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Home My WebLink About0033 BAY LANE - Health F= 1 Lang P 68 C ' li l t � au UPC 12534 ' No.2_3LOR �,�,e NAITINO=,UN I k, Commonwealth of Massachusetts Title 5 Official Inspection Form f e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 33 Bay Lane CCMProperty Address Meany �- Owner a' Owner's Name an. information is Centerville ✓ Ma 02632 8-30-2018 required for every 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 on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return Company Name key. P.O.Box 151 r� Company Address Forestdale Ma 02644 City/Town State Zip Code � 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 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 8-30-18 Inspector's Signa a Date The syste inspector shall ubmit jcoof this inspection report to the Approving Authority(Board of Health or DEP)within 30 ays o 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 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. City/Town 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: Septic is in good working order. No failure criteria was encountered during the inspection 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 Commonwealth of Massachusetts (o Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 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 18 Commonwealth of Massachusetts r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) El 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. 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 ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 . 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 El ® 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 El- El Area—IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc.rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j� 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is Centerville Ma 02632 8-30-2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1000 gal tank . 6'x6' precast pit with 2'of stone Number of current residents: seasonal 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 Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: seasonalDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. Cityrrown 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: owner pumps every 3 years 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 w 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 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: 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 15, feet Comments (on condition of joints, venting, evidence of leakage, etc.): no evidence of poor venting or leaks t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Q� Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.75' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H10 rated 1000 gal tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6"x5'5" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 1" 5,, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in place no visable concrete decay or cracks. tank level at bottom of outlet pipe. 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 ., 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no carry overs. Dbox is structually sound no visable leaks t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Flo* 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: 1 ❑ leaching chambers number: ❑ 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 Title 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 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 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.): 6'x6' precast pit with 2'of stone around it is in good working condition. Pit was dry at time of inspection. stain line on concrwete indicates at one point water level in pit was 4' below invert pipe entering pit 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 7 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is - required for every Centerville Ma 02632 8 30-2018 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 Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .v 33 Bay Lane Property Address Meany Owner Owner's Name information is Centerville Ma 02632 8-30-2018 required for every 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 0,- 30' 6 2- /(,7,5 �a`o5_e G e) z 3 0 i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owner's Name information is required for every Centerville Ma 02632 8-30-2018 page. City/Town 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: 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. 