HomeMy WebLinkAbout0081 SHALLOW POND DRIVE - Health 81 Shallow Pond Drive
Barnstable
A= 254-026 t
� �3
";:�1�-• OWN BARNSTABLE
LOCATION wri" `31 SEWAGE # 5NI " 37`
Y ® e�
VILLAGE C V,O r . ASSESSOR'S MAP & LOT
t
INSTALLER'S NAME & PHONE NO. H-lC'_� e3vS�sq—
SEPTIC TANK CAPACITY 60 0 '
;,I 1CHING FACILITY:(type) �� (size)
NO. OF BEDROOMS� PRIVATE WELL CRPUBLIC WATER _
BUILDE . OR OWNER_a�C�,C�1
DATE PERMIT ISSUED: '7kci I ek
DATE COMPLIANCE ISSUED:
VARIANCE GRAN i ED: °Yes No
Yoe / Y
.� s3
Gy.
dolzIlZ CH,V ,0,60X�
No. C/ Fee D
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0[ppfication for Disposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair(/pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.<k) 5 i A DLO OQJA O ner's Name,Address,and Tel.No.
Assessor's Map/Parcel?
I le�sG�N eoAddr and Tel.No. �� "' a 7� Designer's Name,Address,and Tel.No.
ti
/� t
Type of Building: ✓`/�
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature ofpairs or Alterations(Answer when applicable) 2.��.«(/= �D ZZ"A60 Z)J-5J. ,(19X
WigAg) I4-an
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 lace the system in operation until a Certificate of
Compliance has been issued by this Board ealt
Si ed Date >/��
Application Approved by Date 7`
Application Disapproved by Date
for the following reasons
Permit No. _ 3�� Date Issued LJ
No. 1'/ 3 Fee D v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �-
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliCation for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair((Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.<X O QJ� O ner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1� p (VL 's`
I leV Name Add and Tel.No. � — o?�` Designer's Name,Address,and Tel.No.
O�
Type of Building: S
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) t^ f:F /D/SF, ROTC
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 ce the system in operation until a Certificate of
Compliance has been issued by this Board ealt
Si this
Date 1�Lr'
Application Approved by Date 7
Application Disapproved by Date
for the following reasons "
Permit No. r 3 3 k Date Issued f
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 �p �� L �_rZ
at 7 C ,,W)NO—G/llEl'ias been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No DO/�� c�.3, ated
666 k
Installer Designer
#bedrooms Approved des/i�.n flow /; - gpd
The issuance of this permit shall not a construedlias a guarantee that the system wMIasAdesigpedDate �'J InsPector
--------------------------------------------
--------------------------------------
No. L ~ 3' 3 Fee /0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Bisposal *pstem (Construction Permit
Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( )
System located at 51 f 4 L L o �� Z®
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must fie compl ed i in three years of the date of this permit. —~
Date / / Approved by
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Commonwealth of Massachusetts cEj ®
Executive of Environmental Affairs MAY 3 rt
DES 1996 N
Department of f
E nvironmental Protection 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
U
�-� PART A
CERTIFICATION
Property Address: 81 Shallow Pond Drive. Centerville, Ma.
Address of Owner: Robert & Lorraine Mahar
(if different)
Date of Inspection: 05/04/96
Name of Inspector: Michael D eD ecko
Company Name, Address and Telephone number: Atlantic Environmental -
P.o Box 2384 M ashpee Ma 02649. Tel : (508) 4771420
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and.
that the information reported below is true, accurate and complete as of the time of
inspection . The inspection was performed based on my training and experience in the -
proper function and maintenance of on site sewage disposal systems. The system
--X-- Passes
---- Conditiona8y Passes
- Needs further evaluation by the local Approving Authority
- Fails
Inspector ' s S ignak e. t-S..D ate: 05/05/96
The system Inspector shall submit a copy of this inspection report to the Approving
Authority within thirty (30) days of completing this inspection. I f 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 or the Department
of Environmental Protection.
