age confirmed by a Certificate of dompliance. (attach a copy e) / Dimensions: Sludge depth: Title 5 officiai inspection Forth:Subsurface sewage Disposal System P39e 9 of 17 t5ins•09/08 Commonweage lth of M'assachusetits Title 5 Official In �p�ection Form Subsurface Sewage Disposal System Corm -Not for Voluntary Assessments Lal�evrec✓ Dry Property Address Owner owners Name OA — 3 / information is GQ v. ✓f/i { e - required for State Zip Code Date f In petytition every page. City/Town D. System Information (cone.) Septic Tank (cont.) SLI 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 o% How were dimensions determined? Comments (on pumping recommendtitions, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inverts evidence of leakage, etc.): - 1 T 7 u Grease Trap (locate on site plan): Depth below grade: feet Material of construction: concrete metal lass ❑ polyethylene ❑ other(explain): ❑ ❑ ❑fiberglass 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 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 10 of 17 t5ins•09/08 Commonwealth of M�assachuse#s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for voluntpry Assessments �� �Q� I/12 c.✓ ✓1✓'�j j :Propertyt/"�Address 0 GOwner ners Name �A ! /I� / �0�6 30� / information is C�N Ile Date f In ction required for State Zip Code every page. City/Town D. System Information (cont.) Comments (on pumping recommendations, t and outl leaka et tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence i i i 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 ❑ Yes ❑ No Alarm present: Alarm in working order: ❑ Yes ❑ No Alarm level: Date of last pumping: Dace Comments (condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? Yes ❑ No ❑ Title 5 Official Inspection Form Subsurface Sewage dsposal System'Page 11 of 17 t5ms•OWS t Commonwealth of Massachusetts Title 5 officp ial Ins ection Form i I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I Property Address I 001 i owner owners Name�� /:;�� / 0,4 3p- information is �vl Pi Dat of spection required for State Zip Code every page. City/Town D. System Information (cont.) Distribution Box (if present must bet 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.): �e Moved Y Zee- Pump Chamber (locate on site plan): Yes ❑ No Pumps in working order: I Yes ❑ No Alarms in working order: I Comments (note condition of pump chamber, condition of pumps and appurtenances,etc.): I I I i i Soil Absorption System (SAS) (locate on site plan, excavation not required): i I If SAS not located, explain why: I i I i I I I i i Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 12 of 17 l5ins•09M8 II I Commonwealth of Massachusetts Titl e 5 official Inspection Form Subsurface Sewage Disposal system Form -Not for Voluntary Assessments 26 Property Address z I Owner owner's Name / // pa6� Wofnspection information is Ce��r_vj` e state ZipZip Code Da required for every page. CityfTown D. System Information (cont.) (� ns� Type: W// J T4 ki 6- leaching Pits number00- 1! ❑ leaching chambers number: ❑ leaching galleries number: ❑ number, length: leaching trenches ❑ leaching fields number, dimensions: � ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 0 � - O h „Z 54%; Z 1,7 S �o tee-: Poo 7y 0 S o� 'G" /`` �� f Cesspo ols cesspool must be pumped as part of inspection) (locate on site plan): I j Number and configuration i Depth—top of liquid to inlet invert i Depth of solids layer Depth of scum layer Dimensions of cesspool i jMaterials of construction 1 ❑ Yes ❑ No Indication of groundwater inflow Title 5 OFRdaI Inspection Form'Subsurface Sewage 0000 system Page 13 of 17 15ins-09M Commonwealth of Massachusetts! Title 5 official Inspection Form nts Subsurface Sewage Disposal System Form - Not for voluntary Assessme - 26 'Ze�;�'e V/e,4'-/ Property Address S, V17VC11Y- Owner owner's Name e ev ,,v,/�� information is C� State Zip Code Date f I spection required for CityfTown every page• 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 signs of hydraulic failure, level of ponding, condition of vegetation, Comments (note condition of soil, etc.): I I Title 5 Offidai inspection form:Subsurface sewage Disposal System Page 14 of 17 tsim•Me Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments ,La�vr6"W) 4!��l Property Address 1✓"r O G'Y Owner Owners Name information is required for (--el.