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0090 SHORT BEACH ROAD - Health
�90 Short ~Beach Road Centerville P A = 206 123 f o. ° ✓" PC 12543 .iASTINGS,tin t' AM Commonwealth of Massachusetts W Title 5 Official Inspection Form o Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the 90 Short Beach Road- Centerville computer,use , MA only the tab key Property Address to move your George and Shirley Raymond J �j cursor-do not Owner's Name use the return key. 90 Short Beach Road Owner's Address rQ Centerville MA 02632 19 AV City/Town State Zip Code. September 24, 2006 Date of Inspection: Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental l Company Name 43 Triangle Circle - Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 24, 2006 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M Sye� A. Certification (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 { Commonwealth of Massachusetts 0 Title 5 Official Inspection Form aS Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM A. Certification (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5-2463.doc.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection 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"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, including 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(3)(b)] t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): NIA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—no plan Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 43 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age unknown. As built card furnished by Donald Moncewicz, P.E. on 12119196. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 L i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 1 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 ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 6 inches Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 2 inch Distance from top of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bottom of outlet tee or baffle 13 inches How were dimensions determined? As built card t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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.): 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): t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 .r Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts 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.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 �V Commonwealth of Massachusetts Title 5 Official Inspection Form aX Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M SyO� C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching trenches appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching trench stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed. t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form G„M C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. LOCATIONS EXISTING A B I 20 f t 25.5 f t DWELLING 2 24 f t 28.5 f t # 90 3 28 Ft 30 ft A g I I z SEPTIC TANK o 2 w .z 3 3 ❑ D-BOX LEACHING TRENCHES Li SHORT BEACH ROAD NOT TO SCALE t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 90 Short Beach Road Property Address Centerville MA 02632 City/Town State Zip Code George and Shirley Raymond September 24, 2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 7 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: 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: A survey instrument was used to determine the elevation of the bottom of the leaching trench and also the high tide mark on a nearby sea wall. High water was determined to be 3.9 feet below the bottom of the trench. Applying a groundwater adjustment of 1.1 feet(Index well M1W--29 Zone A, August, 2006 reading = 7.3) demonstrates that the bottom of the SAS is above adjusted high groundwater. t5-2463.doc.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 TOWN OF BARNSTABLE LOCATION 90 Sfo�T�+�fa!'�H /PDI°ID SEWAGE # M �a VILLAGE ASSESSOR'S MAP &LOT AWP/0 3 INSTALLER'S NAME&PHONE.NQ. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) T.&_-iuc.�i �y�_(size)�S�.t•r �� NO..-OF BEDROOMS 3 OWNER /q. 19PY^'lCW_P PERMITDATE: COMPLIANCE DATE:. Separation Distance Between the: , � Maximum Adjusted Groundwater Table and 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) !t0 ?f Feet Furnished by-A*ye►A0 ht! � LsFc/6r/9i76. t �C-7 Ael 1 L rb H—IY I < S?,Q 6 £z 0-r Q 1.4 ." �3 � 1.