The original should be,sent to the system owner and copy sent to the buyer, if applicable
and the approving authority.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville, M a. '
Owners : Robert & Lorraine Mahar
Date of Inspection : 05/04/96
INSPECTION SUMMARY:
Check A, B, C, or D ,
A SYSTEM PASSES:
--x-- I have not found any information which indicates that the system violates any of the
failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are
indicated below
B) SYSTEM CONDITIONALLY PASSES:
---- One or more system components need to be replaced or repaired. 'The system, upon
completion of the replacement or repair, passes inspection.
Indicate yes, no, or not determinate CYR or ND). Describe basis of determination in all
instances. If "not determinated", explain why not.
---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or
exfiltration , or tank failure is imminent. The system will pass inspection if the existing
septic tank is replaced with a conforming septic tank as approved by the Board of
Health.
---- Sewage backup or breakout or high static water level observed in the'distribution
box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven
distribution box. The system will pass inspection if (with approval of the Board of
H ealth). n
-- broken pipe(s) are replaced
- obstruction is removed
--- distribution box is levelled or replaced
---- The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if (with approval of the Board of Health):
----- broken pipe(s) are replaced
----- obstruction is removed ".
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) .
Property Address : 81 Shallow Pond Drive, Centerville Ma.
0 wner : R obert & Lorraine M ahar
Date of Inspection : 05104/96
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
---- Conditions exist which require further evaluation by the Board of Health in order to de-
termine if the system is failing to protect the public health , safety and the environ-
ment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
---- Cesspool or privy is within 50 feet of a surface of water
---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small
marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IFAPPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC-
TIONING INAMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT.
---- The system has a septic tank and soil absorption system and is within 100 feet to a
surface water supply or tributary to a surface water supply.
---- The system has a septic tank- and soil absorption system and is within a Zone I
of a public water supply well.
---- The system has a septic tank and soil absorption system and is within 50 feet
of a private water supply well
- The system has a septic tank and soil absorption system and is less than 100
feet but 50 feet or more from a private water supply well, unless a well water analy-
sis 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 notrogen is equal to or less than 5 ppm.
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria
as defined in 310 CM 15.303. The basis for this determination is identified below.
The Board of Health should be contacted to determine what will be necessary to cor-
rect the failure.
--- Backup of sewage into facility or syst'66t component ,due to an overloaded or
or clogged SAS or cessp .
.P
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville Ma
Owner: Robert & Lorraine Mahar
Date of Inspection : 05/04/96
D) SYSTEM FAILS (continued)
- 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 over-
loaded or clogged SAS or cesspool
--- Liquid depth in cesspool is less than 6" below invert or available volume is
less than 112 day flow.
--- Required pumping more than 4 times in the last year NOT due to clogged
or obstructed pipe(s).
number of times pumped
--- An portion of the Soil Absorption System,'cess cesspool or privy is below the high
Any P R P y 9
groundwater elevation.
--- Any portion of cesspool or privy is within 100 feet of a surface water supply
ortributary to a surface water supply.
---Any portion of a cesspool or privy is within a Zone I of a public well
--- Any portion of a cesspool or privy is within 50 feet of a private water supply
well
--- Any portion of a cesspool or privy is less than 100 feet but greater than 50
feet from a private water supply well with no acceptable water quality ana-
lysis. If the well has been analyzed to be acceptable, attach copy of well
water analysis for coliform bacteria, volatile organic compounds, ammonia
nitrogen and nitrate nitrogen.
Ip ;
i r
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville M a.
Owner: Robert & Lorraine Mahar
Date of Inspection : 05/04/96
Ej LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above
The design flow of system is 10,000 gpd or greater Large System and the system
is a significant threat to public health and safety and the environment because
one or more of the following conditions exist
--- the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
--- the system is located in a nitrogen sensitive area(Interim'Wellhead Protection
Area - IWPA) or a mapped Zone II of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compli-
ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00.
