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HomeMy WebLinkAbout1949 FALMOUTH ROAD/RTE 28 - Health 1949 Falmouth Road route 28) Centerville ' A= 189 003 r I �llll Ja0.ECYc�Oc� UPC 10259 No. HH1632R NASTINOS.NN ���..�Mf.Wr•'a�eN1N'ae+.,4:....:„,...,.,..w ,Mb+& 1�`��"`era;..-w�.e�1�b�Ml1.nw+BM�"'dF"1W"�'M+4y ."^w'r.-., � - ,^»�ry�^�nbrrk'�7�FF��k�'r'°d'!q'.,,,r,ypa�♦ Commonwealth of Massachusetts 003 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 1949 Falmouth Road (Office) { Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 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 outforms A. Inspector Information 64o t4 3cc on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 - sean@smjonestitle5.com License Number B. Certification I certify that:I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete.as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system- 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further:Evaluation by the Local Approving Authority 4. ❑ Fails 2/21/2020 Inspector's Signature Date: The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of.Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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 d - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name. information is required for every Centerville Ma 02632 2/21/2020 page. Cityrrown 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: .The property located at 1949 Falmouth Rd Centerville previously used as a doctor office is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 3050 Infiltrators. The system was found to be in proper working condition at the time of 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 Boardof 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name . information is required for every Centerville Ma 02632 2/21/2020 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): El 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: El 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 Title 5 Official Inspection: Form ' e Subsurface Sewage Disposal System Form - Not for Vol u ntaryAssessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet.of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: El 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 aseptic 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 El ® due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 4 of 18 Commonwealth.of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes: No El ® Static liquid level in the distribution box above.outlet.invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high groundwater 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. Ej ® . 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- El ® 10,000 gpd. El ® The cetera exemasils des r b din 310 CMR 15.303, therefore the system faetermined that one or more of the above �ilsr 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 El 0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name. information is required for every Centerville Ma 02632 2/21/2020 page. City/Town 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? El ED 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? El Were as built plans of the system obtained-and examined? (If they were not ® available note as N/A) N El Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® : ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments L 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): Description: Number of current residents: Does residence have a grinder? garbage 9 ❑ 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 El information in this report:) Yes No Laundrys ins system inspected? ❑ Yes ❑ No Seasonal use? El Yes ❑ No Water meter readings, if available (last2 years usage (gpd)):: Detail: Sum um P pump? El Yes: ® No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker -_ Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Doctors Office Design flow(based on 310 CMR 15.203): 250 Gallons per day(gpd) . . _. Basis of design flow(seats/persons/sq.ft., etc.): 250 gpd per doctor Grease trap present? ❑ Yes 0 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: vacant3+ years Last date of occupancy/use: : Date Other(describe below): 3. Pumping Records: Source of information: 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 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. Cltyrrown 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: system installed 4/11/08 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No: 5. Building Sewer(locate on site plan): 2 Depth below grade: 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,): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 1949 Falmouth Road (Office) - Property Address James H Crocker Owner Owner's Name. information is required for every