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Home My WebLink About0218 LONG BEACH ROAD - Health 218 Long Beach Road A = 205—003 Centerville 6.1 I - �1 F// 5 M EAD® Na 2453M UPC 12M smsad mm • Made In USA i Tev + opv� � C-/�p �? la JU"m� � C 0 3- `_43 zn-- v ti 1 1 �,,�, v�f G, �� jv - r � 4 I f re J .. ix a rz tt x i a 4 r F ` � r. !' 'erliN P' ax {✓ rtR �¢ r#s}�� 'Trv7, ��3• » w '2r �r ) a:1,��t. r..s..'._f ,,y�� A� � 5� � .r f� w .� rpa� ��y�� g ao�s- oc�3 C Commonwealth of Massachusetts �n 1p Title 5 Official Inspection form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 218 Long Beach Road u� Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road r� Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 05/29/2020_. Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N FIND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 11 !, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Long Beach Road V� Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 331 GPD Description: 3 bedrooms per RE agent Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): town water- Detail: In 2019-716,000 gallons were used and in 2018-402,000 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �n _ Title 5 Official Inspection Form <yl' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 218 Long Beach Road u Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 6/4/1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 i Commonwealth of Massachusetts :. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1500 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the bafle was in place. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ 218 Long Beach Road u� Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form t� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: One 7 X 49 w/infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately -�f-0 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 5/29/2020 Assessing As-Built Cards TOWN OF BARNSTABLE /y LOCATION SEWAGE # 7 oZ VILLAGE # AS SSOR'S MAP Q LOT INSTALLER'S NAME & PHONE NOe5r__fi SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PR ATE WELL O UBL1C WATE .. BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No I N �{1 114' l± i I I I • I , I S https://townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=205003&seq=1 1/2 Commonwealth of Massachusetts Title 5 Official Inspection Form Ito Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: ELV 1.3 per plan 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: Plan dated Feb 28, 1992 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Bottom of leaching trench ELV 5.3 per plan observed ground water ELV 1.3 per plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 218 Long Beach Road Property Address Melissa Crane Owner Owner's Name information is required for every Centerville MA 02632 05/29/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Bk 28544 Pg310 #55806 12-03-2014 @ 10: 51a DEED RESTRICTION WHEREAS, Melissa Fish Crane, Individually, of 3 Davenport Road, Weston MA 02493, is the owner of 218 Long Beach Road Barnstable Centerville MA, which Vproperty is more accurately described as: the land together with the buildings thereon situated on the southerly part of the Town of Barnstable and being Lot 2 as shown on a plan of land entitled "Map of Chequaquet Beach, Centerville, Barnstable County, Mass." Made by Everett W. Lewis, dated December 1912, duly recorded in the Barnstable County Registry of Deeds in Plan Book 27, Page 141, being bounded and described as follows: ON THE EASTERLY SIDE, Two Hundred Ninety-three (293) feet by land now or formerly of Alice DeCamp; S ON THE NORTHERLY SIDE by the waters of the Centerville or Chequaquet River v running in a southwesterly direction about One Hundred (100) feet; Lot 4 as shown on said Ian Two Hundred Thirty-three 233 WESTERLY by L p Y ( ) feet; and z Ica SOUTHERLY-,by River Street, now known as Long Beach Road, Ninety-eight(98) 00 feet. 16' For title see Deed recorded in Barnstable Registry of Deeds on September 17, 2014 in Book 28388 Page 79. J WHEREAS, Melissa Fish Crane, as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 16.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum RequirementsJor the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; Bk 28544 Pg311 #55806 NOW,THEREFORE, Melissa Fish Crane, does hereby place the following restriction on her above-referenced land in accordance with her agreement with the Town of bamstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. 218 Long Beach Road. Barnstable(Qenterville) MA may have constructed upon the lot a house containing no more than BEDROOMS. Melissa Fish Crane agrees that this shall be permanent deed restriction affecting 218 Long Beach Road, Barnstable(Centerville)MA, more accurately described above and with deed recorded in Barnstable County Registry of Deeds in Book 28388 Page 79. Executed as`a sealed instrument v day of December, 2014. z Owner's signature, Melissa Fish Crane Commonwealth of Massachusetts County of Norfolk On this -3rA day of December, 2014, before me,the undersigned notary public, personally appeared Melissa Fish Crane proved to me through satisfactory evidence of identification, which was 11% L4Vn3-,< , proved to me to be the person whose namd is signed on the preceding or attached document as his free act and deed in my presence, and who swore and affirmed to me that the contents of the document.are truthful and accurate to the best of his knowledge and belief, arid acknowledged me that he signed ' luntarily for its stated purpose. 