HomeMy WebLinkAbout0480 MAIN STREET (CENT.) - Health 480 Main Street (Cent.)
Centerville.. F
A.=y208_130
goUPC 10259
No. H1630R
X�lTMMA! 11�`
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. City/Town State Zip Code Date of Inspection,
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information 514p PAID11 4
on the computer,
use only the tab Michael DiBuono
key to move your Name of Inspector
cursor-do not DiBuono Sewer And Drain
use the return Company Name
key.
35 Content Ln
Co
Company Address
Cotuit Ma 02635
City/Town State Zip Code
508-364-9587 S113522
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in'full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4.' ❑ Fails
10/19/20
I spector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J & SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® 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:
System is functioning as designed with no sign of failure.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"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):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 118
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
i
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J & SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
i
c Commonwealth of Massachusetts
= Title 5 Official Inspection Form
�- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48
—0 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (coat.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
., 480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms(design): 8 Number of bedrooms(actual): 8
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ❑ No
Water meter readings, if available last 2 ears usage d 358 Gpd
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
. 480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Not provided
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.� 480 M' n la St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
installed 4/12105
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
5. Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
❑cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
System is vented at the roof line
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
A_
c Commonwealth of Massachusetts
Title 5 official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is Centerville Ma 02632 10/16/20
required for every
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 2
feet
Material of construction:
®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
2000
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 2000
Sludge depth: 3
Distance from top of sludge to bottom of outlet tee or baffle 24"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
4"
Distance from bottom of scum to bottom of outlet tee or baffle
30"
How were dimensions determined? Tape Measure/Data On File
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 is recommended if not done within the last 3 years
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is Centerville Ma 02632 10/16/20
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c Commonwealth of Massachusetts
UeTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
Mian St
Property Address
KASETA, STEVEN J & SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level and at normal level
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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
1411 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's(dame
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (coot.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 8
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J & SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No sign of failure
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
ZIP
M 480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
TOP F14DN.AT EL 50.7' SYSTEM PROFILEt TEST HOLE LOGS
.cars wMx ro wnwH e'ar roe eda DN+TD soup A4oxoe WsvccnoH ADAr.4nsH
saes Dax4 M"+LPIIar10 ro e'a rwm+cxwc ENGINEER:RICK JUDD,Rs g
�2' uamWu.rs'a COVER o+ER mu,, rIPRI e'a M,aPMB xX BLRPE RTa1ARBD(Not 4+51Lu ♦9.0' WITNESS: DAVE STANTON.RS
RIw PM lML f'DRusu w4nua Wlsfd2 DATE: 1/26/04 .I D
roR Bxb T / PERC.RAZE.PRDN4lD 2QML 3'MAX. <2 MIN/INCH
48.33' �SVK 48.08' �.0' CLASS I SOILS PB 10661
T4Iw(N-JD-1 4533'
45.70' 000E 000E b
43.17' 000E C3 000❑
(�s sInRI n•r�Vswm sten[ep urr�uw;u� 03 0 E E 0 0 0 E
ruXr- 4� caaPAclaH.(1e.xx+(xD 2' 0 0 C3 0 C3 C3 0 0 0 4311' CP ELEV.