Centerville Ma 02632 2/21/2020 page. Citylrown State Zip Code Date of Inspection D. System Information' (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 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 1500 gallons Dimensions: 5„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from:top of scum to top of outlet tee or baffle 7 Distance from bottom of scum to bottom of outlet tee or baffle 10" . . How were dimensions determined? Opened covers and.took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance.water level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet covers are on risers _ I 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 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town 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 atena of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene Elother(explain): i Dimensions: Capacity: gallons i :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 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every NIP a 02632 2/21/2020 page. Cityrrown 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.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): o„ 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs.of past backup. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage.Disposal System Form-Not for Vol untary.Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation.not required): If SAS not located,explain why: q. Type El leaching pits number: ® leaching chambers - number: 3 3050 Infiltrators Ej leaching galleries number: ❑ leaching trenches number, length: El 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 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town 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.): Leaching facility consists of 3 3050 Infiltrators in a 29'x12'x2'trench.Leaching facility was dry at time of inspection with o signs of past overloading. 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 pond ing, condition of vegetation, etc.): l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Vol untary.Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City/Town 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.&Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) - - - Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. Cityrrown 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 r D _ � 3 ti � o Zo � � ZZ A Z y3 i3 Z 2�i 3 y� 3 3? 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 2/21/2020 page. City(rown 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 groundwater: 12'+ 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS),. ❑ Checked with local Board of Health-.explain: ❑ Checked with local excavators, installers-(attach documentation) ❑: Accessed USGS database-explain: - You must describe how you established the high ground water elevation: Groundwater was,established by accessing town of Barnstable groundwater contour maps. 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 Vol u ntary.Assessments 1949 Falmouth Road (Office) Property Address James H Crocker Owner Owner's Name information is .required for every Centerville Ma 02632 2/21/2020 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 S 9-- 0013 Ik" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Apartment) t„ Property Address James H Crocker r� Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. Cltyrrown 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 c5l po 9,9 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address Centerville Ma 02632 CitylTown State Zip Code. 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number .B. Certification I certify that: I am.a DEP approved system inspector in full compliance with.Section 15.346 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage:disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1 ® Passes 2. El Conditionally Passes. 3.11 ❑ Needs Further.Evaluation by the Local Approving Authority 4. ❑ Fails 2/21/2020 .:. . Inspector's Signature Date: The system inspector shall submit a copy.of this inspection report to the Approving Authority(Board of.Health or DEP)within 30 days of completing this inspection.if the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at.the time of inspection and under the . conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. Cltyrrown 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: ® 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: The property located at 1940 Falmouth Rd is served by a Title V septic system.consisting of a 1000 gallon septic tank, distribution box and 2x 500 gallon precast leach chambers. The system was found to be in proper working condition at the time of 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. El Y ❑ N ❑ ND (Explain below): t5insp.doc-rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 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): . p. ❑ 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 he 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 functionin g 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 P p Title 5 Official Ins ection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system.has a septic tank and SAS and the SAS.is within a Zone 1 of.a public water supply. ❑ The system has aseptic 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. s. 