4 ivota • F blic,j acQ arrie My cokffiission expires: 6/6/2015 IIIRIE V!*:;:,, huee% uet B.2015 0 1 1 TOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS J RECEIVED & RECORDED ELECTRONICALLY s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 1 'I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/6/2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. r ""This report only describes conditions at the time of inspection and under the conditions'of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r t5ins•3/13 Title 5 Official Inspection lForm: bsce Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is Centerville Ma 02632 8/6/2014 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is Centerville Ma 02632 8/6/2014 required for every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 331 gpd provided t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2012= 140,000 total = 384 gpd 2013= 335,000 total = 918 gpd "includes irrigation system Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 6/4/1992 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 10"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 6" t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage DisposalSystem•Pa ge 9 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is Centerville Ma 02632 8/6/2014 required for every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Distribution box was video inspected and found to be in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. was video inspected from the d-box and was found to be dry with no signs of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q` �3 v Z Z Z 3 _7L_ A-3 2a h ` S�st A.Y 33 If2 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 218 Long Beach Road Property Address George & Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 3.5 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: 2/28/1992Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The design plan on file at Town of Barnstable Health Dept. dated 2/28/1992 states the groundwater was observed at 3.5' below grade. This was confirmed by hand augering a test hole. At 37' below grade the soil was found to be damp and was consistantly damp to 5' below grade. The bottom of the s.a.s. is 2.5' below grade leaving a seperation of 13". The adjustment range for this location is 2.3' using index well MIW-29 water level range zone A and current water resources conditions dated 7/2014. See attached Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 218 Long Beach Road Property Address George& Kristen Haseotis Owner Owner's Name information is required for every Centerville Ma 02632 8/6/2014 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 7�c - LXI - 7 SOST�p ,. 6w ytrv��` 3�4V 6 w. 1 M Jt,,t e1,C_ AA 3TIyzc3�Y- Zv ns�' A eAwpte, 0,0 , /_49 3 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 PARCEL ID: 20ts/0w Daniel M. Packard, c/ Gemini Volvo 2 Otter Ct CN RO gEA ,�►' Raymond, NH 03077 �CN� �KET NAN �puN® ® LOCUS MAP i ID PARCEL .ID:. 205/004 Edna S. Kalman 1 Huntington Ave. Trinity Place 1404 Boston, MA 02116 OF n / q LINDA J. G P►h) C, PARCEL ID 205/002 �. Henry C. Homer, Trs. c% Deborah Packard FkjS p�Ql T`A 34 Drury Ln. Worcester, MA 01609 ' \ �\ y 40 0 20 40 ' \,ONE SCALE: 1"=4.0' ELEVATIONS ARE BASED ON MLW=0.0 PLANS ACCOMPANYING PETITION OF GEORGE & KRISTEN HASEOTES LICENSE PLAN NO.Ag ,�: TO CONSTRUCT AND MAINTAIN A PIER Appmed by Department ofEnvironmmw Fi t10n ON CENTERVILLE RIVER CENTERVILLE, MA. of Mmhusett( JUL 2 6 9013 DATE: OCTOBER 29, 2012 SHEET 1 OF 4 A.M. :WILSON ASSOC:, INC. JOB. NO. 2.1740.0 MQO.00,TS oMc►A J, �MSER EN PLAN NO. 13 N 64 1 Q N►QOREp t"�.oATs mired by Department of Eflt+Ironmen l r a, j <,b 1�I W APPROXIMATE TOP OF. CHANNEL � N co � _ EBB CENTERVILLE RIVER TIDAL FLOOD r— 40.9' o I 16 a Jet Ski sf Ramp Ii V w+ w � w '` IILI J121 11 N STONE WALLp,YS a I Fibergiass MA Wp►TERW a Grating s Stairs LIC. 103 Irnl Acces Treed . .......... . Grated MHW p OF L0 W A� a %F ''MARSHY . FACE n ICI _ LW Ir I 0'1 CONCRETE WALL STONE 0.5 WALL J2 w ;3 .W cw LOT 2 0 * , a '0 0 10 20 25,583 # S.F. ti . SCALE: 1"=20' PLANS ACCOMPANYING PETITION OF w GEORGE & KRISTEN HASEOTES TO CONSTRUCT AND MAINTAIN A-PIER ON. CENTERVILLE RIVER ATE: .00TOBER 29, 2012 SHEET 2 OF :4 .M. WILSON ASSOC., INC. -CENTERVILLE, MA. JOB NO. 2.1740.0 i . zo 4" x 6" Post CA _m (Typ•) .to a minimum. z o : depth, PROP( d th, of 4' FIBERGLASS GRATING -10.4f PROPOSED PIER (4' X 41 1=L0) ') (g x 15'f O.C. 1 13' O.C. 13' O.C. 13' O.C. & PROPt O Ulm ,. - JET SIG , .lnw x z