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Home My WebLink About0048 BRIDGET'S PATH - Health 48 Bridge'ts Path Centerville A = 170 - 241 S M E A D No.2-153LOR UPC 12534 smaad.com Made In USA Pm um Y lm BMW 1!E 01A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y— 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. Cilyrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: /�1 key to move your S(� cursor-do not David D. Coughanowr, IRS U use the return Name of Inspector key. Eco-Tech Environmental ICI Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based ing and expe i the proper function and maintenance of on site sewage disposal s Pap ely inspector pursuant to Section 15.340 of Title 5(310 CM bAVttT 9 �� Up.- .JN . o l)pVID ® Passes C.003HANOWR' �8a �u�R s ElF Me El 1093 -mob ❑ Needs h Y aslua b ,A �sW hority �. o. Sq fT .,r� CEVAtUAL • October 6, 2013 Inspector's Signature Date CI7 N r+ The system inspector shall submit a copy of this inspection report to the Approving Authd%(Boa d 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 DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r� zi 3 t5ins•3/13 _ - 'Title 5 OjInspen rm:Subsurface Sewage Disposal System•page 1-ot 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form ` — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system.components as described in the"Conditional Pass"section,need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no,&-not determined"(Y;,N, ND)for.the following statements. If"not determined," please explai ., y The septic tank is metal and over 20+years old*;or the septic,tank(whether metal or not) is structurally unsound, exhibits substantial mfiltr`aiioiitor exfiltration or tank failure is.imminent. System will pass inspection if the existing tank is replaced with a''complying septic tanklas approved by the Board of Health. , - ° A metaliseptic tank will pass insp ction�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. r ❑ .Y ❑-N ❑ ND(Explain below): a 15ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): T C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,^M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 133 gpd 9 ( Y 9 (gpd)): Detail 2011-2012 Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: occupant Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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): Septic Tank and Leach Pit t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 31+ years. Certificate of Compliance for new system issued 6/8/1982 (Permit#82-285) Were sewage odors detected when arriving at the site? ❑ Yes ® No 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: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 0.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 x 5 x 6-1000 gallon Sludge depth: 2 in (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32 in Scum thickness none Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended every 2-4 years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: - . Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Cover was removed and 1.5 feet of leaching capacity remain. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 L 0CA V ONS LEACH -OF SEPTIC COMPONENTS PIT -DISTANCES IN DECIMAL FEET A 8 1 41 22 2 49 35 1000 GALLON SEPTIC TANK 1 THIS SKETCH IS A 8 BEST VIEWED IN EX§STING COLOR FORMAT DWELLING ELL INNG 48 Ui 3 W Z 0 Ui Q a 3 508 364-0894 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 14 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: 6/4/1982 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 of Barnstable GIS Department records You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of leaching pit to be 4 feet above the bottom of a witnessed test pit on 3/2/79 in which no groundwater was observed. Applying a groundwater adjustment of 2.8 feet(Index well SDW-252, Zone D, February 24, 1979 