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Home My WebLink About0129 LONG BEACH ROAD - Health F129 Long Beach Road Centerville A = 205 — 020 TOWN OF BARNSTABLE Y4 n LOCATION (6r+5 IJe4c,+ RCS . SEWAGE # VILLAGE CgrnTtir,1.16- ASSESSOR'S MAP & LOTo14S Oo�O INSTALLER'S NAME&PHONE NO. ff SEPTIC TANK CAPACITY /Soy I;Uk IM Q1 p C ,&A 6 LEACHING FACILITY: (type) Pow w! btgusSo.S (size) y NO.OF BEDROOMS 5- BUILDER OR OWNER 50 ^ 1/er►TL t/ OdAirt 1�roc1St(- PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ��e.►T Qo�c. Al- 3to 59 Nix a i' 3 A3- ycl' 133- 30' Sullivan Engineering Inc. 7 Parker Road, Box 659,Osterville MA 02655 508-428-3344 e-mail: psullpe(a,aol.com fax 508428-3115 April 25, 2006 David Stanton Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: Abel/ 129 Long Beach Road, Centerville Dear David, Contrary to the information contained in Disposal Works Construction Permit Number 91-466, based on information obtained from the Assessor's office and existing floor plans, it appears that the dwelling located at 129 Long Beach Road has always had five bedrooms. Since the proposed remodeling does not represent an increase flow(5 bedrooms/ 11 rooms), we do not believe any action is required by the Board of Health. We have attached copies of the assessor's information from 1971, 1995, and 2006, Page 1 of an Inspection dated July 31, 2000, Existing and Proposed Floor Plans, and a Septic System Evaluation. I trust this meets your present-needs. If you have any questions, please feel free to call. Very truly yours, ?AterSulivan, Sullivan Engineering Inc. ab -L�A OCj `Xi Members of The American Society of Civil Engineers and The Boston Society of Civil Engineers FOUNDATION BSMT. & ATTIC PLUMBING PRICING LAND COST nc.Walls Fin.Bsmt.Area Bath Room Base BLOG. COST onc. Blk.Walls Bsmt. Rec.Room 7P/7 St. Shower Bath� - ` /Y Bsmt. /S3 PURCH. DATE onc. Slab Bsmt.Garage St. Shower Ext. Walls v PURCH. PRICE rick Walls Attic Fl. &Stairs / Toilet Room Roof y RENT tone Walls Fin.Attic /' Two Fixt. Bath Floors . ..._-- iers. INTERIOR FINISH Lavatory Extra -- - - `--" - _ . J- G 3 0 Y ,�y smt. F 1 2 3 Sink / /l+ C. Plaster Water Clo. Extra Attic L — Y .G( /�7 r EXTERIOR WALLS .Knotty Pine Water Only ouble Siding Plywood No Plumbing Bsmt. Fin. �' _ y c Ingle Siding Plasterboard Int. Fin. !%PJ �i,('r� t^/ Shingles TIL • '� Y1 I onc. Blk. G F P Bath Fl. Heat 4 ace Ork.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit •,7 u ?J/-� Veneer Int.Cond. Bath Fl.&Walls Fireplace 4 r0 om. Brk.On H EATING Toilet Rm.Fl. Plumbing 7/r _ olid Com.Brk. Hot Air Toilet Rm.Fl.&Wains. Tiling /7/� —__._ __•'L T� Steam Toilet Rm. FL&Walls Blanket Ins. — Hot Water St. Shower ' 4 { oof Ins. Air Cond. Tub Area Total _ •— —•— •----- Floor Furn. K U;p S J ROOFING COMPUTATIONS - i sph.Shingle Pipeless Furn. S.F. 3/ 7 0 Wood Shingle No Heat S.F. / p? /Z/ sbs. Shingle Oil Burner S.F. late Coal Stoker /�� S. F. j fZ G i1/7"f,4 /J Ila '`:!r 1. .•'.r -� i ile Gas S F �� OUTBUILDINGS ROOF TYPE Electric S F p :� 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED i able V1 Flat Hip Mansard FIREPLACES �/' Pier Found. Floor / Gambrel Fireplace Stack ._L�Q 7 Wall Found. 0.H.Door LISTED FLO RS Fireplace Sgle.Sdg. Roll Roofing j Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine W �/ % J/ Hardwood ROOMS Cement Blk. Electric Int.Finish PRICED Asph.Tile Bsmt. 1st TOTAL Brick i. Single 2nd 3rd FACTOR L'� �� /<• _ (.%�' I REPLACEMENT - OCCUPANCY 'e ONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dap. ACTUAL VAL. I 2 3 4 5 8 7 8 9 10 TOTAL STATE PARCEL IDENTIFICATIO NUMBER DPERTY ADDRESS I I ZONING I DISTRICT CODE SP- DISTS.I DATE PRINTED I CLASS I PCS I NBHD KEY NO. _ 0129 LONG @EACH ROAD 19 RD 300 1G+L0 07/09/95 1011 J3 4-3-WA R2u5 020, 12331 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ•D. UNIT E Land By/Date Size Dimension LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Description I:'�•�/ _T_R i�1 J U D.I7 A P- CD. FF De to/Acres E :4 L A W) 1 4 0 5 s 70 0 CARDS IN ACCOUNT - 15 1 'WATER,FNT 1 X .61 =10C 13.3 499999.95 664999.93 .61 405703 43LD1-j(S)-CARD-1 1 237,500 Cl OF 01 4PL 129 LOA6 3CH RD, COST 643200 BATHS 4 .1 U X 100 2G800.0 C 20800. 00 1 .00 20300 3 4DL LOT 13MARKET 417200 NO 3SMT S X = 100 6.3C 7.93 1266 101OU-3 4RR 0912 0100 INCOME FIREPLACE U X 3= 100 3900.0C 3900.0 1 .00 3900 3 USE A AIR CO ND S X 3= 100 1 -45 1.82 3135 5700 13 APPRAISED VALUE D 643..200 J PARCEL SUMMARY U LAND 405700 S BLDGS 237500 T -IMPS tit TOTAL 64320C E I -CNST N DEED REFERENCE Type Rernrdcd PRIOR YEAR f1 VALUE t T - Book Page Inst. MO.DATE Yr.ID Sales Prico A D 4 0 7 0 0 S 7557/285i t05/91 N 775000 8LDGS 23750C 7522/333, 105/91 - 1 TOTAL A43200 1439/418: 00/00 BUILDING PERMIT _ Number Date Type Amount LAND LAND-ADJ INN ME SE SP-SLDS I FEATURES BLD-ADJS UAITS 405700 20300 33465) 10191 AD 82000 Const. Total ear Y Built Norm. Obsv. Class Units Units Base Rate Atlj.Rate A i Age Depr. Cond. CND Loc oro R G Repl Cost New Adt Repl Value Stones Height Rooms Rms Baths I fix. Partywall Fat:. 