G)uZi o Cl)m D _ MHW N2.5 m n�Rb n - ----- --- MLW = 0.0 - --- ------- PROPOSED RAMP zm c� o ..... .... ....... - ••-. .. - �z�� .Existin Grou �(4' x•16`) D Proposed S o Fn z Access Stairs m C7 rj Z Existing Grated Treads my Zo Retaining CHAIN IN RUBBER D >=� Wall 12" DIAMETER TIMBER .PILE (TYP) BRACKET z DRIVEN TO A MINIMUM DEPTH OF 15' OR REFUSAL FLOAT STOPS TO BE INSTALLS DOZ mmO - (n PIER & RAMP PROFILE DETAIL (TYP.) rc `� � NOT TO SCALE z rn = - UGENSE PLAN NO. 13464 N �,�� Approved by Department of Envkonrnet L. CAsll�s ®ate: ` ¢ n a o � 0 6041 LICENSE. PLAN NO, 134aq BEVEL " Approved by Department of Environmen !P t ate. EL®8.3 49 �Q1 2"x8" RAIL 2"W RAIL EL-5.5 FIBERGLASS' GRATING OR DECKING (SEE PROFILE) DECKING - 2" x 6" WITH 3/4" SPACING 2"x12" JOISTS (USE 4)_ . 314" DIAMETER STAINLESS. STEEL BOLT (TYP) io o°Q 3 x8" YOKE ® 3/4" DIAMETER STAINLESS 'STEEL BOLT (TYP) o MHW 2.5 0 ° "x8" BOSS-BRACING (TYP.) 0: GRADE le DIAMETER TIMBER PILETYP DRIVEN TO A MINIMUM DEPTH0 15' OR REFUSAL TYPICAL PIER BENT NOT TO SCALE . JET SKI RAMP. -DECK EL.=5.5 FLOAT STOPS 12" DIA. TIMBER, PILE ------ - ------------- - - ---------- ------------- MHW4.5 FLOAT DOCK --------- ------- -,I,---- - - - - ------- MLW=0.0 CHAIN80TTOM LIBBER BRACKET FLOAT STOPS TO / BE INSTALLED RAMP PROFILE DETAIL (TYP.) NOT TO SCALE A�b,�ciscE EG��Q PLANS ACCOMPANYING PETITION OF o+va4 B GEORGE do K.RISTEN HASEOTES ARNSTABLE REGISTRY OF DEEDS Tn f 0NSTRI.If`.T ANn MAINTAIN A PIER 1 � srq•- �'' ��- . � �I Re: 218 Long Beach Road/Per TM. The system does not meet local regulations as groundwater is less than four feet. Therefore, no building permits would be approved by the Health Division until the system is fixed or until the owner comes before the Board of Health requesting approval. Note: It is unlikely the Board of Health would approve. They will most likely request a new system prior to any repairs/additions to the house �- Oy- �` 40 S �l Gl� rvur�� Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _ 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1: Inspector: key to move your cursor-do not,/' Sean M. Jones / use the return Name of Inspector key. Capewide Enterprises "v—� •._.,Company N_ame..__--� 153 Commercial St. Company Address Mashpee Ma. 02649 City/Town State Zip Code 508477-8877 SI 4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ❑ Fails ® Needs Further Evaluation by the Local Approving Authority 9/28/2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or hps a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the r—. report to the appropriate regional office of the DEP. The original should be sent to the system owner C"J. and copies sent to the buyer, if applicable, and the approving authority. ;` This report only describes conditions at the time of inspection and under the conditions of use : r` at,that time.This inspection does not address how the system will perform in the future under .: .� the same or different conditions of use. t5ins•I M Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is Centerville Ma 02632 9/28/2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 13 System Conditional) Passes: Y Y ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '^ 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information requ'ired for everyCenterville Ma 02632 9/28/2011 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a rivate water supplywell". P Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 1)Although the soil absorption system is above the groundwater elevation it is within the adjustment range. 2)The system was designed for 331 gallons per day( 110 gallons x 3bedrooms= 330 gallons per day), the dwelling consists of 5 bedroom requiring a minimum design flow of 550 gallons per day per code 310 CMR 15.203 D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Cl ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Cl ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate Lt�5in. 1/10regional office of the Department. 1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 331 gpd provided t5ins-11/10 Title 5 Official Inspection Form:SubsuAace Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. City/Town state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2009=208,000 total=570 gpd 2010=278,000 total=762 gpd ' includes irrigation system Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank,present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No. Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 T'Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1992 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 10"feet Material of construction: ® concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" t5ins•11110 Us 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's(dame information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3.5' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years as maintenance. Water level was ok, tank was not leaking and was structurally sound. Outlet baffle was intact and in good condition. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11H0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ~ 218 Long Beach Rd Property Address Lucinda Hines Owner Owners Name information is required for every Centerville Ma 02632 9/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is Centerville Ma 02632 9/28/2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was functioning as intended. Water level was at bottom of outlet invert with no signs indicating past hydraulic overloading. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owners Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s was video inspected from the distribution box and found to have approx 4"of standing water with no signs of past failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 218 Long Beach Rd Property Address Lucinda Hines Owner owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ��!A3 I � g 0 64 23 0 z A•Z 2, /3.2 3 t 3 A3 28 8-3 39 SAS A• Y 3-7 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 3.5feet 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: 2/28/1992 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plan dated 2/28/1992 states that groundwater was encountered at 3.5' below grade, these measurements were confirmed at the time of inspection by hand augering a test hole , at 37"the soil was found to be wet and was consistantly damp to a elevation of 5'below grade. The bottom of the s.a.s. is 2.5' below grade leaving a seperation of 13", the adjustment range for this location is 1.9' using index well MIW-29 water level range zone A and current water resources conditions dated 9/2011. See attached Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 218 Long Beach Rd Property Address Lucinda Hines Owner Owner's Name information is required for every Centerville Ma 02632 9/28/2011 page. Cityrrown State Zip Code Date of Inspedion E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Ca2A�E _ J3u 7' ,°►was s�9 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 HIGH GROUND-WATER LEVEL COMPUTATION Date: Site Location: Z 60n11601 ,J Permit: Cow,4& Alt., o2b?e_ Owner: Phone: Contractor: Phone: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. 3.7 (depth is in feet below land surface) Date: 47 11 0 mm/dd/yy feet below Is STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A) Appropriate index well M w" Z ° B) Water-level range zone STEP 3 Using monthly "Current Water Resources i Conditions" determine current depth to water level for index well. e•� mm/yy i STEP 4 Using Table of Potential Water Level R' for index well (STEP 2A), current de t water i level for index well (STEP 3), and ater-level zone (STEP 26) determine water-level ` adjustment. / / ,�0 d STEP S ! Estimate depth to high water by subtracting the water-level adjustment (STEP 4) from / /` 0 measured depth to water level at site (STEP 1). ! ' NOTE* Tables 1-9 Potential Water-Level Rise are attached as Wor heets to this file. monthly index well data: www.capecodcommission.org/welIs.htmI TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASS SSOR'S MAP & LOT INSTALLER'S NAME PHONE NO j SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 'Z"j!!� 44 NO. OF BE PR ATE WELL OR PUBLIC WATE \ BUILDER OR OWNER DATE PERMIT ISSUEDr DATE COMPLIANCE ISSUED: — — VARIANCE GRANTED: Yes No �j gSRSSORS MAP NO: r �P-kPARCEL NO: r No..�;z..... s Fus. ��..................... THE COMMONWEALTH OF MASSACHUSETTS V BOAR® OF HEALTH TOWN OF BARNSTABLE AVVliratiou for Dhipiial Workii Tnnitrnrtion ramit Applicati is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at LocaSse 7 r ss- ��► or Lot No. �� ... ... ....... ........--------------...------------.......----------•-•----------........._....----•---......... � fJwner Address aV.� '.... j1l ... ---•---------•------•----------•-----------•-- ---•----•------------------•••----------------••------•-----------•------•-•-•---•------•--•------ taller Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........e)�................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ____________________________ No. of persons............................ Showers — a � ------------------------------p ( ) Cafeteria ( ) Otherfixtures - ---------------------------------------------- ----------------------•----••••---------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid"capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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 .................................-........................................................................................................................... 0 Description of Soil...............................................................................----------------------•-----....-----•------.....-----------....--------._........------ x c-, w x -------------------------------------------------------------------•------------------...--------.....----------------------------------------•--------------•------•-------------•-•---------••------. U Nature of Repairs or Alterations—Answer when applicable.---------------4W--- ------ Y __-_-_-----_-_---_---_-_______-____-_- ..