� State Zip Code Date I pedon every page. CitylTown 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 is water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately FR o n r 4 40 �j e, I a below✓y 11 41 Cover 3 Al a A 7 >31 - a3 63 - q f - ��- Sq 3 d �3 -29- Ir. o�S — `�� 6,� y lP�✓ ,ter►� i5ins•09" Title 5 Official Inspection Form:Subsurface Sewage oisposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Use k./ Property Address o(/ I ✓"10 G�✓ Owner Owner's Name I ^ ? information is C70" - eV-V1 / h 0TCode required for State Z Date of nsp cton every page. City/Town D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface 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 I f Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: o ,p vti e� P,rT a" ` o► � L (� li" Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-09M Title S Official inspection Form:Subsurface Sewage oisposal System•Page 16 of 17 i` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Z G Qt./ A6 fLc� Property Address I v-10c �✓ Owner Owner's Name information is �e ` G required for l ' State Zip Code Date Ins ction every page. City/Town E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked (Inspection Summary D (System Failure Criteria Applicable to All Systems)completed D,-System Information-Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 J o. Fee toot THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pphrattou for 3t5pont �bpgtem Con0tructtou Vermtt Application for a Permit to Construct( ) Repair j Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 36 L n v cvi e�J 'bl2%.1E Owner's Name,Address,and Tel.No. E Dw4rd C to,moc.1C Tr,,sr CevmeaV;II< d. GOA 3.23 Assessor's Map/Parcel '�j t l ®`f9 C GnTEfly itlC YhJ� Installer's Name,Address,and Tel.No. eopewide V1tkCY'?n5e5 Designer's Name,Address and Tel.No. LlZ1-1133 (�o-3-rc 7�3 Lr� Type of Building: Dwelling No.of Bedrooms Lot Size G'it�0 �- sq.ft. Garbage Grinder ( ) Other Type of Building 5'� CA,,-' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 1'ft,Q gg4&<�� 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. Signed Date / 6 O Application Approved by /l Date Application Disapproved by: Date for the following reasons Permit No. 0 00 a /13 73 Date Issued (� 'L ——-———————————————————————— ———----————————— No. Fee ! b t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: —�-- ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �hgpogal �&pztem Congtructton Permit Application for a Permit to Construct O Repair( Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. 36 LA KEVi G..3 "]S2"JC Owner's Name,Address,and Tel.No. E atuar'd C. 0JMOOK Tr iT (,,e'Te2Vi11< fo. GOA 3-23 Assessor's Map/Parcel "L,,.I ��(� G eP,1`Cav ill e- rhri _ I Installer's Name,Address,and Tel.No. CqP�,,�' t`a�fu Pi�ytf Designer's Name,Address and Tel.No. 33 (�v•3� ��3 Type of Building: Dwelling No.of Bedrooms l Lot Size G 5;�� �- sq.ft. Garbage Grinder ( ) f Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) gpd Design flow.provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. a Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: - 1 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. Signed Date % 16, Application Approved by M r,vL Date q1Y 1625: Application Disapproved by: Date for the following reasons rL Permit No. Q 00 eTS ! Date Issued `7 d —-—————————————————————-•————————— ——————— —-- 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 (_4944, ,492 Ch -t%�t S L at �, LQ(.�,;'N 'Po(,U•c (.e w,. -t/v►1, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �(� dated Q� Installer s60�.4��,L�t f E , S Designer #bedrooms Approved design flow gpd The issuance of this ponit shall not be co strued as a guarantee that the syst m wi' functio aside g• ed. DateJ �/ Inspector � ------------------------------------------- No. [TbV5�'` (3 3� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=i9;po.5al *raem Construction Permit Permission is hereby granted to Construct ( ) Repair O Upgrade ( ) Abandon ( ) System located at 1(o If A 6ty,%_&. I 'D r V�r and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date 6( Approved by � LA G v DATE; 12/15/98 PROPERTY ADDRESS: -36 La-keview' Drive Centerville ,Mass . r 02632 . On the above date, I Inspected the septic system at the above address. This system conslsts of the following: 1 . 1-1500 gallon septic tank. 2 . 1-Pump 'cha;mber 3 . 2-1000 gallon precast leaching pits . Based bn my Ine6cactlon, I certify the following conditions: 4 . This is a title five septic system. t;'"78 vOode ) 5. The septic system is in 'p.roper 'working order at the present' time. 6 . Al.l - access covers are to -grade . 