1990 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: town GIS mapping You must describe how you established the high ground water elevation: Area of leaching pit El. 14 bottom of leach pit 7.5'below grade 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Bay Lane Property Address Meany Owner Owners Name information is required for every Centerville Ma 02632 8-30-2018 page. Cityrrown 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 J`.bCATION 2 v3 g `D14AX_ SEWAGE # Y)9,LAGE �rv�l ASSESSOR'S MAP & LOT IIN"sTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ! ClUC3 'LEACHING FACILITY: (type) �oX�o� UtJb Q1 (size) a 5 r NO.OF BEDROOMS / BUILDER OR OWNER P M!�r PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ' g facility) Feet Furnished by i►1' ��r L 1 —07 90 A 3 3 Q a ao '3S y 3 3o YY COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS lugDEPARTMENT OF ENVIRONMENTAL PROT RECEIVED SEP 0 4 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION I l MAP Property Address: 33 Bay Lane PARCEL �D Centerville, MA 02632 _ Owner's Name: Phil Meaney LOT Owner's Address: Date of Inspection: August 21, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 186 Osterville,MA 02655-0049 Parcel: 68 Telephone Number: (508) 862-9400 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(316 CMR 15.000). The system: ✓ Passes Conditionally Passes Need urther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: August 26, 2003 The system inspector shall sub 't copy of ihis 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 Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 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 a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaner Date of Inspection: August 21, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 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 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 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.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? — P ✓ — 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: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)J. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaner Date of Inspection: August 21, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Yes Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ______.gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: Jul. 24187-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meanev Date of Inspection: August 21, 2003 BUILDING SEWER(locate on site plan) 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 TANK: ✓ (locate on site plan) Depth below grade: 15" 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: 1000 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of cum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 1 -6'x 6'(1000 gal.)w/2'stone 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.): The pit had P6" of water on the bottom. There were no signs of failure. 1 dug around the pit and measured the thickness of the stone. The cover was 16"below grade. CESSPOOLS: None (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 no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Bay Lane Centerville, AM Owner: Phil Meaney Date of Inspection: August 21, 2003 Map: 186 Parcel: 68 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 I a ao 3S Y 3 10 Page l l of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Bay Lane Centerville, MA Owner: Phil Meaney Date of Inspection: August 21, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20 +/- 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: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 20'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. Il TOWN OF.BARNSTABLE LJi:A.TION SEWAGE # V�LLArE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. r SEPTIC TANK CAPACITY LEACHING FACEL=: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ��•,�M Feet Furnished by `-_ VnNr . AA 15 AS 20 AC 30 5A 31 50369 be yN 6D lei DO ' REC EIVED SEP 0 2002 TOWN OF BARNSTABLE COMMONWEALTH OF MASSACHUSETTS HEALTH DEPT. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Z 3 _ a d Y Off• In sye� �1 d TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 33 BAY LANE CENTERVILLE, MA 02632 Owner's Name: MR. MEANY R_ Owner's Address: 3417 N. ALBEMARLE ST ARLINGTON VA 22207 Date of Inspection: 9/4/02 T , ! Name of Inspector: (please print 1 ',"...,10- N GRACI COP? Company Name: SEPT161NSPECTIONS inu Mailing Address: "='P.O'. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT certify that 1 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 cf the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes(,, _ Conditionall sses _ Needs Furtl valuation by the Local Approving Authority Fails Inspector's Signature: Date: 9/4/02 The system inspector shall submit 1,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',shalfsubmit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies:sent to th'e''buyer, if applicable,and the approving authority. t Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. t: ;ta 11 Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 Inspection Summary: Check A,B,C,D or E./ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as'de§&I'bed 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,wall pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years'o'Id* 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. + e ND explain: n/a n/a Observation of sewage back`ups;or.break 6.0f 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): _ brokenipine(s)are replaced _ obstruction is removed _ distributions box is leveled or replaced ND explain: n/a n/a The system required pumping more th. i 4 times a year due to broken or obstructed i e s . The system will ass Y Q P p� g ,. Y p�P ( ) Y P inspection if(with approval of the Board+ofH'ealth): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a K r • Page 3 of 11 • '`. ;t. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ij Property Address: 33 BAY 15ANE`CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 - C. Further Evaluation is Regu,ired,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 maiikrz 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 �>1 i 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and,soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a su face water supply- - The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. tt _ The system has a septic tarkk 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'dete~mine distance n/a "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. t 3. Other: :.. n/a rii, Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage,-,into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or pondingof effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NO PIIMING INFORMATION. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspoolior privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool•br privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that iaciliiy 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 forma (Yes/No)The system fails. l,have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails, The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large s stem'ttie�s sterii�must serve a facility with a design flow of 10 000 d to 15 000 d. g Y Y Y g � gP � gP You must indicate either"yes"or"no"to each of the following: il (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet,of,a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 thelu'gr syslenl.luis failed, The owner or operator of nny large system considered a significant lhrent under Section E or failed un&,r1Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. r•i ! Page 5 of I 1 Y <1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 BAY LANE CENTERVILLE, MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 Check if the following have been,done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information wasIprovided-,by the owner,occupant,or Board of Health X Were any of the system,components pumped out in the previous two weeks? X _ Has the system received normal:lows in the previous two week period`? X Have large volumes of water been introduced to the system recently or as part of this inspection'? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up`? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site`? X _ Were the septic tanklmanholes 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`? r,', The size and location of the Soil Absorption System (SAS)on the site Las been determined based on: Yes no •r: X _ Existing information. For example, a plan at the Board of Health. X _ 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)] .1 ail 1 1t. I • 5 If i Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 FLOW CONDITIONS RESIDENTIAL A Number of bedrooms(design):,2 NOmber�bf bedrooms(actual): 2 DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 2 Does residence have a garbage grinder(yes--or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):;NO Seasonal use: (yes or no): NO ; Water meter readings, if available(last 2 years usage(gpd)): R4- 0( _ Ligl000 Sump pump(yes or no): NO Last date of occupancy: n/a O b '02l ut3U COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR.151203): nS/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present'(yes or no): NO Non-sanitary waste discharged'to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a ��. GENERAL INFORMATION Pumping Records Source of information: NO PUMING INFORMATION Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--.How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,''soil;arsorpfion system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) Innovative/Alternative technology.QAttaeh„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): n/a Approximate age of all componentg,.date installed(if known)and source of information: 1946 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO 't. r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 T BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron'X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, `venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a I l's age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" W5' 7'!,W 4',1011" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scbm'to bottom of outlet tee or baffle: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVE`1ZV TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping rec`omriiendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,.etc.) `'At n/a t,i e, �. 'i's.11�1:tea lit El2,pt- l }1t i; Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 TIGHT or HOLDING TANK: '(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons t Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and flow,switches,etc.): n/a DISTRIBUTION BOX:X(if present must,be opened)(locate on site plan) Depth of liquid level above outlet inver: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distr6ution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND, PUMP PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NG Comments(note condition of.pump chamber,condition of pumps and appurtenances,etc.): n/a i r' R Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 SOIL ABSORPTION SYSTEM (SAS): X;(locate on site plan,excavation not required) If SAS not located explain why: n/a Type P 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a ,t innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs'of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT HAD 6" OF LIQUID IN IT AT TIME OF INSPECTION.STAIN LINES INDICATE PIT HAS G NEVER HAD MORE THAN 6" OF LIQUID IN IT. BOTTOM IS AT 8 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a r PRIVY: (locate on site plan) s Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signss of hydraulic failure, level of ponding,condition of vegetation,etc.): E � 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: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage'disposal system including ties to at least two permanent reference landmarks or benclunarks. Locate all wells within 100 feet.Locate where public water supply enters the building. o _ C A h IS Ar ` A 3b cq A D 6q gq 31 60 3S 3 I3c uq gp (D1 in Page I l of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BAY LANE CENTERVILLE,MA 02632 Owner: MR. MEANY Date of Inspection: 9/4/02 , SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design