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HomeMy WebLinkAbout0091 MAIN STREET (CENT.) - Health (2) 91 Main Street (Cent.) Centerville P 5 208 090 I JII r ��1 No. 4210 1/3 ORA Pendaflexo oo®a 100/.W ' TOWN OF BARNSTABLE LOCATION 91 IPPook Main Street SEWAGE # VILLAGE C e n t e r v i l l e ASSESSOR'S MAP & LOT Inspected by : 1 �A 3NAME & PHONENO. T_ P. Macomber Son Inc . SEPTIC TANK CAPACITY 2-Cesspools 1-6X8 & 1-6X6 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER OWNER Nelson Littlefield DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ` - 6 w G�� b% OV 0q D COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE �t�N t RECEIVED 4 50 JUL 272004 TOWN OF BARNSTABLE TITLE S HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION �� Property Address: — �ARCEI. .1-- Owner's Name: �0 ; _ ......�.... Owner's.Address: Q� Date of Inspection: G /a-s',�Y Name of Inspector:(please print) RA W 6& C Dr4wd!s Company Name: num 1-4&sad s c c0--Sx Mailing Address: S6 Y ®t D STa!�F eQV T-Prlo'xr. l4 . Telephone Number: a-a9- 77B- � �f CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Section15.340 of Title 5(310 CMR 15.000). The system: f/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 42 Inspector's Signature: Date: & -2-5— 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I A Page 2 of 11 v OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner- Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ro 1- .-� ha ve not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally.Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 ' Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: b�/ C. Further Evaluation is Required by the Board of Health: ul v 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 CAM 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: �LO Cesspool or privy is within 50 feet of a surface water -40 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has aseptic 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. fiL The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. �l The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. �Lb The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. Title 5 Inspection Form 6/15/2000 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. VVl494 eaA , Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No �B ckup 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 �iquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow ✓Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Df 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. — t�Any portion of a cesspool or privy is within a Zone 1 of a public well. t/Xny 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] A10 (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: The following critAwi2 large e s stem in'addition to the criteria above) ( gg y yes no — — the syste Meet of a surface drinking water supply the system 0 feet of a tribu to a surface drinking water supply y �'the syste nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II o 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 9 Owner: Date of Inspection: c, r sr 6 y Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Ye _as/I_� Pumping information was provided by the owner,occupant,or Board of Health —Le4ere 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 r The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no c� 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(3)(b)) Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 V OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address Owner: Date of Inspection: fn 125'10 V FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .2— Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:_L Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):s"[if yes separate inspection required] Laundry system inspected(yes or no): �d Seasonal use: (yes or no):_,d& Water meter readings,if available(last 2 years usage(gpd)): .j,?002 /A4o ao OG 3 //D Ooo Sump pump(yes or no):_kO Last date of occupancy:A COMMERCIALANDUSTRIAL Type of establishment: Design flow(basedKOC15.203): gpd Basis of design flons/sgftetc.): Grease trap presentIndustrial waste hosent(yes or no):Non-sanitary wasteo the Title 5 system(yes or no): Water meter readinle: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: /1/0A/e 47 ,?g-�;.