--•-----------------------•-----•--------------•--•-----•---------------.........._•---- 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 pot to lace th system in operation until a Certificate of Compliant has been issued y t board of health. Signed ...sue... l f.... ------ -........ .......I� .... ----- Date ApplicationApproved By ------------------------------------------------------ --- ------------- --- -- -- - -- ----------------------------------------- Date Application Disapproved for the following reasons- ------------------------------- ---------------------------- ------------------------------------------------------------------- -------------.............................................................. . Permit No. � ....... Issued Dace------ --- Date � L�w�� `+ (� �-.dam �� r No...79 n � ` - FE$.w ............ f(� THE COMMONWEALTH OF MASSACHUSETTS V - ' ! BOAR® OF HEALTH �---ao�- I TOWN OF BARNSTABLE �4 Appliration for Disposal Workii Tnnstrartion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:V11'/ f `'• /. _PJ n r�r.!.d` .... ............. .....-••-•-------------•----•-•-•-------•-•---•--•---•--•--••••-•-•••--•--•-•--•.................. Location.-�d ress// or Lot No. Oa- / Owner 1�/ Address ---•--•......................... ---.._.....-----------------......--•------ Igstaller Address Type of Building Size Lot............................Sq. feet ►-� Dwelling—No. of Bedrooms_____.._........._......................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other 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 ( ) - � Percolation Test Results Performed by.......................................................................... Date........................................ 0 Test Pit No;jl________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -•----------------------------•--------------------•-••-....--------•._......•-••-•-•----••-•-•-•---......................................................... 0 Description of Soil.......................................................................................................................................................................... x V ----•-----•-•--•-----•••----•----------•...............•-•----••-•----•••----------•---•-•..._•-•-•----....-----------------•---•••--••-•.............................................................. 0 Nature of Repairs or Alterations—Answer when applicable_______________ _____________________________________- ..-•---------•--•-•••-••--•--•--••-•-------------------•------•-----••••••-•----•--•--------...._..-----•----•-•---•------------•-•-------------•-•---•------------•-----•---•-•--•••-•----•---------•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees of to place the system in operation until a Certificate of Compliance has been issued y the board of health. Signed ... icy _�G -` . (/ r Date ApplicationApproved By ------------------------------------------------------------------------------------------------------------------ ---------------------------------- ------------------------------------ Date Application Disapproved for the following reasons• ------ --------------- -------------------------- -----------------------...............................................-------- --------------- ----------------------- Date PermitNo. ......... /--------------------------- Issued --------------------............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifi ate of Taraptianre THIS IS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�-) by------------- . .............. -- Installer at - - - £ .Z¢ :...� ------ has been installed in accordance with the rovisi4ns of TITLE 5 ofjhe State Environmental Code as described in the application for Disposal Works Construction Permit No- ----------------`.'Z-------- ------- dated ........--................................--.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............--- n t ...- Inspector ----------------- - -----.....-.1.....-.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No._.....�.:...�:...... FEE......-11.�........... %yosat WorkD Tlantrnrtion autit Permission is hereby granted•----•------ t.-Vi4uai"Se"wa keq: AAA. '�i to Construct ( ) or Repair ^an In ge Disposal)System/ at No............Z2. s 1.:*'��. ' 4_,.......... r2 r � (i�l? Street qq� as shown on the applicatio for isposal Works Construction Permit No..yl.G 3,2_/_. Dated.......................................... -------------------------.......... -••--• /'� Board of Health DATE.......... - ------ V FORM 36508 HOBBS♦!e WARREN.INC..PUBLISHERS AsBuilt Page 1 of 1 i TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE ASS SSOR'S MAP & LOT—' INSTALLER'S NAME ru PHONE ANO SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size)-- I = � NO. OF BEDROOMS PR ATE WELL O UBLIC WADTE, BUILDER OR OWNER DATE PERMIT ISSUED:- DATE COMPLIANCE ISSUED: 'CG -- VARIANCE GRANTED: Yes__ t No i A( 4 I I I i . I http://issgl2/intranet/propdata/prebuilt.aspx?mappar=205003&seq=1 9/20/2013 � T3 SCHRANGHAMER DESIGN