oBvnl ,p* o
1a yam, �w StoAO �° 3/4"TO 1 1/2"DOUBLE WASHED STONE 4A& .aa
Ilan omm. To, AP
SL
OIRIfT omnl. 1_ 18' 10YR 4/3 47.4' lOGTK)H IFA➢ NIS +
FOUNDATION— 40' —SEPTIC TANK—38' —D'BOX 38' LEA:HINC Bw
FACILITY 5.87' LMS ASSESSORS MAP 20B PARCEL 130
!THE INSTALLER SHALL VERIFY THE 32• IOYR 4/1
LOCATIONS OF ALL UTILITIES AND ALL 0"
BUILDING OF
OUTLETS AND ELEVATIONS - B/C
PRIOR TO INSTALUNG ANY PORTION OF
SEPTIC SYSTEM
LC$
NOTE:THIS AN APPROXIMATE 9MERT DUE TO 101R 5 8
ACCESS DIFFICULTIES 37.3' 47' / 44.9'
CI
p� GS
2.5 6/4
66'
C2
' '�pp II CS
De�N;'nf CFlh'nT 2.SY B 6
-
\ '��fLl+•n. NO GROUNDWATER
ENCOUNTERED NOTES:
90
SEPTIC DESIGN: (DVAa+eC D+SOOfW 6 NOT ALlOWEO j 7.DATUM IS APPROXIMATE NGVD
"� a46 T PLWRM49 \ Z DESIGN FLOW: B BEDROOMS(110 GPD).880 GPD 2 MUNICIPAL WATER IS EXISTING
USE A B80 GPD DESIGN FLOW
I MINIMUM PIPE PRCH TO BE 1/B'PER FOOT.
491,.. �imii'r-- a9s\ \ "tWTIC_TANK! 880 GPD(2,). 178E _ 4.DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10� j
USE A 2000 GALLON SEPTIC TANK _....»urn �•Pi.E„vllr'3"0 B:M:v,2 51:.T.::'0.;. -
nx "n \ a. 6.CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
\ \ LEACHING. ENVIRONMENTAL CODE TIRE V.
4e7 3a'sPRU06 �"'A wsT'a Im R4\ 9 SIDES: 1(78+17.8)2 (.74) a 259 7.THIS PUN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
O'4WND \\ TO BE USED FOR ANY OTHER PURPOSE.
a 76•11.8(.74) 663 BOTTOM:
B.
PIPE FOR SEPTIC SYSTEM TO SCH,10-4'PVC.
se'swaa �4E.I 1u i .Ig4).e TOTAL: 1246 S.F. 922 GPD 9.COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
T ys'o \\aEol '• y,4`W�� �Np,F� \ USE(8)S00 CAL I.EACHINC CHAMBERS(ACME OR IiNRSOPY�B0AR By 0 HEALTH.
DTOF HEALTH AND PERMISSION OBTAINED
90 9.a �4 -"raa ' Al' EOV/L)WITH 4'STONE AT ENDS MID 3.5'AT SIDES ID.PUMP @ REMOVE(OR FILL W/CLEAN SAND)EXISTING SEPTIC SYSTEM I
+a9a A
w.s.aAI �.-4vv46.i .rR1J
PAVID DRIK '\j46y'
n3 �9 LEGEND TITLE 5 SITE PLAN
219.54 IOD.O PROPOSED SPOT ELEVATION OF 480 MAIN STREET
• a a9s 100.0 EXISTING SPOT ELEVATION
IN THE TOWN OF:
10 PROPOSED CONTOUR (CENTERVILLE) BARNSTABLE 1'
BENCH MARK-SLAB AT
GARAGE DOOR EL,-49.3 100—EXISTING CONTOUR PREPARED FOR: STEVE AND SHARON KASETA I
I
32 0 30 60 90
BOARD OF R[LLTH
APPROV DATE
NA SCALE: 1'w 30• DATE: JANUARY 29,2004
D
down capeen
lneerMg,inc. pl
AANB Vvw
CIVIC ENGINEERS oiia.l 3 ARHBH
LAND SURVEYORS N6
`04-001 939 main St.yarnowth,no 02675 TB'�
F+
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is required for every Centerville Ma 02632 10/16/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+
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: 2/7/04
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:
Test Hole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
480 Mian St
Property Address
KASETA, STEVEN J &SHARON V TRS
Owner Owner's Name
information is Centerville Ma 02632 10/16/20
required for every
page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑ A. Inspector Information: Complete all fields in this section.
❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
❑ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
❑ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
TOWN OF BARNSTABLE K
LOCATION !j16 M4/,t 11" SEWAGE# _S'— ,
VILLAGE.aei L peril, & ASSESSOR'S MAP & LOT 6 /30
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY -O-6V\
LEACHING FACILITY: (type) rr (size)
YF
NO. OF BEDROOMS
rn
BUILDER O OWNE ��l�Uw a���S�efi .
