Loading...
HomeMy WebLinkAbout0049 SEA MARSH ROAD - Health 49 SEA MARSH ROAD Centerville A 227 - 128 S M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR �SYABIEFORESTR MIN.RECYCLED INIUATIVE CONTENTIA% Ceri6edFiberSourcing POST-CONSUMER wwwAlprogram.org swim MADE IN USA GET ORGANIZED AT SMEAD.COM i TOWN OF B S ABLE Ll(? ,� 5 I10N SEWAGE # (TILLAGE ASSESSOR'S MAP & LOT Ld INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LW L LEACHING FACILITY: (ty ) �t'ST pl�' (size) ✓ebo NO.OF BEDROOMS BUILDER OR OWNER ML)24nrd PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Feet Furnished by �RJ� uN � . Al At q(7 OD EA PC 3° �Q 3� C44 _Am TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 219 Parcel Permit# 174�7201 Health Division �I �3�Z���v -Ur Date Issued gen� Conservation Division Fee 02 S c,,:n Tax Collector • 3�3/aooa , t -u, cudd r nu Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE A14D Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 19 Sea Marsh lac( Village Cp r,f e-,I L)l I I Q OwnerjUare R Ko&,Xi il6i.wiLi D 4&;aT,TQUSTces 6 Lt1 ,Address 49 Sea Ma la PGA Telephone r�� - O 3 3 Permit Request Square feet: 1 st floor: existing 20 11 proposed 0 2nd floor: existing 2)06 proposed 6 Total new Estimated Project Cost r ca Zoning District 66�: —Flood Plain G Groundwater Overlay Construction Type Lot Size �=�-'s Grandfathered: ❑Yes �lo If yes, attach supporting documentation. Dwelling Type: Single Family W/Two Family CI Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Cklll� On Old King's Highway: ❑Yes Oko Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) RFD Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing f new First Floor Room Count 5^ Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: & Yes ❑-No Fireplaces: Existing I New G Existing wood/coal stove: ❑Yes ®'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:4xisting Cl new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 'l �� DATE S 't TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � � Permit# 2 ealth Divisions ,g Date Issued �— � Conservation Division � � CQC 3l�iC Fee / r� / Tax-Colle r - Q '11�reasure Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project St t Address / Village ,/ r Owner -J t l�v�� T��C, i ( _Address Telephone Permit Request Sx� Square feet: 1st floor: existing 0 proposed U 2nd floor:existing I proposed Total new Estimated Project Cost � `- .000 Zoning District Flood Plain Groundwater Overlay pr ; 6 Construction Type r., ,�i a' � �`► Lot Size 2ct/ S Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family �4 Two Family ❑ Multi-Family(#units) Age of Existing Structure # Historic House: ❑Yes lallo On Old King's Highway: ❑Yes 1allo Basement Type: 1�Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) i `f Basement Unfinished Area(sq.ft) r Number of Baths: Full: existing new Half:existing f new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas A Oil ❑Electric ❑Other Central Air: ❑Yes b No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes N No '1 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size 1 Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use . t , BUILDER INFORMATION Name Telephone Number dress �► ►�� � icense# _dome Improvement Contractor# (r �� orker's Compensation# 33 'W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE / 1 f Assessor's office(Ist floor): e . N te ^ l ' Assessor's _rind lot number �?'. � !'� Board of Health 5rd eW,6ge S Permit =number .................. yue � �. EngineeringrDe6artment '(3ed-floo)s House `number n .} ..... APPLICATIONS PROCESSED 8 30�9 30 A.M and 1 00 2:00=EP ,a'•' s n�^ 3'... F -' 4i + sx-a^ar - ,' '�'"' + .. �y s� -_.r .. .-�.. -0 . . 'BARN :. STABLE" �BIU'ILD1 0- tHSAPECT R , I X- > rS 41 Grp ` 'APPLICATION FOR`'PERMIT TO E. .: } r TYPE OF CONSTRUCTION SS"Lv fl 1 4. ,�„rp cry o�v : .. r . a•t . { / t .......... •. . Ufa 19 -_ _ a a�.. �^t e•'6-r��� � y; f"r f7'f i .t* t t,i*'.s.�-` :.f3'v.wR.°a>�h#'� •"'ir'-.�a� a;� ..S{�. T'{TO THE INSPECTOR OF BUILDINGS., r The undersigned'hereby'applies fora 'permit according to ;the following informat:ona Location ISLJ� �' ~� .1,�.!a��'1r :�{� ` t'yr.ex ., - ., - 't •#' - 1. pa r•r #i '€ %.fir, .g.Sr� •� �. s - ,� x w'Proposed Use 5. /�?.. ,/`...�. ' t �� tp Zoning District : t�.. `Fir ist�ict .. <� . ` , _ a ......... ., Name'of Owne"r : ..!................ y - �.Name of. Builder ..� . .'r•?..T-f€Y c / rf, 5 - - r _ •ht rP' u+r'---'• ,' .,.L.,"°v �� ^ t*.*_akr. •.+i' .�i• _ ,.,, n+,':'J.+a• -,s.�+,wr-,mil,,,-'x .......... .•a.�w � ��A . ., - a i ai^�. eaa �. � 9•i�.x;..a! F..:x., .. r• .b+x .. `� � 3 r,q�r.�� ,�•., Name of"Architect �'l , r ', ' ....5 �..4aa 'Address Tr T," K�T . ....-a T! c K„„; i , ............ '• • 4 F =' r i. r r t•h .. �'Mtn:' 3 yy! '`f' !• °b "4.� ".r jr, Number of Rooms *: .Foundation c r- s -y t " t L✓� L ,V��e w .,• o ' p g t4 ~p S•;//� Extei ror _:. s " ..... a" 6Sz-C r . Roofin * Floors `•. . Cr" r,� �-r .J t ! �Intenor. �.�; !✓ �� w ...... r •ea��i��" �`f ",� r ,n ,Y����,;xy,�C,i�x"'a`""" r „�'I.t� Y..� r"• � ',� +,� T..� a . ............ �` h� Y•S".