�•��•N j 7/1d�'f'Y' r.0• .3�f'•dS •7'M62f-j. Oaaiog Y�rva+s.J �rs+gy „g 7 a ` • V Commonwealth of Massachusetts RECEIVED Executive Office of Environmental Affairs � DEC 1 5 1996 Department of Environmental Protection E�6 . William F.Weld Coxe Caowerrim O So-eudy Argeo Paul Celluccl David B. Struhs U.Cwyem« Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '9AP 2,a G PART A PARc,F,� 0/2 3 CERTIFICATION Property Address 90 f.'l m eT 4.�I9�H.�D j �1,4 Address of Owner. Sao f//G L GREs7 Date of Inspection: 9—/3 L2sc,Eiypl6iC /99tp (If different) i(/,ts,EpNAi»JrJy o�f92 Name of Inspector. Z>avAy..j> IV. OecV&WplaZj A,-. Company Name,Address and Telephone Number. Donald W. MonceviCZ (s'm8) 3 94-o.s'o 9 Civil Engineer 40 Pond Street CERTIFICATION STATEMENT West Dennis, MA 02670 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: W Date: S lap/ (?PC The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional 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: Al SYSTEM PASSES: XI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303_ Any failure criteria not evaluated are indicated below. Bl 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 yea, 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, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failnre is imminent. The system will pass inspection if the existing septic tank is replaced with a ronforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617) 556-1049 • Telephone (617) 292-5500 A ii Printed on Recycled Paper J`s r� UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Pi4.Er-S� Property Address 96) rsocY �,�r�cy /�O• $v.evsr.9.81.� �CFivTaFieY/,L,c iE, �9 Owner. G�-oiesrc ,�f'• /Pi9Y/yI�ND Date of Inspection: B)SYSTEM CONDITIONALLY'PASSES (continued) Se backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a b settled or uneven distribution u ion box. The system will pass inspection if(with approval of the Board of Health): broke s)are replaced obstruction is re distribution box is levelled or The system required pumping more tban four times a year due to broken or obst�pe(.). The system will pass inspection if(with approval of the Board of Health): broken pipes) are replaced obstruction is removed C1 THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Condi exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public heal ety and the environment. 1) SYSTEM WILL P S BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL OTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 5 t of a surface water Cesspool or privy is within'50 feet bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF TH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONIN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is wi ' 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zo I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet o rivate water supply well. The system has a septic tank and soil absorption system and is less than 100 feet bu 0 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic corn indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is ual to or less than 5 ppm. S) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A MAP 2 0 CERTIFICATION (continued) fjge ,� /23 Property Address JO SHO.er Ai ,qcy /ep.� 13i9.e.S/sT.4B.4E lGew�-, V/!.,[,6J1 A%0.9 Owner. G.F ,1rdV X:- fri. /f'Ayi'rJmN� Date of Inspection: q/3 D] SY9 FAILS: I have rmined that the system violates one or more of the following failure criteria as defined in 310 CME 15.303. The basis for this dete 'on is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efII t to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box ve outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below inve r available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NO ue to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the ' h groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or .butary to a surface water supply. PP Y• Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply ll with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water anal for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] E SYSTEM FAILS: b The folio teria apply to large systems in addition to the criteria above: The system serves a facili h 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 envirolhentbecause one or more of the following conditions exist: the system is within 400 feet of a surfac water supply the system is within 200 feet of a tributary to a surfa water supply the system is located in a nitrogen sensitive area(Interim Wellhead ion Area(IWPA) or a mapped Zone H 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 dwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further info on. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B MAP 2 0(p CHECKLIST /�q,eG,ac,C. fjr f /2-3 Property Address Owner. �,,EZ7iCCv.� /q. /�i9yMON1� Date of Inspection: 9/3 jj�c�,F/y /t /9 9V Check if the(following have been done: v Pumping information was requested of the owner,.saatipoasy and Board of Health. None of the system components have been pumped for at least two weeks and the system has�been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N A As built plans have been obtained and examined. Note if they are not available with N/A. A/o e-CCV�GD r t✓.E.�.B' The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow / ✓ The site was inspected for signs of breakout. ✓ All system components,excluding the Soil Absorption System, have been located on the site. ✓ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of constriction, dimensions, depth of liquid, depth of sludge, depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner )were provided with information on the proper maintenance of Sub- Surface Disposal System. �'yvR To otc/.vl9i� N (revised 11/03/95) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C MHP m 6 SYSTEM INFORMATION �AieG.FJ— /2 3 Property Address q0 Sf Ore r /fc%q P BigR/(/�'�i5►13r<.S �C.FiVT,�re)</,C1..��� M� Owner. Date of Inspection FLOW CONDITIONS RESIDENTIAI- Design flow: ons o�s Number of bedrooms: Number of current residents: O Garbage grinder(yes or no): Laundry connected to system(yea or no):y.ES Seasonal use(yea or no): Water meter readings, if available: Last date of occupancy: A-1mr 96 COMMTs IAL NDUSTRIAL Type of estab t: Design flow: gaffarwd< Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: no)_ Non-sanitary waste discharged to the Title 5 system. s or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: n/m /arco,@OS S 496-%,V V rrAB4,w ROARICD of HAALrH System pumped as part of inspection: (yes or no). o^-r© If yea,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow,cesspool Privy Shared system(yes or no) (if yea, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all com Heats, date installed(if known) and source of information: 97 �B�CNs�.4B.t.E Sewage odors detected when arriving at the site: (yea or no) (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION (continued) /23 Property Address 90. Siy 0,e7- Q.r�i'gC/`! /e•�•, 9.eitssr�JoC3.4�� ivr.E�e Y/t c,6,),/l/J' Owner. �,Fd1iC!r+.S A /t!9X"rVm/t/D Date of Inspection: SEPTIC TANK: '�'S /i GOO Gf��-►C-©� (locate on site plan)✓ a Depth below grade: Material of construction: ✓concrete_metal_FR.P _other(ezplain) Dimensions: s Sludge depth: /.2" r Distance from top of sludge to bottom of outlet tee or baffle: 42 f Scum thickness: 6 Z` P =. -It 7- pMZA _A/.ERy,Y Distance from top of scum to top of outlet tee or baffle: ^/o -CC V M Distance from bottom of scum to bottom of outlet tee or baffle: ,t ./Z 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 1 etc.) eBco�M.fs>va R��P/kG .�•eoI►•t =�.�.6T �o�.o�' ' NAS /tq"T.✓.c.�7' I3�.cr_iv� �wCiec�c 7aF.� -.h�A r ourc.Fr Bvrr,T�,c. Cc+vc7- ; wAr,o,-e WN.s 09T O0_1r'A a 'r /-eAeAQeT'•�r,OVA F-r I980ar' 7 "/1VG✓Ki5e Alto Awn"C"V E (locate site plan) Depth below e. Material of construction: concrete_metal_FRP —other(explain) Dimensions: Scum thiekmaaa• Distance from top:of scum to top of outlet tee or e: Distance from bottom of scum to bottom of outlet tee o e: Comments: (recommendation for pumping, condition of inlet and outlet tees or depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /SAP Za SYSTEM INFORMATION (continued) Property Address: 90 SHogr. B.�AG�I /POJ (3rSRNs>H1�•C-,F�G�y�'. - /.�.L-.�>f /YIfA Owner.. /q. /P�yMavD Date of Inspection: 9 13 cr.