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HomeMy WebLinkAbout0034 SEABURY LANE - Health 34 Seabury Lane Centerville A= 208 - 078 i I ll/i aEtvccEo Made R/ 2 UPC 12543 �1 No.63LOR 0�0057CONs�bx HASTINGS,V I �a8-ems -0 Commonwealth e,. Massachusetts ''-x Title 5 Official Inspection Farm 4 . Subsurface-Sewage Disposal System-Form-Not for Assessments Diane Centofanb PropertyAddress — _ 1,7 34 Seabury In Owner Owner's Name Information Is t»t1 required for every Centerville _ Ma _ _02632 _ 10f1412014 page. C(tylrown 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. lmngoutforms A. General Information filling out forms an the computer, use only the tab 1. Inspector: key to move your cursor•do not Michael DfBuono use ft return key. Name of Inspector DiBuono Sewer and Drain Company Name 8 Johns path Company Address S Yarmouth MA 02664 Cityrrown State Tap Code 508-364-9587 S113522 Telephone Number License Number - B. Certification I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.f am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Z;"'-L � 10/18114 Inspector's Signature ._ Date w 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. ""*This report only describes condltions 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 i the same or differient conditions of use, r tit tShn•9ng ..... TNk 5 arrh:W 6npedNn Fam:3u0eutam Sewage Diapme System•Page}or 17 1 .., I Commonwealth t,. Massachusetts E Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Diane Centofanti Property Address —� 34 Seabury In Owner ownees NameInform w .required a Centerville Me 02632 10/14/2014 ►equirad for every page. Cllylrown State Zip Coda Date of inspection B. Certification (cunt.) ❑ Pump Chamber pumpstalarms not operational.System will pass with Board of Health approval if pumpslalarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 pipes)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): Fa.. C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines In accordance with 310 CMR 1"03(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment. ❑ Cesspool or privy Is within 50 feet of a surface water ❑ Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh t5WA 3R3 TM 5 0INW lnspedmn FOrtn:Subswfrco Sawapa Oieposal5ystem•Psge 3 d t7 Commonwealth c.. Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal`System Form•Not`for'Voluntary Assessments s Diane Centofanti Property Addrew 34 Seabury In Owner Owner's Name infaffrequired is Centerville Ma 02632 10/14/2014 required for every , page, Crtyfrum state Zip code Date of Ir*pedlon B. Certification (cunt.) Inspecdon Summary:Check A,B,C,D or E/always complete all of Section D A) 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 system consist of a 1000 gallon concrete septic tank and a 6x8 ft concrete leach pit.The tank is in good working condition with no signs of leakage.Both Inlet and outlet tee's are In place, The liquid level In the pit has never been within more than 22"s of the invert and is still in passing condition. B) System Conditionally Passes: ❑ One or more system components as described In the'Conditional Pass'section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for ges",'no°or'not determined'(Y,N, ND)for the following statements. It'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,exhibtts substantial infiltration or extittration 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 Certficate of Compliance Indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): i Wh.s'3M3 Tills 5 Motel rn"Won Form:Subswrace Savage oispasal SpL m.Page 2 of 17 i I i - .r:.lrtY'w <'n'x• P���. .�rr --�. ., . .. .Y r, t..•.....r:-• i.'.err ��.. _� _:4-�::: . •-r . r r ..... Commonwealth t,. Massachusetts Title. 