GROUP I F.. ______ NEW MARVIN ULTIMATE FRENCH ___ _ ____________ _ -- SLIDING 4-PANEL PRRO DOOR 51 MEL HER STREET 10 NEW MARVIN ULTIMATE CA SEMENT � WINDOW VV YYY I GENERALNOTES: GENERAL CONTRACTOR SHALL MAKE ALL SUBCONTRACTORS AND SUPPLIERS AWARE OF THE REQUIREMENTS OF THESE NOTES. _ - 0 OR - ALL WORK SHALL BE PERFORMED IN COMPLIANCE WITH ALL B R APPLICABLE LOCAL.STATE,AND NATIONAL BURDING,LIFE SAFETY, 1 ELECTRICAL AND PLUMBING CODES. NEW MARVING ULTIMATE FRENCH -- _____ -..a - PERMIT GENES ANDAPPROVALS CONTRACTOR NECESSARY FOR COMP EL BE RESPONSIBLE TIONCOFALLURING�L SLIDING<-PANEL PATIO DOOR --- --- -------- FAWLJ ROOM 1 T WORK PROPOSED WITHIN THE CONTRACT DOCUMENTS. GENERAL CONTRACTOR SHALL LAYOUT,IN THE FIELD,THE ENTIRE WORK TO BE PERFORMED TO VERIFY DIMENSIONAL RELATIONSHIPS BEFORE CONSTRUCTING MY PART,AND SHALL VERIFY ALL EXISTING 9 CLOS.i 1 CONDITIONS AND LOCATIONS BEFORE PROCEEDING WITH WORK GENERA1 ..... .. - �.>... , CONT OR LE FOR 0 Q RDD COORDI ATIONOF IMENHAll BEROUIREM WSBET E I COORDINATIONIR DITFADEONAIREQUIREMENTS BETWEEN THE I. _: �.r° i I ________ ED 110 Mk WORK OF REWIRED TRADESAND'ORBUBLONTRACTORS, B 2 NEW REFRIGERATOR LOCATION _ k I� c�rp { NEW DEEP CASED OPENING,SEE ANY DISCREPANCIES FOUND IN THE PLANS,DIMENSIONS EXISTING USE EXISTING FARMER'S SINK ( �-� I� �y -.. - --.�- INTERINDALB10TIONSANODETAIL CONDITIONS ORANYAPPAEMERROR IN THE CLASSIFYING OR V - SPECIFICATION OFAPRODUCT,MATERIAL OR METHOD OFASSEMBLY T IS TO BE BROUGHT TO THE ATTENTION OF SCHRANGHWER DESIGN ' GROUP IMMEDIATELY. REMOVE EXISTING WINDOW DININ ROOM REGARDLESSOFWHETHERORNOTANREMISSHOWNOR RR IF IT IS IED,THE CESSAENERFLCONTRAER INSTALLATION DE SAID REM 10 _______ O IT N NECESSARY FOR THE PIED.SUPPLIERS AND OR FUNCTION 1 I I I ' _______________________________ OF AN ITEM SHOWN OR SPECIFIED.SUPPLIERS AND I I t. it I y - _ SUBCONTRACTORS SHALL INFORM THE GENERAL CONTRACTOR OF k Oi S, THEIRREWIREMENTS FOR THE WORK OF OTHER TRADES,WHICH " MAY NOT BE INDICATED,PRIORTO SUBMITTAL OF FINAL BID FOR ___ _________1 - ,n WORK NEW BALLISTERAND POSTAi -� I __ -----__ BLIND GUT DOOR PANEL UNDER DRAWINGS SHALL NOT BE SCALED FOR DIMENSIONS ANDIOR SIZES. KITCHEN STAIRS,SEE DETAIL A20 ill STAIR,SEE DETAIL A6.16 THAWINGBMALLYHAVE DRAWN, REPRODUCEDATA SCALE DIFFERENT Ell tfl� - THAN ORIGINALLY OFAWN. __ __ 1 k -_ ,1 I® 09HALL _ _ DRAWING COPYRIGHT: -- - -- - BEDROOM q3 1 ,i SCHRANGHAMER DESIGN GROUP EXPRESSLY RESERVES THE COMMONI-AWCOPPNA THE EDRAWI GSP THESE DRAWNGS RIGHTS AND EARE THE PROPR PROPERTY ERTY OFHTS F SCHRANGHAMER DESIGN GROUP MD SHALL NOT BE REPRODUCED LIVING ROOM NAVY MANNER NOR SHALLTHEY E ASSIGNED FORTHEUSETO MUDRO M 108 ANY THIRD PARTY WITHOUT FIRST OBTAINING THE EXPRESSED ---- -- �'�� 10 i BATH k2 WRITTEN PERMISSION OF SCHRANGHAMER DESIGN GROUP. SEE DETAIL A&6 FOR PANTRY --- -- � 109 BEDROOM HALL DETAIL PLAN MASTER - /3�_ NEW RINTERIOR ELE M FIMURES,SEE BATHROOM RO MH LEI I PLUMBING SCHEDIULE AND 105 6 B GENERAL CONTRACTOR: STRUCTURAL ENGINEER: r I I I SHOWER, TER OR _ NEW SEE INTERIOR 10. ELEVATIONS CHAN IDE.00TING DOOR TO BEA _ u Yr' ---- --- _ 2'4'WIDE.DOOR , --- -- --- ---- NEW AB.16 FOYERBENCH,SEE DETAIL--- VESTI ' F VER MECH.CLOS. 113 -'®ILIL- -' 112 REMOVE EXISTING EXTERIOR MASTER I DOORAND STAIRS BEDROOM ------" 104 ' I O SCHRANGHAMER DESIGN GROUP,LLC PAD OUTEXIST/NG WALLAND INSTALLA 6'6-TALL DOOR - -_.1 SIDE EN RV ___u___ir___I ___"___"___ir___ir 100 II I u i ® 1 , �� u u H „ ,T ❑ The Cottage at 218 Long Beach Road Centerville,Massachusetts 02632 u N T, ____I.___ ____ Proposed First Floor Plan SCALE: 1/4"=1'-0" DATE: 10-15-14 n First Floor Plan-Proposed I SCALE:1/4'=1'-0' ' ®=NEW WALL A SCHRANGHAMER DESIGN GROUP ---------------- - -- ----------------------, 51 MEL HER STREET GENERAL NOTES: GENERAL CONTRACTOR SHALL MAKEALL SUBCONTRACTORSAND SUPPUERSAWARE OF THE REQUIREMENTS OF THESE NOTES. -- ALL WORK SHALL BE PERFORMED IN COMPLIANCE WITH ALL APPLICABLE LOOP AND NATIONAL BUILDING,LIFE SAFETY, -- _ ELECTRICAL PNO PLL MSINUMBING CODES. GENERAL CONTRACTOR SHALL BE RESPONSIBLE FOR SECURINGALL PERMITSANDAPPROVPLS NECESSARY FOR COMPLETION OF ALL WORK PROPOSED WITHIN THE CONTRACT DOCUMENTS. GENERAL CONTRACTOR SHALL LAYOUT,IN THE FIELD,THE ENTIRE ` WORK TO BE PERFORMED TO VERIFY DIMENSIONAL RELATIONSHIPS BEFORE CONSTRUCTINGMD ANS PART,EPROCND E INGWITHERIFY EXISTING " CONDITIONSANO LOCATIONS BEFORE PROCEEDING WITH WORK. _ GENERA CONT TIONOF TOR SHALLDIMENSION BERQUIREM NT BETWEEN OR THE CORKOIF RE OFDIMENSIONALREQUIREMENTSBETWEEN THE WORK OF REWIRED TRADES ANDIOR SUBCONTRACTORS HALL ® _, —. CONMY DITIONS ONCIESFOUND PPAREN THE PLANS, CLASSIFYING OR I I I YY CONDITIONS ORANYAPPAPENT ERROR IN ECLASSIFYING OR STUDY SPECFCATION OFAPR ODUCT, A HODOFA Y_ ISMIPIEOTHEATNTONOFSCHRANGHAMERDESIGN GROUMMDIATEL REGARDLESS OF WHETHER OR NOT AN REM IS SHOWN OR ® ® MASTER ® - NEW CLOSETS WITH BLIND CUT SPECIFIED,THE GENERAL CONTRACTOR SHALL PROVIDE SAID REM BATHROOM IF IT IS NECESSARY FOR THE PROPER INSTALLATION OR FUNCTION OFAN ITEM SHOWN OR SPECIFIED.SUPPLIERSAND DOOR SEE DETAIL A9,1T ----- SUBCONTRACTORSSHALLINFORMTHEGENER