�cM�i ERA /9 9�v TIG HOLDING TANK: N A (locate on ate p Depth below grade: Material of construction: _con metal_FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day \ Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:'y�S (locate on site plan)✓ Co►/.Eie /�� w i O-L- X //— /O •,Gm vG .4.vp Depth of liquid level above outlet invert: O Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,,g)�yL/« —X1"/jn/GC7 of fOL-/D •rVo ,� N O.v ' ariv N6 BCUc' wv ''PVG iv S .L�9�'iNG �vt mfF- .q�v�r ` ' �r►�,F So I- /�v6 mx� ZN P CHAMBER: ���9 (locate site plan) Pumps in working o .(yes or no) Comments: (note condition of pump chamber�co of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) � � 0423 Property Address: 90 S.yoeTs�cfr Rd• Ijssr.9.�s.c.L� /G�vr.:✓e�ri�.c.E Owner. �!A ��cO�C!ae4� �. /c'Ay/'►'lO�t,/D J C �l. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): �s (locate on site place, if possible;excavation not required, but may be approximated by non-intrusive methods) ✓ If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: , ✓learn trenches, number,length: 2 aY.B� •S'•O 70r,9L. leaching fields, number,dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) 41.4 c A4WW -MAI S' .t1CW1nj A& _Tel�vx m6! ,#4vlelw k1Wa;&_1W r/VA.1 /s � 3 � � fovea. C POOLS: '"�9 (locate o lan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids'layer- Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (locate on 7(note Materials ction: Dimensions: Depth of sCommentsndition of soil,signs of hydraulic failure, level of ponding, co of vegetation, etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) gle4a-4- #/.23 Property Address: 9W Sy4e7' Q�Acy �,p ��R•�sT.9 /4'79 Owner. �v.��e!=yi= f#. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �.A" Houses Goe,.v,E.e Bo�l,BD c✓e.q w,� SP.q c.�' .�., �,S.�Trc T�'➢NK�.�r G-oY.�R. ,'�„ disse/13uT�oN Bo X ��►' a .GEitCf//ivG TiP,�iVcH ce�vcscs•,�' +4. ' G.S.T. .4,Lc z3. 9 ..C,. 4-A' .27.6 4, 114, c-F -;e. 8 1 A-H 42•7 � G t _ DEPTH TO GROUNDWATER Depth to gmundwater.'::- 7 feet method of determination or appradmation: *Va.,WJe (revised 11/03/95) 9 ECOJECH Environmental www.eco-tech.us W� THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A sAp `Z,C�(D CERTIFICATION Property Address: 90 Short Beach Road PARCEL. Centerville LOT • Owner's Name: Raymond& Shirley George y` Owner's Address: 90 Short Beach Road Centerville,MA 02632 ' Date of Inspection: October 12,2004 = f, Name of Inspector: (Please Print) . David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental Mailing Address: 43 Triangle Circle ��, Centerville,MA 02563 Telephone Number: (508)364-0894 CERTIFICATION STATEMENT: —_ f I certify that I have personally inspected the sewage disposal system at this address and that the info ation reportep below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature �a^� G '�---- �S Date: OG1` Z, 21 - The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****Thisreport eport only ly describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond&Shirley George Date of Inspection: October 12,2004 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no,or not determined(Y,N,or ND). in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not), is structurally unsound,exhibits substantial infiltration or exfiltration, or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain The system required pumping more than 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 ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12, 2004 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 and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health (and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3) OTHER 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12,2004 D)System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 1515.303, therefore, the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E)Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes" or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes" to any question in Section E the system is considered a significant threat,or answered "yes" in section D above the large system has failed.The owner or operator of any large system considered a significant threat under section E or failed under section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12, 2004 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? Y Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans.of the system obtained and examined?