Please, consult the local regional office of the Department for further information.
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 81 Shallow Pond Drive., Centerville Ma.
Owner: Robert & Lorraine Mahar
Date of Inspection- 05/04/96
Check if the following have been done
-x Pumping information was requested of the owner ;occupant and Board of
Health.
--x None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during the period. Large '
volumes of water have not been introduced into the system recently or as part
of this inspection.
--x As built plans have been obtained and examined. Note if they are not available
with N/A.
--x The facility or dwelling was inspected for signs of sewage back-up.
--x The system does not receive non-sanitary or industrial waste flow. ..
--x The site was inspected for signs of breakout.
--x All system components, excluding the Soil Absorption-System, have been
located on the site. .
- x The septic tank manholes were uncovered, opened and the interior of the sep-
tic tank was inspected for conditions of baffles or tees, material of construc-
tion, dimensions, depth of liquid, depth of sludge, depth of scum.
x The size and location of the Soil Absorption System on the site has been deter-
mined based on existing information or approximated by non-intrusive methods
-- x The facility owners and occupants if different from owner_we're provided with
information on the proper maintenance of Subsurface Disposal System.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 81 Shallow Pond Drive. Centerville M a.
Owner: Robert & Lorraine Mahar
Date of Inspection: 05/04/96
RESIDENTIAL:
Design flow : 'gallons
Number of bedrooms
Number of current residents: v z
G arbage grinder (yes or no)
Laundry connected to system (yes or no): y�S
Seasonal use (yes or no) : to U
Water meter readings, if available: Nl�
Last date of occupancy : e.c_se►_rr`
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow : gallons/day
Grease trap present: (yes or no)
Industrial waste holding tank present(yes or no) :,
Non-sanitary waste discharged to the Titte.5 system (yes or no)
Water meter readings, if available
Last date of occupancy
Other: (Describe) ......................................................
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information
System pumped as part of inspection (yes or no) :...... ........
if yes, volume pomped : .................... gallons
Reason for pumping .................. .................... ................. .................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville M a.
Owner: Robert & Lorraine Mahar
Date of inspection: 05/04/96
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)
--- Other (explain)............................................................................................
APPROXIMATE AGE of a�ll components, date installed (if known) and source of information .
.....................................................................................
................................
Sewage odors detected when arriving at the site : (yes or>no).....
N.U..
SEPTIC TANK :
(locate on site plan)
Depth below grade: ...........
Material of construction: ....... concrete ......... metal ........ FRP ........ other (explain)
..........._.............................::.....................................................................................................
Dimensions: !'.-0..., s rr-.
Sludge depth :.....0........
Distance from top of sludge to bottom of outlet tee or baffle:..........3.y...............%
Scum thickness :....0.!.............
Distance from top of scum to top of outlet tee or baffle. ........1.6..�._.......................
Distance from bottom of scum to bottom of outlet tee or baffle :..... ............
Comments
(recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid
level in reoti n to outlet invert, structural integrity, evidenpe of leakage, etc.).................. ...
.....nJIZ-..?qW1 (12 .C......\SNC�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville Ma.
Owner: Robert & Lorraine Mahar
Date of inspection: 05/04/96
GREASE TRAP . ...... ..'
(locate on site plan)
Depth below grade: . .............
rade: ............... ;
Material of construction: ........concrete.........metal........FR P........other(explain)....
........................:.................................................................................................................
D imensions:............................... _
Scum thickness:.........................
Distance from top of scum to top of outlet tee or baffle:......................................
Distance from bottom scum to bottom of outlet tee or baffle:......................I.........
Comments:
(Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid
level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................
.................................................:..............................................................................................
................................................................................................................................................
ll
TIGHT OR HOLDING TANKS-..P-�U....
(locate on site plan)
Depth below grade:...............
Material of construction:.........concrete........metal.........FRP..........other (explain)..........