018+ OOO 110 110 76.15 83.77 30 85 9 92 100 100 92 258103 23750J 2- 0 6 5 4.1 15.0 Description Rate Square Feet Repl.Cost MKT. INDEX: 1-00 IMP.BY/DATE: i- /92 SCALE: 1 /00-66 ELEMENTS CODE CONSTRUCTION DETAIL PAS 100 83.77 1266 106053 UROSS AREA 2665SINGLE FAMILY . IDWELLING CINST 3P': JG FOP 35 29.32 270 7916 *----16----*-------27-------* STYL 1CG LD STYLE . ES FSF 90 75.39 325 24502 ! 10 OP1 10 D-ESItA- -6jAT J2 ZGA _ _ i bib_ T -10.6 FFG 301 25.13 275 6911 ! ! ! EXTcR.i i LLS-- -_11 a1 DD SNIPdGLES --- D_C� I OP1 125 104.71 270 2 8.272 - ! *-------27-------* itAT/A� T'Ya�E ZG �/AIR � AIR CO 0.0 r 320 00 50.26 1266 63629 ! 820 ! 1NTE-j. F.ItjIa�S J5 EAST R --------- (}.0 FF8 650 65.00 8 520 ! ! IhTER:LAYO0T T2 A-V-Cq 7-N-6 9MAL--_--�.0 *--11--*- 13---* ! 1 N T R:a T_ffCTY- -J2 3 KE-AS-ETcfiER: a0 FFG ! FSF ! BASE 22 FLJJR-S'TTtUCT- J24Y_JD STIaZ-A- - _0 W! ! 42 ! LOST-COO R-'.. -JT A215WOD-D ---------�.0 D 815 1591 ! ! ! 0DF-TTP_----- JZ A CE=i�tf00-YR---�.0 E Total Areas Aux = Base = BUILDING DIMENSIONS ! L tI T R I!',A L 7Td Af.0 T BAS W27 S10 FLOP N10 E27 S1O W27 25 25 25 F 0TV15AT-IU?�--- -J2 �i�CRET�-OL��9C-9�T:9 --------------- -- A SAS �116 FSF �i25 �i13 FFG 4d11 � i � - ---------------------- S25 Ell N25 .. FSF S25 E1.3 .. - ! ! ! FOP ! -----�TEI=�OTBOTCIiJJ6 43i�A-��td1'E0?VIiL L BAS N42 E16 S10 OP1 N10 E27 S10 ! ! ! 10 10 . LAND TOTAL MARKET W27 . . BAS E27 S22 - . 820 N22 ! ! ! ! ?ARCEL 405700 643200 W27 N10 W16 S42 E16 N10 E27 820 *--11--*---13---*----16----*--- 27-------* AREA 188800 VARIANCE +0 +241 STANDARD 25 Property Location: 129 LONG BEACH ROAD MAP ID:205/020/// Bldg Name: State Use:1010 Vision ID:14330 Account#123315 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:04/24/2006 15:45 CU T WNER TOPO. UTILITIES RT./ROAD LOCATION CURRENT, SSESSME T W EL,ROBERT C&MARY J 1 Level rublic Water 1 Paved 17 Excel View Description Code Appraised Value Assessed Value a 7 Waterfront RES LAND 1010 1,959,000 1,959,000 801 1 COACH RD RESIDNTL 1010 477,300 477,300 006 Barnstable Data,M. eptic LASTONBURY,CT 06033 SUPPLEMENTAL-DATA.. dditional Owners: ther ID: TREATED W/R205-01 Plan Ref. Tax Dist. 300-CEN Land Ct# er.Prop. #SR Life Estate VISION DL 1 LOT B Notes: DL 2 GIS ID: 14330 ASSOC PID# Totall 2,436,3001 2,436,300 PSi ,RECORD`OF OWNERSHIP`-,�',. _'"« 'BK-VOL/PAGE SALE DATE'r /u v4l: SALE PRICE'I!C.-` " r °' PREVIOUS"ASSESSMENTS" HISTORY ' � EL,ROBERT C&MARY J 13214/186 08/31/2000 U I 2,700,000 1N Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value VENTER,JOHN C&FRASER,CLAIRE 10499/291 11/25/1996 U 1 1,500,000 1N 2005 1010 2,712,400 2004 1010 2,712,400 2003 1010 1,368,500 INN,PETER M 10498/022 11/25/1996 U I 100 lA 2005 1010 405,400 2004 1010 318,400 2003 1010 335,900 INN,PETER M&JUDITH M 7550/285 05/15/1991 U 775,000 N ORCELLA,PHILIP J JR 7522/333 05/15/1991 Q 1 ORCELLA,PHILIP J JR&HELEN 1439/418 Q 0 Total: 3,117,800 Total: 3,030,800 Total: 1,704,400 i ft zEXEMPTlONS t G __ - �� " ° 4� ° ;O7HEKASSESSMENTS �. a.rs � 4 This signature acknowledges a visit by a Data Collector or Assessor Year Type escri lion Amount Code Description Number Amount Comm.Int. APPRAISED VALUPSUMMARY Appraised Bldg.Value(Card) 474,700 r ASSESSING "' T ;m a Appraised XF(B)Value(Bldg) 2,600 NBHD/SUB NBHD NAME STREET INDEX NAME TRACING BATCH Appraised OB(L)Value(Bldg) 0 WFLB/A Appraised Land Value(Bldg) 1,959,000 Special Land Value 0 1_ Total Appraised Parcel Value 2,436,300 Valuation Method: C Adjustment: 0 et Total Appraised Parcel Value 2,436,300 BUILDING PERMIT RECORD VISIT/CIIANGE'BIISTORY Permit ID Issue Date Typ e Description Amount Insp.Date %Comp. Date Comp. Comments Date Typ e IS ID Cd. Pur ose/Result B34659 10/01/1991 AD 82,000 01/15/1993 100 CE REMOD" 1/20/2004 PM 00 eas/Listed 6/21/2001 PT 00 eas/Listed 4/15/1992 MIL 'LAND LINE VAL UATION SECTION B#, Use Code Description Zone D Frontage Depth Units Unit Price L Factor S.A.IS.O. 1 C.Factor ST.Idx Ad'. Notes-Ad' S ecial Pricin Ad'. Unit Price Land Value 1 1010 Single Fam MDL-01 RD 3 1 0.61 AC 221,000.00 1.47 L 1.00 WFLB 9.90 1,959,000 Total Card Land Units: 0.61 ACI Parcel Total Land Area:0.61 AC Total Land Value:1 11959.000 Property Location: 129 LONG BEACH ROAD MAP ID:205/020/// Bldg Name: State Use:1010 Vision ID:14330 Account#123315 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:04/24/2006 15:45 CONSTRUCTIONDETAIL CONSTRUCTION DETAIL CONTINUED - Element Cd. Ch. Description Element Cd. ICh. Description Style 06 Conventional Model 01 Residential Foundation 02 