Mans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting p ropert.y/observat ion hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a r You must describe how you-,established the high ground water elevation: HAND AUGER- 10+ FT. I ' • 1 +i 4: t9 t t ' f 1 r TOWN OF BARNSTABLE LOCATION G . LahP SEWAGE # IL 2 VILLAGE 7�rey(//At- ASSESSOR'S MAP & LOT . INSTALLER'S NAME & PHONE NO.U,/ ,/��ll�®h+6@!r' j-S"0h tThG. SEPTIC TANK CAPACITY IlG0� (;L `sae LEACHING FACILITYAtype) f (size) 'I(vo L NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER , BUILDER OR OWNER % c_ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: -7 . A v_�7 VARIANCE GRANTED: YesN No �' "00001. f 100 No.�......._...._.. F�s... ....?.�?,.AQ:. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH gown........................oF....... Bann st able Appliratiou for Bhipwiul Warkii Tomilrurtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ....33.__BiY...Lan-e--Lame_ allla............................ Location-Address or Lot No. ...K4.Gr_=.e-------------------- ••-•----••--•---------------•------------------ --...----------.._.....-----•---•--•------ - - -•----....------------.....------•---------•-- Owner Address (4 ---•ilw2i_ a_QA_Cllb.en..........-------•-•--------------------•--------------•-- ----------••--------.._....--•---.._...---...........---•--...-•------------------.......----••--- Installer Address � Type of BuildinZ Size Lot.............._-------------Sq. feet Dwelling—No. of Bedrooms................................. Attic ( ) Garbage Grinder ( ) PL4Other—Type of Building No. of persons____________________________ Showers — Cafeteria P-1 Other fixtures ---------------------------------------•------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G4 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_.-__-___-_--_-_____sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date--------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_..--....__-----__------ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..----_-_____--__-_---. ---------------------------------------------•-••--------------------........_...._..__......_------......................................................... 0 Description of Soil....................................................................--••-•---------------------------------------------------•---------------------•----••------_------ � ................................hand-&,._Grav_el........................................................................................................................-.......... W UNature of Repairs or Alterations—Answer when applicable..........1-1:OQ0...gallgn---TryjaK.s_______________________________ Agreement: The undersigned agrees to install the -aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i� - p - 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be,n issued by the rd oj health. Signed --- /-- - -- ---•- ---7.�W$7••------- Application Approved BY----��1 ---- . ---- -• -------•----• ............................... ........... Date Application Disapproved for the f ollo i reasons----------------------------------------•----------------------------------------------------------•--....._..--- ---------••-------------------------------------------------•-----------------..................-...................................................................................................... Date Permit No........... 7-- � Issued.---------•---...--•----------------------------------- Date No�.....----- F�s........� !....-..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z)' C: ...O F C7..Apphratilan for Dispniial Workii (fnntrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair .( ) an Individual Sewage Disposal System at:' --?»------- ........--.................. ....................................... --......--••-------........_---------------- .....-----------------------..........--- Locat'on-Address or Lot No. i j C',"r•,.,r ...............•.------....._...__._...._................._....__......_._........._.._._..__.._.. Owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1x Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—NTo..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area...._.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date.