(If they were not available as N/A) Y _ Was the facility or dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? including Y _ Were all system components,exeluding the SAS. located on site? Y _ Were the septic tank manholes uncovered, opened,and the interior of the septic tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum.? Y _ Was the facility owner(and occupants, if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y Existing information. For example,Plan at the Board of Health. Y Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 90 Short Beach Road Centerville Owner: Raymond&Shirley George Date of Inspection: October 12,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept. Number of current residents 2 Does the residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection requiredl Laundry system inspected (yes or no): n/a Seasonal use(yes or no): no Water meter readings, if available(last two year's usage(gpd): 177 gpd Sump Pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sgft/etc.): Grease trap present: (yes or no) Industrial waste holding tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no). Water meter readings, if available: Last date of occupancy/use:_ OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS Source of information: System not pumped in recent past(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: X 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/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe) APPROXIMATE AGE of all components,date installed(if known)and source of information: Age: 7+years System installed 12/96(As built card at Board of Health) Were sewage odors detected when arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12,2004 BUILDING SEWER_(Locate on site plan) Depth below grade: 1 ft Material of construction:—cast iron X 40 PVC_other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK: Yes (locate on site plan) Depth below grade: 12 inches Material of construction: X concrete_metal_fiberglass_polyethylene other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance (yes or no):_(attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 6 in Distance from top of sludge to bottom of outlet tee or baffle: 28 in Scum thickness: 1 in Distance from top of scum to top of outlet tee or baffle: 9 in Distance from bottom of scum to bottom of outlet tee or baffle: 14 in How dimensions were determined: Probe to top of tank Continents: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every 2 years Liquid level at outlet invert.Tank and tees appear structurally sound and functioning as intended No evidence of leakage in or out GREASE TRAP: none (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: Comments: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond&Shirley George Date of Inspection: October 12, 2004 TIGHT OR HOLDING TANK: none (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/day Alarm present(yes or no):_ Alarm level: _ Alarm in working order(yes or no):_ pumping:Date of last Comments:(condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: Yes (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: at outlet inverts Comments-(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet inverts. Few solids in sump. PUMP CHAMBER: none (locate on site plan) Pumps in working order: (yes or no) Alarms in working order: (yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George . Date of Inspection: October 12, 2004 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located,explain why: Type: _leaching pits,number _leaching chambers,number _leaching galleries, number X leaching trenches,number,length 2—30 ft approx _leaching fields,number,dimensions _overflow cesspool, number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Soils above leaching trenches appeared unsaturated.No evidence of surface ponding breakout lush vegetation or other evidence of hydraulic failure was observed. An observation hole was dug into leach trench stone and no effluent contact staining was observed. No level of standing effluent was observed. CESSPOOLS: none (cesspool must be pumped at time 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 or no): Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: none (locate