Conc.Block 16 27 Grade A Luxury Stories 2 2 Stories Bath Split 41 4 Full+1H FUS O .MIXED USE ,. FEP 1 ccupancY 10 Exterior Wall 1 14 Wood Shingle Code Description Percentage WDK 17 27 Exterior Wall 2 1010 Single Fam MDL-01 100 27 Roof Structure 03 Gable/Hip Roof Cover 10 Wood Shingle 24 Interior Wall 1 03 Plastered GAR 11 13 tenor Wall 2 4" COST/MARKET VALUATION FUS Interior Flr 1 12 Hardwood Adj.Base Rate: 164.30 42 BAS 2 Interior Flr 2 Heat Fuel 3 Gas Replace Cost 558,456 Heat Type 4 Hot Air yB 1930 C Type 3 Central YD 990 5 2525 BAS 2 27 Total Bedrooms 5 5 Bedrooms Dep Code G 27 Total Bthrms I Remodel Rating Total Half Baths 1 Year Remodeled 10 FOP 1 Total Xtra Fixtrs Dep% 15 Total Rooms 8 8 Rooms uncnl Obslnc 11 13 16 27 Bath Style con Obslnc Kitchen Style Cost Trend Factor Status /a Complete Overall%Cond 35 pprais Val 174,700 ep%Ovr ep Ovr Comment isc Imp Ovr isc Imp Ovr Comment Cost to Cure Ovr Cost to Cure Ovr Comment "OB-OUT_BUILDING& YARD ITEMS(L)IXF-B UILDING EXTRA FEATURES(B) Code Description Sub Sub Descri t LIB Units Unit Price Yr Gde Rt Cnd %Cnd pr Value PL2 Fireplace B 1 3,000.00 1990 1 100 2,600 No Photo On Record BUILDING SUB=1REA`SUMMARYSECTION Code Description Living Area Gross Area E .Area Unit Cost Undre rec. Value AS First Floor 1,591 1,591 164.30 EP Enclosed Porch 0 270 49.29 OP Open Porch 0 270 32.86 US Upper Story 1,536 1,536 164.30 GAR Attached Garage 0 275 57.36 K Wood Deck 0 408 16.51 Ttl. Gro.cc Liv/l ease Area: 3.127 4,350 NIAL PO RC C im cH SUN PORCH T. DINING COVERED DECK Q--e'M POM WrATIQBf6T 811111E11C oEaallo LIVING mac t a�eAMOOM KITCHEN ENTRY UP GARAGE -------------- BREAKFAST FRONT PORCH I I �oor � zsoce NEW UPPER DECK mclLy Aeo%s AND N FOMPMT OF LOWER DICK Y-5 lIr BEDROOM BEDROOM BEDROOM r WAIL'UnIOW OM I III CLO. FNG1206° CLO. UK CLO. HALL LIN CLO. BATH A LK EW 2X8 WALLS 3 llr%i •MASTER BEDROOM BEDROOML mis om F4W KAM BATH 0 w y SITTING Emma"em Zr mw -------------- L—----—-- 4-d' 5'-0 Ve -1 n"W/ ----I- BEDROOM BEDROOM BEDROOM CLO. CLO. UK CLO. HALL "'' CLO. BATH OBATH L (31 BEDROOM BATH Arnc ACCE6S p om D BEDROOM U ZNb Ro d r Ll zs.oho COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS'. DEPARTMENT OF ENVIRONMENTAL PRO 7) TECT ONE WINTER STREET, BOSTON MA 02108 (61 292 e o�sr T COXE +� Secretary ARGEO PAUL CELLUCCI 'Y DAWK STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 129 Long Beach Road, Centerville, MA Name of Owner: Claire Fraser&John Venter Address of Owner: Same Date of Inspection: July 21, 2000 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: 205 Telephone Number: (508)862-9400 Parcel. 020 Lot. B CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evaluati n y the Local Approving Authority 'ls Inspector's Signature: Date: July 31, 2000 The System Inspector shall submit a py 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 to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 .Printed on Recycled Paper Project: Abel Location: 129 Long Beach Road, Centerville Date: April 24, 2006 Septic System Evaluation By Sullivan Engineering Design Flow 5 Bedrooms @ 110 Gallons Per Bedroom = 550 Gallons Septic Tank 150%(550 Gallons) = 825 Gallons Tank Is Adequately Existing 1,500 Gallon Septic q Y Sized Leaching Field Existing Field: 12' wide x 50' long x 0.96' deep Sidewall Area = 0.96(2(50+12))2.5 = 297.6 Gallons Bottom Area = (50x12) = 600 Gallons Total = 897.6 Gallons Existing Leaching Field Is Adequately Sized Note: Design Based On 19.78 Code. See Sewage#91-466. H OF l� ' PETIEn SIILLIVAM 297ti CIVIL y � 12 Commonwealth of Massachusetts-Kqqpt lab,a tiv Execue Office of Environmental Affairs �� CEivo Department of OCT 2 15% Environmental ProtectionKW 4 ` e I, 111 t 1MRNMn F.WWd Ttvdll Cox Go �Gommra C ArBeo lhul CNIucN DnAd;B.�St>1wWts� < ,-f' LL GoNmor ConsnMNor►s% SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 129 Long Beach Rd. , Centerville AddressofOwner. Peter Finn Date of Inspection: 9—2 5—9 6 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: z asses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fail$ Inspector's Signature: Lti a Date: t "` �'' �1 The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 oifiee of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A] PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] Ite DITIONALLY PASSES: re system components need to be replaced or repaired. The system,upon completion of the replacement or repair,panes Indinot determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined", lain w not p by ) he septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is mminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved y the Board of Health. (rev 1 r Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292-SM i Ponied on Recycled Paper I, � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Addrsw 129 Long Beach Rd. , Centerville Owner. Peter Finn Date of Inspection: 9—2 5 9 6 BI SYSTEM[CONDITIONALLY PASSES(continued) _ Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s) 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 boa is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require fbrther evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONINO IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. R) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is five from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) (revised 11/03/95) 2 :a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) property Address: 1 29 Long Beach Rd. , Centerville Owner. Peter Finn Date or Inspeaum 9 2 5-9 6 D1 FAILS: bave determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for istermi I ation is identified below. The Board of Health should be contacted to determine what will be necessary to sore act the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool• Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or oesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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 analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARD SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 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 and safety and the environment because one or more of the following conditions exist: 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 U of a public water supply well) The owner operator of any such system shall bring the system and facility into NU compliance with the groundwater treatment program requiremen of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for finther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PmPwiyAddmm 129 Long Beach Rd. , Centerville Owner. Peter Finn Date of Iaspeatiow 9-2 5-9 6 Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. I/N,ne of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates . during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with N/A. TTT777The facility or dwelling was inspected for signs of sewage back-up. -LAfhe system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. t/All system components,excluding the Soil Absorption System, have been located on the site. Ae 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. LThe size and location of the Soil Absorption System on the site has been determined based on existing information or Za ted by non-intrusive methods. The ty owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 129 Long Beach Rd. , Centerville owner. Peter Finn Date of Inspection: 9—2 5—9 6 FLOW CONDITIONS RESIDENTLNU Design flow:1 y�llons Number of bsdrooms:.�--�/ Number of current rasidsnts:-�— Garbsge grinder(yea or no): Y ' Laundry connected to system(yes or no): y Seasonal use(yearead r ngs,o):Y available:_- 1 9 9 5—1 9 9 , 0 0 0 gals Water mater1996-109 000 gals Last date of occupancy: COMMERCIAL/INDUSTRIAL, Type of establishment: Design flow:gallon0day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non•sanhary waste discharged to the Title 5 system: (.yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and;pree of information: All A System pumped af part of inspection: (_yes or no) b If yea,volume pumped: gallons Reason for pumping: TYPE OF TEM Septic tank1distr'bution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) 0 (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Long Beach Rd. , Centerville Owner. Peter Finn Date of Inspeetion: 9—2 5—9 6 SEPTIC TANK (locate on site plan) i Depth below grade: / Material of construction:_wncrete_metal FR.P_other(esplaim e a 1G fJ fJ� e- .0 i !�I d►ac✓ Dimensions: Sludge depth: / �b Distance from top of sludge to bottom of outlet tee or baffle:_3�2 y Scum thickness: l 6"% Distance!loom top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of li d level in relation to outlet invert,structural integrity, evidence of leakage,etc.) % �+• /< /�i e t: o '5 .5 ®d r— 0 E TRAP._ (locate n site plan) Depth low grade: Ida of construction: concrete_metal_FR.P—other(explain) as: i thickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: ts. ( tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, eviden of leakage,etc.) (revised 11/03/95) 6 r. < SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Long Beach Rd. , Centerville Owner. Peter Finn Date of Inspeot"m 9—2 5—9 6 TI HT OR HOLDING TANK:_ on site plan) IC=ommenu grads: onstruction: concrete_metal_M_othsr(e:plain) gallons gallons/day f inlet tee,condition of alarm and float switches,etc.) DISTRiBUTION BOX._ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP ERc_ (locate site plea) Pumps ' working order:(yes or no) . Comments: (note