• � aF �'ee' ,a 'M �. k 3 °�'p T' ,�yY x -.Y y h. A a� o-a`+ 4 � .� a - Heating .... ^i w/,/ :l•.�v ..1,-.............................v Et 'N+" �Y :i a,,rx•T '!x'j�1/�' 1 L:� -d F +--•a. � `'.s"i 9u k: _Fireplace .................... . !?. ".....: ..... .. y !Approzi hate Cost Definitive Plan Approved by Planning Board 7 a �^ 19'_ "Area-- - ..... ,Diagram of.Lot and Building with Dimensions s Fee .. .. .. ate, SUBJECT TC� APPROVAL OF :BOARD OF HEALTH ' .S . ! .. ,i 8 '•'tiA -•/�/ `�/�l{i '• .:i S- e ry .. x .. h.- k + 1:a y) .. { fie +�59 t� F'js •�' •�• �� y � � ,r• .fi r _r � � l. a. � r b E'»,�.'Yt' ��'._.—..'a.:.^ .—�:'M'.". :'3 G'T ^as., ;�'.._... .•' c r 'P}• r r r �F'�` _ P ,A,,,,.,` The Town; of Barnstable • • •• V� Inspection Department 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner January 4, 1993 Mr. Michael Mumford 49 Sea Marsh Road Centerville, MA 02632 RE: A=227 128 49 Sea Marsh Road, Centerville Dear Mr. Mumford: An inspection of the prefab woodstove at your dwelling revealed that the installation was made in accordance with the manufacturers specifications and meets the applicable sections of the Massachusetts State Building Code. Very truly yours, Richard R. ed rarse f Building Inspector RRB/gr I 1 U A,e��rS C'eNl of Zoe �e,4r Sir ,rev s JfR227 12& LOC10049 9EA MARSH ROAD Crypo TVs! Soo co KEY] 138. NAfLING ADDRESS------- PCAJ1011 PCS]00 YQ00 PAREF j 00OPD, WILLIAM MICHAEL I MAQ AREA]4SAA jV1403744 wopols MUMFORV,NANCY JAME SP1.1 SP2.j 9F3j 49 SEA MARSH RD oil] 1-f1 2] .76 SQ FTj 39SO CENTERVILLE MA 02632 AY0119S7 mygm OBS] CONST] 0000 LAND 72100 IMF 240100 OTHER ----LEGAL DESCRIPTION---- TRUE IYT 312200 REA CLAssrFIED &AND I 72y!00 ASO LND 72100 ASO IMF 240100 ASO OTH #BLD6(S)-CAPV-1 1 240,106 DESCRIPTION TAX YR CURRENT EXEMPT TAXAj #DL LOT 28 TAX EXEMPT #PL 49 SEA MARSH ED CENT RESIDENT'L 312200 312200 312. #RR 1445 0033 OPEN SPACE COMMERCIAL 1NDUSTRIAL EXEMPTIONS SALE J02191 PRICEj 234000 ORQ7447100 AFDj I TE X LAST ACTIVITYJOSIOS192 PCR]Y f. �oF Tod S Town of Barnstab .e *Permit#6 ' 4 `7 L O� /l Expires 6 months from issue date • wtrrsrwat.t: _11 Regulatory Services Fee , 00 9 165 �e� Thomas F.Geiler,Director Building Division )(.PRESS PERMIT Elbert C Ulshoeffer,Jr..Building Commissioner 367 Main Street, Hyannis,MA 02601w OCT 1 1 2002 6 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number 7 Property Address �l , ` ale a Vesidential OR ❑ Commercial Value of Work Owner's Name&Address s h)po I�Me2t_ Contractor's Name� 424 4,e 1.1 nk ���i i S Telephone Number,40 F ;;Z P 11,7 Home Improvement Contractor License#(if applicable) i/a--� '7Z tz Construction Supervisor's License #(if applicable) Qa0lTorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ©have Worker's Compensation Insurance Insurance Company Name T� t�t,�^-,��,�i -� cla Workman's Comp. Policy# Permit Request(check box) I t to-roof(stripping old shingles) a O Y-1 S 1C_(YV(k--------------- (+/� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg 1 One Ashb . .�: �•. I�iLI(J11 �rv:;rr�uc�riory �ui�r_I;`✓I<' -� �• `� � 11:; vC�lt l_IC1:�1,,I.. 026:;?� Ii1.::.Iru:I ct.l 'I I r. 1 "II Ir�11 Irrl ,r•,nalll .nnl ,.i..,,1•; Iri n,Ll,,.. nrrtilu..,l,un. UOA(ZD.;01=UUILUIIJt:: lU_GUI_i1 rlt.ni:; IL LicunLu: COJ�;;'rltUCi'IOtJ :all'�IiI:Vl:,111( Nuiplu,r:'C;; UL;I I�usU'iclutl:+00 MAUL J CALLAuL'r 1505 MAIN ­r 05TCRVILLl, MA 0:'G55 �� - 'i% .►1., AlLnnu:,lr:,101 ne j� Board of Building -Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2004 Paul Cazeault - P.O. Box 2781 Orleans, MA 02653 Update Address and return card. Mark reason for Change. Address t I Renewal i Employment Lost C:ud Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expiration: 7/9/2004 One Ashburton Place lira 1301 Type: Private Corporation Boston,Ma.02108 I 4 MAR-06-02 WED 09:56 AM MAS'('ORS & SERVANT FAX NO, i1018ti!)g,u _- -- F+k .ACO D..�.. CERTIFICATE OF LIABILITYLIABILITYIIlISU14j� ; IVi`J 1-C)J-r & :�r�:L"'va1,t- , j,[:C] . THIS ClH1iFIC,1TL IS I';SUE[-, I ONLY AND CONFLHS NO 11 .57 0 0 F'.C):3 t 1(o]i? 11OLDE1• THIS CLH1lFICA I I I?.O. 1..1'_i 8 ALTCH THE COVERAGE nF{D 1✓�::�L- Cre�nwi�•h , P.I 028,�.t INsuRCHsn! L 1:liurlr0 ('.11ll,�. Caz aUl[ (�C SOi15 1�f1AfI)L INS- ...A. CQ11L 1.I'L1:17� :11 N.O. LO)C 930 IN;•UHi Flu '1'1' a i N.'1T'SCW6 Mill',, MA 026--.2' IrJ.^,unr.RC. IN'I COVERAGGJ— THE PCII ICIES Gr INSUH.ANCL" U_':,TED DELOW 1-IAVI: UCCN ISoUi:D TO TNr: 1N�UACD NAMED AUOVE. f=0rl TI i[POL ANY PiErUIRCMF.NT, )F'F"vl ON CUNGITI'?N 01: ANY CON'fIAACT OR OTHER DOCUMFN•i WITII RL:;PECT To WHr H LIAY F'E:n'fA1N, THE IE sunP.NCC AFfURDEiD BY THE.- POLICII�;S DI=SCRILTEiG IiFRFIN IS SUUJL=LT To ALL TT1l� TLIt'1j I''OLICIC-S. AGGRCGATC LIR1i S CI-IoVJN ti1AY I-IAVC JCr:IJ nE=DUQED OY RILIAID D HF1:. I::'.N .. .. .. _. LYa TYFf•OF a+`:Ufl/l.Cti, .._..._._..- 51rUINiiUC{7 ( YI) 1 J. GCHCIIAL LIADILITY l : rd002413 O } L3 GUI:N C;CIAI ;f NFk,;. Ui.Ilr � 0/C n411f";//1 I30//l�l1n01.1v13 - 000. ,t.._ 'GFw l nr;i•nl:i:nle ull Irnrr'uCs r•I:H: ' w Pllrr t,IC.. All'1'(iWp/i1LF,LIACII_I1.Y Afff AUTOi -_- I i A1.L 0WI,:f D Alfl G', I I" SI;MI:UULL-U/,U'IDS UIF,fQAUtp I D •/ IfOa•QYR.1•.I)Alilily I )C ANY AI I'I,) -•- 1 .,I_.