on site plan) Materials of construction: Dimensions:_ Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100'(Locate where public water supply enters the building) LOCATIONS A EXISTING B 20 f t 25.5 f t DWELLING 2 24 ft 28.5 f t I # 90 3 28 ft 30 ft � g I I z I SEPTIC TANK MO � 2 w Q I 3 3 ❑ D-BOX LEACHING TRENCHES Li SHORT BEACH ROAD NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Short Beach Road Centerville Owner: Raymond& Shirley George Date of Inspection: October 12, 2004 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 7 feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed X Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators, installers-attach documentation) Accessed USGS database You must describe how you established the high ground water elevation. A survey instrument was used to determine the elevation of the bottom of the SAS and also the high tide mark on a nearby sea wall. I4igh water was determined to be 3.9 feet below the bottom of the SAS Applying a groundwater adiustment of 2.5 feet(Index well MIW-29 Zone A September,2004 reading=9.4)demonstrates that the bottom of the SAS is above adjusted high groundwater. 11 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j 0 F........ .:5z I� (' L , ppliratiun for Disposal Works Tilustrurtivaa Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No r. c t_....— •. gaga gaga---gaga-- ll Location-Address or Lot No. 3:1.7cY ___...... ... — ....._... - _...... ............................................. Owner -d ...-+gaga- - - _ ' gaga - gaga--•' -- -- _.Y -•--- ---'------ -•- - gaga---• -� -••--= I taller Address a d Type of Building Size L t. 4_03.�_._ Sq. feet --- U Dwelling—No. of Bedrooms______________________________ __ _____Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building No. of persons____________________________ Showers ( ) — Cafeteria (, ) a' Other fixtures ____________________________ •-••---•--------------•--- ------------------•--•- ....................... - ? -- .- •-- gallons. W Design Flow_______ ___ ____ _____________gallons per person pe ey. Total daily flow._._______._ gallons. WSeptic Tank—Liquid capacityfu �gallons Length____6____.__ _:Width---------------- Diameter________________ Depth--:-_ x Disposal Trench—No ____________ __.___:Width.................... Total Length.................... Total lea ching area--__ _ _._-.:_ - t. Seepage Pit No. �--_ iameter_._._--•gaga----.--- Depth below inlet.................... Total leaching area: '.- _ ._sq. ft. z Other Distribution box ) Dosing nk ( ) `-' Percolation Test Results Performed by----- ___________ _____________ Date--014-)_73________-. a 4 Test Pit No. 1________________minutes per inch Depth of Test"Pit.................... Depth to ground water----------------------- -. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--_____________--- -------- ---------------- ------•-•------------------------•--------------•-•---•-.__--•--------•---•--._.---•----••••••-•----•••-••----------•-----•-•---- O Description of Soil---------------------------------------•-------------------------------------------------------------------------------------------------------------------------------- x U -------------------------------------------------------------------------------------------------------------------••--------------------------------.._._---------------------------------------gaga-- W U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------_________________. -------•--------------------------------•-•-----------•••-----------•-•--•-•-•-•••••------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Co e—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ed by tl oard of health, Sign '� -I- ---?1 -- -- - •gaga ---•--------•------•--gaga-- ---•-------------------••-•-•--- ------- ate. Application Approved By.... ...... - - -•-. p_ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- i --------- / Date Permit No.----•----•-----•---••-------------•---------._....._.... Issued-------41 --/ d ----------------•-- Date - THE COMMONWEALTH OF MASSACHUSETTS ��K-��� ���� K-��� HEALTH ' ��~-. .. .~~ =~" ' � | �F----- ................ .............................