��.�-� Was system pumped as part of the inspection(yes or no):AO If yes,volume pumped: -- �allons--How was quantity pumped determined? Reason for pumping: �(D TYPE QF-SYSTEM eptic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: p g2 / 9,7 gs= -, Were sewage odors detected when arriving at the site(yes or no):Azo Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Zfu r� Owner: A/( Date of Inspec�-4?�'2 5—/12 4-- BUILDING SEWER(locate on site plan) Depth below grade: /.2/" Materials of construction:_cast iron _40 PVC 4 other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: /z be � Material of construction: Loncrete_metal_fiberglass_polyethylene --other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: j� Sludge depth: /U6,ZkP Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: &d&k Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 3 A 1114�� GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of constivictiom._concrete_metal_fiberglass polyethylene_other (explain): ter. Dimensions: Scum thickneXomo Distance fro of outlet tee or baffle: Distance froo bottom of outlet tee or baffle: Date of last p Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 411 Date of Inspection: 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: allons Design Flowroo): gallons/day Alarm presenAlarm level: m in working order(yes or no): Date of last pComments(crm and float switches,etc.): DISTRIBUTION BOX: present must be opened)(locate on site plan) Depth of liquid level above outlet invert:. Comments(note if box is level and distribution to outlets equal,any evidence of solids,carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order s or no): Alarms in working o order (yes or no): Comments(note co dition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 , owner: e� Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):�cate on site plan,excavation not required) If SAS not located explain why: Type !/leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: 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.): >rf7ra Gyres% CESSPOOLS:_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liq 'd to inlet' vert: Depth of solids lay Depth of scum laye Dimensions of c spo Materials of c structio Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate n site Ian) Materials of construe' n: Dimensions: Depth of soli Continents(n a condi 'on of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/15/2000 9 t Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: ��/0 S� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Title 5 Inspection Form 6/15/2000 10 ` Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �/ 427& 4d4 Owner:. Date of Inspection: .z SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Qbserved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) �cessed USGS database-explain: You must describe how you established the high ground water elevation: Gr/.� 2s 3 ai G a-s• .2 wed wa r. q Title 5 Inspection Form 6/15/2000 11 Q 9 TOWN OF BARNSTABLE LOCATION i SEWAGE # VILLAGE Cee 1-21lw11 e— ,,�/'ASSESSOR'S MAP& LOT L4F—OpO �©INSTALLER'S NAME&PHONE NO. er h e5�9&17-, SEPTIC TANK CAPACITY ©m�l LEACHING FACILITY: (type) /DmD��/ 6,X6A,91�- (size) NO.OF BEDROOMS . j BUILDER OR� PERMITDATE: 3v— 30 `'?5` COMPLIANCE'DATE: -9- (D F7 Q Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility rf Feet Private Water Supply Well and Leaching Facility (If any wells exist g on site or within 200 feet of leaching facility) INIA Feet Edge of Wetland and Leaching Facility \any wetlands exist within 300 feet of leaching facility.) Feet Furnished by jJ&,Czz� 000 - N ® �� lib TOWN OF BARNSTABLE LOCATION 4-r SEWAGE # VILLAGE C it I-r11/11'e, ,,� ASSESSOR'S MAP & LOT L©g 0Pp INSTALLER'S NAME&PHONE NO. AYOA 4eeh CB/�s, 7ZZ`� � SEPTIC TANK CAPACITY ®O� LEACHING FACILITY: (type) _��®��C/ 6.X6,di (size) NO.OF BEDROOMS 13 BUILDER PERMTTDATE: 30 "�'J� COMPLIANCE DATE: .2— ( — �7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility f Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Rep q� .9,Ok © I® No......