PERMITDATE: —COMPLIANCE DATE:
Separation Distance Between the: r .'
Maximum Adjusted Groundwater Table to the Bottoin 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 hletlai4s exist
within 300 feet of leaching facility) _ Feet
Furnished by _
L
1
S�� ���
®`.
"Z1��r
1
- �
��
}
� �- 21
,� �l.g ��
�� -
No. 1 y� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: :
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Migonl 6potem Con0truction Permit �5
Application for a Permit to Construct( . )Repair( Upgrade( -�'<Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No. 0 r
R Owner( e,A ddrekss and S T��A
Assessor's Map/Parcel n�� 0 �.. �� S T^
0
Installer's NaT,A dress,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size �3 71?99 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank a GUU a tln Type of S.A.S. or, C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 b this Board of Health.
Signed A Date_L 1 as
Application Approved by Date 2 y
Application Disapproved tTr the following reasons
Permit No. a i2a Date Issued 41 1 1
A 6
No.} a + Fee Ido
.-THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE..MASSACHUSETTS--
-, e s
\
ZippYication for Miipooal *p!tem Cott.5truction Permit -
Application for a Permit to Construct( . )Repair(jo�Upgra de(01'Abandon( ) El Complete System ❑Individual Components
1
Location Address or Lot No. �8U n 1 S Owner's Name,Address and Tel.No.
-� fI -Steve k�s
//� 4�A.
Assessor's Map/Parcel l.C'N k-m// ,
wC-o
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
\ ..
,Type of Building:
Dwelling No.of Bedrooms_ Lot Size"3•?9 sq.ft. Garbage Grinder(�)�
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Oiliac Type of S.A.S. l
Description of Soil
r .
Nature of Repairs or Alterations(Answer when applicable)
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 this,Board of Health.
Signed \ Date _
Application Approved by 1 /n Date I
Application Disapproved r the following reasons
Permit No. ����=/yam_ Date Issued �4-�
————————————————————————————— ————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( )Upgraded
Abandoned( )by �A!�%y.,r c,0_3
at �ON_ C����A.ro.Clip has been construc ed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.a 2�/y�dated ,
Installer �' Designer v
The issuance of is pe t shall not be construed as a guarantee that the sy ts�mwill fun ltidon as ydigned.
Date L r, Inspector ",
No. 616) /3 Fee /ru
r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Diq;pbol *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( p rCJpgrade(✓S Abandon( )
System.located at �\Rt5 Q,� � (2�f [" _ (°\ �ou—,I-if u r t ,_►e
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of pe �1 D
Date: �(./�I��i� Approved b
TTF 7 ' -
MAY-04-2005 10 :27 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01
-74.........
Town of Barnstable
' Regulatory Services
aaMer�ece, Thomas F. Geiler,Director
= �
MAC. Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Fax. 508-790-6304
Office: 508-862-4644
Installer&Designer Certification Form
Date:
Designer: W c.eW SO2/4 e_-ey( t y Installer: �
Address:
Address:
On %A-\2 -0 S 4 r was issued a permit to install a
(date) (installer)
septic system at %A fV'P' 4 S'T cg r .. based on a design drawn by
(address)
dated
esigner
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow.
`�J OF 04A`S5
qcS
(Installer's Signature) OVA
n
CIVIL n
No. 30792
a
(Designers ign a (Affix p Here)
WTVWWWW-
PLEAU RETURNBARNST LE PUBLIC UXALTH ]XVISIQD1. CERTIRCATE
OF CoMpLIAMMWII. NOT BE ISSUEDUNTIL- BO HI RM
BUILT CAED ARE RECEIVED BY THE UAJRNSTABLE PUB IC TH . O .