of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P"*' y Addeee0 1 2 9 Long Beach Rd. , Centerville Owner. Peter Finn Date of Inspeotion: 9-2 5-9 6 SOIL.AWORPTION SYSTEM (SAS). (locate an site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type leaching pita,number:_ Isaebing chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (note conditiMof soil,signs o ydra is 'ure, levjel of ponding,condition of vegetstio etc.) 6 J o t 1'.s 1C �o' '� Q �, n.r i., i w a—ate t d x(� c LS: (locate a te plan) Number d configuration: Depth-top f liquid to inlet invert: �of layer- Depth of layer: of cesspool: Materials construction: Indicatio of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on plan) Materials construction: Dimensions: Depth of so Comments: ( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 129 Long Beach Rd. , Centerville Owner.. Peter Finn Date of Inspection: 9-2 5-9 6 SKVMH OF SEWAGE DISPOSAL SYSTEM: include tiea to at least two permanent references landmarks or benchmarks locate all wells within 100, -14 aC1 b i 4 �i a- y `!/Sf I T DEPTH TO GROUNDWATER Depth to groundwater. feet method of determination or approximation: (revised 11/03/95) 9 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n/a As built plans have been obtained and examined. Note if they are not available writh 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,excluding 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 conditions 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 on the site has been determined based on: ✓ 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 owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): S Total DESIGN flow n/a Number of current residents: Varies Garbage grinder(yes or no): Yes Laundry(separate system)(yes or no): No; If yes, separate inspection required Laundry system inspected(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-189 000 Qals.: 1998-149,000 Qals. Sump Pump(yes or no): Yes Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) 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: Last date of occupancy: - OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped on Dec 3197 and Jul 21100-per treatment plant. System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons 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) _ I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Unknown Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6ofII ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 1500 Qal. 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 dimensions were determined: n/a 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.) The tank was full up to the cover because a puma in the pump chamber was broken. The tank was pumped, and then the pump was repaired on July 31100 GREASE TRAP: None (locate on site plan) Depth below grade: 4 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: 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.) revised 9/2/98 Page 7of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or 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/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: Even Comments: note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was level, and there ( were no signs of solids or leakage The cover was to grade - PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order: (Yes or No) Yes Alarms in working order: (Yes or No) Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) The pump chamber was full because the pump was not working. The work was done on Jute 31100 and the pump was inspected and was working properly. revised 9/2/98 Page 8of11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 D. SYSTEM FAILS: You must indicate either"Yes"or"No" as to each of the following: _ 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 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 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_. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion.of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria 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 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 H 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 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic.tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. Y supply The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water pp y 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 (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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 roved b the Board of Health,will pass. mp ep ep approved Y 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 obstructed pipe(s) 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 The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass _ Y re9 P mP g Y inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 COMMONWEALTH OF MASSACHUSETTS AFFAIRS EXECUTIVE OFFICE OF ENVIRONMENTAL .'