CONTRACTOR OF THEIR REQUIREMENTSFORTHEWORK ITALOFFINA ES,BID WHICH NEW BATHROOM FIXTURES,SEE ^ PLAYROOM EMS MAY NOT BE INDICATED,PRIOR TO SUBMITTAL OF FINAL BID FOR INTERIOREIXT RONSAND ` 1 PLAYROOM WORK PLUMBING FIXTURES 202 _ DRAWINGS SHALL NOT EE SCALED FOR EDDIMENSIONS SCALE IFFESIZES. DEMO EXISTING WALL,REPLACE DRAWINGS MAY HAVE BEEN REPROpUCEDATASCALE DIFFERENT WITH GLASS SHOWER ENCLOSURE, /�-��f �® _ THAN ORIGINALLY DRAWN. NEW COPPER PAN,TYPICAL THROUGHOUT,SEE INT.ELEV. rah .' �. , _ _ _ DRAWING COPYRIGHT: -� NEWBOOKCASES,SEE DE TAIL NEWOORMER.SEE WALL SECTION SCHRANGHER DESIGN GROUP EXPRESSLY RESERVES THE Ad 1 BATH#4 '"" - I - I A8.18,AND REFER TO SHEET All - AM 201 i� _______ . E G COMMONLAWCOPYRI HTS AND OTHER TO RIGHTS F xA - - FORADDITIONALOETAti THEDRAWIS.THESE ORAWNGSAREE PROPERTY OF HALL INANYSCHRANGHAMER DES IGNLL GROUP THEY E SHALL NOT BE REP RODUCED INANYMANNER NOR WITHOULIRST BE ASSIGNEDTHE EXPRESSED NEW BATHROOM FIXTURES,SEE ANY THIRD PARTY WITHOUT FIRST OBTAINING THE EXPRESSED INTERIOR ELEVATION S AND , � ;; j i i � � WRITTEN PERMISSION OF SCHRANGHAMER DESIGN GROUP. PLUMBING FIXTURES -------- __ ______ ________________ __ __________� GENERAL CONTRACTOR: STRUCTURAL ENGINEER: I — I , I NEW BENCH.SEE DETAIL A8./9 NEW BOOKCASES.SEEDETAIL EXERCISE ROOM B00w ARlk AND REFER TO SHEET A11 FORADDITIONAL DETAIL 206 = NEW CLOSET.MATCH OPPOSITE , � __ L _L__CLOSET —. � U n__nn I _i = T T O SCHRANGHAMER DESIGN GROUP,LLC API i== i- The Cottage ' F _ ;r at 218 Long Beach Road Centerville,Massachusetts 02632 dS—dL-ov9=o=�=_=�=--u==d6o-dhoodh=o d'0009==vro Proposed Second Floor Plan SCALE: 1/4"=1'-0" DATE: 10-15-14 n Second Floor Plan-Proposed I SCALE:114"=1'-0' O=NEW WALL 1 .2_ "S• SOIL. TEST PIT DATA INDICATES INDICA TF.S SEPTIC TANK DETAIL 1000 GALLON DISTRIBUTION BOX DETAIL: b B - _S LEACHING DRENCH DETAIL : STANDARD PERIC OBSERVED NOT TO SCALE NOT TO SCALE x TEST GROUNDW� a INFILTRATOR c NOr TO SCALE TP P- 7655 TP TP NOTES I SEPTIC TANK SHALL BE STEEL 4 INLET AND OUTLET TEES TO BE CAST IRON, 30/ NO. OF OUTLETS: -7 _ TP REINFORCED CONCRETE SCHED 40 PVC OR CAST-IN-PLACE CONCRETE TEES z '� _ GIRD EL +-6 GRD. EL GRD. EL GRD. EL 2 SEPTIC TANK TO WITHSTAND H-2+7LOADING TO BE CENTERED UNDER MANHOLE COVER - NOTES n ror ob oa prrc-ti4 ��- . r-; r�-Y-•.• .�p T ' �C, �� •,.Erfo.��a°.f�e �en,�,eTeo��ao,�;�e o��o q°,f„�� j GW. EL. I.3 GW. EL. GW EL GW EL. 5 RECOMMENDED MANUFACTURER-ROTONDO UP I DIST BOX TO WITHSTAND H-20LOADING h r ) O APPROVED EQUAL 4' PVf, TOP It SUB SOI L l PRECAST 1�+ 3 ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER ' " I DIST I - 112 18"MINI. � C.I. IS j2 -.I 2 l' ? CONSTRUCTION TO BE WATERTIGHT BROUGHT TO rlN+s� GOALIE I BOX 2 PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF °j°4'� L _ MEDIUM INLET PIPE EXCEEDS 0 08 F T/F T OR IN i4r��5 t +lcv� �lf+ �� M�•� i PUMPED SYSTEM (f� SAND j g � ' ? z MIN o fk , L - - ---J 3 FIRST T TWO FEET OF PIPEOUT OF DIST 4 4 4 ",. - - 3 r- 4 PLAN VIEW BOXO BE LAID LEVEL PROF TIHIS� PLAN S r�,;k :+E SIGN ANG �. B _Q" E C LE CONSTRUCTION OF THE SEWAGE 4 4 RECOMMENDED MANUFACTURER- ROTONDO5 10 NI MOVEABLE r- MEASURE SLOPE AT THIS C,INT DISPOSAL FACILITY ONLY ^NORMAL WATER ..E VfI `J 5 5 T T I Y vER OR APPROVED EQUAL 2 ALL CONSTRUCTION METHODS AND -_ - --- ? 14" � 3" � I• OIST -150xSLOPE t _ - Z- -- - -i )AM 8 SEED 2 � o MATERIALS SMALL CONFORM TO MASS 14 2 /o MIN FINISH GRADE t b 6 6 i NLf T Tff �}'-10" k:7vIGE - T ,ram •J__. JF HEALTH ,-REGULATIONS AND IONS AL BOARD '. WATERTIGHT } �--L "..` x �. 0" YIN Ou T L E t S "S , _ MIN 7 7 7 PgECAl7 4'11 ,)INTSltypi I • I' , •I' x < } t BTP lEPTIC 4 '�+ 1 L QUID DEPTH TEE �r stE I SUSFE'JLiCLJ ► ALL PIPES LOCATED UNDER PAVEMENT �r N Tf z I � w �}" PVL - PERFi - ---- +►- TANIt 4'-10' 4 ,NL E ' - .. _ I y ? MIN OF I/8 TO OR TRAVELED SHALL 8E SCHEDUL E GAV I NG 8 8 8 4 uU T LE T y; FULL L(NC.T N I p' I/2" WASHED STONE 40 :)R EQUAL T t I .ti 9 9 9 9 R� I { I• 2 �PELIFICATIDNS STANDARD 4 THERE ARE NO KNOWN WELLS J 1 1 i I; L__ __ �� J t L _J NFILTRA1DR � t t •' - I� 4' LOCATED WITHIN 100 FT OF THE U IO - 10 - 10 t --=--- =- -- --- -- ' t t � 3/4• TO, 1-1/2" DOUBLE PROPOSED LEACHING FACILITY NOR -; BOTTOM ON LEvEL STABLE BASE ,t;,( ( „ � TT +M 'N �I� F S X w.Z r: 1 ,YO T H 5 ..- __ 3" 2' ESE, STAB(f 1. WASHED STONE(no fines) ANY WELLS PROPOSED WITHIN 100FT E I - I I I I '�`'-' • i CROSS-SECTION j � A- -)F ANY KNOWN LEACHING FACILITY t MIN �/4 RASE WEIc�NT Z_1 Ibs T1 L O'' EITHER SIDE Pt AN VIE W ROSS SECTION VIEW a MIN �i. To NE CROSS SEL _�N 5 'HI`, SYSTEM I� NOT 12 12 _ 12 12 - z sT >ME STC>RA6t 8 8 fts ( (olo GAL ) DE, GNEI Fmk THE USE F INVERT ELEVATIONS: DATE DATE DATE. DATE 2 -20 -g2 TEST BY TEST BY TEST BY TEST BY _7 + THE DSC GROUP (( �� 3 , p / 4" INVERT AT BUILDING 7- SO L. WITHIN I. MIT OF EXCAVATION REMOVE ALL TOPSOIL, SUBSOIL ANL 0 THE R WITNESSED BY WITNESSED BY WITNESSED BY WITNESSED BY � 4" INVERT AT SEPTIC TANK(m) `/.00 MPERVIOUS MATERIAL tIIC�RANDI �UNNINL� �.