reading =47.0) demonstrates that the bottom of the leach pit is above the adjusted high groundwater elevation.Town of Barnstable GIS Department records indicate that the property is 14 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 48 Bridgets Path Property Address Frances T. Paparo Owner Owner's Name information is required for every Centerville MA 02632 October 6, 2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE - NOT TO SCALE Z Q w A a x 4 PRECAST yLEACH Ln r W it"iigg+ PIT ° w +Y f' Z BOTTOM OF a LEACHING � PER DESIGN � PLAN LEACHING IS ABOVE HIGH GROUNDWATER t— 4� o 4- ¢~� nj Q NO GROUNDWATER ENCOUNTERED GROUNDWATER ELEVATION PER GIS MAPS (Sins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 L0 CATION S E W A G E PE RMIT -NO. / ® T VILLAGE R / INSTA LLER'S NAME i ' AD.ORESS 0 U I L D E R OR OWNER ►i i� -X 0 2.y DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED w '�+ry' -� ..•;• .� a�. yc a� ,��, , '� i w ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......................OF..Z!9.it•�sr!fQ....... ApplirFation for Uispoii al Works Cnnnitnutiun rr"tttit Application is hereby made for a Permit to Construct (✓j or Repair ( ) an Individual Sewage Disposal System at: Location-Address A or Lot No. • !S= '�'p`"� ....�79 �Y9..� -••...............•............. ...:C.ie!Si_t�lkt!:�Y ....... -.......................................... Owner Address a SiP...TAU..... --•-•-----•--•------••-----•-----•- --.. T=! t- ................•-•----•--•-------•---•-------•-----......-•-•--•. Installer Address dType of Building Size Lot.. .......Sq. feet Dwelling—No. of Bedrooms.....Th .............................Expansion Attic (Ar4; Garbage Grinder (�tld� per, Other—Type of Building ....... No. of persons.......3................. Showers (Z_ — Cafeteria (wr4 Q' Other fixtures -----------•--•-••----•-•-•---•. . W Design Flow..............lLd......................gallons per person per day. Total daily flow..__....._._._..........._3 3...Q.._gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x 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 ( ) Percolation Test Results Performed by....... ....._7- Vl�.....691t. Date........ ........................... Test Pit No. 1.......A.....minutes per inch Depth of Test Pit........ZiR..`... Depth to ground water_APQ- — (i Test Pit No. 2.......:........minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ra ---•-----•-------------------------••---•-•--------•---•---------•-•-•-••-•--•---••-----•-----------.......................................................... •-•---•---= ----••......--•---•. Description of Soil Q_-, .eSQ .°...se ,ro{G s 5�� r.'a ..................................'' ` W ---•--••---•----•---------------•--•••----•---•-----------•------•----------------•---..........-------•------------------------•••-•--•---••--•--•-----------•---•-•-•-•-••-•-••--•-••..........-•-•-- VNature 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:ITLL- 5 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. Signed..... . ............. ...i.................................................... ---6' y- ------ Dat Application Approved By-•-•---•-••. -•: =..- . .. •.................................. ,,-= Date Application Disapproved for the following reasons:.............................................................................................................. .....................•--•----•---•-----------......------------------------------•--.....--••--------•-----••--------------------------------------------------------------------------------.......... Date PermitNo........................................................ Issued....................................................... Date ��- �� ^ � - ` ^ ��m-��^----_ � � THE CoMMomvvsxcrH OF MAseAoxussTrs � �� HEALTH � �°�~^�" ~�~ ~=" ________��p_�7�,..��_�.