__...--- �_._. I ._.._-_.._.— -....... ... I t III •BRCr;i:;1 UM11L17Y - - ;UT I I(11'.(•UH I I QA11.1:MAnf; _ ---.--. .—_-- I 1 -,(•I I` • t,;C • •r rnl�l:rlrn.F � I 13 I ClAro)ns��nalufv ION nnu —�FWi:l S,0 -'w:j 711 0 _.f. 1c OCiOfaP'fIUI+Or pr'F.rIA110N5fLOCATtUNVYt:n14L7 SIL'ACLU.10N3 ADDCp OY EI+UOftSCM[INtfSP r.,A I- C L Pri4VISIDNS -" '- s Crocker, Sharon From: Shea, Sally . Sent: Tuesday, August 25, 2020 3:55 PM ],� To: Mioran i.,-Donna kleath.DeptMaiIbox / Cc: - uifdin`g Dept Subject: - RE:49 Sea Marsh ��p Hi Donna, _ have a septic site plan dated 1/20/8 try folder showing a design for 4 Bedrooms. We have a building permit in the folder issued in 1999 that indicated the house had 4 bedrooms. We have a permit to create a bathroom in the basement showing 4 bedrooms existing on the application with the homeowner as applicant stating the property had 4 bedrooms. I see a note on that permit that states no add/bedrooms. Hope that helps Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 From: Miorandi, Donna Sent: Tuesday, August 25, 2020 3:29 PM To: Heath DeptMailbox Cc: Building Dept Subject: FW: 49 Sea Marsh Hello all I have a phone call from a man trying to buy a house that he states as well as the assessor's is a 5 bedroom. The email that Dianna Bellaire has sent me shows an as-built for 3 bedrooms. Dianna states that the 86-81 septic permit is missing from the street file. I don't know if outback has been checked. The septic inspector on his report states that it is good for 5 bedrooms but he is not a sanitarian nor an engineer. I need to know if this house and septic is GOOD legitimately for 5 bedrooms as the potential buyer wants to know. Sometimes and this is asking for a miracle that the building dept. may have a copy of the septic permit in their street files. Any assistance in this case is greatly appreciated. . Lbonna X cNGioran&Q, �-4. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such, it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of // '�p 0. �rYI fo l�@ tk-C1a� 1 � II Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. From: Bellaire, Dianna Sent: Tuesday, August 25, 2020 3:15 PM To: Miorandi, Donna Cc: Bellaire, Dianna Subject: RE: 49 Sea Marsh Donna; I found two asbuilt cards. There was no file anywhere. The permit 86-81 was missing from the drawer. I looked in all of the 1986 in case it was misfiled but, no luck. I've attached the two asbuilts though. I am working alone right now because of board meeting. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire @town.barnstable.ma.us The information contained in this electronic transmission("e-mail'),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Miorandi, Donna Sent: Tuesday, August 25, 2020 2:46 PM To: Bellaire, Dianna Subject: RE: Sea Marsh Hi 49 Sea Marsh was built in 1987 so I hope a 5 bedroom permit is there. If it says 4 then oh well he will have to upgrade if there are five bedrooms such as he states and the assessor's Donna c/1tiorand` Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also 2 . + ,,,,TOWN Cif" � S ABLE LWATIO1V SEWAGE `I1LLAGB.................:::r ` :.$:..:�.. .. :.:' ASSESSOR'S MAP � LOT._. INSTALLER'S NAME do PHONE NO..—-—-,..---,_ r..... .....�. s SEPTIC TANK CAPACITI' LEACHING FACILITY: (ty, :) �. � . .��e = ;v (size) �' f NO.OF BEDROOMS_,,__.,,,... BUILDER OR OWNED PERMITDATE..- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of leaching Facility Private Violater Supply Well and leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ��� Furnished by 1 .......,:........ CS819SSORIS MAP ;. ................. N w ION S E WA G PE IT Q. VIi:L LAG E 'N S : L L 7 F.. .o S {.£.'f N.E D D R E S S NY d U I L D E R DR: o NE ' r DATE PERMIT ISSDEO ty{ S DAT E C0 M P L I A N C E ISSUED S' f 1 ............................ Commonwealth of Massachusetts lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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 I �� on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key: 74 Beldan Lane ICI Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com 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 4/21/2020 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 Ca Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. Cityr town 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 49 Sea Marsh Rd Centerville is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and two 1000 gallon precast leach pits. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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"n y ( , ) g is of 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts i Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary.Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is Centerville Ma 02632 4/21/2020 required for every page. City/Town 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 Commonwealth of Massachusetts - r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (c.ont.) Yes No ElStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume.is less than 1/day flow El ® 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. El ® 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. El ® 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 within400 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 1451, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. City/Town 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? El ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd Description: Number of current residents: 0 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)) Detail 2018 = 111,000 total = 304 gpd 2019 =65,000 total = 178 gpd Sump pump? ❑ Yes ® No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. Citylrown 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? El Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Tank cleaned at time of inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? size of tank Reason for pumping: routine maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments u 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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: original system installed 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 4.5 feet Material of construction: 0 40 PVC El cast iron El other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 4 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: 511 Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 711 Distance from bottom of scum to bottom of outlet tee or baffle 1011 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 was pumped for inspection and should be done again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet covers are on risers. t5insp.doc•rev.7/26/2018 Till.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 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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 l5insp.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 .i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 page. Cityrrown 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): Oil 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.): Distribution box was video inspected and found level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is Centerville Ma 02632 4/21/2020 required for every 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: 2x1000 gals ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name. information is required for every Centerville Ma 02632 4/21/2020 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.): Leach pit#5 on as-built was video inspected and was found to have 4' standing water and a stain line 2' higher indicating that it has been full to the inlet. Leach pit#4 on as-built was located and excavated and was found dry with no obvious stain lines indicating that it has seen minimal flow. 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 pond ing,.condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is Centerville Ma 02632 4/21/2020 required for every 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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 C _ to 3 � L/ �31 316 A2 I y rig 1 f�3 y e 3e �� 7y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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: 1 feet e Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach.documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Property is elevated compared to nearby pond 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.�/ 49 Sea Marsh Road Property Address Pamela S. Kogut, Trustee Owner Owner's Name information is required for every Centerville Ma 02632 4/21/2020 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 4 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 I SSOR S MAP NO. + :f ARCELLQ 0CAT1 SEWAGE PERMIT NO. L44 96 VILLAGE I N S T A LLER'S NAME S ADDRESS B U I L D E R OR OWNER fr���''� _��•-�-�� rl rJ rll? -)' �!• <,�� Ii iir � �.) �• Q DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED M . J Vt I Commonwealth of Massachusetts Executive Office of Envirolunental Afairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 Jolm Grad D.E.P. Title V Septic Inspector kir P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor 6 �. ARGEO PAUL CELLUCCI ��; Lt.Governor �9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A S CERTIFICATION 1p Ly �a Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Address of Owner: Mn, Date of Inspection: 9/24/98 (If different) J Name of Inspector: JOHN GRACI MICHAEL AND NANCY JANE MU F RD ��� r9� I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) l Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V Condition asses code 310 CMR 16.303.My findings are ofhow the system is y performing at the time of the inspection.My inspection does _ Needs F th r Evaluation By the Local Approving Authority not Imply any warranty orgueranteeofthe longevity ofthe Fells septic system and any of Its components useful life. Inspector's Signature: �t Date: 9128198 The System Inspector shall s bmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoThpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street 