ThMK YM
Q;Health/Selrric/Designer Canitication Form
TOWN OF BARNSTABLB
LOCATION V Slo d4 tJU 77-CtT SEWAGE #
VII.LAGE�CK�Te7ZVt z•LG SSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. AWN
SEPTIC TANK CAPACITY O O b - `0o O ` W t' ow
LEACHING FACILITY: (type) (size) C
NO.OF BEDROOMS
BUILDER OR OWNER /1�✓I f/���`�
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) Feet
Furnished by
4J
1�
�-\ COMMONWEALTH OF MASSACHU M INSPECTION
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
MAP Pon
2��p
PARCEL ; 3
TITLE 5 LOT
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:
, ` OQti
Owner's Name:
Owner's Address.
�l �a �
Date of Inspection:
Name of Inspect please print) -T. ((`
Company Name,
Mailing Address:P16.A2>ex -7
Telephone Number: ,R5R --7-21'qA99
CERTIFICATION STATEMENT t ll7l
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
eeds Further Evaluation by the Local Approving Authority
, Fail
Inspector's Signature: Date: /a r/o�-
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP..The original should be.sent to the system owner and copies sent to the buyer,if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Forrn 6/15/20.00 page 1
!' Page 2 of 11'
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
r�. CERTIFICATION (continued)
Property Address:,
.1
Owner:
Date of Ins ection:
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:
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 exfltration or.tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipes)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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARYASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: Ov
1
Owner:
Date of Ins ection: a
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
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
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:
3
r ,
Page 4 of I I
OFFICIAL INSPECTION FORM—NOT FOR V DLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYST M INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner: `
Date of ins ection /U, r)dG�'
D. System Faillure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/
V ackup 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 wateta 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 '/z day flow
V 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.
V . 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 15303,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 ' y'
_ the system is within 400 feet of 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 i l
OFFICIAL ]INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: d9b
A
Owner:
Date of Ins ection.
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes
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?
v/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
�f the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of scum?
V _ 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:
Yes ono
l/ 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 15.3 02(3)(b)]
5
t
Page 6 of l 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: V ;,
Owner:
Date of In pection: Q
FLOW CONDITIONS
RESIDENTIAL ✓
Number.of bedrooms(:design):- Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 11.0 ZIP x#of bedrooms):
Number of current residents:
Does residence°have a garbage grinder(yes or no
Is laundry on a separate sewage system(yes or no .[if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or n :1L)011- .
Water meter readings, if available(last 2 years usage(gpd)): 00
Y.
Sump pump.(yes or no)•
Last date of occupancy:
COMMERCIA:L/INDUSTRIAI
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:
Was system pumped as part of t e inspe tion(yes or na j/
If yes,volume pumped: gallons--How was qu ntity pumped determined?
.Reason for pumping:
TYPE OF SYSTEM
eptic tank, distribution box, soil absorption system
t/Single cesspool
Overflow cesspool
_Piivy
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):
A proximate age of all components, date installed Of known) and source of inform09
f992 Q
Were sewage odors-detected when arriving at the site(yes or no
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address:
Owner: ti
Date of Ins ection: /OUa
BUILDING SEWER(locate on site plane
Depth below grade:
Materials of construction:_cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting, evidence of leakage, etc.):
SEPTIC TAN locate on site plan)
Depth below grade:
Material_of construction:_concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee.or baffle:
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:
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TR�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
t
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: . ^
Owner: 1,
Date of In eetion:. 4 (,-c 3-
TIGHT or HOLDING TANK:A/A(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):
-Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX: &114if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): -
PUMP CHAMBER- locate on site plan)
Pumps in working order(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:
Owner: /hA
Date of I spection /
SOIL ABSORPTION SYSTEM(SASI.,,j,0�(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:
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.):
CESSPOOLS: A(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 or noLA-4: A
omments(note conditionf soil,signs f hydra. . c failure, level of ponding, condition o egetation, etc):
` �0. �
PRIVY�./Jd�L�(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
t
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �`S^ ice
Owner:
Date of I pection: f0 ! '�VUo2
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.