`+�__________________ ` `. for�� lliiivatial Workii Towit4urfillit frnat � is hereby made for u Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ' �6' '�' ^ '_-__---_��-'--...=---'-^__----'--'---_-'-----__- _-'----------'-'__'-__- ...................... �� mu or ......................-.......................................................................... ..........-..................................................................................... o°ner.,,~ Address � ----'--------------------------------------------' -------.----------------------------------------_ ' Instal e, Aadr"s s +c' n '--7ypo of Building Size .o�- � .-.......Sq. feet Dwelling—No. of Bedrooms �'�' ' ' --�---ioo A�� Garbage Grinder ( �9�� - z ) - Cafeteria of Building ------------_'- Jo. of persons ^ 04 04 -, Other .� ~~.^^`. -'----...-__--------.--_----.---.-.-_--.----------_----'��'_'-_----'--- Design F�n�_'__-.��.__--_-'-. per person per day. Totalda�vflow._-_----�-'__...3.._�' . Septic Tank—Liquid ................ ---------------- ' Disposal Trench--No .................... Width.................... Total Length.................... Total area.----'--'--og 8. Seepage Pit No.----..-- Diaoeter------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (~- ) Dosing tank ~~ Percolation Test Results Performed bv-.-.��'�..��.��.c'�---'�z.°��.�.--'^m,..~, D�e--' .�. .......... . ^� ' /� � ' �� Test P� ��o. ]---.---.minutes per inch Depth of Test Pd---__--' Depth to ground nmtcr.--..�.----_. Test Pit No. 2-----.--.minutes per inch Depth of Test Pit.................... Depth to ground water........................ -` .............................................................. --'- _--_-,-_' of -- ---_- --------------------------------------------------------------------- ------------------- ----------.-.------'---'-_-.--_---.---_-_--_--------_''-_---'-_---_------_-'--_---. � U Nature of Repairs or Alterations--Answer when applicable............................................................... ............................... -----_------_-.----'---'---'_-'_-----.--'-___._-----_--------'-_--_---'_--`-_''__-'----_-- | Agreement:` | The undersigned agrees to install the uforedeyccibc6 Individual Sewage Disposal System in accordance with the provisions of TITI 5 of He State Sanitary Codc—The undersigned further agrees not to place the system in operation oo6l u Certificate of Compliance has been issued by h nlof ................................' - -------------'.'-�-- *a ` ' DateApplication Approved 8y_--------_------------__�-----'------------'--- DateApplication Disapproved � for the following reasons:................................................................................................................ ---------------___---..__'--___--__.___------___--___-'__-__--_-'_--__-_--_'----_�- . "=e | Permit Date THE COMMONWEALTH orMAsSAcxussrrs BOARD OF HEALTH --------------OF---------------------------- (Intufiratr of THIS IS ,TO ,That,the Individual Sewage Disposal System constructed (- ) or Repaired / ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- '7-e.U' e- at-------'-----------'--'---''----------' -------------'--------------- has been installed in accordance with th6 provisions of TI E 5 of The State Sanitary Code as described in the � application for Disposal Works Construction Permit No......................................... dated_--------_--_.----' � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA�U� RY. [��TI�----------------------'��-�+��------ Iooyeotor------�~��'^�---_------------------------- _~�� w-^ ' THE coMmowvvEAcrH OF MxssACxuSsrrs , BOARD OF HEALTH -76�,' ~ � ...........................................OF-'-'.------------------------' No......................... FEE........................ to at N � ao shown oothe application for Disposal Works N ' ��'----_-----'------_- DATE............................................................................... | ,onw 1255 xoaeo * WARREN. INC., puoLIsxcns p�slGt`► DATA t►�GLC= MlL -- � BF OR.QoM � �� s FA Y oA,LY FLOW z Ilox 3 = 3306.Ps? 5EPT►c -tAtiK = 330x15o% =-4956.P. Q y� U51=- 1000 GA►-. 