81GNATUR!7: Name: J . P. H*a c o m b e r Jr:,,_ 9 .'J. P,MacoWber & on"'Yrtc , ' Company•-----------=------- ' . Addresa:_„gax_66-----=a-- 2 40CM Phone:___SO•g__77 c,_333'8_______ .. 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER •& SON, INC. T+nks-C9wpools-Lsachflslds PUmp+d t{ IniUIIW ' Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.5-333b 775-6412 COMMONWEALTH OFMA,SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02103 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Govemor Cornmi- inner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CER71RCATION Property Address: 36 Lakeview Drive Name of owner Edward D i m o c k Centerville Mass . Address ofOwnw:36 Lakeview Drive te Da oflnspection: 12/15/98 Centerville ,Mass . 02632 Name of Inspector:(Please Print) Joseph P.Macomber J r. I am a DEP approved system inspector to Section 15.340 of rrtie 5(310 CMR 15.000) �,yNm,e: JMacomber & Son Inc . Ma&VAddress: Box 66 Cpntervi1 le ,Mass _ 02632 Telephone Numbw 588—�7 — CERTIFICATION STATEMENT 1 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: asses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails hupectofsSignature: t Date: lf� The System Inspector all su mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of•Environmental Protection. The original should•be sent tovw system owner and copies sent to the buyer,if applicable,and the approving authority. . NOTES AND COMMENTS revised 9/2/98 page iorn iJ Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSA4 SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 Lakeview Drive Centerville ,Mass . Owner: Edward Dimock Dale of Inspect—: 12/15/9 8 INSPECTION SUMMARY: Check A, B, C, A A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: System is in excellent working order - System is designer( to henrll a a fQur--opdF-nAm hAIiBe . B. SYSTEM CONDITIONALLY PASSES: —.A v 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. 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 complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructedpipe(s) 9 P 9 or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced /Ud - The system fequired pumptrig-more than fourtimes a year due to broken or obstructed pipe(sY. The system wilfpess-- Inspection if(with approval of the Board of Health): - broken pipes)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 Lakeview Drive Centerville,Mass . owner: Edward Dimock Date of tr'spec6°n:12/15/9 8 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Alb 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL.PROTECT THE PUBLIC iWALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy Is within 50 feet-of 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 HEALT44 AND SAFETY AND THE ENVIRONMENT: .10 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. IV The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance -,eV44 (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART-A CERTIFICATION(corttinued) Property Address: 36 Lakeview Drive Centerville ,Mass . O1M11ef: Edward Dimock Date of hapection: 12/15/9 8 D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: A'Z) I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No 1/ Backup ofseWege irrlofecility"er•*Tatern componertt•dns�to an overloaded or-clogged SASor"aspod. 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 a distrib ion box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in coeepooHs /less 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). Number of times pumped f2. J/ 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 I 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" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No j:y/ the system is within 400 feet of a surface drinking water supply /v the system-is witWn 200 feet of-o•ttibutary 40-G ouFfaoo•dri ik ag.wat4W-OUP V ••• 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4or11 i i SUBSURFACE SEWAGE DISPOSAL,SYSTEM WSPECTION FORM PART B CHECKLIST Prop"Addre*s: 36 Lakeview Drive Centerville ,Mass . owner: Edward Dimock Date of Inspection:)2/15/9 8 Check if the following have been done:You must indicate either"Yea" or"No" as to each of the following: Yeses No L/ Pumping information was provided by th owne occupant,or Board of Health. - None of the systemsompooanta.kawaJmenpuaipad4opstJeasttwo%veakeaadthe'rystemhasbaao4scaiaiagrwsaat-flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,ee4cluding the Soil Absorption System, have been located on the site. _ 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. / The size and location of the Soil Absorption System orr the site has been determined based on: Y Existing Information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owasr.