5 Official Inspection Fora Subsurface Sewage Disposal-System Form-aot'for-Voluntary Assessments Diane Centofanti Property Address 34 Seabury In Ovmer Owner's Name information Is required for every Centerville Ma 02832 10/14/2014 page, cty/rown State Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unless the Board of Health_(and Public Water Supplier,if any) determines that the system Is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. .❑ Tte_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 -collform-bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes"or°Afo"to each of the following for all inspections: Yes No i ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ElDischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or.dogged._SAS.or.cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool ❑ ® liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow 49m'3f13 TWO 5 OftW 1045pepkn Ram&.6wriam Sewage D'apWd System•Pape 4 of v I , Commonwealth... Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not-for Voluntary Assessments Diane Centofanti Property Address�- 34 Seabury In Owner Owners NameinfDrr - regdr dfo Is Centerville Ma 02632 10/14/2014 required far every page. CilyrTown slate Zip Code Oats of fnspeWon R. Certification (cont.) Yes NO ❑ ® Requlred pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy Is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy Is within 50 feet of a private water supply well. :i ❑ ® 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 conform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided-that no other failure criteria are triggered:A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails,I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system falls.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 1: 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. For large systems,you must indicate either"yes'or're to each of the following,in addition to the questions in Section D. .:.; Yes No — ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply 11 El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone It of a public water supply well If you have answered"yes"to any question In Section E the system Is considered a significant threat, or answered'yes"in Section D above the large system has failed.The owner or operator of any large T 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 s tem owner should contact-the appropriate � � Y• regional office of the Department s. Ti00 b DI6da1 fncn ram:6uhawtace sWA988 oicpcgt sraam-asps 5.117 I inn S Commonwealth Massachusetts Title 5 Official Inspection Form, Subsurface Sewage.Disposal System.Form---Not for Voluntary Assessments Diane Centofand Property address 34 Seabury In Owner Owner's Name Information is required for every Centerville Ma 02632 10/14/2014 page. CityfTown Slate Zip Code Date of lnspec dm M System information Descripbon: The system consist of a 1000 gallon concrete septic tank and a M ft concrete leach pit.The tank is in good working condition with no signs of leakage.Both inlet and outlet tse's are in place,The liguid level in the pit has never been within more than 22"s of the invert and is still in pMiRgcondition. Number of current residents: 2 Does residence have a garbage grinddr? ❑ Yes ® No ?fi' 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,Ifavailable(last 2 years usage(gpd)): 2012 28,0002013 23,000 Detail: 7t)Gpd over two years. Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commerciaillndustrfal Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft,etc.): Grease trap present? ❑ Yes ❑, No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: l9re•3n3 TV&6 MM kwpwlbn Porat 8u&s9reM Smoo Dispel SMem,Pape 7 of 17 .''t ::vs Commonwealth Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments Diane Centofantl Property Addrew —� 34 Seabury In Owner Owners NameInFOE - -- requ dfoUDR Is Centerville Ma 02632 10/14/2014 required for every C41TOM Stye by Code Date of Inspection C. Checklist Check If the following have been done.You.must indicate"yes"or°ne as to each of the following:- Yes