9� 9 9�. 9 da I p¢oP DISPOSAL P1T U5E~ I000 C7G�L. p,r 5%pF-WALL Ae.Ea. = t 5o S.F ,o¢cr9 a Igo 5.t: X 2.5 = 375 G.po 0 — -- Ffroto 0 50TTOM AP-EA= �O 5,F• Z ThAv.-,3 � 5a S.F.- x I r o - 5 o G.P o 'ToTA1- aEStGN : Ar2l ••TaTAL. DA t L�( FLotr! - 33o G Po 32'± �� PE2COLATIDK! RATE I'�tly 2MEN c�czl�55 30 ?EEC Te!3T &-f GQav u.. TAycoz cow. 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': '�I 1 f! 1 i i•�• - p ill n -,r .tx � s -'L[>� ,.r s".a---�"'-r'i : ;,, 5 `"•—sue 1 gy:- '°5 -t 1 a�z�5, y, ��a a� � ,��.�.�•�-.s�'.,%��"{ "�;� �`x��i?�a -z--"�r�.'�4.� - C 9 1 � •• a e oe �,r£ r t 4.9•^• K x .y. ��....;' .w�Si.��j'3'x-�d*�1#..}. .�._- '+",91€^'�il'�.,a��P T1a��,y;�r•�� `��4��ti.. �'�r�� .'.s,�.a�.''..�v._.S_...�....�4.", .,.,..:L:. /�. .C'> _.i a .gs.�„x��'��5-�v r�"'�"T,..�c�r�-`vA�s—�-Y`�r�`�� ,s t ,.: '�`�,.�a- ia�-��•�v=4r'�•"k':;a-�a `�,r^r:_a a� _ Y - x ��-��. kt�.,�F<i'��-`F ;��-:�F.�e-�,,,41,_y'.�a;'�.�r"�. �� x.t€. ��k'i4�,°".F�La4�'`�`_s�a � -:--•--�.• '�: _ a 1' -All R' • .e sue.:+a �:.±`-t Y. , aY-?•: 1 [Y sake a. is�� a?r11 ,. a'•Ee �:T:H o :! a:' 1eI11tc1i a+. C.a:. ti Ie :U aYll s :1' :11 I a IP.. •� a �_ - aria "�1t:1- =a.l{-:• •I -:11 •1- Ih:6Y. •1 "•111111 • 1 t = _ ,.elifllY"•. Iial . 31�- 1 caa- :9 ti a a,:•! ei •1 '.ae= 71 la 11 - a•'-•-11 - .-.1 Illi+i9 Il: II1: ' :i/le,_-1t7a1F:• - BeamChek v2007 licensed to:Glampietro Architects Reg#7124-1030 Davies/Paparto l3 Date:12/05/10 $aGC Selection (2)1-3/4x 11 718 1.9E TJ Mlefollam LVL W=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=2.5 W R2=2.5 W (1.5)DL Deft-- 0.56 in Data Beam Span 16.0 ft Beam Wt per ft 10.68# Ream 1 TL 1885# Reaction 2 TL 1885# Bm Wt tnctuded 171# Maximum V 1885# Max Moment 7542 V Max V(Reduced) 1652# TL Max Deft L f 240 TL Actual Deft L 1342 Attributes Section Shear M TL Deft(in) Actual 8226 41.56 0.56 Critical 34.76 8.70 0.80 Status OK OK OK Ratio 42% 21% 70/8 Fb(psi) Fv ) E(psi x mil) Fc t (P } Values Reference Values 26W 285 11 750 Values 2OD4 285 1.9 750 Adiusiments CF Size Factor 1.001 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress WA Cm Wet.Use 10Ff 1.00 1.00 1.00 Cl Sfah tif'ttf 1 EIOQEI Rh=0mo Le=0-00 Ft Kbe 00 Loads Uniform TL:225 =A Unarm Load A R1=1885 R2=1885 SPAN=16 FT Uniform and pmfrat urftm haft are Ms per f neat fL BeamChek v2007 licensed to:Giampietro Architects Reg#7124-1030 Davies/Papagb Back Beam alternate ''l Date: 12/05/10 Selection (4)2x 12 SPF#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=4.5 in2 R2=4.5 in2 (1.5)DL Defl= 0.53 in Data Beam Span 16.0 ft Beam Wt per ft 16.4# Reaction 1 TL 1931# Reaction 2 TL 1931# Bm Wt•Induded 262# Maximum V 1931# Max Moment 7725`# Max V(Reduced) 1705# TL Max Dell L/240 TL Actual Dell L 1359 Attributes Section(in) Shear i TL Dell m Actual 126.56 67.50 0.53 Critical 105.94 18.94 0.80 Status OK OK OK Ratio 840/6 28% 67% Fb si Fv psi E(psi x mil Fc L (psi) Values Reference Values 875 135 1.4 425 Adjusted Values 875 135 1.4 425 Adiustments CF Size Factor 1.000 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress WA Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL:225 =A No.4MFdMWA IA Uniform Load A Q 0 R1 =1931 R2=1931 SPAN=16 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2007licensed to:Giampietro Architects Reg#7124-1030 Davies/Papapp Middle Beam fbPAY-l 2 Date: 12/05/10 Selection =(3)22 SPF#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=3.3 in2 R2=3.3 in2 (1.5)DL Defl= 0.52 in Data Beam Span 16.0 ft Beam Wt per ft 12.3# Reaction 1 TL 1418# Reaction 2 TL 1418# Bm Wt-Included197# Maximum V 1418# Max Moment 5674# Max V(Reduced) 1252# TL Max Defl L/240 TL Actual Defl L/367 Attributes Section(inj Shear in TL Defl(in) Actual 94.92 50.63 0.52 Critical 77.81 13.91 0.80 Status OK OK OK Ratio 82% 27% 