.................................................................................................................................................
Dimensions:............................
Capacity:....................gallons
Design flow.................gallons/day
Alarm level:.............................
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.) .
..........................................................._.....................................................................................
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAR T C
SYSTEM INFORMATION (continued)
Property Address: 81 Shallow Pond Drive. Centerville Ma. _
Owner: Robert & Lorraine Mahar
Date of inspection- 05/04/96
. t
DISTRIBUTION BOX:..d*
(locate on site plan)
Depth of liquid level above outlet invert ... �k
Comment:
(note if level and distribution equal evidence of solids carryover, evidence of leakage into
or out of box, etc.)....>..-., ..- ...n ..g... ��. Q.ti.. ...�,,�.l:..0.9.
. . �P.�.��...�,�:!�
PUMP CHAMBER:.... L�...
(locate on the site)
Pumps in working order: (yes or no)............... Y
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)....................
.. .................................................................................................................................................
.................................................................................................................................................
SOIL ABSORPTION SYSTEM (SAS):..:..�A:e.5....
(locate on site plan, if possible, excavation not required, but may be approximated by non-
intrusive methods)
if not determined to be present, explain:
..................................................................................................................................................
..................................................................................................................................................
Type:
leaching pits, number-. ..�... .�.�..4�.. P
leaching chambers, numbe :........
leaching galleries, number:...........
leaching trenches,number , length......................
leaching fields, number, dimensions:....................
overflow cesspool, number:..........
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding, condition of veget ion,
etc.
).�c �.Gr..:..� .:`.�:"vc.(
h
t. G..... .
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) ;
Property address: 81 Shallow Pond Drive, Centerville Ma.
Owner: Robert & Lorraine Mahar
Date of inspection: 05/04/96
CESSPOOLS:........
(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: .....................
Indicator of ground water: ....................
inflow (cesspool must be pumped as part of inspection)
.................................................................................................
N ........................................... .................................. . ......
1 '
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
PRIVY : ...0.6.....
(locate on the site)
Material of construction: ...................................
D imensions: ......................
Depth of solids: ................
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.) .
.......................................................................................................,........................................
................................................................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address : 81 S hallow Pond D rive, Centerville M a.
Owner: Robert & Lorraine Mahar
Date of inspection: 05104196
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks locate at
wells within 100'.
y
I
CFI /Y 30
1 AZ 4 LA
to—
h
N
DEPTH TO GROUNDWATER;
9
Depth to roundwater: .�:.3.S�.feek
P
Method of determination o roximakive:
{
1lS:.�ccaLcr.�,c..f.�Q..�s�ri..,rx. '. S:.t-�t-�+t�5:ti\o:��.�,.. Tti�k,��r \ c�r:-� .T..�C`�`�..�:-.M.•.�..,..f�``•Z
�.�vw:S..��.1'A�.1�:� �..�. r'�;:t..,..f.��T��.t�d�..�4�:..c.�.►uau c:� .�r :?� -....!�.�..:.......±...
. 5..,
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE-5 : .
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 81 Shal low Pond Dr
en ervi e.
Owner's Name: Pam Craig
Owner's Address:
Date of Inspection: j /
Name of Inspector: (please print)^William E_ •Robi nson Sr.
Company Name: William E. Robinson Septic . Service `
Mailing Address: P O Box 1089
Centerville, ' MA
Telephone Number: ( 5 0 8) 7 7 5—8 7 7 6 `
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
�ses.z
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ' . Date: '''��
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaKh 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 Form 6/15/2000 page 1
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 81 Shallow Pond Dr.
Centervilie
Owner: raig
Date of Inspection: 7
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. /Ibave
Passes:
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. stem Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaire .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer es,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
e 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 is replaced with a complying septic tank as approved by the Board of Health.
•A me I septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indica ' g that the tank is less than 20 years old is available.