0 Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124198 — Sew,acte backup or.breakout or high.static water level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ::logged cesspool. — SAS is in hydraulic failure. (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Add reSS: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124199 D]SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Add re SS: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124199 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. x — As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9/24I98 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): n1a Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: nra Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r9a System pumped as part of inspection: (yes or no)ve: If yes,volume pumped:2000 gallons Reason for pumping: MAINTENANCE TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) VA Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: 1986 Sewage odors detected when arriving at the site: (yes or no) No (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124199 SEPTIC TANK: x (locate on site plan) Depth below grade: 4' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age We . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L9'6"H5'7"W4'10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to Outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY Two YEARS.. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rtla Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rva Date of last pumping;Ia Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rJa BUILDING SEWER: (Locate on site plan) Depth below grade: 4-6" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction llne:TOWN Diameter: pia_ rNeimments: (conditions of joints,venting, evidence of leakage, etc.) (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: We Capacity: rda gallons Design flow: rda allons/day Alarm level:_n1a Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Me Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rJa (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 SEA MARSH RD.CENTERVILLE LOT 28 Owner: MICHAEL AND NANCY JANE MUMFORD Date of Inspection:9124198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: 2-1000 GALLON LEACH PITS leaching chambers, number:Iva leaching galleries, number: rda leaching trenches, number,length: rya leaching fields,number, dimensions:Wa overflow cesspool, number:nla Alternate system: rda Name of Technology._nra Comments. (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY,THE PIT D WAS EMPTY AND THE PIT C WAS FULL AT THE TIME OF THE INSPECTION. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: rda Depth of solids layer: n1a Depth of scum layer: rda Dimensions of cesspool: rVa Materials of construction: rVa Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: rda Dimensions: Na Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rJa (rerlaed O4127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 SEA MARSH RD.CENTERVILLE LOT 28 MICHAEL AND NANCY JANE MUMFORD 9124198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) A � M C. �a O qj 4C 9) AD-7i � I$ 6 c 3b Epp 3� Pape 9 of 20 (revised 04127197) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 SEA MARSH RD.CENTERVILLE LOT 28 MICHAEL AND NANCY JANE MUMFORD 9124198 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in,your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revised04R7197) Page 10 of 10 t ,A-S�SSOR'S MAP NO. = � P ARCEL 2� tt, AT10 SEWAGE PERMIT NO. ��la AAri VILLAGE IN SIT A LLER'S NAME i ADDRESS i 'te a ,U/I L�Dl�E R 1/ 0 R. {/�}/OWN ER / �. LI p DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ���'�- C - I No I Fes$ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /cvc�n9 .. .............OF.......f�.9lZ.vsTl f. ........................................... Appliration for Bhip a al i0ark.5 Tonotrnrtinn Vernfit Application is hereby made for a Permit to Construct (J() or Repair ( ) an Individual Sewage Disposal System at:. ................._.�....i.�.�:........A...G., .��....M. I-........... ••••.....--------------- T. - ..__...... ..._._............ i Location-Address or Lot No. ________________!__£_SwW i.jp__....5��.Oh`s 2�'L�nj._______________-__......___^_ ...............Z;� ........................... Owner Address a ------------ ------------------------------------ -----•-......------..._..-••••••-•-•--•-••••••---•-•••--•-•••--•............-•-•---•----......•••- :' Installer Address UType of Building Size Lot__ 3;__l K5....._Sq. feet _ a Dwelling—No. of Bedrooms............................. ............Expansion Attic (Ald) Garbage Grinder (h) a, Other—Type of Building ____________________________ No. of persons________________-___________ Showers ( ) — Cafeteria ( ) Other fixtures _..__. W Design Flow_______________________________,a-s.....gallons per person per day. Total daily flow.......................4-'SFB.........gallons. /01 WSeptic Tank—Liquid capacity_!-SO.P_gallons Length_10'—_.46."._ Width._.