. DEPARTMENT OF ENVIRONMENTAL PROTEC/TTQN �� w ONE WINTER STREET, BOSTON MA 02108 (617)292-&550 61j` ,r vO�i�T TQY CORE Secretary ARGEO PAUL CELLUCCI ` DAVID B RUHS Governor ' ' Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 129 Long Beach Road, Centerville, MA Name of Owner: Claire Fraser&John Venter Address of Owner: Same Date of Inspection: July 21, 2000 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville, MA 02655-0049 Map: 205 Telephone Number: (508)862-9400 Parcel. 020 Lot. B CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and - maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes _ Needs Further EvaTy the Local Approving Authority 'is Inspector's Signature: Date: July 31, 2000 The System Inspector shall submit a py of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days design flow of 10 000 or greater,the inspector and the system owner system is a shared system or has a gpd g 1� of completing this inspection. If they y g mP g P� shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the p g p system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 Printed on Recycled Paper v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 SOIL ABSORPTION SYSTEM (SAS): ✓ (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: 4 flow diffusors (per last inspection) leaching galleries, number: leaching trenches, number, length: leaching fields, number,dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The flow diffusors were located but not dug up There were no signs of failure in the D-box. The bottom to grade was approximately 28". CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: None (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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 129 Long Beach Road, Centerville, MA Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 Map: 205 Parcel: 020 Lot: B 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) 1'pIG� A � a o 00 . A I �_ � � 3 Aa- r�a- a � A3- yq 133- 30 revised 9/2/98 Page 10ofll i J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 129 Long Beach Road, Centerville, AM Owner: Claire Fraser&John Venter Date of Inspection: July 21, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells 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 ✓ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of Health Checked FEMA Maps Checked pumping records _ Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) The bottom of the flow diffusors to grade was approximately 28", and is at a higher elevation on the lot. The sump pump in the basement was in groundwater, which was approximately 67"below the outlet pipe in the basement. There is no groundwater adjustment for this area of Long Beach per the Health Department. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 TOWN 6ii 3ARNSTABLE LOCATION_ /a A4V 5 SEWAGE # VILLAGE Li�L'�� ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY__��1 LEACHING FACILITY':(tgpe) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �/ /� DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No O ' t _ 'ASSESSORS MAP NO: V/ PARCEL N0: J' ....... � No.. ......... ... Fps... . ............. THE COMMONWEALTH OF MASSACHUSETTS o �� BOARD OF HEALTH TOWN OF BARNSTABLE ApplirationJor Pi-qVuiial Works Tnnitrnrtinn mit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Syst .... . _1 .L ......................... ---------------- - ------------•... ----------------......•.......---....---- �Iro�at� -Address or Lot No. ......... ......... --- •-•--•------------•-••-••-••--•................ ..........•--•.......-----------............- •--.......................--••- W Owner Address a .......... ............................................................. PQ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms ._ .___.Ex Expansion Attic�+ g— P ( ) Garbage Grinder ( ) aOther—Type of Building ...........:................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ...-------- •--------------------------•--••-•-----------•----•-••----------••---•-----------------••-----••--••-----•---------•••••......-----•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length....................Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ P4 •-••----.... I r � _ O Description of Soil_______________________ �� N IFIRVISE .....-•--•---------•---••--•-•.............••---•• .-- -- ...... w ---------------------------------------------------- - - - - -- - -- - -- ------------------ U Nature of Repairs or Alterations—Answ r when a cable............................................................................................... ••------•-------------------•--••---------------•--•----•--•------••----------------------•--•--------------...