Loading...
HomeMy WebLinkAbout0729 SOUTH MAIN STREET - Health 725 SOUTH MAIN ST. CENTERVILLE A = 185 011 UPC 134R • i } Commonwealth of Massachusetts COPY Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return Name of Inspector key. Ready Rooter Excavating �y Company Name P.O. Box 89 Company Address Forestdale MA 02644 Cityrrown State Zip Code 508-888-6055 SI 12843 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority October 2, 2013 Inspector's Signat ru a 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. o D/b eg t5ins•3/13 Title 5 Offcial In t n rm Subsurface Sewage Disposal System-Page 1 of 17 Coinmoriwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is September 25, 2013 Centerville MA 02632 Se required for every p page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >•'° 729 South Main Street Property Address Thomas Bagley Owner Owners Name information is every Centerville required for eve MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N (I ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °< 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: *• This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is Centerville required for every MA 02632 September 25, 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 ❑ [I the system is within 400 feet of a surface drinking water supply El E] the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 6. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1100 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owners Name information is required for every Centerville MA 02632 September 25, 2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: System over sized due to garbage disposal. As per owner: As of November 20, 2013 the garbage disposal was removed under a plumbing permit and inspected by the Town of Barnstable Plumbing Inspector. Owner to submit copy of permit to BOH. Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2011=279 GPD 2012= 328 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to th itle 5 system? ❑ Yes ❑ No Water meter readings, if availa e: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ra r W%� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is Centerville required for every MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No previous records found Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 2000 gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Maintenance& heavy solids in 1st compartment Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.� 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed 10/23/1997. Certificate of Compliance on file at Board od Health Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 lines- 1'6" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. n/a feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 8° Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 12'2"X 5'8"X 6'8" 2 comp tank Sludge depth: 8 t5ins-3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26 Scum thickness 10" Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 3 How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee missing from garage side line. Cannot install due to cover. All other PVC tees in place. Liquid level at outlet invert in 1 St and 2nd compartments. Both sections of tank pumped and cleaned by Oceanside Septic after inspection. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is Centerville required for every MA 02632 September 25, 2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet, four outlets. Speed levelers in place. Equal flow. Light solids carryover. No sign of high water staining over outlet invert. Cover 1.5' below grade w/elongated H-10 DB-5 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 6,- 12 W X 48'L X ❑ 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.): Camera used to inspect and locate field lines. No standing water or sign of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is Centerville MA 02632 September 25 2013 required for every p , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name infirued fb is cared for every Centerville MA 02632 September 25,2013 page. Cityfrown state Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i O 0 i Ois•3H3 Tim 5 Mad hspec6on Fom[Subsufaoe Sewap Dwposd SySt9M•Pape 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owners Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 04/25/97 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: www.terraserver.com ma.water.us s. ov You must describe how you established the high ground water elevation: Slope to ocean drops below base of system. Test hole in 1997 found adjusted high ground water at evl=2.3. Base of SAS at elv= 7.3 per engineered plans on file at Health Dept Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 729 South Main Street Property Address Thomas Bagley Owner Owner's Name information is required for every Centerville MA 02632 September 25, 2013 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �N r sheas/2013 10s01 IAPPLICATIO OF NNPROFILE Ipiappent Gr GENERAL APPLICATION Application ref 201308066 Fee Effective Dt 11/04/2013 Department BUILDING DEPARTMENT 1^ Location 729 SOUTH MAIN STREETr Parcel 185011 Cross streets Addll loc desc LOT 2 � Municipality CENTERVILLE Subdivision Lot 0 Existing use SINGLE FAMILY HOME memo Current Zoning CRAIGVILLE BEACH - CENT RIVER Flood zone Applicant PLUMBING CONTRACTOR Proj/Activity ' PLUMBING RESIDENTIAL.- C4 Class of work OTHER I Description GARAGE DISPOSAL REMOVAL u �9prOO Proposed use SINGLE FAMILY HOME memo Proposed zoning CRAIGVILLE BEACH - CENT RIVER Flood zone Non-conforming N Applic received 11/04/13 Estimated cost 0 Estim start/end Actual start/end 11/06/13 Impervious Surf Assigned to Status COMPLETE Status code desc CLOSED APPLICATION Multiple submissions N Next action Government owned N memo Ordinance ref Reason for app Parent app Point in time fee effective date Fee expiration date ROLES/NAMES Role Name/Address PROPERTY OWNER BAGLEY, THOMAS S CID : 380313 729 SOUTH MAIN STREET CENTERVILLE, MA 02632 PLUMBING CONTRACTOR CID : 814188 222 MID-TECH DRIVE Phone: (508)775-1303 WEST