-----------........................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 01 ---------•-•------------------•----------•-•---••-•---•----•--------....................._..------.......................................................... 0 Description of,Soil------------•------- -------•----------------•----•---------------•------.._...-------•-•-----•---------•---•-----...-•--------•------------•----------••-••-••---••--- x - .,c- w ..revel. U ----------------------------- ---------•----------------------•-----------•-----------------------•--------------------------------------------------------------------- ------------------------ W V Nature of Repairs or Alterations—Answer when applicable =` ,")_, • �.. �.. -..:.. 1 . I... G • ..tJ�1 pit . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T%T IE4 ;of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. It Signed----- -•--= / li �_. Application Approved BY---i an--- - ...-=---=.... -- ..----------• ............................... ----------------------------.....•.....- Date Application Disapproved for the f oll wi g reasons---------------••--......---••--•------------------------------•-------------•--•-------------------------------- -------•--------•-------••----•---•----•----•------...--••••••••----•-•-•.................•---------••--- Date PermitNo......... .. ... -------------- Issued_....................................................... Date THE COMMONWEALTH OF A ACHUSETT L M SS S BOARD OF HEALTH i �. .. l OF............:-....f. '....t...................................................... Tntifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired' ( } by-- --....='-----------------------------------------------------------------------------------------------------------------------------------------------------•-•------•-----•---•----- �, _ Installer at .._.._ . has been installed in accordance with the provisions of Tl` � The State Sanitary ode as described in the application for Disposal Works Construction Permit No._��:�.�................... dated_.. �.2�-_77___---_______-- TFIE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............:7... .►j.._ 1�5 ................................ Inspector------. �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... .r NO. FEE......................... Rquisal Workii 0ontrnrtion prrutit to t ...... L:... Permission is hereby granted..........-----------------•-•---••--------•--.-------•--.._..----------------••--•-------------------.._........---------....--••-•---.....-- to Construct (, ) o Re ai � ('' an Indiyidual Sewage Disposal System t T Street as shown on the application for Disposal Works Construction Permit No'.}__.=.......�.. Dated............... 41......... .___... ,- - --f '�.. .......................................» oa8 rX;ld of He�ith FORM 1255 HOBBS & WARREN. INC., PUBLISHERS W _ V LIST OF DRAWINGS C. COVER W 1. LOWER FLOOR PLAN n W 2. MAIN FLOOR PLAN Z W. 3. UPPER FLOOR PLAN 4. FRONT&LEFT SIDE ELEVATIONS 5. REAR&RIGHT SIDE ELEVATIONS W 6. MAIN FLOOR FRAMING PLAN N 0�000 7. ROOF FRAMING PLAN WW ❑0��El 8. MAIN FLOOR ELECTRICAL PLAN D ❑�00 9. . _UPPER FLOOR ELECTRICAL PLAN M Z - W Q' V W 1 AUG 2003 Thomas French Architect� 6723 Whittier Ave. EXTERIOR VIEWS suite 402 McLean, VA 22101 RENDERINGS ONLY; REFER TO PLANS&ELEVATIONS FOR.ACTUAL Tele. 703 734 0084 DETAILS Fax. 703 734 1964 L =.J C1won Dlnnenekne:1. . ,.Daaotar oo d,aa,gay iaNew airranswne eo as to understand afticd relaSaneNpaand V el nwft.and visit of to verily as Olmw W one prior to a V Rath dw Wank. 2.Dknensidu noted with an asterisk(`)ere cAtlml erw deperderd oR etigvreNs w1h eristlr,p buk*q%Oea,Vdamel wale or cenOwl net.These alnena ens may vary W to aBsue L prow a§Wwnwft a Dlrnernsiorns rioted with a Owrlle m0amk(" 1 ens lase tlnarn afticel and mar very alghdy to aooarmrodete azdem dgvn nb elsewhere. e.Daflenalotw w1h ro aacarrrperrylq aymhd anal Ie eawrrled to be veld end etnel net very. 5.Interior dM,enaiwre are to face of send at new pwsslc nvala(Wass noted odrendse)and to • *Wmd tape at misft peNaonsAvala. 