__ N Diameter________________ Depth.- �_g. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ ......... Diameter-----l.1_--------- Depth below ...... Total leaching area__0.4._....sq. ft. Z Other Distribution box (X,) Dosing tank ( ) Percolation Test Results Performed b /=c �_! ___ o!�cr ___ Date_:__S__! �-� if Test Pit No. 1------ _.......minutes per inch Depth of Test Pit.......! ____ Depth to ground w ....... ........ GZ Test Pit No. 2------?.......minutes per inch Depth of Test Pit.....!1-1 Depth to groun a+ ---------------------- ------••-•--•---•--•----•••••••---.....----•-••••..._....._...__..._...........---•-----•----- S��PHEtV �y '0. Description of Soil.___.Descri _%�_"`1.___<2-1ZI'_ rxa__`._l "-_!_ 9�`--- �► --;-_---•-------- -X --- p 1 i r - A1:LYPI , �e O .V ..�-rc�uL1.<.__.. S.?. .____!C1(11.�DJV,_..___ Uw ...............................•••--------------•-••---------------------- . o�_.302�1a � Nature of Repairs or Alterations—Answer when applicable.......................................................... 9 T. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'iU 5 of the State Sanitary Code— The undersigned further agrees mot to place the.system in ., operation until a Certificate of Compliance has b issued by t and of "' Si n ., � ate Application Approved BY °....•-• 1..._I_._ . -• ----- Date Application Disapproved for the following reasons:......... ----------------------•----------------------------------- -•••-••-•-•--•------ ......•---------•------•--------•----------•---•••-•---------•-•--••-••••------••-----•--------••--••-•-•-•••--•--•••-••••-- ---------------------•-••-----••---------------•----- ---••---------••- C' ��i► C�� Date PermitNo................. ' Issued...------.`........................................... Date r No.--•-C=--•------•-•- Fps.-:�,.-�................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .VAVA") ...............OF........ 1. .........------..._.....----.........----- Appliratiin for Dispaoal ,ark' ( ontitrurtion "grunt Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: ................---................ .. .. •-----..........---------•-......----- -•-----•-•------•-....._�4?j-�,'�'. ---..................----------- ................. Location-Address �+ or Lot No.. ' ................ .t�L�i/aldl?•-•a�.K9ll�f/�/..5?�A�------------------------------- - ..... ..................... Owner Address 00 T e Of BuildingInstaller........- Address 3. .... � V YP Size Lot__ f.�_.d$......Sq. feet 1-, Dwelling—No. of Bedrooms............................}----___--_-_Expansion Attic (A4) Garbage Grinder (x) `4 Other—T e of Building a —Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . = • .... W Design Flow..............................-.S..__.gallons per person per day. Total daily flow-----------------------40+0.........gallons. W Septic Tank—Liquid capacity_j_pp_gallons Length.J*1,4"-• Width..zV±njro'Diameter_.""- Depth..t'.f-11_p x Disposal Trench—No..................... Width_................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........Z--------- Diameter-----1_•.al'........ Depth below inlet_._S.G.7..0... Total leaching area---T-0/6i.....sq. ft. z Other-Distribution box (A) Dosing tank ( ) / aPercolation Test Results Performed by...... -" , __.�o.�r� .............................. Date....191.�1__.._._........... Test Pit No. I.......a_____-,minutes per inch Depth of Test Pit-------1.4 *. Depth to ground w ......... r=, Test Pit No. 2___...g,,......minutes per inch Depth of Test Pit------ ... Depth to grown � N -•--------------------------••----•-----....-••--------- =--•-....-----...-----.._...--•---.....-----••-•--•--••-••. -d ................. ' O r -� STEPHEN x Description of Soil--T� l---6 -!2-'-`-- s 3. ws----i -- 14�1 Sar�cQ--s-•----------- - W �►'�... -.G twee------- 4l bsef*----•- x -----------------------------•--•------------------•-----•----•----•-..................................................................... --••--------•---•- ;a�ND.3II2 & U Nature of Repairs or Alterations—Answer when applicable.__________________________________________________•-.__-_ •----------------------------------••--------------------------------------------------......•-------------•---------------------------------.....----------•-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst in accordance withrovisions of AITiy the : i. p 5 of the State Sanitary Code— The u dersigned fur'.er agrees not to place the system in operation until a Certificate of C iancessued the board Signed. _�..__._............ = ' _..-- ---•------•-. Application Approved By...................."J Date Application Disapproved for the following reasons-----------------------------•-•--...-------------------------------------------•---------.......•----...--_...._ ..................................................•------......----------••---------•--•--------•-------•--•---•--•---••--•-••----•------•••----------•-•-------•------•--•----•-•-----•--•---....----- Date Permit No................. - ...................................... Issued......