No ❑ ® Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® _❑ Has the system received normal.tlows..in the previous_two.week.penod? ❑ ® 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 NIA) ® ❑ 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(6)1 I D. System information Residential Flow Conditions: Number of bedrooms(design): ? Number of bedrooms(actual): 2 3 -` DESIGN flow based on 310 CMR 16203(for example:110 gpd x#of bedrooms): 220 r k� ISinB•31f3 TWS0Ww hapeaGnn Fomr Szm>awtace sexege Ofcposq Systwn•PaW 6 01 47 i i-•: 1 1 .;Y Commonwealth Massachuseffs "Title 5 Official Inspection Form f Subsurface-Sewage Disposal System Form-Not-for Voluntary Assessments- Diane Centofanti Property Address 34 Seabu_ry In Owner Owner's Name require for is Centerville Ma _ 02632 10/14/2014 required far every _ page. City/Town State Tip Code 'date of Inspection D. System Information (coat.) Last date of occupancy/use: Date; Other(describe below): General Information Pumping Records: Source of information; Pumped last In 2012 Was system pumped as part of the Inspection? ❑. Yes 0 No If yes,volume pumped: gaaons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy i> ❑ Shared system(yes or no)(If yes,attach previous inspection records,0 any) ❑ InnovativelAltemative 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): <. taK-sna TM 5 0MdW kwP=&n Famc Subsmraw Sowago pMOM System•pegs g or17 r ; Commonwealth,., Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System-Form-Not for Voluntary-Assessments Diane Cerrtofanti Property Address 34 Seabury In Owner Owner's Nam information is Centerville Ma 02632 10114=14 page-required for every CRyrrown State Zip Code Date of Inspection �- D. System Information (coot.) i Approximate age of all components,date installed(if known)and source of information: 34 years old Were sewage odor's detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ®cast iron ®40 PVC ❑other(explain): Distance from private water supply welt or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Vented through the roof. Septic Tank(locate on site plan)— Depth below grade: 1 ft 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 certficate) ❑ Yes ❑ No ::• 1000 Gallon Dimensions: - -• 3"s Sludge depth: ,Sins 9f13 1108 5 GftW bipw*an far¢Subsurface Sewepe otsposaf syusm-Pape 9 of 17 _... l� Commonwealth Massachusetts Title 5 Official Inspection Forte Subsurface Sewage Disposal`System Form-Not for Voluntary Assessments Diane Centofanti Pmpeuy Address 34 Seabury-In Owner Owners Name Information rs required for every Centerville Ma 02632• 10/14/2014 page. cKyrrown State tip Code Dale of Inspedion D. System Information (coat,) Septic Tank(cone.) ry Distance from top of sludge to bottom of outlet tee or baffle 24"s-- Ws Scum thickness Distance from top of scum to top of outlet tee or baffle 42's ---- Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick Tape Measure How were dimensions detennined? Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity. liquid levels as related to outlet invert,evidence of leakage,etc.): No pumping required at this time.tee's and baffles are In place. Grease Trap(locate on site plan): Depth below grade: NA _.._ 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 — t Distance from bottom of scum to bottom of outlet tee or baffle y. s Date of last pumping: Date f w£na•3flS TAN S O final i*PWion FWa SilbuffWa SewsYe +•Poo 10 or 17 i. Commonwealth r.. Massachusetts Title 5 Official Inspection-Form _-... Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Diane Centofanti Fmper{y address 34 Seabu In Owner Owner's Name inrbrMrequired to a Centerville Ma 02632 1 Dt1412014 required for every ,_..