5.EAt dor dhianlons are so amide d eheadanp at new waft and outside d.Mish at edslnp waft. A \ 7.Wrinen dimenabm nde.Do not scale pero. Z E. E. 1 R NEW SR.COL OCN«PxW r`ot' i .. IXMA9OMv I— J D(SEAM REiONfIX PEW P7 ABOVE PIER AS fE0'D. E X. U N F I N I S H E D B A S E M E N T r , RE-P09nON ln/AO LM IX R ON.WALL IX.APPLIANCES n ❑ I I ON I I IXQ4 iMtt E. $g I I R UWEIPNIX I PPOR.WALL I I AS REO'D. I I - I I 'CONC.SIAa RENF.W/J OaeW IAW,LWWF I I �OVErr6AtPay.vAg7R I I I OArsaHt OVER rGRAVEL TVP. I I BRK[LEDGE (Rot we Oran rat s I 11.41 UNFINISHED I I e I ) STORAGE I 1 AUG 2003 SCIA.U.R•ON. I I I I wML ivp. I ,TCJA.U.RDN.WALL I ) Wiaa5o top a I I ,v z Zrca+T.Callo. I I Y 2."090TWt/w. _ ,0, a I ------ I RAaESZ PLATE 1'511 I ONrC.M.U. w00051EP5 .r.,tp - r0 MPL S ABv. PN.GRADE IYP. I I Thomas French Architect Pc 6723 Whittier Ave. L O VAT E R FLOOR PLAN McLean,a VA 22 01 Tele. 703 734 0064 1/8'1 = 1'-0" Fax. 703 734 1%4 L J r � � w Notes to Omens wm: 1.co ntiema,to tt-ou *neArw dlmwmtenm so w to Y11e819tww aitlwl rewbonmapt and ■ eRQxreMs,and Anti site to Aemy so anwrofons viler to pnooeedtq with the Work. V 2.Dinwisions noted with an astetsk I-)ale aitlrat and dependent an alw-errs whh exis&V btW&V 1aoss.intemel welt or oenterlines.These dnmnmi may vary sW*to beam the . pmWWgvnwft &Dhreneterm noeA with a table ealenrin(" 1 are tees don atlKal and they very eVdY to aaxamiodate critical aligra ns MsewhWe. a.Dimensions whh ne s000n p""symeol shell he aewred to be valid and anal not vary. S.MOeder dmenefcrs we b feos d tad at new paMtlam/wels(Wass noted dMMse)and to mimed two in exm*V patddormAgfa. 6.Edenior nmsnsions M to wdetde d meethhp at new web and outside of rstsh at emfty r T, CN web. 7.Written nl'xnsnskx rub.Do not scab plans. E. ON II NOTE TO WINDOW SUPPUER: E Lr I.Wh,dow and tow s4m anted oA pennanic.A 2152 wkdow meere a Hatt tlst b 7d' t2 R wide and 5.7 tell. ~+ EX. BEDROOM EX. LIVING ROOM E E. 2 w w indo suppl to en er is opN amt*M with final window tatsoe for reArw prior to W }� prey ceder with mandeohner I _— — i rarptn openkgt to omsactor. responsible for detemYnatlon of location(s)wAne ternp red ^� NEW POstS NEW POST Rlees r n°°dn°°. ASREO'D. ASREO'D. - E. EX. E. 12 EX BREEZEWAY R . E. E. E. E. EX. HALL E. E. E. E X. PLINABING— E. _ GARAGE U INN PUCK, ABV.AS REO'D.CNASEASREO'D. U EX. BEDROOM I EX. EX. E. REMOVE IX. 010 KITCHEN 1 BRKFST. , ceN'T. E X. pip - , BATH 1 2 � _IF L IX SECMETER _ oN oN 31? E. — E. E E. CLG.SRK J VAIATED NEW ry - SMPS � \ I AN. STEPS t \ , � o 2 NSW FAMILY r R O 10 M 1 AUG 2003 I r '°C r te a ( 1 L TIEro� a C. r r r r I e. Sylac DDRS r r I r � sxeewr lapxrN601.lAaV. ___ eA,3rco-oasM. .. 1 / 1 DN tell REW. ' CLEARANCE".—// SEPRC TANK TO r ADDRON Thomas L French Architect P. 6723 Whittier A v e. MAIN FLOOR PLAN Site 402 McLean, VA 22101 Tele. 703 734 0084 1/0'1 _ 11_0it Fax. 703 734 1964 L J W Notes to Oharebns: /• ,.Oorrtraeta to +Ir review anraralaa so Be,to understand aroaa rehiorrsttipa surd V and visit aft to veluy of amerttiolm prior to wawBWV wmr tha War. 2.Deranslo re rraed with an 0aedtr e a I•)are nd�l e depa t ldert on agwww with acs" . ... feces.bsema waft a wrderfrret.These d'menaiaro my vary cYglldy to assure the I noted with a double asterisk I- )are has elan edfcal and may Vary 9Yghfy to awon 11 critical VJO alb elseMlae. 4.O ttloi lint with n0 m to lsog of s at afrel be awAvab b he valid and ehal not very. .d 5.bderl0r dbrermiona ere b law d turd a new paNfalsAvafs(relha9 noted adrerwbe)and to 6sslr0d face a eldsary pe ffawwafs. &fxbrbr a'rrraraiorm am b adeba d o e&ft a new wags end aatida of&doh a edarig T 1 �T z Wei 7.Wriden Amenahrro rule.Do na ewh plerm. INE OF HOLM BELOW Fi 1 ON 3671 DN 767 DN am1 DN NOTE TO WINDOW SUPPLIER: 6'.7 N.WALL Fb OTE:———————, v, h� T�� WIPCOW ,,, ul CLOSET DOORS TO eE tDI1VErED f.wtrdow a rd dot sizes aged ae perrerk.A 2a52 winnow meam a urdl tha b r 1'44 �----- J wide and S.r h1. F Q —NEW2x4Nr. - c 2.Wi rdow srppfa b b srypy endand wM M1rd wrrdow bkedf far review prllor bPARMION O pWchg order with nrerrrdaaurw (S/NDED}TYP H B.Wkrdow Nrppfer b tdely rasponsBb for proriarr f rough apanirps b arrtncbr24 ROOM F BEDROOM �° w b sapwefrla for daemi alto d IoatbMs)Where Derr peed f T l NEW MDR. M 7H NEW waAavl pat 2668E Posy I Aev. M H j a 0 I 12 R Z. CM;;V 3SSS Z I HALL 3� �? _ F �F �� 24 NAIF WALLTO f9 �• a•ABV.VAMrV a W a � N Z3 C 8 0 V H H 1 pl 7D71 aT �7 DII ]NI DN 12K 4On. WALL }TYP. . 