-'-'-----'--------_ � . . | . �o~° � �������w��» �� � ��4� ������ ��u���4��W�K� ���uKt . Application is berebn, made for u Permit to Construct ( } or Repair ( ) an Individual Sc=ugc Disposal System at: Location-Address Lot No. O;n� Address " - Address_ � <11 Type of Building r� Size �o�-..�'*-��,_.-Sn feet Dwelling—No. of Bedroom ---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other ���� o�� Liquid capacity-, Disposal Trench—N Seepage Pit Nol Z Other Distribution mx ()KI) Dosing4tank � Percolation Test Results Performed by \-��-'-�--�--�---�----'--'T-'�-'-------' D�^� --��� --_---------------- Test � ~ Pit No. L------'minutes per��6 Depth of Test ----' ' Dcyd� to ground water Test Pit No. 2L------_minutes per inch Depth of Tes |r*') .------ Dcothh` A7ooud water........................ | ------__----_---'--'-''---_-_____-----__-'--'_''---------_----------------- Descriptionof Soil........................................................................................................................................................................ ..._--_-----_--_.-'-----__-'_-__-__----__-___--_.__---_'-'----_-_-----__-_-_---_. -'--------------'---'--'--------'---------..'-------'----'---'-----------'''-'---'. | Nature of Repairs or Alterations—Answer when The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary C(0e—The undersigned further agrees not to place the system in operation until a Certiff�ate of Compliance has beeniissued by the-board of health. Application Approved By.. 5ate .......... ......................... ----------------------- Date //D te Permit No....................................................* - //- ) Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH THJS I TO CT-, TIFY, That theiIndivid Senge"Disposal.System constructed (�ror Repaired has been installed in accordance with the provisions of Article XI of The State 'Sanitary Code as described in the THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE . ^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH to Construct or Repair an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction,�'Peertnit Dated---------z................4........ Board of Healt FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS � ^ � � TOWN OF BARNST'ABLE 3 1.,,,C ANON ON 90 .�1w�T L��S�'.�f� /L'D19D SEWAGE # M 20 VI.Li+ E G��/���//-�� ASSESSOR'S MAP & LOT % /�r/Z 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /j.�� LEACHING FACILITY: (type) ZAA-vcle ?) (size),; �•X-i srMA- NO.OF BEDROOMS .3 -J &OWNER /�• �1�3Y D PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: , Maximum Adjusted Groundwater Table and 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 f�� f Feet within 300 feet of leaching facility) Furnished by PWA.WAO A/ �aFc�6�/996 "A HoVl� Co a v�R Bevy eD ��vsri vG ,#94n B" hburc Gaye vE/e 6o.v Go ,,c�. GA.e,v�.E �.u�cE.jey6baea /Gbo .. + G.S.T. A-LC z3. 9 .. S'D.B. B-� 2B. .F A-F 27.B a C-A o:a a 4-G S3•o \I � F-G -4o. 9 f A-h' 42.7 u B-N .37.1 Woo�p qq I W! _TOWN OF BARNSTABLE LOCATION QO� S�Oq j JSCZ_ f2U2� SEWAGE # VILLAGE 0 1 C-V U (Le- ASSESSOR'S MAP & LOTve? 4103 INSTALLER'S NAME&PHONE NO.SEPTIC TANK CAPACITY tGoo &miQ�, LEACHING FACILITY: (type) 27 (size) JrU�-•%- � , NO.OF BEDROOMS BUILDER OR OWNER G •QZ h,O�C PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: f Maximum Adjusted Groundwater Table and 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 1-4 within 300 feet of leaching facility) Feet Furnished by-? o1x21 W• Md(tcev i c,2 7.& /a—16 47Wo '..4 DecA Q It ,1 • N O N zo [A EE rs " O _ LL O W L 0 - LL sf Ono" � o - - W L FRONT ELEVATION Z SCALE: 1/4•e V-0• m e� a 6 ® 12 r q•'^` Es? LLJ Ld HE S REAR ELEVATION SCALE: 1/4'- 1'-0• t SHEET . JOB: 0620 DRAWN BY: KW DATE 1 22 07 uN M zN O M � � M O J J � O woo W Eil Ell EE E I � ANC 00 'on m w -71 � a o m M a RIGHT ELEVATION SCALE: 1/4-a 1'-0' = - — O — -- -- -- - - to m _ O U r7� LEFT ELEVATION SHEET SCALE: 1/4" 1'-0* _ 2 2 JOB: 0620 DRAWN BY: KW DATE: 1 22 07 ��, • N uw zN o LQ A6 A6 5+-r A6 IG R„� O -r ,��• ,T->• �-•• J [n 00 W O L G ra.l W s U tL, DECK xB NUO Pro 2959 MASTER coNnNuous TO BEDROOM (3)2.10 HDR ® ® I; 00 29 3/4-x59 3/4" O WOOD FLOOR -, I fi i DINING i M OPEN TOI� 7 h 000 FLOOR - EN 1Lo E7 L LIVING Z 1 DTR 7217 ® I LA 1 72"x17 3/4" .1 5 7z-.Ra- PAs TO � CPN 2959 ® 15-33/4• 2fl 1T-0t/x' O •av I ---------- -. _..___...__.1'D•-0 /4• (`` - .