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 El ® 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 g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for.Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02%21/2020 page. Cltyrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool. ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 groundwater elevation. 0 ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - - El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. El... ® 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.] ❑ Z 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 within400 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments v 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. Cltyrrown 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? ® ElWere 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, depthof liquid, depth of sludge and depth of scum? ® El: the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage.Disposal System Form - Not for.Voluntary Assessments 1949 Falmouth Road (Apartment) p. Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 3.10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd: Description: Number of current residents: 1 Does residence have a 9 garbage finder? ElYes 0 No Does residence have a water treatment unit? ❑ Yes N No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection El 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 current Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1949 Falmouth Road (Apartment) Property.Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310.C.MR 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? y Yes, No Water meter readings,.if.available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? p ❑ 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 1949 Falmouth Road (Apartment) Property:Address James H Crocker Owner Owner's Name: information is required for every Centerville Ma 02632 02/21/2020 page. City/Town State Zip Code Date of inspection D. .System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system q. ❑ 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 El Tight tank. Attach a copy of the DEP approval. El Other(describe):: Approximate age of all components, date installed (if known) and source of information: system repaired 2/28/02 per town records q. Were sewage odors detected when arriving at the site? ❑ Yes: ® No I 5.- Building Sewer(locate on site plan): 2.5 Depth below grade: 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.): Joints in good condition, no leakage, vented through roof. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 9 of 18 ... .Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 1949 Falmouth Road (Apartment) - Property Address James H Crocker Owner Owner's Name: . information is Centerville Ma 02632 02/21/2020 required for every page. Cltyrrown State . . Zip Code Date of Inspection .D. System Information (cont.) 6. Septic Tank(locate on site plan): 2 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑.fiberglass. . ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is ago confirmed by a Certificate of Com liance? attach a co of certificate Yes ❑ No 9 Y p � f PY ) ❑ 1000 gallons Dimensions: 5". Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3' 21 Scum thickness Distance from top of scum to top of outlet tee or baffle 101, Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Covers are on risers 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 Vol u ntary.Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 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 El polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee orbaffle 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. Cityfrown 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): OilDepth 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.): Distribution box was level and in good condition with no rot. water level was even with outlet invert with no signs of past backup. t5insp.doc-rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville Ma 02632 02/21✓2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I * 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: El leaching pits number ® leaching chambers number: 2 El leaching galleries number- leaching trenches p 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 i Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker Owner Owner's Name information is required for every Centerville - Ma 02632 02/21/2020 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.): leaching facility consists of 2 precast leaching chambers; no signs of past hydraulic overloading 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 i Commonwealth.&Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Vol u ntary.Assessments 1949 Falmouth Road (Apartment) 4-5 Property Address James H Crocker - Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. Cltyrrown 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.): p. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1949 Falmouth Road (Apartment) Property Address James H Crocker - Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. City/Town 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 fV o � ❑ 3 n_ t �31 _ 36 �}2 �Z 3 z3 _ (3 3 37 t5insp.doc-rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments �V'w' 1949 Falmouth Road (Apartment) Property Address James H Crocker - Owner Owner's Name information is required for every Centerville Ma 02632 02%24/2020 page. Cltyrrown 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 groundwater: 12'+ 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) . ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: - You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. 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 1949 Falmouth_ Road (Apartment) Property Address James H Crocker Owner Owner's Name. information is required for every Centerville Ma 02632 02/21/2020 page. City/Town 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 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 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppfitation for Disposal *pstem Construttion Permit Application for a Permit to Construct( ) Repair( ) Upgrade N Abandon( ) 'Complete System ❑Individual Components Location Address or Lot No. l 9 N /-'Z/m cur li, Pd. Owner's Name Address,and Tel.No. Ce- �ltrui//c sy I ve" tape_ J2,T, Assessor's Map/Parcel 1,5gleo3 !v LJ, n na A �5s�c rw/jC l??os d Z 5 5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 50&-77/-75-O Z. 7 5 +'cc t {VPa s 026d/ Type of Building: } Dwelling No.of Bedrooms /���e Lot Size 67 IU( sq.ft. Garbage Grinder OVd (p � Other TypeofBuilding ,c}c s �r No.ofPersons Y nec.hcr: Showers No) Ca.feteriaWd Other Fixtures Design Flow(min.required) /336 gpd Design flow provided /3(oZ gpd Plan Date j% A- Z o 1 7 Number of sheets Revision Date ---- Title _T,-i9k �/u> COST - �12 S Lip.," Pr-oTD,tz �1s(cm Size of Septic Tank 1/&0 114/11OW-1 2 fD Type of S.A.S. nowd, Zj. d"3 wJ/".56e.a e Description of Soil f2 +, (,n;,5 P-15 Z 57 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenanc of the afore described on-site sewage disposal system in accordance with the provisions of Tit e nvir ental-CQde an n to place the system in operation until a Certificate of Compliance has been issued by s Bo d of Hea igned MAP- Date Application Approved by Date �" O ApeOption Disapproved b � /�-- r_. ..__ Date l N 1 er')I� 'harms ,s for tl a following reasons I`l L�% �.�z I r {L,a n pj hG l -S �:I�u )z yC w,N.+ f C,+� Sr I I�;�J}+`r L S►y�+ - �J c, ,es, 1, '33� isng,rcvj P����� N Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee -- r � 20� No. D [ �_.�..e._.�r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Mjs;pogal *VgtCM (rottgtruction 3pCrm t ©jr A`- Application for a Permit to Construct( ) Repair(,, _Upgrade( ) Abandon( ) F7 Complete System ❑Individual Components Location Address or Lot No. !7 / �VV`h Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '7 1. .�.ti "D UOb�i Type of Building: Dwelling No.of Bedrooms VQc,Mrg AL. Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures � CC Design Flow(min.required) 217�0 gpd Design flow provided gpd Plan Date j l�) d�6 Number of sheets Revision Date Title Size of Septic Tank ��<"�� Q Type of S.A.S. �Uf �1,:33 X lJ Description of Soil , C.C. RAE&A Nature of Repairs or Alter tions(Answer when applicable) f7 ` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date f Application Approved by IDate Application Disapproved by: Date for the following reasons Permit No. Date Issued '.'.r'y`"'' �. - ::..::._<-_--�_: ,. ,—• :.-, :..-f r'=��,.,'_,-.--'r,-.�.-w+...,+v^x�^.�-.---w,.-wt:.�.•wa�!-�r_i^:-E-..:-.• _ �tvtv-..v '�c ;-'a"ti r-^"r'.+ No. Fee 3, Entered in computer: THE C' MON WEALTH^OF MASSACHUSETTS T PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZlppYication for �Mpogal *pgtem Congtructton Permit � '`�, u�1 Application for a Permit to Construct( ) Repair( .Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. M I �t Vvt`,\ Owner's N. e,Address,and Tel.No. - n Assessor's Map/ParcelIX o Installer's Name,Address,and Tel.No. 6 1 y Designer's Name,Address d Tel.No. 3 7 S t v tcl F"--�.K. 1 t- c.r--o D'U" ,^ ,a a s k ^^�• Sdffa�i UObS • Type of Building: Dwelling No.of Bedrooms Vpc,-N�f A (,C. Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �S� gpd Design flow provided 3� gpd Plan Date ( l'9 ilao Number of sheets Revision Date Title Size of Septic Tank /'s-1 0 - Type of S.A.S. j )'Z) .,,-`ram, 6_r. X Jl,33 X Description of Soil C P��,A Nature of Repairs or Alterations(Answer when applicable) P Zn�r',x r%o [W 6 Date last inspected: ` r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. j Sign A„ Date Application Approved by Date Application Disapproved by: r v Date for the following reasons Permit No. ^ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded ( ) Abandoned( )by SC 0 �A 'Ic�c-(1S/(_ at C 5 t:_l n�c�._saCl.,�. �� � '� Q � 6hNAn. �eas_been co strucWiacco dance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �—::CD 7C-,,LC_ Designer Q #bedrooms Approved design flow / E gpd The issuance of this permi shallot be construed as a guarantee that the system w f ction),as designed c Date Inspector �, 1 ---No. � ---� ----------------------- Fee le�p --- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 'Wigpogar �bpgtem Con.Wuctton Permit Permission is hereby granted to Construct ( ) Repair ✓) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Co stl uction ust mpleted within three years of the date of this pe r Date J �� Approved by xs_ In� � TOWN OF BARNSTABLE LOCATION /'1 t��J �-�, MCy�,' P d SEWAGE# �( + " TILLAGE _ _ ASSESSOR'S MAP&PARCEL In - d®3 INS TALLERS NAME&PHONE NO. om q SEPTIC TANK CAPACITY k CO (30)C. n L LEACHING FACILITY:(type)—N \�:-c..\'Lf� p (size) pr�!. / ; S NO.OF BEDROOMS OWNER �o� PERMIT DATE: I 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) 1 Feet Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) C,r� C', Feet FURNISHED BY C,,-et Q�W� A cry �y cl A ^%ro fi,�XA got MRVP # Assessors office (1st Floor) Assessor's Map and Parcel # ' � r d0 3 Building Department (4th Floor) Zoning INSPECTION FEE ���d RE-INSPECTION FEE $15.00 Request For A Housing Inspection For Certification Under the MA Rental Voucher Program Your Name s &,±- n � L Affiliation (Circle One) Owner Real Estate Agent Tenant Your Address G s r i �E "" K+4U�,`TV Telephone Number (Day) �{ b (Night) Address of Property W ere nspection is Requested Unit/Apt.# L� Name of Owner '►-, "`1yl�Q Address Iq 2& � wi L�z Mailing Address (if different) Telephone Number (Day) (Night) Will there be any children under the age of six (6) who will be occupying the rental unit? (circle one) Yes Was the dwelling constructed prior to 1979? oes No ------------------------------------------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwell ' n unit, o rooming unit located at rry Yin was inspected on ! Z vp _ by a Iry a, � Health Ins ect r for the Town of Barnstable and was found to be in compliance with the provisions contained within 105 CMR 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation. However, this certification does not include a determination as to whether this unit contains any lead paint because under 760 CMR 49.02 Massachusetts Rental Voucher Program, a separate lead paint inspection must be conducted. Inspector's Signature Date ?/ 2 � FORM 30 CAW HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � c S f,r16&. CITY/TOWN a D PARTMENT _ ADDRESS GSM 5V0" f3 TELEP ONE Address V 7 - t /V4'1 Occupant -)rGL44: � �H 3 �^ Floor Apartment No: No. of Occupants a— No.of Habitable Rooms_ No.Sleeping Rooms, No. dwelling or rooming units—./ No.Stories_ Name and address of owner_6_0. Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: 14—k4 Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Crlr Chimneys: 'i Central Z�-Y_ ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W-.Tanks Safety and Vent s ELECTRICAL Panels, Meters,Cir.: V j &ii ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT S (. Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room /V Yz Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas i Elect.: v - Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink f c v CZ Stove 0,226EA,0 a� �� Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: I'U Wash Basin,Shower or Tub: o/ Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: V General Building Posted orj Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI F PERJ Gam' E !�"v( 'vI T_INSPEC TIT L A. DATE 2, TIME J�. •M• A.M. THE NEXT SCHEDULED REINSPECTION '��t �`'' P.M. �,...,... ,�,,::.,���.�r�qi'R;y,,.a-'E�^+•-�.arP''_''r:i�mk..•lw wr�.•':;5�':.-'x^.T+1� �t.:�n'N.'i'iM�'�'sk";:r,dy�,�?�7 �!,"at,,t5�>'C4nR.:fr�'•32�' �,�'-'�"F.W 'i"r': �,..:r,:.,: r -,,. ... .. . 