YARMOUTH, Tradesman Name Lic Type License number Class NAICS Expires RUSTY'S, INC. MSTR PLUMB 7794 _ 05/O1/14 11/13/2013 10:01 (TOWN OF BARNSTABLE; PG 2 shear APPLICATION PROFILE Ipiappent Application ref: 201308066 (continued) RESTRICTIONS/HAZARDS Restrct:/Hazard Hold Comments RST BARN H IST PREREQUISITES Prereq Action Dept Needed By Approved By Status WORKER'S C SUBMISSION 6300 11704/13 SSHE APPR 11/04/2013 PERMITS Type Permit Number Status Issued Fee Unpaid Amt S PLUMBI 20131381 ISSUED 11/04/13 40.00 .00 'INSPECTIONS PL�UMe FIN 1 Requested Scheduled IEJENr 11/06/13 rmd Results Bal Due .00 AUDIT HISTORY Department Action Source Created by Date Comments 11/06/13 See text Application status change APP jenkinse BUILDING DEPARTMENT PLUM FIN 1 APP jenkinse 11/06/13 11/06/2013 PASSED INSPECTION , BUILDING DEPARTMENT Permit issued APP permit 11/04/13 Permit no 20131381 - RES PLUMBI, PAID BUILDING DEPARTMENT Prerequisite approved APP permit 11/04/13 WORKER'S COMPENSATION CERTIFIC on 11/04/13 BUILDING DEPARTMENT Prerequisite deleted APP permit 11/04/13 HISTORIC BARNSTABLE DISTRICT BUILDING DEPARTMENT Permit payment collected APP permit 11/04/13 Payment collected on permit RES PLUMBING PERMIT P BUILDING DEPARTMENT Application entered. APP permit � 11/04/13 *+ END OF REPORT - Generated by Shea Sally ** J TOWN OF BARNSTABLE LOCATION 779? SEWAGE # 9? � VILLAGE ASSESSOR'S MAP& LOT j INSTALLER'S NAME&PHONE NO. 1�V-ItY 66,t.Srr'v 070 h SEPTIC TANK CAPACITY V LII-,Cc LEACHING FACIL rTY: (type) � � (size) X �� NO.OF BEDROOMS BUILDER OR OWNER V-24 V-Z>e y PERMTrDATE: c�' ' I _9 J COMPLIANCE DATE: ,_'11 • 9':2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2.00 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f6 of leachin acility) Feet Furnished by ,� `�`►����►.S �7 b� o 171 No. L / — Fee L '� THE Y MMJNWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYicatiou for Miqaar *p6tem Comgtruction Permi t Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) Y Complete System El Individual Components Location Address or Lot No. 72ry 50vf4 I/fvrvJ S¢ Owner's Name,Address and Tel.No. C ev.izrv�/Le I lvo lmm 1bc.,jl c! ,e_t u x Assessor'sMap/Parcel 7249 Sovih vmadrt St /FS Cc-nkrvilu- YIMW 62,(03`Z Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /�Csx/v E'/VcJe r/1G• Type of Building: Res#cQ4,0%&X Dwelling No.of Bedrooms S Lot Size� sq. ft. Garbage Grinder(✓) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //b gallons per day. Calculated daily flow gallons. Plan Date .zo sgyat. 96 Number of sheets / Revision Date 92 &aZ V Title S&z Pk,,% Q 7ja Sesu4t. ftj&. t. Shrr_f- � C��►�waf(e W11c�ss. f.E lr���l�. Size of Septic Tank 2chwxn, %sitan Type of S.A.S. ), Description of Soil e5—/ Lc+vs„ A Sv6,;l /h4 _�i9�/�u.,s --*e114 06.5 49.tJ 10 Z/eu 2,3 Ah 4:U, 17 Nature of Repairs or Alterations(Answer when applicable) Ra to c. � g►, e c Ss n��j s coo& -ri+le spbf-skrm Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is Board of Hea i, Signed 0WJA Date Application Approved by 114 Date Application Disapproved for the following reasons Permit No. 9 7-2-1/ Date Issued i ? No. / — //- -�'".