-•------•----------------•--------- --•-•- Date THE COMMONWEALTH OF MASSACHUSETTS rr BOARD OF HEALTH .........I................................OF....................................................................... Trrtifiratr of Tontpliaurr f THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.........................................................................................----------- ^�=' j y-} Installs r at...............C:_c> � ----•--------•--- -- 1•- l � = has been installed in accordance with the provisions of y _ j of Th State Sanitary Code as des gibed in the application for Disposal Works Construction Permit No........,_-_�r______________________ dated_-....... 13/ ._-__„- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL IFU*CTION SATISFACTORY. 1 v� DATE. Inspector ----...-•-- TH MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.....:................... F Er........---............. Permission is hereby granted............................................................................................................................................... to Construct ( ) or Repair ( ).'an Individual. Sewage Disposa�ll System at No....................................l n Street � �•.� �� � ���� as shown on the application for Disposal Works Construction Permit No...... Dated---- .................................. G/ / - .......... - ------------- Board of Health DATE...........................---------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '" y z �EG EV 2'O. 3 7 + ; x'9�,, .'f-y�4'yYF '� �•tU'. � I _ S .1��C. F hAT.Alm t - Our•y ir4J�r bkY� f... � � � ., t>Jf-,:, 5 a ;:t ., k. �"-. /y.� 0 { Q- L "• W h 23 .. 4' 0: ks t f�'f 23. � S • y o O V 4 T/Gy a49'9 . ,' . , ( A :�►9 AA /'� - ^ y f� 45 � : Ore� xr �: « 4 � p f�• �' + r �(1 `.. of t _. F • � v • `- : �,a:- �{ OF. . . � �t. , 9 •23 r PAUL LO -BARNSTABLE ZONING BYLAWS DATED:.. FEB 1985 • $� soNIsos x 'ZONE. RB t SETBACKS . FRONT 20' rk,rr y SIDE 10' `REAR _ 10' PROPERTY LINES SHOWN 'HEREON iWERE;.C`OMPILED :FROM"PLANS"O '-.RECORD AND DO NO'T REPRESENT t PROJECT NO. 3-1565-01 ,AN;ACTUAL ;SURVEY ON `THE ,GROUND. ' ,THE. STRUCTURE DEPICTED ON *THIS', PLAN WAS. LOCATED r ;' PLOT ..PLAN' .-OW,'-THE sGROUND. '. r BY SUF�VEY ON "3/7/86 t 1,n. AND` EXISTSa AS.SHOWN AS" OF THE :DATE; OF LOCATIONY. ' T L ,P r, y. H { BARNSTABLE ` . M'ASS . F E�._1"=30 FTHISyPLANJISaFOR PLOT PLAN PURPOSES ,ONLY ANO SCAL . MAR. B 1986 SHOULD�NO , BE USED FOR ANY OTHER PURPOSE .� BSC / CAPE;C00 SURVEY 'CONSULTANTS M3 t 3261 MAIN STREET $DATE PRO c ,,, fSSIONAL LAND SUR R . '''' T BARNSTABLE ,VILLAGE, 4MA. .02630�, (617) 362-8133 V ViEVISION,5. DETAR "A G P I _fKN BOX DETAIL.:. INOIGATUJ I'A"FF-30J D TANK' DETAL- LEACHIj EPTIC SOIL TEST P1 I DATA: 101) AV,3 _0 I. - T 0 8C A I E NOT TO SCALE v F_ N01 NOT TO "AUE T r3 T (IfJOUNOViA YEA �Ep r NO rF�, "r 1 0 11,C). 0 F u MANHOLE COVER M 8.4;EFD lb ic rANK SMALL BE STE.El 4, 1 h?--Z 3 OUTLE-T TEES TO Or- C A 8 R N ( '? - 'r L E TS: _2 111.1HFURCIE'D CONCIRF-Tr. t�,'Rowjlir TO FINI$li GRADE u ri PAv E maj r C E N T E R 0 UN 0. sr;pyic w)K 'TO WITHSTAND H-iO LOADING T 'ES 40, PVC, Q_ TO T P T P MANHOLE ��OVE R. rri CARD. OX TO WITHSrAND H-10 LOAOING 2"fAIN ("I F /9'-, C$1 R D. E L Ivc.�; OR (IF?D E GIN. TRAVELED WAYS,WWERUN H-20 I_031WING S UNDCR PAVEMENT, DRIVES Q0 TO 1/�?" V U."JUSF UNVER Plalv�.wal-, rm C)Wi t (4w. UNL0 GW. E L Gw. EL. rRAVE-Lrl) W903 WHEREIN H-20 LUADIM,� WASHED 3i4ALL APPLY. s_10N� 'Tj 3HALL APPLY. PIPE GONNEC'NQNS AND GONC�it:TE WS'T 3, ALL 4ANHOLL w� x . 2, PROMDE INLET TEE OR 8AFF-I-E W�,ZRE. 3t.()PE OF RUC,rioiii 'to m wm F,,�i riawr, Mr TO FlIM10 GRADE it CONST --T PIPE U=j c-_1 c­_-�-�] C7-) CD p "IPE r..XM�My 0.08 FT./FT OR IN INLET % Z, R w: i 3. NIRST TWO FEE7 OF PIPE OUT OF 016-4 _RAL. NOTES: < E.Ac��iwj n,r To GENE c T, 80X TO OE (-All) LEVEL. WITHS AND H-10 LOADING PLAN VIEW THIS PLAN-i-3 FOR DESIGN AND me UNLES3 UNDER ;g S11A) Af3t PRECA�5T J, 'TRUCT 'ev, t�f j, �A RAVE M EN 1 t,R I VE,-0 R- AGE c 0 N S NON OF THE SEIN, 'D WXf WHI ER E I N DISPOSAL FACU'rY r_)_ z covtq 3/4" .() I-/ - - . - TH AV E L I- 1Z JOLE PIT H­20 LOADING 31­141_�. A TION METHODS ANU APPLY. P. ALL CONSTRUC .13 tOVOF _77, IALL (;QNFQRM TO MASS. I`AArf RiAL$ S1 R&E T Ttf WATL j IDS% (no I al O.E.0,E. TITLE 5 AND -LOCAL ROARD f 1, v 7 OF HEA 0- LTH F?F(,,,jL ATIONS. q -0" M121 09TLET 4,1 TEE 76 .40TE 2 3. L-O'CATED UND ALL PIPES ER PAVEMENT j a OR TRAVEILEU WAY S H AL L BE 13 A SCH E 0 UL E� 40 OR EQ0AL., `0 ,-j LI - /V'm 4. PROPERTY LINE INFORMATION COMPILED J. , g 9 i" 1 fROM A PLAN RECORDED AT THE TOPA 0 jkt '- __L L­ 1 .- ­80TTOPA 0 ;0 V TO'd ON E'if 1. 3 rA6L t GM17 0"�V S7AOLF BARNSTABLE REGISTRY OF DEEDS IN PL.BK- 3015 PG.46 AND DOES REPRESENT Pi.AN Vl:,&w 0oss-5f:C,rIOu VIEW '�Q -i3f: ACTUAL SURVEY ON THE GROUND. 5. TOPOGRAPHY PERFORMED BY THE TRANSI a STADIA METHOD. T IC N )TES: D ATE 0 A . E: DATE: CONSTRUC Jill C D'A T E: ,\T10N4c` F-1 1NV` __.-__EV)e T 8 Y. 'J"r BY TEST By. TE ST B Y: A', NVERT AT ;3UILDIN 01 '7 -r;,D fj Y PL, 8K. .30 NVERT AT SEPTIC TA N Y, WITNESSED BY: i s s 1: . 