ND a lain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obs cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
ap roval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND ex lain:
e system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass ins ection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND plain:
Page 3 of l] P
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 81 Shallow Pond "Dr..
Centerville' r .
Owner: Craigk
Date of Inspection: y
r
C. Further Evaluation is Required by the Board of Health-
t
Conditions exist which require further evaluation by the Board of Health in order to determine if the system,
is f 'ling to protect public health,safety or the environment. .
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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.
.y
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the i
Sys em is functioning in a manner that Protects the public health,safety and enviionmentc"
_ The system has a septic tank and soil absorption`system(SAS)and,the SAS is within 100 feet ofa
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 feei 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 ppm,provided that no other.
failure criteria are triggered.A..copy of the'analysis must be attached to this form.'
3. Other:
3'
Page 4 of I 1 '
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 81 Shallow Pond Dr.
Centerville
Owner:
Date of Inspection: "/0tQ
D. ystem Failure Criteria applicable to all systems:.
You ust indicate"yes"or"no"to each of the following for all inspections:
Yes o
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''/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
T be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gp
Yo must indicate either"yes"or"no"to each of the following:
(Th following criteria apply to large systems in addition to the criteria above)
yes o
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary.to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If yo 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 famed.The owner or operator of any urge system considered a
signi scant 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
l
Page 5 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 81 Shallow Pond Dr -'
Centerville..
Owner: �Y„
Date of Inspection: Q'—7 6—-ti-L I
Check if the following have been done You must indicate"yes"or"no"as to each of the following:
I jes o �_ 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 recewed'norinal1lows mi 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'
u
Was the site inspected for signs of break-out? �
Were all system components,excluding the SAS,located on site? s,
Were the septic tank-manholes uncovered,opened,and the interior of the tank inspected for the condition
, d de th of scum .
, ofslud e an
th of liquid,
de th g P ,
de a
of the baffles or tees;material`of construction,dimensions; p q d, . P _
. . - 11 . .
_ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface'sewage disposal systems?, a ,
The size and location of the Soil-Absorption System(SAS)on the site has been'defermined based on:
;..
Yes no n
Existing information.For example,Aplan at the,Board of Health. k"
{ Determined in the field(if any'of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310.CMR 15.302(3)(b)J'
5 '
Page 6 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 81 Shallow Pond Dr.
Centerville
Owner: Craig
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL -
Number of bedrooms(design): Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 G D
Number of current residents: 0 �--—
Does residence have a garbage grinder(yes or no):�'`-' 1
Is laundry on a separate sewage system(yes or no): 1,,-) [if yes separate inspection required]
Laundry system inspected(yes or no): %- t,
Seasonal use:(yes or no):&v c) --— -
Water meter readings,if available(last 2 years usage(gpd)). 1.9 9—00 1 9,_0.0.0—ga 1.
2000 01 83. 00:0_— al.
Sump pump(yes or no): 4L-0 �—__ 0 0 , g
Last date of occupancy:
COMM RCIAL/INDUSTRIAL
Type of es blishment:
Design flo (based on 310 CMR 15.203): gpd
Basis of des flow(seats/persons/sgft,etc.):
Grease trap resent(yes or no):
Industrial wa to holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter eadings,if available:
Last date of,ccupancy/use:
OTHER( scribe):
GENERAL INFORMATION
Pumping Records
Source of information: A
Was system pumped as part the inspection(yes or no): J
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYP 'OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and sg ce of information:
Were sewage odors detected when arriving at the site(yes or no): /L
6
Page 7 of 1 l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ;
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
SYSTEM INFORMATION(continued)
Property Address:81 Shallow Pond Dr.
Centerville
Owner: Craig "
Date of Inspection: $-10-6 )
B DING SEWER(locate on site plan) F
Depth elow grade: '
Materi is of construction: cast iron _40 PVC_other(explain):
Distan from private water supply well or suction line:
Comm nts(on condition of joints;venting,evidence of leakage;etc.):
SEPTIC TANK: (locate on site plan)
Depth below grade: , a
Material of construction:�oncrete 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) t
Dimensions: �b
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: dl i
Scum thickness: 3- ►.