`� Fee 1 THE "OMMIWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBbb HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS pricati for Mioogal *pgtem Comgtruction Vermit 4 Application for Permit to,Construct( )Repair( )Upgrade(✓)Abandon( ) De omplete System 1:1 Individual Components F ddress or Lot No. 72y Souf/j /7�la.�t Sf Owner's Name,Address and Tel.No. ,tcf- uxMap/Pazcel 129 Sovlt� Y►►tain14Il. /6S ffarceY /! Cd�ttrvift MA 6z.(037- Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 13o.Jer F''/Ut'6 TiK.. ` Type of Building: Rc s c dtcN%*.k Dwelling No. of Bedrooms S Lot Size 740 sq.ft. Garbage Grinder(✓S Other Type of Building No.of Persons Showers yp g ( Cafeteria( ) Other Fixtures Design Flow //b gallons per day. Calculated daily flow SSZ3 gallons. Plan Date .Zo SAO 96 - Number of sheets / Revision Date R8 A,ord V Title S�Fa 6�1a., ic1, 72.Et 5e,u i111t�i� S�-ie.r� I Ce�+ktru'���n a Whe sis �., 71-,owrc crl.e eM`�u Size of Septic Tank ,2�Item - Type of S.A.S. Description of Soil iS-,&�, Lnoa, / S,6sad 4 1s ► fir„®� 6ia.r�;i f 4� /.�'li.�iL, 'SAW Obs G/J � F/ru 2 3 Ah G i/i T� a :! Nature of Repairs or Alterations(Answer when applicable) 2 tb C�1,,hn�T F. Nj S �� to i dt, T�•1-1 e S �ti Date last inspected: a y Agreement: 'r , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordancE with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is Board of HeallL 1 Signed �. Date Application Approved by t,,r A 4 Date Application Disapproved for the following reasons Permit No. 9.7-'Pau _ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - r Certificate of Comptiance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ! dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date C� _ - Inspector ————————————————————— ——— —— —— — - No. 9 2— 1) Fee i « .. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Xigpoga[ *pgtem Congtruction Vermit Permission is hereby granted to Construct( Repair( )Upgrade ) undo ( ) , System located at 7 �' �(i � l/l'I�rc� ���Pac. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to f comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: 2 g �� Approve b y��� i r , TOWN OF BARNSTABLE LQCATION iL °3� 1 SEWAGE# VILLAGE C-�V.��ru��L� ASSESSOR'S MAP&PARCEL 1 I1SR'S NAME&PHONE NOt��' SEPTIC'TANK CrAP_ACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 57 OWNER��®y�n„cxSG PERMIT DATE: s COMPLIANCE DATE: t®o Separation Distance Between the: ` Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 13©<2� Feet FURNISHED BY i \l� +✓� G a� z}.� 3-� z���j AJ SIC 6 C33J57 TOWN OF BARNSTABLE ` LOCATION 2,99 /�%A,) -5V_ SEWAGE # VILLAGE G",eny-e►.,V ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. lC Vle-yc cont STYa cGm K SEPTIC TANK CAPACITY LEACHING FACILITY: (type)eAL (size) N X '40 NO.OF BEDROOMS BUILDER OR OWNER lVE)e PERMTTDATE: ^ J —9? COMPLIANCE DATE: 1'N • 7;Z— Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f of leachin acility) Feet Furnished by I I I 0 9 SL" ° 0� o tH �-dzxw Z7 116'•2 15116" m m �w Z N_ N W 1 W ,a> Q -- O 53'-0 3/1b' —lb'-b 1/2"— 46'-b 114" m 1 S UN5PEGIFIED c Fv 10'-9"x 15'-1" _ ff DINING 16'-0"x2V-2" FLORIDA ROOM Lq 35•-0•x 15'-1" m ----- - -- - - - STAIRWELL 'v 64"x 3'-11" GRAFT ROOM° q ENTRY i ! +� 43 m * 15'-2"x 24'-2" ! t 3 12'_7'•x 9'_7" I \ 2,•t�)I - i I a tQ In ; FAMILY I i I W 33'-3"x 24'-2" 1 !