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of'a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so include shall in no way be construed as,a determination that in ever case and therefor.. is not included in this listing. Failure to c y Y 9 other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. electricity (C) Shutoff and/or failure to restore or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of'disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a•kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. _ (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner. to remedy said condition within the time so ordered by the Board of Health. lOFM30 CiKW HOBBS&WARREN'M THE COMMONWEALTH OF�MASSACHUSET�TS (IBO,ARr-) OF,, INEALTM� �Acv-4 5 f&to k CITY/TOWN a D PARTMENT . U, c y- s 3 ADDRESS // U _O TELEPHONE Address � _� _�u_ -- Occupant e.�V H S 0-^ Floor Apartment No. No. of Occupants No.of Habitable Rooms_ Y No.Sleeping Rooms No.dwelling or rooming units /_. _ No.Stories Name and address of owner_ K I_ r' _ _ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: �,. h frutiC� Roof Gutters, Drains: Walls.- Foundation: Chimney: BASEMENT Gen.Sanitation: ,/�� ry Dam ness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: " HEATING p j Chimneys: fS! oj &q Central - ❑ N Equip. Repair t TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent s ELECTRICAL Panels, Meters,Cir.: / knNA-,` v fi d by of a ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Sh.404C Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den 0 Living Room ,L//1, y>�Z Bedroom(1) Bedroom 2 Bedroom 3 Bedroom 4 _ Hot Water Facil. Sup.Ten.,Gas,160 Elect.: 9VI 30 Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink I l o.� f 14,E a. fJ O17 -dAA 4,14 k"I J) �►/U �,OL ..:_. Stove _ 6 P ct ✓ %3+!^ l�t�f�. _ 'Wo /o=_- Bathing,Toilet Facil. � Vent., Plumb.,Sanit'n.:( UZ � ,,. two k aio W Z i5 a.,,,,--X U 7S") Wash Basin, Shower or Tub: 0K WI Infestation_ Rats, Mice, Roaches or Other: Egress Dual and Obst'n: /)Pt. General Building Posted o a Aaoj 44*Ak Locks on Doors: ` ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY. ' INSPECT ��rO /4o TITLE V ^, A.M. DATE 1 Z � TIME r/`/ P.M. trG�-�1,� i - A.M. THE NEXT SCHEDULED REINSPECTION (kSr� ek_ P.M. 4 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM 30 C&w HOBBS&WARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w S`tW b(C CITY/T WN b DEPARTMENT ADDRESS i % �/�� TELEPHONE Address /9�'7 �4~44 /w� 6-*4 �"'wl��ccupant Uc-. V� " 0�..17z- 1 O ("'s cam' Floor Apartment No.— No.of Occupants Z No.of Habitable Rooms No.Sleeping Rooms '7- �v 1" fNro OCC C6- No. dwelling or rooming units � —o. Stories_ — Name and address of owner { Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. . Steps,Stairs, Porches: Dual Egress:and Obst' .: ❑ B ❑ F ❑ M Doors,Windows: vy vt.- S e&,i lU 93-/ Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen. Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su .Ten.,Gas Oi Elect.: v Stacks, Flues,Vents,Saf ies: Kitchen Facilities Sink ICUE CU� Stove & v , fr✓V R, -- -- CC �- Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE P RJUR ." INSPECTO. ' TITLE Z if A.M. DATE TIME 3 _ A.M. THE NEXT SCHEDULED REINSPECTION P.M. yt.P,, ,+.«�,wn ,x......n...ry,:r`o .n , .,.e .n ,. 'C•� '� 'e ro.0 . } .+N- r�tl?•. c w+'uv. r .,r..y... . .A .. .� 410.750: Conditions•Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter ll, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests .or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5). Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105'CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. %- FORM 30 H&w HOBBS&WARREN m THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' CIWWN I o DEPARTMENT 16 7 - Ate.. SI-e e yi , I�1�� ►k-C-0 ADDRESS M s 76 7-66 Y TELEPHONE �-- Address __ _ — Occupant_im e._ i'�� oe io Floor Apartment No. ______ No.of Occupants �,V OCGl nt No. of Habitable Rooms__No.Sleeping Rooms_- 'L t�u d M No. dwelling or rooming units o.Stories Name and address of owner___b_0r Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: •t (y c/v, S eL f 9-5-1 Roof &I G d v ef Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT S GP Ventil. L to . Outlets Walls- Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1) OK Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su .Ten.,Gas Oi Elect.: � Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink . a .cam dy C,CQl9�c C/�[v Co0 2 ._. Stove cc �Ch '{' Pf p�,c:T Bathing,Toilet Facil. Vent., Plumb.,Sanit G�a-t CD�t•atJ` �'' L- Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJURY." INSPECTO . TITLE z �,,A, Jf A.M. DATE j Z �'tl vv TIME 3"" A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 'i l oaTME�, Town of Barnstable . P# L� Department of Regulatory Services BARNSTABM ' Public Health Division Date a " A 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By:_2/4 V lLJ fL7 /'/ f(50 �4 f Witnessed BQL "�"5� LOCATION&GENERAL INFORMATLON Location Address d.e Owner's Name ��JJ( - ��j r / �UI.L(C1 �Cn�a�nV�} -7 Address Assessor's Map/Parcel: �Cj s ®0 J Engineer's Name �1 C'1 � 0/\ NEW CONSTRUCTION REPAIR Telephone# ? f i Land Use � � � Slopes(96) O Surface Stones A44 Distances from: Open Water Body ' ft Possible Wet Area ft Drinking Water Well Drainage Way ft Property Line /0 ft Other g SKETCH:(Street name,.dimensions of I /exact locations of test holes&pert tests,locate wetlands f,n proximity to holes) I � - ._ -. -,.