------------------•---------------------•-------------------------------......_.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of. TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co has been is ed by the boa d of h alt . Signed --- --- - --- - -- -- - ----------/.....------. Application Approved By .. .... ....... ........ ..........,... Date Application Disapproved for the following re nS- ------------- ---- ------------------------------------------------------------------------------ -------------------------- - ---------- Date ---------------------- Permit No. --- 1.......... ... .... ...... .. .................... .. Issued -- -------------D-ate- -- ---------- ......... -... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTAI UNING ENGINEER MUST SUPERVISE (�E>CttCit#� (1�� ` LATION AND CERTIFY IN WRITING. YSTEM WAS INSTALLED 1 TRI T 1 Disposal D T N T IS CERTIFY, That the Individual Sewage D s osa S �e P r Repaired g C I g p � � LA�JQ P C ) by ` / at .....1..- 9 . .. �LI-`.....--/ )... ------x has been installed in accordance with the provisions df TITLE o the e nvironmental Code as described in the application for Disposal Works Construction Permit No. --- .. dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CON TRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I DATE --- -- -- ----------------------------------------------------------------------------------------- Inspector .--------------------.......................................................................... o --- �`' F�s...�......._...............-• HE COMMONWEALTH OF MASSACHUSETTS n a 'BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration.f la _ hi n,ial Wo rks Tum xttrftuu 6rutt Application is herebymade for a Permit to Construct or Repair fan Individual Sewage Disposal \5 st P a : - . ( �r P ( `/) g P ..y ...Po, 6:p�...Tjr .......................................................................................... y- or Lot No. = ddress.4E ------ --•----------•............................ ---.........-----.....................__•••--- W Owner Address �-•� ........... ................................. Installer Address Type of Building / Size Lot............................Sq. feet a Dwelling—No. of Bedrooms-All._.....�_________________..........Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QIOther fixtures ...----........... ............... /•-------- --------------------------------------------------------------------------•-----_------ W Design Flow........................................ :gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity...._�...g�llons Length................ Width................ Diameter-_--_-__-__-_- Depth................ :_--r x Disposal Trench—No....... ....... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.._.`\..____.__..... -Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( )^ Dosing tank ( F) k Percolation Test Results Performed by........ l Date. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 93;4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ O Description of Soil............................... " " - - -- ....._.. xv-- ----......................................................... w = ` -----......... �... •-------• �- .�-�- - UNature of Repairs or Alterations—Answ hen app*cabI ......................................................��_._....................._........... ------------------------------••--------------------------------------------------------.......••------...-•-••----------••---•----•---•••••--------••---•••----------------•.....-------------.-.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com has been is ed by the boa d of healtllr Signed ... . ---.----`- - -- ---- - ------ -- ........ II ----------- -...-------- . Application Approved BY :.-.... 6 �f�. .. Date Application Disapproved for the following re s s: ......... ------------------- ----------------------------------------------------------- -------------------------------- --------------------------------------------------------------------------------------- N ..................... __.................... ...................................... Date----- Permit No. --- ---.. Issued Dace �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ertifiratr of C�umpliance TRIA IS TO CERTIFY, That the Individual Sewage Disposal System constructed by ........ ( ) or Repaired ( ) �Co-------------------------------- Install '/ ' / at ......�. .... '!/ ... A�✓ - 1..