'd 1 AUG 2003 Thomas French Architect Pa 6723 Whittier A v e. UPPER FLOOR PLAN Site 402 McLean, VA 22101 Tale. 703 734 0084 1/8 f1 = 1 1-0It Fax. 703 734 1964 L J f -1 W • NEW 91®DORMER AT IX OPENM IEW 94ED DORMER - 12 12 11n.ar '1nn.a Ex.Root - NEW LOW-SLOPE ROOF W � E(.ROOF 31n.X2 e ,2 — A z w 12 IIIIIfIIIII MAN 11- 'M -PORCHFLw wam Vee RIMP .. E..� 9RRGLE eASE LWER TO BOOR LNE M KALFPOST (11H69DEONLY) zenz LOWER FL � u w j LEFT SIDE ELEVATION 1/8 - 1 -0 FLOORLIPPER PEWROORNG TO MATpR OWW..". / DC CIRNEY `NEW ROOF 1In-X2 _ NEW F SONG /1 TO AMT0 4 EaSl65TN(•.AV. E1.GAR.,.. 1 AUG 2003 ® IX NEW T DETA9S ROOF TO MA TMTCH E7RSTN('.119. IX 1 ROOF 1 FEWpODF<,IC S TO MATON ERST1W..rw. IX 9l/GLE SDM ® ❑�❑^11711❑❑❑❑ IXiMN.WALL IYP. VA MATw TO ❑❑❑❑❑❑ e. CHEX,Ex..rvP. euLalEnD 5 FF1ED RCN ADDRgN LOWER FL_ Thomas French RDM.e ArchRect. 6723 Whittier Ave. FRONT ELEVATION MLean,eVA22101 Tele. 703 734 0064 1/81' = 11-011 Fax. 703 734 1964 L J NEW WNDOW w NEW91®DORMW AT IX OPENNG NEW 94ED DORMER 12 V IX ROOF NEW IOWSLOPERDOP 2 IX ROOF A '`/ 2 2 rp"'��"11 w >4 > -00 � � M z M Z V �R O ADDN, RIGHT SIDE ELEVATION 1/8 - 11-011 UPPFF ROOK ADDR,ON 5 ,,/2. /,2 �-rREwaooP-J 1 AUG 2003 IX GARAGE IXHREE2EWAV ROOF IX f' _ - UPPER FIL .. _ 00 MAN R.fillip 11111111 pill _ Thomas French UWER R_ Architect P, 6723 Whittier A v e. REAR ELEVATION Suite 402 McLean, VA 22101 pQ Tele. 703 734 0084 1/8 T T = 11-0" Fax. 703 734 1964 L J f w I V • z �, W Aww z r —--I > > L _ J � NEW NEW COL ON NEW x'a x a'a%ra NEW POST AeovE DL muLsoFm CONC. G. I — I IX Dc. L J E%. RE-POElfIX 6fEfi0UfED) PER AS REO"D. RE-PDBRION HVAC LNES� NEW POST ABOVE • � W IX FNDRE WALL aD E FACE MERIOR W/ CON X=%7RUCNRAL We PER MFGR.REQWTS. • 2%10 • PROVIDE -• I I I I OTT TDO ON SR TO DINWEUS I I I MAX P'O;; p I UIEPOSRIVE CH I RAISE _ TO MN.R ABV. I FN.GRADE TVP. 6 I I I 1 I I I I _ I BVCK VENEER TO I I I NEW R".WALL �+� I I I ~0KIPa/.wwo 1 AUG 2003 ,%NG.,w. �H OF I I I I I L————— p�� MICHELE sq g iI i r_ III I IIII UC. . .STRUCTURAL CRITERIA Jo15TNANGERrP: TUDO R No.34LOAos(vsF) LIVE oLo rorAl 774i -------- I I llm—4 STRUCTURAL FLOOR JOISTS 40 10 50 —__—_ , I _—_ ADD FOR THIN SET TILEIMAfiBLE t7 RAISE saiPLATE I __ I r J 3/STER��` ADDITIONAL CRITERIA: F:° w v I I A. %ry,�A G DEFLECTION ON ALL MANUFACTURED FLOOR JOISTS SHALL BE LIMITED TO U40o y t\S OR 1?.,WHK'J•IEVER IS LESS. A& Thomas French Architect F� 6723 Whittier A v e. MAIN FLOOR FRAMING PLAN McLean,eVA22101 Tete. 703 734 0084 1/p it = 1 T-o IT Fax. 703 734 1964 L J W V - W � Aww z x In % 1? n SI 1 TTT 1 � ' 1 , LA ISL 1 I 4 4 T 1 31 2-1 !% 1/! ffl 2-I /P% I! .OEL -17 X9/!1.R2 L idl 1 TO I! I c EAR uL I I RE-B" AMpRq MN. , RE'BI11lD 2 w a W/ % In • 1 r n O ' CHIMNEY TO GAIN - I_ J REo'D. �= Typ. ' FROM FRAMex; W I 1 J FO: LOC. % 1/7 1 7E 7 1 rZX!In I 7E In sl 1 71 %51 T'1. 1 2-17/PX71/ILVL alit . RAFrERCLP / ZX12RU(.E (SM.PSON H2.0 Tw. 2 X 10 COUAR TO LOW SLOPE RAPIERS: 2x 1202PO.C. x .LOW-SLOPE RAFTERS: 2X 12e 2PO.C. u d h 1 AUG 2003 AA j RAPIERCUP - ' TOP F COUM TB MUST BE WITIM BOTTOM (S ► jN Or M ' WWN N2%IM TOP OFW�wi ROGEAS MEASURED FROM gnnA o� MICHELE -7/T C.2XA G TUDOR m STRUCTURAL CRITERIA No.34774 LOADS(PSF) LIVE DEAD TOTAL 7.2X4 STRUCTURAL HOLD BOT.OF BEAM HIGH POST 2x6RAFIFRSe ^ ! ROOF RAFTERS 25 10 35 i0 CI EAR TOP OF ARCH a 2P O. 5e � V/ST��`O` ADD FOR GPDW AT VAULTS ♦5 40 1 CEILING JOISTS(NO STORAGE) 10 10 20 , lAL .\t' CEILING JOISTS(LIMITED STORAGE)20 "1 - 30 �o Thomas French Architect F. 6723 Whittier A v e. ROOF FRAMING PLAN 8ui1e 402 McLean, VA 22101 Tele. 703 734 0084 1'-0" Fax. 703 734 1964 L J i w R � V (/► /� MG.FAN n ❑' SPELLER Q�I SMOIE DEFECTOR W ® LOW VOLTAGE PIN UGH N mEFHOPE C«?ECRCN A. O LOCERCABNETNOCKEYMUCrUGHT p COF,iMRER HUB CONNECROH o DIRECTIONAL RECESSED UGHT ® T.V.SAT.CONNECTION Z W II ® RECESSEDW-MT ® FLOOROURET F� W e RECESSED LIGHT LOW VOLTAGE WALL OUTLET(110) L RECESSED UGIFT LOW VOLTAGE I& WALL OUTLET E11f!) WATERPROOF ® CLG.MOUNT FLUORFSCQ CWIALL) WALL OUTLET(110)WATER PROOF W ®1 UNDER CABBET LIGHT WALL OUTLET(GROUND FAULT) {} CLG.MOUM- - E7RWX;I FAN KTr WHLMOI1NfI1GM ! UGH(SYNTCm • u �'1 ® CLG. 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V f � 1 AUG 2003 Thomas French Architect PO 6723 Whittier A v e. UPPER FLOOR ELECTRICAL PLAN McLean,eVA2211 Tele. 703 734 0064 1/81' = 11-011 Fax. 703 734 1%4 L � J