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.):,
n 9,4 1- �.wG� 1�� r r I� ;� 7 ,y tL
GREASE TRAP:_(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.):
: - ° .. r T•
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEW
AGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 81 Shallow Pond Dr.
C nt-Prvilla
Owner: C'ra; rr
Date of Inspection: j
TIG or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth b ow grade:
Material f construction: concrete metal fiberglass_polyethylene other(explain):
Dimensio s:
Capacity: gallons
Design Fl w: gallons/day
Alarm pr ent(yes or no):
Alarm le l: Alarm in working order(yes or no):
Date of 1 st pumping:
Comme s(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):
f9
PUMP CHAM ER: (locate on site plan)
Pumps in workin order(yes or no):
Alarms in worki order(yes or no):
Comments(note ondition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9ofII "
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
z, PART C
SYSTEM INFORMATION(continued)'
Property Address: 81 Shallow Pond Dr.
Centerville
Owner: Craig
Date of Inspection:
e
SOIL ABSORPTION SYSTEM(SAS):. (locate on site plan,excavation not required)
If SAS not located explain why:
Type
eaching pits,number:. ,
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length: v
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.): / -a o � S sO r0
_ e C A s 1, C .
CE POOLS: (cesspool must be pumped as part of inspection)(locate on site plan) -
Numbe and configuration:
Depth—top of liquid to inlet invert: '
Depth o solids layer: a
Depth of cum layer:
Dimensio s of cesspool:
Materials of construction:'
Indicatio of groundwater inflow(yes or no):. ,
Comment (note condition of soil,signs of hydraulic failure,level of ponding,condition-of vegetation,etc.):
PR (locate on.. ite plan)
Materials of construction:
Dimensio s:
Depth of olids:
Comment (note condition'of soil,signs of hydraulic failure;level of ponding,condition of vegetation,etc.):
9
r
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 81 Shallow Pond Dr.
Centerville
Owner: Craig
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
a
3;L
S �
10
1
` Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
PART G 4
SYSTEM INFORMATION(continued)
Property Address: 81 Shallow Pond Dr. „
Centerville
Owner: Cra i
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water _feet
Please indicate(check)all methods used to determine the high ground water elevation:
btained 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:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
D A To6 07 g . 91�i
r
Fxa......... 1�. ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
$� Appliratiou for Diti-pntittl Work,i Tomitrurtinn Fami#
V. Application is hereby made for a Permit to Construct ( ) or 'Repair ( ) an Individual Sewage Disposal
System at
Location-Address or Lot No.
44/
Own e L � Address
Installer Address
Type of Building Size Lot............................Sq. feet
,., Dwelling—No. of Bedrooms-------- ____________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- - -
W Design Flow....Ild.... ..........gallons per person�A�r day. Total daily flow........... .....................gallons.
WSeptic Tank—Liquid capacity------------gallons Length__15._G_.---- Width-: v__ Diameter---------------- Depth_--�-*.
x Disposal Trench—No. __.------_-------- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit Diameter..../6---------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed by ..._.. ...............!�_ Date....._.. /�ie....1��____.___....
,,`" ------ /----------- -
,� Test Pit No. 1 2---minutes per inch Depth of Test Pit.-. ........ Depth to ground water-----1Vt..........
f% Test Pit No. 2................minutes per inch , Depth of Test Pit-------------------- Depth to ground water.-..------_-__-•.---_---
0+ -----•----------------------•--•----•-••--••-••--•---- .....................................................................................................
0 Description of Soil-•-------------------------------•••-- ••••-•-----•--------•-••---•-------
vx -----•••-•-•------•-•------••••••-•-----------------------•---••--••L.. -• Z" ..� /a
-�; ------------
----------------------------------------------------------------------------� �------.. V-"/------------ .......................................................