-....._ page- cKyrrown State Zip Code Date of inspecdcm D. System Information (cant.) Comments(on pumping,recommendations,:Inlet.and outiettee or baffle concHtion,.structural integrity.,- liquid levels as related to outlet Invert,evidence of leakage,etc,): L.icuid levels are normal and pit shows no staining higher than within 22"s of the invert Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: ,---- i >c Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: - - Capacity: gallons Design Flow: gallons per day _ Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: testa Comments(condition of alarm and float switches,etc.): 'Attach ropy of current pumping contract(required),Is copy attached? ❑ Yes ❑ No tERu•3r13 TWO 6 OMW tr"WM FW"Sdbwdaoe SewaOe D1 SylW-pogo 11 of 17 as Commonwealth to Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Diane Centofanti Property Address 34 Seabury In Ovrner Owner•a Name Inforrriatlon is Centerville Ma 02632 1t7/1412Q14 required for every page. CROW state Zip Code Dale of Inspection D. System Information (cant) Distribution Box(if present must be opened)(locate on site plan): na 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.): No d Box Pump Chamber(locate on site plan): Pumps in worsting order. ❑ Yes ❑ No' Alarms in working order. ❑ Yes ❑ sYo` Comments(note condidon of pump chamber,condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): i If SAS not located,explain why: y i i 9 j (i ON•W13 TIYa s Dfidat Unp¢sda,fans A3arraw sewage D epowl&yslmn-Pape 12 or 1r %: } - I Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form_-Not for Voluntary Assessments Diane Centofanti Property Address 34 Seabury In Owner Owners Name infonnarion Is Centerville rre Bntery fired for every C entervtyrrown Me 02632 10/14/2014 We Zp Coda Date of lnspeetbn D. System Information (cons.) Type: ® leaching pits number. 11,000 Galion ❑ leaching chambers number: ❑ leaching galleries number: _- -• ❑ leaching_henches number.length:.. ❑ leaching fields number,dimensions; ❑ overflow cesspool number. ❑ innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): No si ns of h drualic failure,break out or ponding. 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 i Dimensions of cesspool Materials of construction i lndication of groundwater Inflow ❑ Yes ❑ No i ibeis•3fi9 T&S MW hspedkM Farm 8ubsurf=9 Sewage DmpaM Sysbun•pMe 13 of 17 r 1 Commonwealth w Massachusetts Title 5 Official inspection Foy Subsurface Sewage Disposal System Form-Noi for Voluntary Assessments Diane Centofanti Properly Address 34 Seabury in owner Owner's Name information e�, Centerville .required for Ma 02632 10/1412014 - page. cityrrown Stete Tp Code Date of Inspection D. System Information (cons) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): No signs of hydraalic failure,break out or ponding. 4 Privy(locate on site plan): Materials of construction: Dimensions Depth of solids - _... Comments m nts(rite condition of soil,signs of hydraulic failure,level of pending,condition of vegetation, etc. Am•3d13 Toe 6 orMdd h*W&W Few&bs,Kfaw Sewage pi RSW System•page 14 d 17 -- I Commonwrealtfi vo Massachusetts Tide 5 Official inspection Form_... Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Diane Centofantf Property Address 34 Seabury In Owner Ovmers Name Informadon Is Centerville Ma 02632 10/14/2014 required for every page. Cdyrrown State Zip Code Date of Inspection D. System Information (Cont.) Sketch Of Sewage Disposal Systerri:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 1 feet. Pe 00 f t.Locate- where public water supply enters the building.Check one of the boxes below; w: ❑ hand-sketch in the area below ® drawing attached separately Fes... lbfnB•3113 7M2 6 016clal kwPeaftn FWM SuLwdace Semp DiWaqW ay=n•Page 15 of 17 "'- AsBuiit Page 1•of 1 LOCATION Lof SEWAGE PERMIT lie. • _ �Sf �eR�bv�5 f /t. INSTALLER'S NAME R ADDRESS R UrLOER OR ER H z DATE PERMIT ISSUED /oa_ tFd DATE COMPLIANCE ISSUED 7- ® 1000 G,C logo a14t • 1 E i e fittp://issgi2/intranet/propdata/prebuilt.aspx?mappar'208078&seq=1 11/7I2014 Commonwealth or Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal.System