- �v (� SILT FENCE I 1 ' 4" INVERT AT SEPTIC TANK((out) �5 PERC RATE PERC RATE PERC RATE PERC RA 'E m 3 / 7. REPLACE W TH _-_EAN WASHEC SAND 2- 4" INVERT AT DIST BOX(m) �•IDD _)R _ THER CLEAN GRANULAR _ MIN./INCH M{N./INCH MIN./INCH __. MIN./INCH 4 INVERT AT DIST. BOX(out) �- v 43 - � � MATERIAL HAV,NG A PERCLATION HATE OF L E .,; THAN 2 MiNuTEI- DATUI V 1. - - PER Nc: BEFORE ANC: AFTER o Z INVERTS AT LEACHING FACILITY. F LACEMENT g EX:ti No' IL ' ES WHERE SH,,WN Go i HF VERTICAL DATUM NC,VD ,� � 4 INVERT AT BEGINNING ri HAWING` ARE APPRuXIMATE. / OF LEACHING TRENCH ' HE uNTRACrOR SHALL BE RESPON b 3n b�E - F, �'R ;PERLY L„GATING ANL ' OR; NA' NG `HE PRUPuSEG CLN BENCH MARK. USED TOP of CONCRETE BOUND � S.W. CORNER OF LflT I_18 --;�/ 4' INVERT AT END ,TRUCTIuN AiTIVITY WITH DIG SAFE y' OF LEACHING TRENCH ;NL THE APPI_.ICABLE UTILITY ELEVATION AT BOTTOM ,uMPANY AND MAINTAINING THE EXIST NG UTII T r SYSTEM IN SFRw_E OF LEACHING TRFN':H ` DI', ;aFE '>HaL , BE NOTIFIED DER PROFILE: NOT TO SCALE (11 I I OBSERVED GROUNDWATER THE STATE OF MASSACHUSETTS STATUE CHAPTER 82 SEC:T1uN - ELEVATION ,T TEL I -Bur - 322 4844 THE A QRICtC ENGINEER DUES NOT GUARANTEE PA1-ICE �\ • T-iFIR ACCURACY OR THAT ALL SPRINKLER COKITRDL- ES ANG SUBSURFACE STRUCTURES / E"t SHOWN Lu(,ATIUNS AND -VIAPrv_r <, H " Rc , IFEL CES LE A UNS _)F UNDE GROUNC UTh T EXIST I NCB S POvI_ �. / r r` � _ /� AKEN FRc�M RECORD PLANS THE �� TD BE FILLED ❑ :uNTRACTOR SHALL VERIFY SIZE, EL Q.5_ EL_- �t.l c, I,F DECK LOCATION ANL: INVERTS ,F UTILITIES T =+E ';F _ --, S CTUR S AS REQUIRED PRIOR •, I FINISH F')R '�:N 8.� `__ - FADE AND TRU E 21b EXISTING CESSPOOL DESIGN CRITERIA: TF{E START OF CONSTRUCTION 5 0` FILLED 'MIN r a"P,r. `F�I N" MIN p EL l TO BE i ° 4 PVC yL H 40 - - �� 4 oVC SCH 4C F q F is UfKL f AASI I' L 3 B E Q R�L� L N 6 M W �! To _ A T • 7_so �,75 -_ FIN. FL. = 12 .D5 � DESIGN FLOW l I 21 g PRO PDSE� BSC�.00 �•`o � � BEDROOMS ,I�= G.PB /D 33o G.P.D. w - - `.3v / 5 =(0.43 O PLANTINL» C.. N NIG Uj WA T F f, [ I PRECA NI;Nf v 3 Q �, Q X SE , J sT��E wal` � REQUIRED SEPTIC TANK NOTES I- ALL FILL WORK TO BE CDORDINATED' w/PROP WORK FOR KALMAN 4 OT�fER LAND Of LUNG BEACH REAI_Z'+ r'U_S7 � I L w I SPRINKLER OO� ALLbN _ K A L M A N 330 _ �}9S (;AL • 1KEL ° SEPTI TANK 2. RECONISTRDCT t REPAVE DRIVEWAY IN LOCATION OF EXISTING `l LINE ° LCjr�rfZOL_ E�Ox I° SEPTIC TANK PROVIDED = 1000 GAL G 3- GAS SERVILE LDCATIDN -rD BE CONFIRMED PRIOR TO ANy r�1 0 G d ExCAVATIDN. SEE GENERAL NOTE 8. MASON n ti, a SIZE OF LEACHING FACILITY REQUIRED TheBSCGroup-Norwell Inc J RASS 9 l DESIGN PERC. RATE MIN./NCH O N G 1 S L A N D o 29'3 Washington Street 4. ASSESSORS MAP 205 PARCEL 2 O O r, y �_�' - Norwell MA I- �- � I �, ',.. FOR RDDITIoNAL 6RADIPIL� SEE n�tTE - J. I� NHL/SF 2061 S. PLAN REFERENCE SK 134 PAGE 149 ° < �� 330 = O.l5 4 40 S F c , ( °Yt N BARTER It NyE SITE: PLAN SUPPORT NET POSTS r O r1 i LATCH BASIN ASSUME I' DEEP x -1 ' WIDE InIFILTRAT6R TRENCH ----------- --- (o. FEMA PANEL NO. 2�0001 OOICoC MAP REVISED B P4 8S POST lU 18 5 RIM - 40' REVISED IZ 3l 91 . 440 ._ q S r= /L. F. = 48.q L. F 617 659 7981 tt FILTER FABRIC / ZONE A 13 ! EL. = 11.DO/ SECTION-B I ! j I O'f� TO BE RE►•'IOVE D - --- 7. ALL DISTURBED AREAS TO RECEIVE t. ' LOAN, AND SEED I I L SECiI ON-A L1.1 11 W - TOPv1Ew Cr, SIZE OF LEACHING FACILfTY PROVIDED: 8. FOUNDATION TO COMPL`f WITH STATE NLDG CODE '1BOCMR _ BACKFlLL FIFTH EDITION SECTION ?_f0?_ FLL,C)D RESISTANT CONSTRUCTION EosT COUPLER e n x I ( ( SPRINKLER LJSE . STANDARC) Nr LirZATOR SEWAGE DISPOSAL FILTER FABRIC 1854 I I l T`I P_ *� 9., HOUSE IS TO SE RESET EXACTL`f AS IT PRESENTLY NOW SITS _. , ;, LIMIT OF EXCAVATION I ' DEEP �c -1 ' WIDE x 49 LONG SYSTEM STEM DESIGN IFE / I I ( SEE NOTES 12 . THERE ARE NO PROPOSED CHANGES IN OFFSETS TO PROPERT`I BACKFILL I \ LINES •� ' i NATIVE " sEctoN-B `I $ ,Z' _ 3 TOTAL LEACHING = 441 S F. OR 331 GPD "0 SOIL '1 SECTION-4 �� j 2� 5 L O T ET �� J l � I LONG BEACH ROAD LAP KES AT TOE-IN MET'HQp$ JOINING SECTIONS OF ENVIROFENCE LAP JOINTS -_�, _ ° , F�1 LOCUS PLAN: NOT TO SCALE CENTER\IILLE) MA I LOAM SEED SI LTATION FENCE DETAIL \ // .___.--_ —„— . •L NOT TO SCALE 1 I J / 5 cB1DH o - - -- — — ❑ _ FND c a/�-' N BIDS 19 I S" ❑ ❑ �GRAVEL 13ACKFILL o E� EVERY TIER F NG — ° $ 0 P. rr j „ 2" BATTER PER TIE (MAX.)--••I BENc H MARK — ,� LONG [3 EACH ROAD REALTY EL. = 4.83 n NEW 6",8"x8' L_S TIE O m 0 NOTE OMIT DEADMAN IF LONG BEACH ROAD r/N OF Nq�r P� TRUST (TyP) ' ° LESS THAN 4 TIERS HIGH ', a DAVID :. ��., _ /4 CRiSPIN �- RIVER 3] 0 MAIN STREET N x EACH DKE 3"sFROM ! 9 No.32112 „ (jERGN, CIVIL ROgO WORCEST ER, MA — - --� � ENO EACH OEAOMAN �_ \_.-4`DEADrIIIAN TO FACE pF �A F ``o , FSNAI iNrJX�E RA1b EHC II )AT I F E Q. 2 I OIOI Z - --- +• WALL 8 O,C. STAGGERED — _ �• L" EVERY THIRD TIER — OMP DE`_)iuN C, RUSSELL l � LOCUS E1ECK D. CRISPIN PRESSURE TREATED LANDSCAPED PLAN VIEW: �3AWN D. L . / W. B. SCALE: 1 n= 2O� JOr RIGHT THEP I At OPYENG OF ANti FUB M CENTER I/I L L S H A R B O R iELD TIE RETAIN ING WALL SigNliq.00.� u' ,FA;,OPYRGHTEDWOKS Wlitit' • NCI TO SCALE •RIaleS10N r_. 'HF rrv°16H-nWNER i^^VU ' Il_E NO - )W(3' N() 3g30-04 �F+I I T o to %c -- 40 I,p FEET y� iOB Ni ! 4-S040.00 I I:)I I . 3g3D -04-