U Nature of Repairs or Alterations—Answer when applicable.-.--.-.........................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ----- -----------------------
Application Approved By ............ ......... ----------------------------------------------------------------- .... ..,_/�r--.Q .
Da
Application Disapproved for the following reafons- -------------------------------- -----------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ -------------------------------------
Dare
PermitNo. ......T-1---------3_7 ------------------------ Issued -------...........................................................
Date
a: C_
Fas..........
G ....
.._
h THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEALTH
TOWN OF BARNSTABLE
AjiVftrativu for i Vwml Ark,i Towitrnr#inn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System. at
Location-:\ddress or Lot No.
1.�V:..Zvi---• --- ••- -------------------------------•••••......-Z - -�
Owner Address
Installer Address
UType of Building Size Lot............................Sq. feet
t_t Dwelling—No. of Bedrooms.___-__---3----------------------------Expansion Attic ( ) Garbage Grinder ( )
44 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04
Other fixtures -----------------`_----------------
---------------------------------
-------------•-
- ------------------------------
W Design Flow....//a------//_//..........gallons per p'ersoner day. Total daily flow-.________33
. .6 .gal.................... lons.
WSeptic Tank`Liquid capacity------------gallons Length__ .`6__.._. Width___/.�U__ Diameter................ Depth__S` _-?
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.___0_/2--e---- Diameter..../6----------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box)( ) Dosing tank ( ) �-
'~ Percolation Test Results Performed by._r�-__L-�v `__. ....�................... Date____....??6-...��........__..
l Test Pit No. IZ-11,2...minutes per inch Depth of Test Pit---/__ 7--------- Depth to ground water...../-Vc..........
fit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ --------•--------------------------•------------•---•-----•.---•• .i••-••......-•---........._•...•.........................................................-
0 Description of Soil................................................................. -----••--x / Z I' G// -------------------------------------f-------------------------------•--------
.----------------•------•-••---•-----------•••-...........-----------40--•-
VW -••--•------------------ ---------------------------------------------------- ----- ------ ----------------------------------------..............
U Nature of Repairs or Alterations—Answer when applicable.____-_.........................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed - �� `� ----------------------- ---------------------------------------
Dare
Application Approved By -------------- �� ---------------------------- -../..1-..��'! ...
-----------------------------------
� Dat°e
Application Disapproved for the following reafonf: . . .. ... ............ ...................................... . .................
M -----------.......................................------------...............-----------------------------------------------------------------------------------------....._
Date
PermitNo. ........T.`l i..7k------------------------- Issued -------------------------------------------------------- ------
Dare
------------ —•——————————————_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
&I-tifirate of C ontyliance
THIS IS TO.CERTIFY, That the Individual Sewage Disposal System constructed ( >K') or Repaired ( )
by .....................IA....{..r. ----------------- -------_...__---- ---------------m tan-- l rt----------------...-------------------------..----------------------------------------------------------
at ..----------G....0T---�� ......_S '��t c �� _.... -�'- ......
has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ......I..-. � 76........ dated ._.._.._._..._.-......_......___..._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE,
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - ^'... - ------- Inspector s... % t' ✓ -'
--- ------ --- -- ----------------------- -----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE---.��/S.%?.......
Biiipmal nr Tuni#ration aunt
Permissionis hereby,granted---------- --` ------------------------------------------------------------ -------------.......•-------.-••----•---
to Construct (>,:f) or Repair ( ) an Individual Sewage Disposal System �-� e�,
at NO................. �-'..7•....-5 l --S� !�� f��•1 '�1.,�Q .t._J_-._(• (moo<t M............
Street qq
as shown on the application for Disposal Works Construction Permit No.__l_1::;37 __ Dated-----------7-.....1./........... .._.