`t....../ v a - .......... .V/ -_........... ............................................... has been installed in accordance with the provisions of TITLE o The��S��ta Onvironmental Code as described in the application for Disposal Works Construction Permit dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------ --------------------- ------------------------------------- --- Inspector ----------------........................------•--- -- ----- --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..._.�_. ...... .. FEE........................ orkii T11mitr trtivit antic Permission is hereby granted...__.7� � -•,----•--------------- ----••--•--•--- to Construct,( ) or Repair at I an Indivl pa Sewage•Disposa-)System 1� I .. Street as shown on the application for Disposal Works Construction Permit No. Dated..... ► e � %---..•• .................................... - -, ....-1---------------------•----•-•------......-- `� DATE------... - _ -------------------•-------•• Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 6� GRAPHIC SCALE pJ -7 �y -5 � 0 10 20 40 LOCO S CRAIGVILLE 1 BEACH C G NANTUCKE T SOUND F�_OpO LOCUS MAP N SCALE 1 : 25,000 Ege ASSESSORS MAP 205 PARCELS 14 & 20 " ZONE -4.0 R.D. & A.P. -4.0 FLOOD ZONE A13 (EL.11.0') PANEL 8 OF 25 COMMUNITY PANEL NO. 250001 0008C MAP REVISED AUG. 19,1985 -?.6 FLOAT FLOAT -2.5 _,.5 cat REPLACE EXISTING PILING -'.6 _, h < c ` MISSING Q `-� a' PILING Ln m rn • _�' e- - - ' - z _j m M. MARSH 0 . • ' �� ' A;EA TAKEN TO M.H. N. 101 M H W _ 5 - d A6 \ �'f OF ��'' W m cV (_0 Q S B A.7 N� I I }{ A i / O W a 00 FND. 45 / C.B. w J > Orj �n ' A41 I n rT _ Y ? wuo0 1 Qz o 0 za- too- �_ 4 Co Cc x CC) LLj am 0 \ _j CA 0 -) Q arn0m 10 LOT .A \ � � <I I �. `�' � < .� � m 0 co 4,272 s ft UPLAND "II I o 0 ~ Jx0 0 oI I 0. 0 m C.B. z 972 3q ft. WETLAND > � z C.B. SET i_ 5,244 sq. ft TOTAL 98 65' < I I SET S89.51'15"E - Q - /- -co - /-7�- - - - - - - - - -100'±- C.B. FND. �OA r/ r '& 1 �Tj� 1939 TOWN I LAYOUT �T VEM EN T 134.19' EUGE OI`- - - - --- - -- -- -- - -PA- - - - - - -�- - - - - - - - 182.74' B.R.B. FND. S89'51'l5"E I 98.75' 32/10 S89'S1'15"E i POLE AT CORNER I e I� i I v -H C.B. 6 co r- SET 7 4X3 - S rL' i0i9�JEx I' WASHED i cj L I ---- f o P .. v _-5o 00 66.7i1' -�- ,� N�4 0,l zoo Q / 4,c P ivi VP 1500 GAL. w G 5 RIE�UTiON BOX - 0 1g -SEP TIC TANK J 14.52' - - - - - 6.46 ~ 0 �n E_ }{� HOUSE 0 o F � Lo o Lnc C �Lo oLo 129 2 QY ooLn o Ym Z 2p � F- a � U UJ 0 z n- CL r I. 6.94Q o ELEV. . Z N Z' co - 0 co Z EX �TiNG DWELLING n 100't w _j > a- o cy) 0 � N 0 Jcl)cr_0 R 14.10' _ ..-. 0 I ¢ W o o JXCD J 1 � m ; Q `° P m < LOT B I = W uj m p 3 , o p. l (('' DATA 15,595 sq, f't. UPLAND 0 -' Q I) �! }_GN DATA 0 1 `Lz 11,097 so. �t. WFTi_b Nn Lu I!I z 6 26, 92 SCE. c' TGTAL z. 110 Y ' . "^ ) ;.P.D SET w /- N83'5 ,EF iC TA,�."' = 440 X. 150/ =660 G.P.D. B.M. 0 / --_ 2 4o W - - - - 10 1 ' 100. C.B. USE 1 500 GA>_. WALL 0 �� 09' TIE L -- -- -\ - I SET �- 4 FLOWDIFFUSOR - USE FD 4 X 8 - S ELEV. = 10.3' 0 - - - _j CONCRETE RETAINING WALL - - - -- USE 4 (4 X 8 ) CHAMBERS ac= IN A 12' X 50' WASHED STONE FIELD 8 - AS SHOWN i SYSTEM IS WITHIN 250' OF A RESOURCE AREA THEREFORE THE APPLICATION RATE EQUALS 440 G.P.D./.75 = 587 S.F OF BOTTOM AREA IS REQUIRED 12' X 50' = 600 S.F. OF BOTTOM AREA IS PROVIDED. PERCOLATION RATE: 1 INCH IN 2 MINUTES OR LESS. BEACH BREAKOUT COMPUTATIONS 0 S = 7-5/40 = 2/40 = 5% DIST. REQ. = 5%X 150' = 7.5' DIST. PROV. = 10MIN. O.K. NOTE: WATERPROOF TANKS PRIOR TO INSTALLATION. NOTE WELL THIS REQUIRES LEAD TIME. ALL PENiTRATIONS TO BE WATER TIGHT INCLUDING FRAME & COVER. - 2 - - - -- - - - - _ _ - --`- - 100'+ jr UC �7' SO UYVD - PLAN = • � - N1, ti. SCALE; 1" = 20' - F � $LIt.LI'1�� dI Yi 'IONS ARE BASED ON N G.V.D. SITE PLAN OF LAND IN ALL COM^ONENTS CAST IRON FRAME & COVER CENTERVILLE) TEST HOLE TO BE H- 20 SET FLUSH WITI-I F.GRADE OCTOBER 22,1991 EXISTING F.F. = 9.8' BAXTER & NYE: D. DAVIES j B A R N S TA B L E , MASS . ELEV.= 8.8 CAST IRON FRAME & COVER TO FINISH GRADE ,NE ` F.c.= 8't TOP OF FOR P, DR FOUNDATION EL 8.0 __ PETER M. & JUDITH M. FINN /M LO F.G.=&Ot ST IV. INV. = 7,.5 IhV. =5.2 INV. = 5.8 AM & SUB SOIL PERC. � EL 6.0 = INv. = 7.0 40 p,V.G. PIPE 60x T 1000 GA' . INV. = 5.4N N4 5.6 CRAWL SPACE TOP ELEV. = 7.5' SCHE�VLE tER INV. = 7.3 r Ao +'HAMBER 2" PEASTONE 4' o�A,�E INV. =5 a 1500 GAL. SCALE: 1 " = 20 DATE: OCT.22 ,1991 -- -2" PEASTONE - SEPTIC TANK 70.00' FD 4 x 8-s MIN. BAXTER & NYE INC. a V b a v v v v v 7 v O v b v v O O v O v voovovoovavv cvovbvvvvavv EL = 6.0 MEDIUM ovvvvvvvvvv vvvvvvvvvvv SAND 3/4" TO 1 1/2"� COMPLETELY WATERPROOF REGISTERED LAND SURVEYORS o WASHED STONE BOTH TANKS CIVIL ENGINEERS 2" DIAM. P.V.C. PRESSU 'IPING FROM ❑STERVILLE, MASS, -- 4.0' -- 4.0' - 4.0' PUMP TO D.-SC CivL`(. 12.0' Ln OBSERVED WATER == EL. 1.0 WATER ® EL 1.0 E- -7 F'ISO FILE OBSERVED THROUGH TIDE CYCLE, NO FLUCTUATION. NO SCALE. I „� DEED REFERENCE : BK. 7550 PG. 285 #91117