Form-Not-for Voluntary.Assessments Diane Centofand Property Address 34 Seabury In Owner Owner's Name Wom Won is re Centerville Ma 02832 10/1412014 ulred for every q pie, Citylrawn State Zip Code bate of lr>spect'ron '> D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water [] Check cellar ❑ Shallow welts Estimated depth to high ground water12}h feet Please Indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: bate ------ ❑ 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: local usgs maps show the nearest open water venue well over 30ft below lot elevation You must describe how you established the high ground water-elevation: local uses maps show the nearest open water venue well over 30ft below lot elevation 1 Before filing this Inspection Report,please see Report Completeness Checklist on next page. 0"•3R3 Tme 5 0104W Mepa0m Foma Suborlam$wasp obppsw Sysrvm•papa is or jr '�1 Commonwealth or Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Diane Centofanti PropertyA dress — -�- 34 Seabury In owner owner's Name information is Centerville required for eve Ma 02632 10/142014 page. city/rown Stele Tip Code Date of InspecUm E. Report Completeness Checklist ❑ Inspection Summary:A,B,C,D.or E checked ❑ Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage.Disposal System either drawn on page 15 or attached in separate file I i 1 i f i i i i I i e5vs•slis �slles o� { l+t FomC SubstQfare Sewage Disposed Syslem•Pepe 1 i of it p� P LOCATION �¢2' SEWAGE PERMIT NO. J y VILLAGE INSTA LLER'S NAME i ADDRESS N UILDEIll OR _OWNER� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Id-7_ �� I� jqn z-o t t 000 G i 1 ,, J*+ ' i000 Qom! 0....`.fl..:'.......... Fps t. .� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...�OWJ.'2.....OF. COY.",57al •--------------------------------- ll �' , ppliration for Diapasal Works Tan.6trurtijan Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at . .............. _.IAZI_41�.................................................... n-Address r Lot No. yea.............................: c��11 ................. --------------- ner12PeJ.r-_!;��Q� ................................Address . a Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building ............... No. of ersons........_._..__..._..__._.__ Showers G.i yP g ------•-•---- P ( ) — 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..................-_ Depth to ground water-__-_•__-__-_-_-----__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 .. ..-•-••-•_..----•.... ............................................................................................... LISQ O Description of Soil............. ,(�d...�.. L.0 ---------------------------------------------------------------------------------•------------- x .---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••- x --•-----•--•----------------••---•-------•--•-•-------•----•--------••--•----•----•-•--•-----•••••---- -- -----------••------------- U Nature of Repairs or Alterations—Answer when applicable___1_.=.1�(�. __ _ f ...-.._._l_.:�.��_Q. � .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the board of hhealth. Signed•-_. . .FJ�S' ..... ............. Date Application Approved By.......a,.z. . .- ( �� = Date Application Disapproved for the following reasons---------------------------------------------------------------•-------------•--•------------------.....------... .....................................•---•-----•--------•----•---•--.........--------------...............-•----•----------........................•---v---'-✓-•---•......---- ......-••-•----- Date PermitNo......................................................... Issued......).-- \\ Date �J — No................ .....-- Fiz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Dispaii al Workii Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: :�1..... :%C rf. t.:►Y•t_:� ................................................ ..... ----------•------- ....... ..---------------•-------..........------ - .. I Location--Address ,� d or Lot No. Owner r 4'. � Address a ....-----•--- •--•----------•--....----•----•-••--..... - ----------------------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------------------•..................-•••• . - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Ix Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No.................... Width.................... Total Length.....................Total Ieaching area....................sq. ft. Seepage Pit No.................. . Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box O Dosing tank ( ) ~' Percolation Test Results Performed by....................................................................... . aTest Pit No. I...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2.___._._...I_..minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil------------- !_f_iZ V ................t'............................ -... W ...-------•-•-=-------------••---••••-•---•-•-••-•--•--•••-•-•-•-----------••-----•--.....•-•-•--•-•----••-•.................................................................................... UNature of Repairs or Alterations—Answer when applicable...1_.__,If..!........... ll.lf f .............. ...... 1._.......... r_ ,. -•------••-•----------------•--------------•--=----••----•-•-------------------•----•-••-------•--••----........----------------------------------------------------•-....•••-----•-•--•---••---......_. z Agreement: i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT ILE �5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by !! the board of health. / SI n f 1 rl I ✓ � --------- ------•- { t � f' Date Application Approved By..... AAA .�'•------------------------ "z_`e�-© . - -•.... .... --•. ..-.-I*i ______________ Date Application Disapproved fear, the following reasons:...........................................-----•--••--._........---------------•--------------•------•---....-- 'Date PermitNo............... -------------------••- ... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... . .!...A. ... ...OF..... ✓&..........................b)�—��.......................... (Inrfif irate of TontpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by :_'......1 "JL. J. t Installer at ..-•-•=-•--•..:........... ---=---t--------•----------------•-•---......•..---.......------------------------------....._..........-•.................................... has been installed in accordance with the provisions of ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ._ _r.......... dated_...-------------------------------------- THE r ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSJr ® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION, ATISFACTORY s DATE ............... ,5 4tP's'wr'p'r: _6rs.� •4'C i '`: �.+.,�. `�r.�}+yt,:z�.� t^. sa Ma'�"'�R�}+L'7iaX':'.'�' Miaf'§? 't>� �" r a4iir3 ".°...'"'4,�tY-"�y�".�#c xR air �` i fi., . i;'Si�,'.ss,.a�^:6x.V.#a.�+.C..ri.'w.t..�:r.✓t:G'.. .� - _ t THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH No.......... -_G.S`' OF FEE.. --�:Ci i o ttl i rk �ono#rudion 11amit Permission is herebyranted._.__-%._. ____._..... (-('1.�7;�f`... -��..... --�n g l to Construct (_ ) or Repair O an Individual Sewage Dispo al System J at .....L t.:....... (:}7 7 F i.C.>> ------•-------•-••-----•-•---•-•-•------------••-- J street as shown on the application for Disposal Works Construction PSg9t N .._._._ Dated..... ................................ •/D ----------------------------�© Board of Healt DATE.. ........................