(and.^^__p:n*4..if differ—fr^^•ownsr).wsre.prayidad wlth lnfnrmatioaan thaTprnpa■mni^taA&QG"f Subsurface Disposal Systems. i I ' revised 9/2/98 page sorll l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION P,.,pertyAdd,.: 36 Lakeview Drive Centerville ,Mass . Owner: Edward Dimock Date of Ir-pec-doc+: 12/15/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: L!D g.p.d./bedroom. Number of bedrooms,(design),P- NumberNumber of bedrooms(actual): - Total DESIGN flow * 6r. of current residents. Garbage grinder(yes or no): ' Laundry(separate system) (yes or no):N" If yes,sepatateInspection,required Laundry system inspected (yes or® Seasonal use(yes or no):--IV-& Water meter readings,if available(last two year's usage(gpd):0 Sump Pump(yes or no):-�Ns�0 L ,9 S Lest date of occupancy:-V�7 f /!�!o'IO�I/TrLC; COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: VA RPd ( Based on 16.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no),& Non-sanitary waste discharged to the Title 5 system:(yes or no)" Water meter readings,if available: AJ 4 - Last date of occupancy: OTHER:(Describe) Last date of occupancy: Allf GENERAL INFORMATION PUMPING RECORDS nd sour e�information: System pu p d as part of inspection:( es or no If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM LSeptic tank/distribution box/soil absorption system 4l' Single cesspool Alb Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,If any) .0 1/A Technology at .Attach copy of up to date operation and maintenance contract Tight Tank WW Copy of DEP Approval Other A/ `M PPROOXI TE AGE of all components,data installediif known)-and source of•imformation: /Sewage odors detected when arriving at the site:.(yes or no)ova revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Lakeview Drive Centerville ,Mass . Owner: Edward Dimock Date of Inspection: 12/15/9 8 BUILDING SEWER: (Locate on site plan) Depth below grader /4 Material of constructionist iron0 PVC_other(explain) Distance from rivate water supply well or suction line WILL Diameter Comments: (condition of joints,venting,evidence of leakage,-etc.) Joints appear tight No Pvidenr•P of 1PnkagA d i s c r-i-b-iL14o-n box. SEPTIC TANK: (locate on site plan) �� Depth below grade-, !�*it 8 ' Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is Instal,list age d Js.age.confirmed by Certificate of Compliance4(Yes/No) Dimensions: /Dx 5l "kJIPi Sludge depth:_ Distance from top_,(sludge to bottom of outlet tee orbaffle• Scum thickness: ��--� �p � Distance from top of scum to top of outlet tee or baffie:cZ= Distance from bottom of scum to botto of outlet tee r baffle- How dimensions were determined: Comments: (recommendation for pump)n condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,structural-integrity, evidence of leakage,etc.) Frump . tank annually : Garbage disposal. is present . Inlet & outlet tees are in p1PcP Ti =ttid depth at the nntlAt iuert of the tank i c fi fty obA 1 pche6r, The teiik struettirally satind and shows GREASE TRAP: ZdVC no evidence ofleakage . (locate on site plan) Depth below grade: Material of construction rTAVconcretVV'1metaKAfFibergiassd�4Polyethylene'��ther(explain) 40 Dimensions: 4.114 Scum thickness: V Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Date of last pumping: Ifo Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present . revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 11continued) Pr.p"Addr,1:36 Lakeview Drive Centerville ,Mass . Ownw: Edward Dimock Date of hupecfwm: 12/15/9 8 TIGHT OR HOLDING TANK-A&�i(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:AiconcretevAmetal vNFberglassoV4 Polyethylene Nlother(explain) Dimensions: Capacity: gallons Design flow: 4.4 gallons/day Alarm present 4441 Alarm level: Alarm in working order:Yes/64 No�W Date of previous pumping:AI Comments: (condition of inlet tee, condition of alarm and float switches,etc.) ig or—holdinp, tanks are not nrPs nr DISTRIBUTION BOX:,/ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: llire•if level and distribution is equal,evidenoe of solids carryover, evidence of leakage into or out of box, etc.) stribution box has two laterals Teaching nitro are n=arating equally No evidence of sol i dG r nrry near &a avi rlonro of leakage i nrn nr n„t- gf thQ box gygtem is v®ated tr-he;4ghtihe D—Box PUMP