__ .._. _ .. A 29 3/4-x59 3/4" yry� ! ICI 24 24 ( R ) Rff. li WOO�R: 7e.DTR 7217 3/4 OF57252 MASTER I n".52' BATH I�7Ni'.�6if,LlSt-- OI©;©I I ®7 / 4'-9 1/r I 1 T-0 t/Y WOOD.FLOOR FOYER KIITQ ik pl R I b ® IR 13 W000 FLOOR 21 R W/D I p H IX! ® lL ITC r Rfl ua -. ( [f ,, O �� z I b 3fi o 1 GRANITE Bfi WOOD ®A FLOOR t1P G TE A6 I 20 �y L______11 I Q I I I I I I I b le 1 Ib O n n n IFL}.?x D PTO 2553 I PTD�553 A6 MAINTENANCE 25 3/4"•53I3/4" 25 3!4".53 3/4" F U 5•-r 5-e• 4'-4• 7-Y e-C K-9 5-4• a-5• I < Q N ,Y ,T-B• tY-Y• - I m Z I I 47-5• b I E b I " STORAGE I O Pro 2553 I PTD�SJ A g A6 A6 zs 3/4•x53 I3/4• zs 3/14•x53 3/4' I � I 7'x9'O.H.DOOR ` L v SH FIRST FLOOR PLAN r-o• 7 x-o• EET A 3 1 JOB: 0620 DRAWN BY- KW DATE: Y 22 07 • � N u M N O ■^ in YJ I I I I Y-Y tY� ,r-,• r-4•, r-o• r-o• 4•-r e e e 0 a � O ' W t Z €, 1 2 BA ,. ..:.......... r, i. MASTER 2fi BATH #2 ns W o ® RELOWT�® 2 til V i PE V' r b - MASTER P7D 2553 TMP �BEDROOM #2 z5 3/4'.53 3/4" WM OOM #1 ` ® CARPET CARPET �..: ! O 1Y-S 4• 2 ,r-O 1 I }. PM 2953 4'-Y ® (D O T ® 2 OD T .. .. (3)PCC 2525 '(} O 29 3/4'.53 3/4" 2fi 1 T 25 3/4'.25 3/4' Lo h W W/D e „ I \\\ fi 24 W TV O ®N \\ T / � \ CLOSET 2� \ '......' r-1� 10.E PTO 2553 TMP O b ATH 1 �/ I \ \ zs 3/4'.53 3/e m i LE I A\ ?Jv ^ ^�^ ® i LOFT \ b Pas°: F� WOOD BOOR \ SEAT s I m P.4t ��I t PCC 2929 b n I f I r C n III i� 1� 29 3/4".29 3/4• "• ` I #t� - I 3j A6 It l i1 1 AT �- n N iitII.ll itTILE ® t U— LL ON. 1 P C 2929 4 2 3/4".29 3/4" ' PLAY ROOM E "I " j ti I IIIIf1: CARPET A6 cO1i 1 v i�li i?��+t I (4)PCC 2929 § Q O I 29 3/4'.29 3/4' IN, Q O nl p A B § P C M. A6 Al + z 3/4•.29 3/4' I u i < Q i f ill t. L3.J ® „1 m z 1, Q ry J n Y-Y a'-� S-s• Y-Y Y-C Y_p• Y•�• s'-o• Y-0' S-0' ,S-e r-e fY-0N Y-r 1S-0" SHEET ` SECOOND FLOOR PLAN 4 SCALE 1/4'= r-0• JOB: 0620 i DRAWN BY: KW DATE: 7/22/07 r M SEPTIC SYSTEM AS PER AS—BUILT PLAN �� o ON FILE AT THE BOARD OF WEALTH i DATUM: NGVD . ALL DOWNSPOUTS TO BE CONNECTED TO o DRYWELLS Horseshoe L y� t •_ � Q �rn oy Locus oa ..,/ i � '� � ' si on eoc E�13 V1-n°° Nantucket NT LIC.#6741 Sound MHW ON REVETMENTONE RE Q LOCUS MAP R°$oIs sow ® � _ 7 �1 ry �~v� SCALE 1"=2000'f so Sao ®`® may ® Cedars �e ava %ft (typ.) ry \ •.yam ASSESSORS MAP 206 PARCEL 123 -'`... BAN COASTAL I OP. aft PROP. PECK / a''® ` LUESTOP E PATIO \'- ® '`� LOGOS IS WITHIN FEMA FLOOD ZONE A13 AccEs STEPS 0 ''� ® -� A10 ELEV. 11 AS SHOWN ON COMMUNITY I 538 SF OF EXIST. \ �� Cedars ti PANEL #250001 OOOBD DATED REV. AV LENT TO BE \\ ( Pines , \ r ` 5 7/2/92 LOCUS IS WITHIN RIVERFRONT ZONE NATURAL\\EA WOOD PIER, RAMP AND FLOAT e ��� ZONING SUMMARY LIC. 741 / Cedar �.®� p� Z �"" i \ \ WOOD BULKHEAD Y �� Q�°� �� "� �\ \\ ZONING: RD-1 ® Q�/o? EXISTING 3 FAR � �4' �,� � \ � �/ ` � � MIN. FRONT SETBACK 10' NATURAL AREA / DWELLING PROP. 2 c \ -H MIN. SIDE SETBACK EXIST. CANTREVERS ., �� MIN. REAR SETBACK 10' FIRST FL. EL. 10.9' Pine �� ( T010) 8 SITE IS LOCATED WITHIN RESOURCE—PAVED PROTECTION OVERLAY DISTRICT / OVER AP DRIVE LAY DISTRICT �. Cedars r l �` Rol PROP. 2.5' REFERENCES GRAVEL �( V I EXIST. 1000 GA1« j�� WOOD BULKHEAD ! I ( / SEPTIC TANK. \`q"� CONC. WALK PAR ING DEED BOOK 9503 PAGE 113 // 8263 / '�` / PLAN BOOK 360 PAGE 24 (CORRECTEq PLAN) E F LAIR S • GARDEN ® >6' RAZE EXISTING DWELLING. PROP. 3 00. EXISTING PROPOSED CHANGE BR DWELLING TO BE WITHIN BENCH MARK - TOP OF EXISTING FOOTPRINT. PROPOSED I — _ 8 UPLAND LOT AREA 25,066 SF 25,066 SF NSA CONC. BND EL. = 4.8 FIRST FLOOR ELEVATION TO BE — _ / HOUSE 1,940 SF 2,164 SF 224 SF 12.25'. TOP FNDN. AT 11.25' NGVD. / DECK 679 SF 751 SF 72 SF FLOODZONE FOUNDATION REQUIRED. / PATIO 591 SF 342 SF -249 SF (DESIGN BY OTHERS) // LOT 1 IMPERVIOUS DRIVE 2,445 SF 1,894 SF —551 SF FINAL GRADING TO BE IN UPLAND AREA (TO PERVIOUS DRIVE 447 SF 447 SF O SF ACCORDANCE WITH FLOODZONE 1b NIHW) - 25.066t SF STANDARDS. NO BASEMENT > R'S5.00 TOTAL SF 6,102. SF 5,59>3 SF —504 SF ALLOWED 00, o� TOTAL % 24,34% 22.33% 2.01% .0 Shor g Beach i?oad S11E PLAN OF 90% SHORT BEACI-i ROAD off 508-362-4541 (CENTERVILLE) fax 508 362-9880 PREPARED FOR do wn cape engineering, Inc. SV1OFMg6BAYSIDE BUILDING, INC. �� �N OF , VANIEL Cl VIL ENGINEERS �, LAND SUR VEYORS oAN�>:LA A.©JALA FEBRUARY 21 , 2007 ; OJALA � C1VIL " a No.409al)„ " 939 M©in Street — YARMOUTh'PORT, MASS. No.46502 �a 4 Scale:1 - 20 0NAt 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. 07-016 07-016_SP.DWG (SBO)