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i+ J� r712f a7 d-04 REFERENCES: ZONE:RC Assessors Map:208 Setbacks: Parcel: 78 Front:20 Side: 10 Rear: 10 I N/F Thomas & NIF I Lee Beverly Murray W partald P & Nancy 127001188 18662/31 CB/DH N84'00'20"W �l Fnd 1 00.00� Cz 10_Setback ._— -- --'— --'i _— — I 24.1' I I I - I I 04N I I Lot B j 3 12,500'f I o Shed I Lot 2 I I 05, 34.7' ............... I I I . I Septic System`^•...,`.........,'` I o By BOH Card (approx)/ j �1 15* O I I 3 I E Meter I til o Paved I j Drive j Shwr O y � Water O I O c Gate W Cellar I ip N) .0 L En try j r 1 � � j I a I #34 I Z SN 1 Sty w1f I � .� 24.01 z N Dwelling I Ad 3 I i o I I a I I o 35.01 I a Deck I ti o tl� � al to N �j I � 28.1' W Z N j 20'::. a I o � I Proposed Porch & Deck 31-°' • !-.--.-- - --•-- --.- •-- --..- I 10 Setback 100.34' / 83'2 4'10" E N/F v Lot 3 S Lot A The HidoNI Realty Trs o 17615/85 o N �m o I certify that the structures z shown hereon conform to the v,o setback requirements of the ^ °f�'� Zoning Bylaws of the town = WAS D y�� f Barnstable. R. g . c� LHEUREUX #34312 PLOT PLAN A�°FEs IN 71,7 BARNSTABLE Professional Land Surveyor EGte (Centerville) MASS. NOTES: DATE: 171J0007 SCALE:1"=20' 0 10 20 40 FEET 1.) The structures shown were located on the ground by conventional survey methods on 61JUN107. PREPARED FOR: Michael Grillo Management Co. 2.) The property information shown hereon was 221 Route 149 — compiled from available record information. Marstons Mills, MA.02648 3. s plan is not or recording a ) This f di p gnd is not PREPARED BY: to be used for construction layout or deed CapeSury description .purposes. 7 Parker Road Osterville MA 02655 DWG #: C552_1 G1 FIELD 'BY: WHK/DWB (508) 420-3994 / 420-3995fox 9 (� oo -7 ,03005 f -51-r . ---- (� 0 N G A 1dt 2dt Q) N � M j C N ElKITCHEN/ DECK ' DINING — v t _ � i c: � v SHOWER lJ LU Z a BATH II II fo BEDROOM C� II II BATH II II L II II LL- II II II II •—' Lin U. Y LIVING ROOM EXISTING FIRST FLOOR PLAN PLAN 4- SCALE: 3/16"=l'.0" NORTH •X w BEDROOM — CONCRETE PATIO LEGEND �-- — EXISTING WALL TO REMAIN Q �� — EXISTING WALL TO BE REMOVED n O 'Nx O Q) (N C] N d• • - V N Q� aj "D p 3 v O Q) N v M c -- fp v Ll i tEL1 1 a0❑ ❑❑❑❑ ❑ _ ❑ w s FIRST FLOOR -- --� -- -- ---- --- -- -- -- — --- --- --- -- -- -- -- -- --� -- -- — -- -- -- — .— — — — ---- — — — — CONCRETE PATIO O b4 C W EXISTING SOUTH ELEVATION N A2 SCALE: l/4"=V-0" n O O co � N d' Q) - V Q) �p C N r M 4+ �.. C FUD , -� EH uu FIRST FLOOR y��0//�� �/ 4- v� x . W EXISTING NORTH ELEVATION M A3 • 1 4 =V-0" SCALE. i ti O • O � N C� cn d' Q) . C N Q) Q C N no Q) Q Q) > ca JL c LU FIRST FLOOR _ _ ._ — - - - - - - - - - — U-i CONCRETE PATIO bQ V, uj EXISTING EAST ELEVATION A4 SCALE: 1/4"=1'-0" O • O a? N � N d' - - V N u, ro .� _go Q) DC O Q v c: m TH o m H 1 - w --- FIRST FLOOR ` ) �0 C 4- X U-1 EXISTING WEST ELEVATION Lr) AS SCALE: 1/4"=1'-0" i i 1 9f 1 i n _—J — - o (10 rn ' � N i EXISTING- CRAWL SPACE v --- N v �'o V C N J � �^ a L Ov, > N � a M C ca a) V EXISTING SLAB ON GRADE N z 3'-3 1/2" v EXISTING X FULL BASEMENT -- - ___ -- LINE OF _ -- - - �"— BUILDING ABOVE (CI ------- 101, CONCRETE FILLED SONOTUBE Ln - - - -- � (TYPICAL) 2x10 JOISTS @ 16 O.C. �o ----'- - -- -- -r -- ,` - T- - - -..._. 1 FOUNDATION PLAN PLAN - ! - NORTH _. AG SCALE 3/16" 1'-0" Z, 7`7° y LINE OF DECK ABOVE -: ,p,; --- --------,--- .-;---___-�-_ LEGEND 8" 0 CONCRETE '--- {--------- '._ ._-_. FILLED SONOTUBE — EXISTING WALL TO REMAIN (TYPICAL) 5'"11" 4'-2 1/2" 5--ill 16-0 N EW WALL 28'-8 1/2" __. --- -,� p --.-- _ y- I EXISTING BUILDING NEW n O --- - ---- -- ------ O -DECK _ o N KITCHEN/ �t DINING u SHOWER ••� c cv t\)Vl Z 0. —�_(C------- BATH I I c M o v BEDROOM QBATH m II II z 3'-8 1/2 11 II W II II fV . I , �— — LINE OF O M 1 LIVING ROOM CEILING ______ _ Al2 -- ABOVE .-LIVING 14 SEASONS m BEDROOM r " q ---ALIGN SUB FLOORS O cp 4- - _ -- — _ O A Woo', ! 1 FIRST FLOOR PLAN PLAN PLATFORM NORTH A7 SCALE: 3/16"=1'-0" 31/2" 3'-51/2" 4'-3" 4'-3" 3'-51/2" 1. 31/2" LEGEND .�' f - - /-__ EXISTING WALL TO REMAIN 16-0" ,... 1 — N EW WALL EXISTING BUIL7ING NE�'V ' O I ai O 0 N NEW EXISTING BUILDING N - — V RIDGE VENT C N � rO C N —------- - --- MATCH EXISTING RAKE DETAIL N 12 — — — — --- - CEILING BEYOND CATHEDRAL CEILING co 10� -- - - C ❑❑ ---------_ ------ - -- —-- ------ - - --- -- WHITE CEDAR SHINGES —LIE 1=171 _ _1C�. 