��`/G 1 F�$....$....3.0....QO.. THE COMMONWEALTH OF MASSACHUSETTS \ r BOARD OF HEALTH ` TOWN OF BARNSTABLE Applirativit for Divi-Vuuttl Works Ton.itrnrtiun rrrntit Application is hereby made for a Permit to Construct ( ) or RepairX�X) an Individual Sewage Disposal System at: 91 Main Street Centerville ........--••-•-----•....................•--•------..._...-•-------------...•--•-•-•••-•-••-----••- -•----••---••----------•---•-•....-••--••.....--•...---•--••--••••••------•---••••-•••-•-•----••-- Locat'oi \ '%ess or Lot No. Nelson L [C sae` ield o v 1� � Address W l� U -----•---------••---------•-•----•---•------•---------•--•-•-•--•---••--•--._.._-•.-....------ Installer Address Type of Building Size Lot............................Sq. feet Dwellin)fXXNo. of Bedrooms------------3_________________________-__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons__--___2_----------------- Showers ( ) — Cafeteria ( ) dOther 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. Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by............................. ---------- Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-----............... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ------------- •--------- •--------------- --•-----..---- 0 Description of Soil----------------------------------------------------------------•--•--•---••--•----•---- v .................. -•-•-•---•-•------ ---- x ---------------------- ------------------------------••--------...------ ------- -------•---•••--------------------•-------------•-----•----•------•-•------•-------.----- V Nature of Repairs or Alterations—Answer when applicable._.Omit cesspools. I n s t a l l- 1—1 0 0 . ..................gA!I. n_..tank_ 1 -distribution box and 1 —1 000 gallon leach pi Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place h�--- system in operation until a Certificate of Complia ce has b en.'ssued by the bo rd of hea Signed -------- Application. .2 5./9.5.....:... .... . ...... .... Approved By-�,7-_--- ...:.:.. .............. . ..................................................................... ...... Application Disapproved for the following rearonf: .................................................... ............................................................Dare ............................................ ......................... ...... ... . ....... ..... ...... .... ---------------------------------------- - 'rPermit No. -J74 ... ... Issued ------ . - . c -_ Dace No................_....... FEa....... .....?. .,.h.0 THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF - HEALTH TOWN OF BARNSTABLE Appliratiun for Diij-putial Warlw Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair 7(X15 an Individual Sewage Disposal System at: 91 Main Street Centerville .....................••-----•-•----..................---•---•--------------------•---...-••••••••• -----•--'•'-'-"---••-----'-'•---••---•••--•--•--------------•-•-•--------------••------•-----•--- Nelson hTtEl'k-Teld or Lot No. --------� -------------------------------------••-•-•----------------••-------------•--•_--•---------------- -•-•-------•-----...-._---...-•----- S r �[I��.// Address Installer Address Type of Building Size Lot............................Sq. feet Dwell ingxxh'lo. of Bedrooms--------------3 --------------------------..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons....._.__2---------------- Showers ( ) — Cafeteria (_ ) Q 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........................................ Test Pit No. I................mmutes per inch Depth of Test Pit.................__. Depth to ground water-.--_--.-._.