04
Cog '
10
Page I 1 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
r -
Property Address: U A,, jyj.
AM
Owner: t/
Date of I pectio ® )000,
SITE EXAM
Slope
Surface water
Check cellar
-Shallow wells
Estimated depth to ground water_Z feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date,of design plan reviewed:
Observed site(abutting property/observation hole.within 150 feet of SAS)
Checked with local Board of Health-explain:
Ahecked with.local.excavators, installers-(attach documentation)
ccessed USGS database-explain:
You must describe how you established the high ground water elevation:
11
Permit Number: g� Date:
Completed by:
HIGH.GROUND-WATER LEVEL COMPUTATION
?Site Location: ��� rf� �l [�:G� j '/��f���" Lot No.
Owner: /j �Q'� Address: SC�IJ
Contractor: �� Address:
Notes:
STEP 1 Measure depth to water table f
to nearest 1/10 ft. .............................................................................. .Date
month/day/year
STEP 2 Using Water-Level Range Zone .
and Index Well Map locate
site and determine:
OA Appropriate index well........::............................ ..
OB Water level range zone ................... ...............................
STEP 3 Using monthly report "Current
Water Resources Conditions"
determine current depth to
water level for index well ...........................
month/year
STEP 4 Using Table of Water-level Adjustments
for index well (STEP 2A), current depth
to water level for index well (STEP 3),
and water-level zone (STEP 2B)
determine water-level adjustment ....................................:.....................................................
STEP 5 Estimate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water Z
levelat site (STEP 1) .............................................................................................................
Figure 13.--Reproducible computation form.
15
Mo - s �•-
tv tt � � �
°F114E t° Town of Barnstable
P
Regulatory Services
* BARNSTABLE, * Thomas F. Geiler,Director
9 MASS. �a
3�A�� Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Steven J. Kaseta March 1, 2005
18 May Street
Needham,Ma. 02492
NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V.
The septic system owned by you located at 480 Main St. Centerville was inspected on, 12/12/2002
by Robert J. Bortolotti a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00) due to the following:
Single Cesspool,.
Our records show that the system has been in a failed state for more than two years.
You are ordered to hire a professional engineer.or registered sanitarian to prepare a plan of
proposed replacement septic system component(s). This plan is to be submitted to the Town of
Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis),within
(90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR
15.00, The State Environmental Code, Title V.
You are a lso o rdered t o upgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our
receipt of this letter.
Any person.aggrieved by any order issued by the local approval authority may appeal to any c ourt o f
competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of
requesting an adjudicatory hearing pursuant to 310 CMR 15.422
Failure to comply with this order will automatically result in a public hearing scheduled before the Board
of Health.
F HE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
CC: Board of Health
1/failed septic letters
Barnstable Assessing Search Results Page 1 of 2
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�a/�F3 �.?'L"�,r.,. ��' � � ._:s �✓' � r ��� ',•��L .fir:`t", ;.
Home: Departments:Assessors Division: Property Assessment Search Results
480 MAIN ST-IMPAE'J'" (U'VENT.)
Owner:
Property Sketch Legend
KASETA,STEVEN J&SHARON
Map/Parcel/Parcel Extension FU f 34
208 /130/ $ tINT 6ffl, 5$
Mailing Address
n;;
KASETA,STEVEN J&SHARON
ti
` 86
18 MAY ST
NEEDHAM, MA.02492 E�
2005 Assessed.Values: No,
Appraised Value Assessed Value � �
Building Value: $398,000 $398,000
Extra Features: $4,500 $4,500
Outbuildings: $6,500 $6,500
Land Value: $371,700 $371,700 Interactive Property Map: Ma req 11 uires Plug in:
Totals:$780,700 $780,700 1 have visited the maps before
Show Me The Map
April 2001 photos available _. - .