5 T WL(TYPICAL) L) ❑❑ 37100❑1] ❑ ❑❑ - Q o ❑❑❑ ❑ w ® JLI 0000❑o 2x MAHOGANY SUB-SILL _11111E EMEME 11111 W/TAPERED FRONT EDGE O AND 1/8" KERF BELOW (TYPICAL) O �1 MATCH EXISTING FIRST FLOOR — SUB FLOOR - ---- -- _-_ ---- _ > 4) --- 1 x TRIM (TYPICAL) W I i s SOUTH ELEVATION - 00 A8 SCALE: 1/4"=V-0" NOTES: MATCH EXISTING TRIM, RAKE, SIDING, MISCELANIOUS DETAILS (TYPICAL) i O • O QJ N G� cv d' i Q� V - � N C N c- M � lJ ELIO HR FIRST FLOOR Q -- --- W O z NORTH ELEVATION A9 SCALE: 1/4"=F-0" _ O • O v N m C� N NEW EXISTING BUILDING Q) v - • C N Q) 0 CN RIDGE VENT — — -- -- -- --� ' Q Q) p u ASPHALT SHINGLES (TYPICAL) ------------ --- \\ cc: M °' ROOF BEYOND Ix FRIEZE BOARD (TYPICAL) LJLILJ ------- _ ___ - - -- — -__ ----- ---- x = _ o L.U =- - - � Q O M w 1 +J i FIRST FLOOR Q) I ru Lu -+- - ! - J L ,... O EAST ELEVATION A10 SCALE: 1/4"=1'-0" O • O +�-• N co U N V v v � C CV _ � O L N CIO FI RST FLOOR -- -- - - - - - - - - -- - -- - - - - - a) WEST ELEVATION �-- All SCALE: 1/4"=V-0" n O - O 4; N � M ' C� N RIDGE VENT j // —__ ---_ 2-1 3/4"x 18"LVL RIDGE BEAM 2x4 CEILING JOIST Q 16"O.C. V I TYPICAL WOOD ROOF CONSTRUCTIO 30 YR.ASPHALT SHINGLES.OF N: Q)' N LT SH '' W 41 CD r / / _ C F SHEATHING 30 LB FELT PAPER 1/2"CDX PI YWOOD COO N Q j 2x10 RAFT-FRS(-i116"O.C., v 12 "• UNLESS NOTED OTHERWISE i -�\ PROP-A-VENT OR EQ. 10 "� R-30.8 1/4"FIBERGLASS INSULATION co ocu N /:•;/ —--_—---TYPICAL CEILING CONSTRUCTION: , ;I- v i Ix3 STRAPPING @ 16"O.C. 1= VAPOR BARRIER C(f U /2 SHEET ROCK I ,_. SEE ET TYPICAL WALL CONSTRUCTI ON: - - -- - - jV i I ii w WHITE CEDAR SHINGLES :4 W/STAINLESS EL NAILS '. f l Z 15 LB FELT PAPER. 1/2' CDX PLYWOOD WALL SHEATHING 2 x 4 STUDS Q 16'O.C. I, R-13,4 1/2"FIBERGLASS INSULATION VAPOR RE TARDER 7 Q w �OL_ JL 1/2'SHEETROCK TYPICAL FLOOR C ONS TRUCTION: /41.T+G PLYWOODFLOOR _ -19 6 1/4"FIBERGLASS INSULATION PR2x0 JOISTS @ 16"O.0 o MATCH EXISTING FIRST FLOOR SUB FLOOR 4— I � — — — — — — — - — — — — — — — — -- — — -- — -- — — - --_--/-= 1/2 T GALV.ANCHOR.BOLTS — -- -- -- -- _.... - - -- y , ^' - 3-2x10 P.T.BEAM \ --6x6 P.T.POST I L I �----- CB 66 C LUA4N BLUE 2-5/8" GALVANIZED I "� �? Q BOLTS +�--- 10"0 CONCRETE c:Q I I FILLED SONOTLIBE L uv (TYPICAL) �t m , /4"P.T.PLYV6'OOD---- `- 2x10 P.T.JOISTS Q 16" - i ' ADDITION ^ BUILDING SECTION Al" "—ALL: NOTES EXTERIOR%'ALLS-2,4 FRAMING O Qj O 4— Cr; cc C) N DOOR SCHEDULE SYM. MANUFACTURER DESCRIPTION UNIT# SIZE REMARKS ;-� � V W x H _ f THERMA TRU� SMOOTH STAR FIBERGLASS DOOR S 262 LE 3'-0" x 6' 8" LOW E Excl.Pri O —__— --__-- �Ff ERE I.'i7:�ED A 1 (V� 1 -/ Q) v --- --- — _--- PROP A'dENT OR EQUAL `---TJ, •'/ C (v ----- — --- ----- ------ AI Ili DRIP FDGE IT,PICAU—_— J O / • fo �� v 30.0 11 FIEERCLI S INSUTATI01, I� L DOOR TYPES - % =!0M-111110 //�� 1r:3 STIL\pflNG�l I'Y�D.0 v 1v SJFFIF —�/ / O 1/1 'CFFIT VENT EXTERIOR DOOR —� m 1 FRIE2E EJAFD ITi FIiAI) , N07 TO SCALE WHITE C CAP.iHIVUES — 15 LB ELT PAPE0.---- li _J,—O..._.__.�.: ILI3,4!/i:"FIGERc'ASf INSLI I.A;(ION --- 1 SOFFIT SECTION A13 SCALE: 1/2"=r-0' -F� - /Q) (DS-262-LE WINDOW TYPES WINDOW SCHEDULE NOT TOSCALE SYM. MANUFACTURER DESCRIPTION UNIT# ROUGH OPENING LIGHTS GLASS TYPE REMARKS �'-6 1/8" 2'-0 5/8" W x H Q) ANDERSEN WOODWRIGHT WDH24310 2'-6 1/8" x 4'-0 7/8" 6 OVER 1 HIGH-PERFORMANCE PROVIDE INSECT SCREEN =_—_ - --: - bo - V OA 400 SERIES DOUBLE-HUNG LOW E4 -- — — — -- ---- — — __ - --- ------- ---------- ---- -- — 2' 0 5 8" x 2' 0 5/8" — 4 ---- HIGH-PERFORMANCE PROVIDE INSECT SCREEN r, Fll _ OANDERSEN AWNING A21 / o N' 400 SERIES ---- --— ---—--- -- ------ _LOW E4 ----- - ———----- — 0 A21 rn OWDH24310 NOTES: GRILLE TYPE: PERMANENT EXTERIOR-PERMANENT INTERIOR GRILLE WIDTH: 3/4" MATCH EXISTING COLOR. HARDWARE, FINISH, ETC. SEE ELEVATION FOR MULLION PATTERN INSECT SCREENS FOR ALL OPERABLE UNITS