CHAMBER:_�/ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: rnote condition of pump chamber,condition of pumps and appurtenances,etc.) rump chamber is in excellan ump an oats are operating properly No mayor G1udgP ui ]I revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Address;36 Lakeview Drive Centerville ,Mass . Owner: Edward Dimock oats of 1nspection: 12/15/9 8 SOIL ABSORPTION SYSTEM(SAS)-k-009024�"O."9 0_,44jP (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: 0 leaching fields, number,dimensions: overflow cesspool,number: Alternative system:_� ll Name of Technology: f dpawl Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) L a ,sanj to ,stgney sand tQ mpHillm figia Spande No si ns a.L i u r e or pen 1nQ Soil is dry and the ypgptatinn is normai . CESSPOOLS: e. (locate on site plan) Number and configuration: 0 Depth-top of liquid to inlet invert: Depth of solids layer: IVIO Depth of scum layer: /V Dimensions of cesspool: Materials of construction: Indication of groundwater: IVA Inflow(cesspool must be pumped as part of Inspection) o esspoo s are not prespnt Comments: (note condition of soil,signs of hydraulic failure,.level of pending,condition of.vegetation, etc.) Cesspools are not =rp Cpnt PRIVY:A26Y_ (locate on site plan) Materjals of construction: Dimensions: ",Z)19 Depth of solids:v[7 Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.) rive is not prpepnt revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress: 36 Lakeview Drive Centerville ,Mass . Owe: Edward Dimock Date of lr+spectia+: 12/15/9 8 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) apt cnat �`7 ak '4c�3►ar,bar i i revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Lakeview Drive Centerville ;Mass . Owner: Edward Dimock Date of Inspection: 12/15/9 8 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wella checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record serve ite utdng property, bservation hole,basement sump etc.) _ZDetermined from local conditions Checked with local Board of health /C'hocked FEMA Maps y Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Gahrety & Miller Model 12/16/94 revised 9/2/98 Page It of11 •w+mr+r -nrr'•'-.•rrrnrmr•nnn.s••wn+�n.+nnr.�r++esr►r�r•+mm�nern�tnsv�rtl� TOWN OF Barnstable WARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I� F.•••T^I�T••,•••f—T.11►�.�TTtJRf'l1I YT,'RI TRTiQ�/7R•RTrr�t•f"{ITR7�O�T�fR�t�1•Illt�i�l7 r�N •.TrT'1'"11�•r.A -TYPO OR PRINT CI.EARLY- PI?OPERT Y INSPECTED STREET ADDRESS 36 Lakeview Drive CenterrviJlle ,/M,ass . ' ASSESSORS MAP, BLOCK AND PARCEL # '?'��1"� OWNER' s NAME Edward Dimbch >mi PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Svtf `INc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632. Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790- 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate , and complete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: 1 !/Systeui PASSED , The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con acted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date LZ- One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTII. * If the inspection FAILED, the owner or•1"operator shall upgrade ' the eyetem within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . u partd .doc PLOT PLAN OF LAND CLIENT FILE NO. 1334 DEED REF: BOOK 13264, PAGE 125 I OWNER: EDWARD C. DIMOCK, TRUSTEE OF THE PLAN REF: PL. BK. 600, PAGE 18 EDWARD C. DIMOCK TRUST LAND COURT CERT. OF TITLE: ADDRESS: 36 LAKEVIEW DRIVE LAND COURT PLAN: CENTERVILLE, MA-02632 ASSESSORS MAP: 214 PARCEL: 49 VIEW pRwE 5690 LA►�E wAYI C30,WIDE _pRIVA�E •— S80o2653°W J37.90, 00 MAP 214 0 0 PARCEL 49 to 0 1.56 Ac.±(PER ASSESSOR) q; ; O N � o Q N� o 0 Q tA G m� m Ir EXISTING BOATHOUSE EXISTING 352 DECK - BENCH MARK NAIL IN TREE EXISTING ' EL.=100.00' SEPTIC TANK ASSUMED INV.IN=95.8`± 25.5' #36 EXISTING EXIST. DWELLING DECK \ -f - WEQUAQUET LAKE I hereby certify that the lot corners, dimensions and setbacks to the JC ENGINEERING, INC. existing structures as shown on this plan are correct. 2854 CRANBERRY HIGHWAY, E. WAREHAM, MA 02538 TEL. (508) 273-0377 FAX. (508) 273-0367 THOFq,, o�� qSc DATE: NOVEMBER 19, 2007 SCALE: 1" = 40' 5 0 JOHN R. y FARREN No. 33590 ss A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 250001 0005 C DATED 08/19/85 HAS BEEN CONDUCTED AND TO THE BEST OF MY INTERPRETATION, THIS �� STRUCTURE IS IN FLOOD ZONE C AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD ZONE. Date Professional Land Surveyor Job #1334