^ (y r .... •n= _ 91"to recessed front door I -BATH i I 'x �_-- ---------------21'-2 1/2"----- ------ ! I GARAGE I I HALL 25'-3'x 37-3" I 4'-2'x 5'-1" ENTRY I � x 6'4"x 12'-0" ;n N d 5'-211/16" N N o VP NO 1AUNDRY --- ---- - 12'_7"x 9,_7. >:72-3/4 4;t.5" e„ 3..= in in oCk V «,m 3 i O l6 � o DATE: - 26' ---- - 14'---- --6'--= ---------16'---------- --------------23'--`_-------�' .------ —16'--- � - ---15'•2 15/16"— —. SCALE: 1 W-2 15/16" LIVING AREA 3398 sq R SHEET: EXI5TINO 1st FLOOR 11kCc JEe,f, St,r✓i (--WO 401+0214Fx 0 4v i vi ( Ce c zc - `Fo c t (cf- s o r, U� �f 2G re po IIL J 0 UJ DECK 1'1'-4"x 5'-10" Z in LU -- ------- --- ---��' ------- ------- ---- o> w I BATH " gos I 1 o 12 10 x7 10 i ly w I DECK © BEDROOM a I 1V-0"x19'-4" CLOSET ® s l he I itGLOSET e-4"x5-1 R I 1 x4-1t MASTERBDRM — --———-----" " -- IPA I I I CLOSET I SITTING FAMILY I I 7'-5"x 4'-q" 1I 333 18'-7"x 14'-8.1 I 5l 25'-3"x 24'-'1" I CLOSET 6 I I I I UP (. Y��_ "J � � r'�'f >FC'1 C � ,d�«a. �( ,1+° I I �� 1 � N v EXISTING • —I -- it 12'-10"x 2a'-2" m T C `� (MASTER BATH j N BEDOM BAT / \ 1`" I 9'-2"x q'-1" I N 3 ._. -5IZ— x83-' - //OFFICE`'\ .I�;�� i �7l -- 4 � � w / \ / 15'-3">E 14'-5" \ nwo� X U V I• I ��o"rop L" — ✓ I I ------ ----�------—-- "r/ I --- --II ---- L I - _ I I I I EXISTING BEDROOM I EXISTING BATH 40'-0112" r LJ 32-01/2" 14'-5"x 12'-3"I I 10'-b"x 12'-3" ( 0 JR,� d:) !! LIVINO AREA � > tq V �� _ ✓�5 1^� 2580 5q R U) VyAe a LIVING AREA 987 sq ft G Ie �,(.l� ' 1 /e j j ( V L M� (� � �/��C/I Ut/ ��Ir►1-� 5/27/14 R. 2nd Floor SCALE: SHEET: tit $4 LINE DIRECTION DISTANCE L1 N 5432'53" E 0.86' }. •k� �' ,��• 4/Z 5/9,7 by .�x�.- /vye rx ti..�.. t o ' 1 )off Y..• \ Is" F%oor E/cv I3.2.5 7 \! 4 i I I pna : 4ccec s Go✓r. i -6"13c%c.� Finish Giude % l ^ �' �'•�, f'Ylc {. $ate �� �•: 4 �. m FrsE 2 LcUcl - Z p e f �g„- y4„ Washco� Slone 4" Pcr�.Sch 9 o PVC 5 c�,odS 4I n pIST, _ _ _ -_Gdp Pipe Sndv • 1 .O t o... M Si 5"O 2000 G u o,,� 9 6C3 sox 3�4 I'/Z" .WAS tied • }, �Ylea� a m iduc o � 8 Y I� �a• San�6 � ,4b. g�rr�c Ti�Nrc 40 B.O� 4a� ?•� S Z T <1 � M. :� cs + .. _for.GrvsAccD SfOgC A 5 „ s� „a mod: LOCATION MAP _ , {�i�� z,,3 8 � HYANNIS QUADRANGLE SCALE: 1: 25,000 OV MHW'-EL l,S N-G.U,D ASSESSORS o • SYST�m PROp"ILE (No•t +o .Sole) MAP 185 PARCEL 11 ZONES: AQUIFER PROTECTION OVERLAY DISTRICT ZONING DISTRICT: RD - 1 MINIMUMS AREA = 43,560 S. F. FRONTAGE = 20' WIDTH 125' \ FRONT SETBACK = 30' SIDE SETBACK = 10' REAR SETBACK - 10' BUILDING HEIGHT = 30' �,.rsh -. G•,•�c (OR 2.5 STORIES IF LESS) FLOOD Z'Jfi-lES: B & A,1.3 9`m,.