Sales History:
Owner: Sale Date Book/Page: Sale Price:
CHAPPLE, KEVIN P 3/15/1995 C136518 $375,000
WATT, ROBERT D JR& 3/15/1989 C117051 $ 1
WATT, ROBERT D 5/15/1987 C110750 $ 1
WATT, ROBERT D C19416 $0
WATT, MADELINE M-792 $0
KASETA, STEVEN J&SHARON 7/31/2003 C170025 $745,000
2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Land Bank Tax $ 141.70 Town Fire District Rates Other F
$6.05 Barnstable-Residential $2.12 Land B.
Barnstable-Commercial $2.80
C.O.M.M. FD Tax(Residential) $788.51 C.O.M.M.-All Classes $1.01
Cotuit FD-All Classes $1.28
Town Tax(Residential) $4,723.24 Hyannis-Residential $1.52
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/17/2005
Barnstable Assessing Search Results Page 2 of 2
x
Hyannis-Commercial $2.39
W Barnstable-Residential $1.44
W Barnstable-Commercial $2.10
Total: $5,653.45 Due to rounding differences these values may vary
Land and Building Information
Land Building
Lot Size(Acres) 0.87 Year Built 1850
Appraised Value$371,700 Living Area 4567
Assessed Value $371,700 Replacement Cost$530,602
Depreciation 25
Building Value 398,000
Construction Details
Style Colonial Interior Floors Pine/Soft Wood
Model Residential Interior Walls Plastered
Grade Custom Heat Fuel Oil
Stories 2 1/2 Stories Heat Type Hot Water
Exterior Walls Wood Shingle AC Type None
Roof Structure Gable/Hip Bedrooms 8 Bedrooms
Roof Cover Wood Shingle Bathrooms 6 1/2 Bathrms
Total Rooms 13 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL3 Fireplace 2 $4,500 $4,500
FGR3 Garage-Good 672 $6,500 $6,500
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/17/2005
T
�a
Septic Inspection Information
Data;EntryDate1 12/27/2002 �SePt�c tnspe Plo 987
Assessors Map= 208 Parcel 130 Lot:
. .
RRa ram,,
Number 480 gdOMOM IMain Street Cent.
vivacje Centerville
" Y Robert J. Bortolotti
sped date 2/12/2002 r System Stag IF
Comment Single Cesspool
��Permi � � ReairDat
'Notfieation t)' gtlnstaller'
� Repai;r40eadli�ne Date
Postal777777
CE
RTIAE'ONAIL RECEIPT
u7
m0FFCL U
Er Postage $ 1' J�/�
I� Certified Fee t
M Return 1
Retu Receipt Fee �� Here
u"t (Endorsement Required)
C3Restricted l�iivery Fee
(Endorsement Required)
Total Postage&Fees
Sent To
Er
Street,Apt.No.;
r9 or PO Box N-- �� r��
O MY,State,ZIP+PS
Form 3800,January 2001verse for Instructions
Certified Mail Provides:
E A mailing receipt'
i A unique identifier for your mailpiece
■A signature upon delivery
■A record of delivery kept by the Postal Service for two years
Important Reminders.
■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
■Certified Mail is not available for any class of international mail
■ NO INSURANCE COVERAGE IS PROVIDED with Certified;Mail. For
valuables,please consider Insured or Registered Mail.
t
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and.attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS postmark on your Certified Mail receipt is
required. �.
■For an additional fee, delivery may be restricted to-the: addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
e If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. if a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT.Save this receipt and present it when making an inquiry.
9
PS Form 3800,January 2001 (Revelse) 102595-M-01-2425
SEN9,,E.R: COWPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signatyire
item 4 if Restricted Delivery is desired. ❑Agent
■ Print your name and address on the reverse X > 0 Addressee
so that we can return the card to you. B. Received by(Pr ame) C. Da of Delery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address differen rom item ? ❑Ye
1. Article Addressed to: If YES,enter delivery address below: ❑ No
t. \ 3. Servi ype
Certified Mail ❑ Exgress Mail
❑ Registered I '�eturn Receipt for Merchandise
�i ❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(Transfer from service label)