................................... ---------------------------------------------------
Board of Health
DATE 7.. = C aBoard
FORM 36508 HOBBS Q WARREN,INC..PUBLISHERS
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NOTES
1. DATUM IS NAVD 88
2. MUNICIPAL WATER IS EXISTING
Roue 6 Exit
3. THIS PLAN IS FOR PROPOSED WORK ONLY AND 16
NOT TO BE USED FOR LOT LINE STAKING OR ANY viGe Rd'
♦ OTHER PURPOSE. 5e�
4. CONTRACTOR SHALL BE RESPONSIBLE FOR
CALLING DIGSAFE (1-888-344-7233) AND
VERIFYING THE LOCATION OF ALL UNDERGROUND &
OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF pleoscOl
Fines
U s8 WORK. Locus
59 5. EXISTING SEPTIC LOCATION PER TIE—CARD ON
57 60 FILE WITH THE TOWN.
� _
We uet c
6. POOL FENCE SHALL HAVE SELF—CLOSING SELF—LATCHING 4 Bearse ... Shallow
GATES, SIZE AND MATERIALS TO MEET LOCAL AND STATE Lake Pond N Pond
s� S � BUILDING CODE, ALL DWELLING DOORS OPENING TO POOL �c
s9 / SHALL BE ALARMED TO CODE. � cl
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63 M 6 1%
LOCUS MAP
\ s9 SCALE 1"=2000'f
59
41 2� 36,, ASSESSORS MAP 254 PARCEL 26
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o DRIV D LOCUS IS WITHIN FEMA FLOOD ZONE X
(AREA OF MINIMAL FLOOD HAZARD) AS
SHOWN ON COMMUNITY PANEL #25001C0562J
s� EXISTING / oo DATED 7/16/2014
DWELLING I 41VE
AVEL /
59 TO = 64.2 ZONING SUMMARY
3 � �
60 s8 ZONING DISTRICT: RF-1 RESIDENTIAL DISTRICT
E s�
LOT 31 �� X\\ 62
k / 6'' MIN. LOT SIZE 43,560 S.F.
4 3 SFf MIN. LOT FRONTAGE 20'
65 h� ��; DECK MIN. LOT WIDTH 125'
MIN. FRONT SETBACK 30'
�0. 61 MIN. SIDE SETBACK 15'
} MIN. REAR SETBACK 15'
66 s� } 226, 7095 _ 63 MAX. BUILDING HEIGHT 30'
SITE IS LOCATED WITHIN THE WELLHEAD
p0 OSF� PROTECTION OFERLAY DISTRICT
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3
OWNER OF RECORD
65
63 so a oo 1 GARETH AND STEPHANIE MARKWELL
6 SHALLOW81 DRIVE CENTERVILLE, MA 02632
6 1 k
FIRE � �r,` 64
REFERENCES
DEED BOOK 28328 PAGE 53
PLAN BOOK 440 PAGES 27-29
64
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S6 6
LEGEND 6�' �2 6
99 EXISTING CONTOUR 65 SITE PLAN
X 99.1 EXIST. SPOT ELEV. 61 OF
—[99]— PROPOSED CONTOUR J #V 1 SHALLOW POND DRIVE
[98•4] PROPOSED SPOT EL.
66
CENTERVILLE, MA
TH1
TEST HOLE 68 PREPARED FOR
SLOPE OF GROUND 7 At'-A'
GARETH MARKWELL
�OLD UTILITY POLE O �
68
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� FIRE HYDRANT y } �� � D-a�lE�_A �•,�, DATE: NOVEMBER 16, 2018
418, C)JALA
■ CATCH BASIN � off 508-362-4541
I C1��iL U�
4'^ NO ,651) �n
fax 508-362-9880
WATER LINE
fir, y � F 'isr�P r downcape.com
W
X FENCE `yam 40Wn cape engineering, Inc.
NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING Scale: 1"= 20' �,g civil engineers
'�� /�D< land surveyors
f 939 Main Street ( Rte 6A)
0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
LICELICE �— c��85 18-385 MARKWELL.DWG