__-_--_----- (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ----------------------------------------------------•---------......_....-•-----•--'-------................------------•--•--..........._......--•-.......... 0 Description of Soil....................................................................................................................................................................... x Sand & Gravel U ---------------'---------'-'--"----------••'-------•••------------•----•--•----'---•--•---.......------'---'-•--•-----•--'----'.......------------...---•--•-----------............----------'-------. W x Omit cesspools. Install 1 -1000 Nature of Re ai s or Alterations—Answer when applicable ----- -------- ...._._________----- .........--.......,__-_----.---_---__. v gal�.on tank 1 -distributio'i box and 1 -1 OOf? gallon leach pit. •-----------------••-••-------••--•----------------------------------•------------------------.....----•--------------------------------------•--------.....-------•-•---•---•---------........-•._-'-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to p -- system in operation until a Certificate of Compliance has be n 'ssued by the board of heatt . S1grled r........... .... .. 3./2 5_/9 S - Application,Approved B - A PP PP Y - -- - - - `e ..... � Application Disapproved for the following reasons- ------------------------------------------------- .......................... ................................... ......... .. ...................... Permit No. Dace ............ ........ ......... Issued ....... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �Ertifirate of 11-IImplianre THIS IS TO CERTIFY That^the Individ �Bwa e I�lsp a�Sys em constructed ( ) or Repaired (XXX))b P / (iQ by ............... ........... ............-....... .....--.. `....C, . h-5-------------------..._.__.....-----------_---------------------- 91 Main Street Centerville m.,,aue at .............. ..---------------------------------------.....-----...-...------ ------._....._--------------._..-.....----------------------..-..-------------------------------------------------------------------- has been installed in accordance with the provisions of TI'II_F r5 of ,he State En�vviironmental Code as described in the application for Disposal Works Construction Permit No. �''. � � dated �� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THATl* %THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------ -..-.��.7--- -- ------------------------- Inspector ..... . --�--� t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE $ 30.00 No................... FEE........................ Diupuuttl Works Tunutrurtiun "Vrrmit JP.Macomber---�r'-----'----------------"-----••-----••-•--------------•-•-- '-....-"--'---••---__.........-- Permission is hereby granted_...-_' to Construct ( ) or Re air (4X) an Individual Sewage Disposal System �1 Main street Centerville. atNo.....................................................................................................-'----- --------------------------------------------------------------------•-------•-- as shown on the application for Disposal Works Construction PerrgT� 'o Date =,:_ ,.a__ _....'".�e�1 Board of Health DATE............................................................................... FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS TOWN OF M NSTABLE LOCATION Q/ 5r SEWAGE# ASSESSOR'S MAP & LOT ?= _�Q� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ID�a LEACHING FACILITY: (type) /DDD yll 6.t`��/T (size) 6X�� NO.OF BEDROOMS /II., 3 BUILDER OR E�R PERMIT DATE: 3- 3O : �' COMPLIANCE DATE: ,) Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist 4// Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Rear qR S� S� fib, 1� 3. TITLE PAGE NOT TO SCALE fd the lest of my kmwledge these plan were drawn+n CA[212o5icjr15 ' carrrly with owner'said/m builder's specificatwm ad ao'cha des made to them atte p lots are made will be'rode at the owne%sad/m builder's 2ESQiENtIhL vW CEF%J Pd. C 505)398-41a4 ' - addkiaal eJpense old rezpmnlblitu. iMe Cmtracter 4olf verify all dmenslms aril enclosed aI aw,.,t5 CM KffC-tN M516N W C 508)wa-4144 7esgro Is not liable for errors oree ca6trucum has Et:EP.GY LPLC'S. _ _ fP.AMING PLANS E-hVJI, III WOOD 5EAM P.EPO,PT5 jay@CadAeSigrts.