PS Form 381 1;August 2001 Domestic Return Receipt 102595-01-M-2509
cam
UNITED STATES POSTAL SERVIC __ rvt4 FiMVC1ass:Mai(�� -«
t, Postage:.&..F:ees Paid
P tvi ii.+ ,._ . --USPS
Permit No. G-10
• Sender: Please pro,a _� n� rn`e, address, and ZIP+4 in this box •
Public Health Division
Town of Barnstable
200 Main St.
Hyannis, Massachusetts 02601
ll,,,,,,II Ill I III,,Ill,,,,,l fill„f III,,Ill ifI
oFt1N*E, Town of Barnstable
Regulatory Services '" ` -
BARNSTABL& * Thomas F.Geiler,Director
y Mass. g
i639' Public Health Division
ArFD MA'S A
Thomas McKean,`Director
200 Main Street,Hyannis;,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Kevin Chappie April 18,2002
480 Main Street
Centerville,MA 02632
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00,STATE SANITARY CODE H,
MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF
BARNSTABLE RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 480 Main Street Centerville,was inspected on March 15,2002,by
Edward F.Barry Health Inspector for the Town of Barnstable because of a complaint. The following
violations of 105 CMR 410.00,State Sanitary Code II,Minimum Standards of Fitness for Human
Habitation were observed:
a
410-602A There are piles of brush and other debris on the ground at the rear of the building.
In consideration of the neighbors,it is suggested that no meat or fish products be added to a compost pile
due to rodent attraction and odor. See attached pamphlet.
You are also directed to correct the above listed violations within seven(7)days of receipt of this
notice.
You may request a hearing if written petition requesting same is received by the Board of.Health within
seven(7)days after the date order is received. However,this violation must be corrected regardless of any
request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not.more than$500. Each
separate day's failure-to comply with an order shall constitute a separate violation.
You are also subject to non criminal citations of$40.00 for the first violation and$15.00 for each additional
violation. Tickets will be issued daily until the violations are corrected.
PER ORDER OF THE BOARD OF HEALTH
CCv�.
Thomas A.McKean
Director of Public Health
CC: Mr.Robert Gallagher
52 Maple Street
Centerville,MA 02623 a
Q/Health/Wpfiles/Chapple/Orderlet/fs
TOP FNDN. AT EL. 50.7'f SYSTEM PRFILE TEST HOLE LOGS
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN
ACCESS COVER {WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER RICK JUDO, RS
/49.2 . MINIMUM .75' OF COVER OVER PRECAST / WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM
49.0 WITNESS: DAVE STANTON, RS
2" DOUBLE WASHED PEASTONE DATE: 1/26/04 I '$ �
RUN PIPE LEVEL '�
47D33
1t* - FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH PV* TREE
PROPOSEDQ
+.. GALLON SEPTIC 46.0$' r/ 46.Oi CLASS�I SOILS p# 10661 A�,�'s
TANK (H- 10 ) GAS : n�R
BAFFLE 45.70' 0 45 og 0 0 C� G7
45.17 COCOL 0 m 1711710171
( 2 % SLOPE) 6" CRUSHED STONE OR MECHANICAL 00 0 � � ED � 0 o
COMPACTION. (15.221 [21) oo�$ 2 0 0 0 0 0 0 0 C3 0 0 43.17'- Oft 4$'
DEPTH OF FLOW 4 ( 1 % SLOPE) ( 1 SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE Ap LOCUS
TEE SIZES:
INLET DEPTH = 10" SL
OUTLET DEPTH 14" 16" 10YR 4/3 47.4' LOCATION MAP NTS
Bw
FOUNDATION 40 SEPTIC TANK 38 D BOX 38 LMS
LEACHING ASSESSORS MAP 208 PARCEL 130
FACILITY 5.87'
*THE INSTALLER SHALL VERIFY THE 32„ 10YR 4/6
LOCATIONS OF ALL UTILITIES AND ALL 46.13
BUILDING SEWER OUTLETS AND ELEVATIONS B/C
PRIOR TO INSTALLING ANY PORTION OF
SEPTIC SYSTEM LCS
NOTE: THIS AN APPROXIMATE INVERT DUE TO
" 10YR 5/6
ACCESS DIFFICULTIES 37.3' 47 44,9'
C1 6
PERC r'S
2.5 6/4
64"
C2
I^ l CS
„ 2.5Y 6/6 ,
46.8 r, �e 138 37.3
\ ( NO GROUNDWATER
ENCOUNTERED NOTES:
SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED 1 . DATUM IS APPROXIMATE NGVD
ROCK WALL
GARAGE 48.6 AT PLANTINGS \\ DESIGN, FLOW: L BEDROOMS ( 110 GPD) = 880 GPD 2. MUNICIPAL' WATER IS EXISTING
\ USE A 880 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
aE;s SEPTIC TANK: 880 2 1760 4. DESIGN LOADiNG FOR ALL PRECAST UNITS TO BE AASHO H- 10
"" 491 TRI. 10" 49.5� ` GPD ( ) -
1S HOLLY.