65% Fb(psi) Fv(psi) E psi x mil Fc L (psi) Values Reference Values 875 135 1.4 425 Adjusted Values 875 135 1.4 425 Adiustments CF Size Factor 1.000 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00- 1.00 1.00 1.00 CI Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 165 =A Uniform Load A Q Q R1 = 1418 R2=1418 SPAN=16 FT Uniform and partial uniform loads are lbs per lineal ft. BeamChek v2007 licensed to:Giampietro A►chitects Reg#7124-1030 Davies/Papanp Continuous Hdr @ Front Date:12/05/10 Selection (2)2x 12 SPF#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=3.7 in2 R2=3.7 inz (1.5)DL Defl= 0.17 in Data Beam Span 9.33 ft Beam Wt per ft 8.2# Reaction 1 TL 1578# Reaction 2 TL 1578# Bm Wt.Included 77# Maximum V 1578# Max Moment 3680 W Max V(Reduced) 1261# TL Max Defl L/240 TL Actual Defl L/646 Attributes Section in Shear( TL Defl(in Actual 63.28 33.75 0.17 Critical 50.47 14.01 0.47 Status OK OK OK Ratio 80% 42% 37% Fb(psi) Fv(psi) E(psi x mil) Fc (psi) Values Reference Values 875 135 1.4 425 Adjusted Values 875 135 1.4 425 Adiustments CF Size Factor- 1.000 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 330 =A Uniform Load A 0 R1 =1578 R2=1578 SPAN=9.33 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2007licensed to.Giampietro Architects Reg#7124-1030 Davies/Papaso Roof Rafters @ 16"OC S � ?" Date:12/05/10 Selection 2x 8 SPF#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=0.6 in2 R2=0.6 in2 (1.5)DL Defl= 0.32 in Data Beam Span 11.0 ft Beam Wt per ft 2.64# Reaction 1 TL 235# Reaction 2 TL 235# Bm Wt Included 29# Maximum V 235# Max Moment 645 # Max V(Reduced) 209# TL Max Defl L/240 TL Actual Deft L/418 Attributes Section in Shear(irrj TL Defl(in) Actual 13.14 10.88 0.32 Critical 7.37 2.32 0.55 Status OK OK OK Ratio 56% 21% 57% Fb( si) Fv(psi) E(psi x mil) Fc L (psi) Values Reference Values 875 135 1.4 425 Adjusted Values 1050 135 1.4 425 Adiustments CF Size Factor 1.200 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL:40 =A Uniform Load A 0 R1 =235 R2=235 SPAN=11 FT Uniform and partial uniform loads are lbs per lineal ft. BeamChek v2007licensed to:GiampieW Architects Reg#7124-1030 Davies/Paparto 11'span/no finish materials Garage Ceiling Joists(A no"O.L. Date: 12/05/10 Selection 2x 6 SPF#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=0.3 in2 R2=0.3 inz (1.5)DL Defl= 0.37 in Data Beam Span 11.0 ft Beam Wt per ft 2.0# Reaction 1 TL 121 # Reaction 2 TL 121 # Bm Wt Included . 22# Maximum V 121 # Max Moment 333 W Max V(Reduced) 111# TL Max Defl L/240 TL Actual Defl L/354 Attributes Section rnj Shear(inj TL Defl(in) Actual 7.56 8.25 0.37 Critical 3.51 1.23 0.55 Status OK OK OK Ratio 46% 15% 68% Fb(psi) Fv(psi) E(psi x mil) Fc I (psi) Values Reference Values 875 135 1.4 425 Adjusted Values 1138 135 1.4 425 Adjustments CF Size Factor 1.300 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 20 =A Uniform Load A RI 121 R2=121 SPAN=11 FT Uniform and partial uniform loads are Ibs per lineal ft. �. - Zp j g a - W : t 0 _ Y, i. r �h E .. : ... _. . ._ �✓ Di Ale t f }7`V� II .,M . 1 ........-.__ - --- r uE . -- _ ( ,d•x t, po�s`� �,+G �' � � � 1 :.1�-Lam:.�atrL _- _ 1 _. 7-7 rR� C�LLiK?51 .x�s-Dow Cce�lG.syl =-. h�5tr tn�{�2Ic z • ,I >r C. .,,-44 I oJ. Aj a .N w WHO I � .t i. _ .: .. ....n�.. .Asa, wv s•.,..i�s..t� _,1 ..__fee.ler•�i1_ LAIL • �ti `��Ht�.V[ �-'1.41►..1Cal�S 1c�.11-1/�'�'Gt•� �. i`t -+ �(.:�, :� �. � �L�12�!'e•�'�'11�:•�L, .S,r^''"'-ti.. r' �'�. :.. '� - ��►� i P`I�1 G.1.1�s_.. i tis ._ ::" IL. 2'� t3 TITLE. . DRAWING-- " WIN j IUD 1 �+ Us ! -t 41, >*.a .r` �i�T ��i a �,. Mom• 1cat,.I •� -.1, -. . . - f f-- . 1 tit P n ' .. P ,4 I -,..It? l�l ul . .1V1�.: ; �..Fs r, • �pIT+ePI-�.��ao►2 t k. �.. . A, _ � ,,� _ � �' .:��.► - gip_��r :=�r�a �--�-,-- �^_--. .:.i" ' �.,6 lQ � I I � .. i Y _. ._... M PROJECT• K � ' .... _ ' I SIIEET.No.. 11T ... I :... .- '... • 1 i . .:. .. _ L.tom..:r �,�...�: .. -