�i2 Mile every effat'ras been made in the prepa-atim of 30 VIEWS(INi.&EKiJ WcB51fE this Am to avid mistakes"the maker r rot cwarltee `. EYJ51HO NOL"x man error. the human the cmtrxtm of the jd oust rock AMMAfED WALKir 1,166d!5 www,caaae5ig15,6iz -- Al dimes -ad other detads prior to crostnxtm ad be sdeiu responsible thereafter. ® - AREAS FOOTAGE EINI51i r'LOOR AAA 5QLAla�-f. 0 TOP05fD ADDITION . G�N� N01�5 1=1N19f12 3A5MENf A°EA N/A ' 15f FLOR ALTA VI A.L A;OeK s fO COM"LY M�TN THE LAf-rsf ADOPTED 2ND Loa AAA ck l VRSIOW OF hE MA CIILOIN(LODE EDITION?b AW ANY COWTY OR fOW CULDINGTGMMENT5. iINI5HEP AMC MZ'A - N/A � 2. ��(�rIN15N FLOOR NF-A CC)OvER 5c&W DIMEN5 e, PO NOT 5C ,---TNF PMN65 MIS-.AAA s. cESGNLows: GAP.AGES `� c LINGs 20 R.si COVERED vORCNE5 ROOF 20 r.511. u FLOCX e0!25r. WGGi7EN 17ECK5 DECKS 60 P.Si. <. INAGAfON (MINIMUM e0l1'eNENf5 SEE.Mf.`,Cf v'LK IN5LAT'0J NEMP) WNJ-5 n.lp TITLF PA2 �- 2, FWNT& M,�L�MION5 . ALL e,MRIGR WPLL CI�MW.5 3 MARWG WXL } ixrEmm, /4AVEX'I.IDFEALEEStPLE550TFERWA'z 3 LE;I I& F,16K�L�VA110N5 - WrnLArED. � b. 5 FO'RSCLD"rGLWeMENf DEGA:AGE" q. FOUNPAVON PLAN & Cn055 5FC110N5 NOIxE FO;,FPCO:E t�OUIREMENI. - 7.:EAO i. 0 M MM WWD -N = 50.FfW1HAMN.aEA?0vENWG 20"X2!1W5I1FER 5, 15T G L00�PLANN � L) u Cj C DI�CfICAJ AVD A SLL W'Glii LESS:/WJ 44"�F 1E FLOOR. I2^OF ANY Dore ALLWND01 GULL yAVE 1EM��D raAZING.Wtt'ANIP"6nEFLOO�AWDw W 6, 15T FLOOp PLAN -A1�PMON ONLY . a ALL ilk`rX WOwER ENCLOil sAw f03:,IAZWVh1TN I 1 zAFEry GVZwG. � 10, PLL EX'E a MINOOW'5 AR--fO Ce 000M(LAZED —' I NV ALL E<:E9(At.XOr,ke—0 6E 50,I0 CCR'WV II I WEAi'fRSfAPFING.. 8' I I:I II. COMP€Cf PLL SMGYE v'1:tELiQ?5 f0:D�ELEC1RICh'- 0 5Y51ElAANL!N(ERLOCK EACI 50 MAi WIEN ANY QNV 15 9 11 -1 1:.0 tiell ALL WILL 50U1D. .II 12, 7ROV.iECONCu57N APVENIS(W/`,CWEN)Fp.?PNY O, 1 I AMANCf.Yn',.AN GPIN FLANS. I� .r� I:. 3ATFE(tA5 AW0 Ln rY R00M5 A>w fO CE VENTED f0'YE I I IAT� 01G OU1`VEW1HAMWVAUM0FA90C.'.M.FM. ` FINAL 155ULG i4. FOGYIItwl�fO C:.AR ON UNVISflP.✓.-D LEVEL SOL v D ✓cvdO G AN'I(XG/.VK MAfrRlA,S A.VD 5tE°PED:S 12. DaOUMD MNfAIN TIt ReGUMV MM CELC7W[Ne FRJA,GYAVE SIX GEARING A551 AEP f0 CE 2000 P.5.!. 3, 15 PLL.,-! 09EE56. 5'.ZNHAVEn VA.Y5.M Ci v- __ ______________ 2.500 0 5!C✓Mtl1F55!0N S�NGTl;IN ZP DP.YS. LI- 16. ALL'WI1 P IN LWK.'MJN C-IN Zf f0eF . R.'TE55L.�s nEO. 5 17. ALL� C I'NAi".��ROOF 3ASE',A'r!Jf WtiL53FOF 3P(.I✓LLIW/. 5C/ UNLE55 16, IP, CrAM FIXr-F.5 IN CONCke?E IO rM 1/2"AQ ALE Af NOTF'P 5�7TS M'D N05 K7M A MA'!MI1M 6.i'DEARING. I ' / � OTN�pW151� 19. 3A`zJIRI:S AN0 LELLNS N(/f U',E0 AS NPL'I(PDI.E. Q '7 UFMLF'fALE-.191U 3E.PROVIDED VA14 A MINIMUM I� U OL?:LVIW.IWE,CX AWWWG I)-3A-NWNf'MIMP(M5 FIX Q � NEW 150(,HCAIPRE FEET IT FL0(T.:PREA.IN MIL'PLE5 TFE.°Err"AWD IN.l.DE LOUP_D,P51EA"P57RPfiK,N.,TO . °ROMP C9055 V9JTLAf1(}J. N 20 MOVI9EIN5U.AN/NCffFLE5Af EAVEVrNf5. 20 21. ALL A1',';S PAIISfv'JF.NTED.VEN(`lu1M EmER �- � M] YhFY IP S?^;'DGE'kNf Af EPNE PM)GhAE ZIP � !.OuvkE50""VC1VENTAffrP. z --Izs CC) v 22. 0 3 3 nAL+� # Lig 2 X 12 POe 5T? li PX RIDa N1 N 0 T � u u CA'f1MAI, _ 1 CEILING 0 uM EXISTING NOUSE -2" � ;; a w � 1 I I � Vt.!&r✓ 25pb - fLOX pp0 5Fr7I3Ft7p00M VAllL�E17CEILING O ^, --- ------ -------------------- w tb 24 24 6 ^ EX151M HOU5F Z out OF � rINAL ISSUE m 5/19/W v � 1 - I ZIA„ SCAM UNLE55 NON7 42'-6'LK OTN�pW15� N J s IST FLOOR PLAN ILI n � 3 i,� N - N 2 X 12 FOR 5TaK 1.FM117Ck C 24(TEMP R GLASS) 1 _ � 61 w �I - 9 CATH�PM N ; OILING o A o _c II V5 504 cz �XI511NG NOUS� � 32"�owEn �� � o poi 0 ii 29"W.C � � AP.LI�wN N - I II 0 CAP. Cc� 26, 0 CLGSE u u � ------- ---- --T7i/4" 39 1'101/2" c-gU4;' N O PA Pro 05F19 �r:vN000M VAULTED OLiN6 o ---------- ------- ---------------------- N 0 24 24 6 N � C7A� 0� I EXI511NG HOU5� 4'c' 6" 4'6" z FINAL Issue 5/19/05 SCALF UNLE55 N01W 3G5ii � pW15 24'-6" co N IST FLOOR PLAN 7s 0--Z��—DITION ONLY 3/8 n s IV pAL,� #