5 PG ----_----------- ZONE ff AT SEPTIC;=7 IN V E R1 'S C. RATE P f: PERC. RA PFFIC. HATC R AT,- E 77BA CKS: lit')V E R T AT Di'l)"I'. BOX(in) FRON T 20' INVERT AT 01, BOX(ou 111 V E R T A T L F_A H 1 N G P i 'r 7 SIDE HEAR /0' 601'*TOM OF LEACING PIT EATUM' MAXIMUM GROUNO Y2 VERTICAL DATUM: 'ROUN' \M T E F� B E �R V V BENCH MARK USED: VAT 10 N E L ` 7 CB/DH (FND) CB/DH (FND) CB/DH (FND) J7 Tj; go ELEV.- 20.37. -LOW- B.M. ON TA G BOLT# 459 HYD. A 0 0 M 50 CB/DH (FND) 96 The BSC G(oup A J 7t_ 0 GAL, G A L. �Qdct kirvey qp'o Y REQUIRED: S V E 0 F LEAGH!NG f:AAIT DESY-3N RATE: h r R�,4.tq,6A Barnsta'bko Villq 6MA 043Q 011 6171 362 P-E7 L,A 'PROJECT T IT L E: E W A G E DISPOSAL /* SYSTEM DESiGIN , EGEND L HYD. FIRE H KDRA IV 7* LOT 28 4- SEA M APSH RD. EX1,57ING CONTOURS CENITERVILLE MA. ­10- rES 7' P1 r CB/DH CONCRETE 4704IND W1 TH DR' ILL HOLE d �4 PLAN: g t3 4 DATE V, HOWARD JOHNSTON' PROFESSIONAL LAND- SUF VE YQ R ilk 1/ 2-0/86 COKAP/DESIGN� -Vq w CHECK: PROFE, IONAL ENGINEER7 CIV14�, DA TE DRAWN' G,G.M. PLA! V` E W FIELD. D.J.B. / T.J.Y. 2 U��5 P�G 46 , FILE NO' 20, 1066 (�HEET DO)G. NO IQ 20 4Q 60 ET SCALE: 1, 2,083't -01 1 1 OF I NO 3"15651 IROK PT I C A N K' 1)ET AIL.- BOX DETAL ILP" ACHING PIT' DETAIL TIES SOL TEST PI"T tN=,-k E PER 08nFRVED t 0 C)U C NOT TO CA t. E. NOT TO SCALE-'- NOT 10 SCALE N, b4TF IRA P4 'N A Ll I f- �NOT 4 INLET AND OUTLET tEES TO BE CAST IRON OR MANHOLE COVER i FS- SEPTIC TANK SMALL BE STEEL _0-4 0116)'11,LL I's OR PAVEMENr -------- Tl .11 p REINFORCED CONCRETE. SCHEtl4GPVC, TEES TO BF. i,:ENTERED UNDER BROUGHT TO FINISH GRADE k F TP TP Tf t NOTES! 7' �O LOADING 77,-, .1 , .1 MANHOLE "OVER. SEPYIC TANK TO WtIHSTAND H _j_ GR FL-______ GRD� EL. UNLESS UNDER PAVFMF.NT, OR I. DIST, BOX Tf WV'41-SrANC H-iO LOADING 2 MIN OF v-3"7./� GW. EL. Gvv. EL. GW. I- t�*L!ESS UND'ER �AYEMCNT, DPIVFS Oft TO 1/21' F I L!_­ TRAVELED WAYS,WHEREIN H,2C LCAD%G 12"MiN 3HALL APPLY. PR - 7RAYEA-ED WAYS *4CREIN H-20 LOADIN(� WASHED -------- E CAS T SHALL APPkI.Y. 3, ALL PIPE CONNECTIONS AND CONCRFTF, CONSTRUCTION TO SE WATIERTiGH'I'. OADUG�"T TO pJ11*430 apA�,E BOX PROVIDE INLET TEE OR SAFFLE WHIE?w SWIPE OF PVC �N,._Er P;pF. 'NLET !YIRdP PI EXCEEDS 0 OeFT/FT (,,A IN _j M C. NOT U. 'ECT (,ENERAL NOTES. COVER j FIRST T WE) I- UF PIPE OUT OF 01ST i.EAGt-411NG Pl'p TO 8 OX 1 10 0 E �_AID LEVEL. WI FHSIAND H-10 1-04DIN" I THIS PLAN IS FOR DESIGN AND UNDER tr PLAN VW* Lai ------ 2­_ LINLESS CONSORUCTION OF THE SEWAGE PAVEMENI �_ I�IRIVF OR C,A S T j -_ 1"" DiSPOSAL FAC!LiTY ONLY FRAVELEZ. WAY WHEREIN -A i: 5,4,7' rOUSLE .�'ACHiNcl P Z. ALL CONSTRUCTION METHODS AND r IT H. Z(,� LOADING SHALt 'HALL WASHED APPLY MATERIALS CUNFORM TO MASS STONE .1 INL,CT TEE D.E.G.F. TITLE 5 AND I OCAL BOARD LU T. _T (no fines' j I u c-1 r--) c OF HEALTH REGULATiC;W t 4'.0" M104. OUTIAET 7.- :_7 -_ t i0ljlil) D1 r�'V�4 N! p P.t 3. AL.1- PWIES LOCATED UNDER PAVEMENT t TEE 2 C-m f:_D, I'--. OR TRAVELED WAY �,HALL BE Y LE. x U SCHEOULF 40 OR EQUAI.. T 7 6 K!, N. 4 PROPERTY LINE INFORMATION COMPILED 9 D�A 19 FROM A PLAN RECORDED AT THE L I 1BOTT-W ON BARNSTABLE REGISTRY OF DEEDS ur OOTT046 001 LEVEL ST&DLF 13A51E IN 0- VE L STAKY PL BK 305 PG.46 AND DOES REPRESENT CROSS--SE',r�TION IBASE Pi.AN VIE" ciposs--sFe'rioN viFw ACTUAL SURVEY ON THE GROUND. 5. TOPOGRAPHY PERFORMED BY THE TRANSITI. a STADIA METHOD. CONSI_�­,.�CTION NOTES: A D A 1"E DATE" i)AT E. DATE: " 'VERT ELEV "rEST BY- TEST BY: T CS T 8 Y:TEST BY� iNVERT AT BUiLDINC.1 WITNESSED BY: WiTNESSED IBY: WITNESSED 8Y� W117NESSED FY: 'NVE J.1 1 AT SEP"FiC 7 A N K" i 'NK WUO ZONE RB iN V E RT AT SEP M T A,' SETBACKS CKS: INVERT' AT ois,r. 133�,)X(in) fi PEPC. FIATE: PERC. RATE: PFIRC. P ATE: •PERC. RATE: j KAIN./INCH MINJINCH FRONT 20' INVERT AT D183T.- 6�0"MQ0t) SIDE /0, i�J, %1- 'r AT LEACk ING F`r 14.4 7. DA-FLU REAR /0, B01 TOM OF LEACHING F'T U S�G. S. MAXIMIUNI 6ROUND r VEIL , K",A L, 0AT to�N1 WATER ELEVATION OBSERVED GROUNDWATER BENCH %i,,'%PK LiSED: ELEvA7r10N CB/DH (FND) CB/DH (FND) V V, CB/DH (FND) TF R1 NA, 4662 B.M. ON TAG BOLT# 459 7* ELEv 20 37 H Y D. DESIGN FLOW' _TU 4--BEDROOMS ATZ_,/_0_G.P.3.1D _14CLIGP.D. 28 r , \ \ \ CB/DH (FND) 3 �tqqvioG 96 AI EPTIC TA REQUIRED SE Z,�V 7- 'CIO, {ten 5 V r GAL r 5EP7 ;C TANK Ffq 0 V IDE D, GAL. p1r_ Cape Cod Survey Consultants OF LEACHING FACIL;TY REQLARED- .10 E)ESIGN PER-C, RAT :> 3261 Main Street 7­�' )_A j_ &.�FZH.AiLd.,d Route 6A N. Barnstable Village MA I)L'C 02630 Q ------------------ ....... � ..� 617 362 8133 VE6,E_TATg;a_ rr-rLA /Y 9,. ,0,j E C T 1'1'r F SIZE OF LEACH14G FACILff'Y PROMED: o 60 SEWAi33E 01SPOSAL r ; p L ;b 1"I-0-v I .........z ...... _M DP'1"`%N 4\ SYSTE LEGEND LOT 28 HYD. FIRE HYDRANT' c!) EX/STING CONTOURS —------- SEA MARSH RD. E CID x TEST P1 T CENTERVILLE, MA. All. cs/• H CONCRETE BOUND WITH DRILL HOLE t d", -N D US Pl.__.AN� N 11. ZS 0�ik Wa- I Of Vv CK lik A PROFESS 101VA L L A ND SURVE YOR DATE HOWARD JOHNSTON .�jo�IrA: 0 (0 cict/s P 6 x ALLYN 0ILSON LA 1/ 20/86 PROFESSIONAL ENGINEER-Cl VIL DATE pi DRAVVNI G.G.M. A f'\', RELD. D.J.B. / T.J.Y SCAL.E. 20, c-_ILE NO- C'4 3. NC- 1066 SHEEI k; 10 20 40 60 i SCALE: I"=2,083't iOBNO 3-1565-01 1 OF I