� -..36°�+�x coucr FIRM CtOMMU11411 i Y No. 250001-0016D Z Pcaslcsnc J- REVISED: JULY 2, 1992 '/"- t/2� V{/ashc� Stone 4/ AS SHOWN ON THIS PLAN �- 3� �� 3 ' SEE NOTE RE ORIENTATION/PLACEMENT �2� SEcTI wv 4- A, DESIGN DATA : G�xlsf-In� 5 6rtdroorn house us/ qar-ba_ge 9riv-dee- (DesLy-, FLOW = 5x 110 _ 55-0 G,�, D FLOOD LINES DIGITIZED USING FIELD/TOWN GIS SHEET LOCATION OF Se.pt-ic, '(•2,nIC _550 x Zo0% = 1 100 ga11ons EXISTING MAIN BUILDING ON LOCUS AS ORIENTATION; TOWN GIS SHEETS _ ALLIGNED WITH FIRM COMMUNITY PANELS USING ROADS AND WATER LINES. USE ; Z,000 Ca211on -la v�►t 9.7 / 5-50 G.P.D. _ O,'74 5F/G.P.P t Solo = ///6 SF Lr_aai Ficicls - IZ'f 48/ / � Z \ AD CO* i NOTES' 91 f \ &4/DH WATER SUPPLY FOR THIS LOT IS MUNICIPAL WATER s's ( \ 2 1 LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN. AT f a 7.8 LEAST 72 HOURS PRIOR TO ANY EXCAVATION FOR THS PROJECT THE CONTRACTOR SHALL MAKE THE REQUIRED +�. ® �� ti% NOTIFICATION TO DIG SAFE (1-800-322-4844) ANDo� APPROPRIATE WATER DISTRICT FOR LOCATION DATA. :�°` =s �4. THE CONTRACTOR IS REQUIRED TO SECURE APPROPRIATE .2 . � PERMITS FROM TOWN AGENCIES FOR CONSTRUCTION DEFINED x 9.6 7.3 \ Ss\ �+�► i BY THIS PLAN. \ °' �o• a x 94 St3 8• L�xtstiv,� cesspools M^e -t-o he Pumpeeo out a►,aQ fillcco wl+•il c.lcarl 5And( BULKHEAD 0� /G TANK \ EL 0 FLOO .4' 4.6 E P F►Ic No 55 3-3083 6.4 D 4.4 TBM ® CB/DH 9.1 11' (�] .4 ROSA RUGOSA EL = 3.92' Plumb,r%5 inside house -"o be mwor-kGCQ � 1 x 1\ \ BEACH GRASS NGVD 3 0 \Qs t�ccolcc9 •f•o drum -}c� (Orvposcc1� �r •9 v � \ 4 LAWN --- �✓ >-5 t r c \ 3.4 s I c a z .rest alc x 10.3 .3 8.9 -n 12 /2q f \ `'s• moo. J _ 10.1 h � Q � �� � \ CB/DH >�\ A PAVED \ 3.4 3.4 � 10. , PARKING AREA .6 •6 '-' I \ 1.5 x 0'4 / R RUGOSA / \ 3- �b PROPOSED �� 7.6 4.2 / > �cr �. - DRIVEWAY 3.1 #194 O� -6-1 x 10. / L5c ,o `�s. 4.2 p/, 1.5 x 10.7 C�`�O�O Appr l-oc, of Cc spools �V x 9� TBM 0 LCB / / �L EL = 9.76' a= Ce o�y `�Fo 1 3.1 t� y .7 NGVD 33, .8 � F` J 0 1.4 GQO¢ O x 1.5 O x 10.5 \Q 9. N x 11.0 44 .8 x .0 x 10.9 PAVED G e\ T 1. -0.6 36 4.2 LAWN 4 x 3.5 ��G 0.6 10 11.0 J�� O• �, ti5/ '�- aG 6 x 3.5 4. 0 rcp. 10.7 G� `� off( / 27 3.8 0 /y S GAO oL F x .7 x 10.2 O�\G`h � / 3.5 x 3.5 4• / .off ,�� 1 52' x 10.8 _ '� x 3.5 �010 �y�p V. VP 8 C �► `� pF 4. .r� o T �_Aljoprvw_ � REPAIR/REPLACE EXISTING STONE Loc. O t c e s s poo I 9. OF 01 D LAWN �S x 3.5 WALL AS REQUIRED IN SITU / �. 8.7 00� `5� Q�Q O� .8 -0.6 / g 9.2 4.2 x 3.5 / x 7.7 / 4. 0<, C> / / 2s 0 ip 4.7 / 6 oAF 1.0 - 4.0 . 4 x 3.5 1.5 / n 1 4.5 � ram\ LAWN CC v 1 00 �6'' 4 4 ` .0 � F \, SITE PLAN ¢ �`� AT 9�� 5 4 x 1.5 ry 729 SOUTH MAIN STREET CENTERVILLE, MASS. x -T.1 �0 SE3 2242 FOR - .0 00 NOTES 2 18" ALUMINUM PIPE - INVERT EL = 0.6' it THOMAS BAGLEY, ET UX. ELEVATIONS REFER TO NGVD REFERENCE M 28 QS EL = 27.42' 0 DISCHARGE ROAD RUNOFF o REVISED: 11-22-96 Revl5� 41 i-7j9-7 -0.9 FROM SOUTH MAIN STREET ELECTRIC METER ® n� REVISED: 09-24-96 Rc-tscd 4/2a/s 7 WETLAND FLAG BY FUGRO EAST, INC. BASE OF EXISTING SCALE: �� = 2O� SEPTEMBER 20, 1996 FLAGGING DATE: 9-6-96 q`� STONE RIP-RAP FIELD LOCATION DATE: 9-17-96 4.4 BAXTER & NYE, INC. 812 MAIN STREET ` PROPOSED NEW CONSTRUCTION: OSTERVILLE, MASS., 02655 d s-��HE�a (508)-428-9131 A4 .3 vA soNu OP NC/6216p . �= GRAPHIC SCALE 20 0 10 20 +o so ( IN FEET ) 1 inch = 20 ft f� 96116 .(PPP01.DWG)