Q J. F-'i t-'t JIJefV f.:> i V Gi, iwrii is
USE A, 2000 GALLON SEPTIC TANK
+ \ \ . 6. CONSTRUCTION DETAIL) TO BE IN ACCORDANCE WITH MASS.
4g ,; .2 49.2 2 \ .� \ a c
" SPRUCE 49.4 a9.s '' a \ �'� \ LEACHING ENVIRONMENTAL CODE TITLE V.
+ 48.7 9.3 ,.}-..�-111' EXIST. 8 BR �-o \ \ SIDES: 2(76 + 11.8) 2 (.74) - 259 7. THIS PLAN` IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
36" SPRUCE' + 000
00 �.• DWELLING \\ 4�s - "` TO BE USED FOR ANY OTHER PURPOSE.
PARCEL 1so \ a9.9G _' 't 47.4 BOTTOM: 76 x 11.8 (.74) 663 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40--4" PVC.
37,897tsF 49.2 \ 50.7 + '', G �'�`48' \ TOTAL: 1246 S.F. 922 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
' ..�g,g7,5
36" SPRUCE � 4�'1 4 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
+ T �49.0 \ \ DECK9,g W/,. Hf \ USE (8) 500 GAL._ LEACHING CHAMBERS (ACME OR
-- FROM BOARD OF HEALTH.
49.4 48.1 ) 10. PUMP & REMOVE OR FILL W CL
\ 49.6 .o -r4 .7 �tS. 4- 47.6 EQUAL WITH 4' STONE AT ENDS AND 3.5' AT SIDES
� �a9.o �� � ��.4 f ,- '' ( � EAN SAND) ..EXISTING SEPTIC SYSTEM
+ 48.5
69.0 + 49.1 N-.49.4'�.3 'r
49.3 ..-�1��1
5
PAVED DRIVE
GARAGE ' y, 445-4 LEGEND
TITLE 5 SITE PLAN
a9.3
100.0 PROPOSED SPOT ELEVATION OF
g,/219.54' 480 MAIN STREET
A + 49.5 100x0 EXISTING SPOT ELEVATION
IN THE TOWN OF:
100RoposEo cOlvrouR (CENTERVILLE) BARNSTABLE
LGARCAGE
H MARK - SLAB AT 100 EXISTING CONTOUR
DOOR EL. 49.3 PREPARED FOR: SIEVE AND SHARON KASETA
30 0 30 60 90
BOARD OF HEALTH
MA SCALE: 1" = 30' DATE: JANUARY 29, 2004
APPROVED DATE
off 508-362-4541 £
fox 508 362-9880
Z}F OF M4
clown cape engineering, inc, ARNE SspyG ��cH OF 0,
ARNE H oyG�
CIVIL ENGINEERS oJALA N otA
LAND SUFRVEYORS No.2saae o
.0
939 vain st. yarmouth, Ma 02675
04-001 H. 0 APE P.L.S. DA7`
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