- p�r _ S Parent material(geologic) A ' Depth o Bedrock 100 Depth to Groundwater. Standing Water in Hole: /n� Weeping from Pit FpCe Estimated Seasonal High Groundwater / . ,4 DE ATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment fG Index Well# Reading Date: Index Well level , Adj.factor- Adj, roundwater level Observation PERCOLATION TEST bate Tuna � / Hole# Time at 4" _ Depth of Perc _ Time at 6" Start Pre-soak Time @ 4-6 2 "r � Time(9"-6") le I End Pre-soak fl A141 ,Rate MinJlnch 04/ � -. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ?; , Original: Public Health Division Observation Hole Data To Be Completed on Back----------- v ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIMERCFORM.DOC DEEFOBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency,% vel Deptl Surfai TEST HOLE LOGS _ SOIL EVALUATOR : , I � Cam / WITNESS : da All DATE: — PERCOLATION RATE: ,G 4 Depi nn TH- II,t`*Z" T -Si* Surf tot" 10 62. 2` Sull Flood Insurance Rate Ma Above 500 year flood boundary No— Yes �0 Within 500 year boundary No v' Yes �.. C—� Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us t nal exist in all areas observed throughout the �-.., area proposed for the.soil absorption system? If not,what is the depth of naturally occurring per ous material?.. .U] " }C Certification ' I certify that on �d (date)I have passed the soil evaluator examination approved by the q Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. CZD Si natur Date Z g . Q\\ EPTIC03RCFORM.DOC TRANSMITTAL BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyors PQ 78 North Street,3`d Floor,Hyannis,MA 02601 Tel:(508)771-7502 Fax:(508)771-7622 h•� Date: October 27 ,2017 TO:Dave Stanton Total No.Pages: Health Dept. �..0 BN Job No.: 2017-015:01 200 Main Street h Subject: 1949 Falmouth Road(Rte.28) Hyannis;Mass. 02601 J Centerville Phone: cc: files We are sending you E Attached ❑Under Separate Cover ❑ Via Fax(No.of pages including Transmittal Sheet) ❑First Class Mail/Registered#: ; ❑ Overnight ❑Pick up ®Hand Delivery The following documents: ❑Prints/Plans ❑ Order of Conditions ❑Variance Approval E Recording Slip❑ Septic System Permit ❑Notice of Intent ❑Determination of Applicability � Other DATE COPIES NO. PAGES DESCRIPTION 3-16-17 1 3 P# 15295;Perc tests&soil logs These items are transmitted as checked below: ❑ For Your Use ❑As Requested ®For your Files ❑ For Review And Comment ❑For Recording ®As Required Remarks: If you have any questions or comments,please do not hesitate to contact me directly at 508-771-7502. Stephen A. Wilson,P.E. 0:\2017\2017-015\ADMIN\TRANSMITTALS\P#15295.doc Note: This transmittal contains privileged information.Please contact the sender immediately.if this transmittal is illegible, incomplete or not intended for your use.Thank you. I:\document templates/transmittal template I_ Town of Barnstable P# /.5 .2 9S of.t+e ro Department of Regulatory Services HAaNgrABLE. r Public Health Division Date 3 la 7 y MASS., .$. t6319. 200 Main Street,Hyannis MA 02601 prfo Mpr Date Scheduled 3 Time /0,�A'7 Fee Pd. Soil Suitability Assessment for Sew e Pisposal Performed By: Save ��/ S on 1 Witnessed By: i�✓ tv ✓f r le ,p LOCATION& GENERAL 1 INFORMATION Location Address �Y� 7 �ec f yvl a u f'Fl.I'24 (R 4 t .24 J Owner's Name �d N C,rr�-,( GGN fGr e /le Address P,U, 13v1r 666 CeNf�'rur�/�C Assessor's Map/Parcel; np. 8 q. PC/ D O 3 Engineer's Name 13_1yJ 'v- " ki ye, NEW CONSTRUCTION REPAIR /� Telephone# SO O - 77 Land Use t2 ea r GLjA-ia j 1 Dac-1 1-% CA Slopes(%) eJ Surface Stones kj ej a G Distances front: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to(toles) Parent material(geologic) u �(,/.a � Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date 3/(o 7nme Observation Hole# 3 Time at 9" /4% / 7 Depth of Perc y�z , �r Time at 6" Start Pre-sonk Time a D:L Time(9"-6") End Pre-soak u vl�G t7 Ld- A-0 soak Rate Min./Inch 'leL, Site Suitability Assessmmit: Site Passed 1pl*'O' Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation testis to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. , Q:HEALTH/W P/PERCFORM 2 cj t•7:0 15:6 1 f DEEP OBSERVATION HOLE LOG . Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,° Gravel) Q u 1' We-A,SaKzP YR 14,1,10 _ W/Ccalia4al s e OLE DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil 'Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,°°Gr vc err_ 3a�c! /0 `/l? 2/1 !6"�132 G rA ,/S, ly l o �� S� — /UG DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.° Gravel) /Yltd, Sartcl. /D Y4 S/Z �s _/Uv LFIulNr� 6tH /U Y,�. S/r — '- 132t� C �� S.•t� A W, 6b DEEP OBSERVATION HOLE.LOG Hole#_ Depth from Soil Horizon Soil To Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,°°Grovel) �6E ` �c►na� /d J� �l '^ 8,'�lhr' � �aa.Y,ySu%d to YR Flood Insurance Rate Map: Above 500 year flood boundary No_- Yes Within 500 year boundary No Yes Within 100 year flood boundary No ✓ Yes Depth of Naturally Occurrin Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the'soil absorption system? Y,�f If not,what is the depth of naturally occurring pervious material? Certification I certify that on ,( 111 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by the consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date,/Q-26- 2C/T Q:HEALTH/W P/PERCFORM Legend r r AVA c rCAI a=41=p LEI, Spot Heights(NAVD88) Intermediate _. ntours r�' - � � — Index Contou so(NAVD88) `4 VO- m 4-I s 88) ?G f 189606004 +1 1 t Barriers #3 189067 Gnces ils #192 7 > Retaining Walls It ' Stonewalls: �. - Other Walls '. 189000005 Hedges s- 11 , Pat hs Sidewalks/Walkways 0 Paved 4 - Unpaved s Swimming Pools e r ®Above Ground Swimming Pools _. a y �, �,I � _. ❑ In Ground Swimming Pools Exterior Structures ,..— .. _ 13 Decks 5 r ®.Palms .. r 1.... } Exterior Stairways. Dodos Pier . 47.73 .. ;. '� .. ❑ Boardwalks .. X _. a Tanks _. R „ Yjj Fuel Tanks r` '% Water Tanks ` Jetties/Revetments 13 Stone Jetties Revetments 189003 - 0 Concrete Jetties Revetments #.199 o +0 Wo d Jett es Revetments t7 S Recreation Facilities porlsAr as, I IlitieS Wooded Areas _rt [-1 Golf+ Areas Parcels "rF Town Boundary 0. — Railroad Tracks X r, B . � uildings Painted Lines Parking Lots ti� prl: Paved .Unpaved ... Driveways Paved ~` '189002001 Unpaved M1 � Map printed on: 10/26/201� This map is for illustration purposes only.It is not Parcel lines showlron this map are only graphic Town Of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.'1'hey are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent .67 Main Street,Hyannis,MA 026oi O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx. Scale: 1 inch= 42 feet Q cartographic errors or omissions. l,�is 2town.barnstable.ma.us YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. . DATE: a 17 Fill in please: r_.;:,�, ,,, ;;. ;:.,;i;,;a�• F�;..�,,, APPLICANT'S YOUR NAME/S: YOUR HOME ADDRESS: BUSINESS ' TELEPHONE # Home Telephone Number �n E-MAIL: OR EIN #: NAME OF CORPORATION: NAME OF- BUSINESS b - 4� TYPE OF BUSINESS s IS THIS A HOME OCCUPATION. . YES N ADDRESS OF BUSII\JESS.ng 17PTr A,5 CmlikViLil-MAP/PARCEL NUMBER Ig [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Main St. (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been inforehhatt&e**� t requirements that pertain to this type of business. Authorized Si COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing.requirements that pertain to this type of business. Authorized Signature** COMMENTS: TO' wn of Barnstable, SHE r Regulatory Services Thomas F. Geiler,Director saxlv:S�h$LE. " a Public Health Division i6s .�� ArFp ya Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: t A Z� ��Uf) Desi' er: gn InstaHer: c�Uw-I 1�1,�1 L� Address: . ��� , Address: on was issued a perm+to install a (date) (installer) septic system at �Cj q�A_ tjj�s, Qd Cc L 1 jq based on a design drawn by (address) (TV) 'R- 7 dated (designer) 1-certify that the septic system ieferenced above was installed substantially according'to e ' {.he design, which may include minor approved-changes such as latera ,relocation of the djj tribution box and/or septic tank. I certify that the septic system referenced`above.was installed vsnth'na}or,changes.'( hP,, greater thz'10' lateral relocation' of the SAS or any vertical arel6oati6n'of any component, of the.septiesystem}but in accordance with State Local,Reg lotions. Plan revisioxk or certified as-bik*designer to follow. (Installer's Signature) -C B �.>. l41AS.ON m s'tNlTAR\Pd (D er s Signature) ( V er'.s Stamp Here) 7 �` � ' PLEASE )E27ETIJRN TO l6A t1 STAEL `PUBLI.C�.HEALTH DMS1, C RTM.0 TE OF CQM]P ..IAN.CE WIIX 'NCr'7' CBE-ISSUER' 'i3N'TIL`:BOTHI:T-IS}FORM AS- BUIILTCARDARE RECETVED II'Y `HE:BAIL, STABLIE PtTBL :BTH DIVTSIOI�d THANK YOU. •t 1 Q:Health/Septic/Designer Certification Form ,+q r TOWN OF BARNSTABLE LOCATION / / �] rc, MC) p d SEWAGE# Q� `PILLAGE UAhtj �\\,f ASSESSOR'S MAP&PARCEL /n — INSTALLERS NAME&PHONE NO. �MY SEPTIC TANK CAPACITYO Q t LEACHING FACILI:TY.(type)�;� }:-,c.kU/ 301,Q(Size) 9,!'. 7.? NO.OF BEDROOMS e y {.Q, X q Deep OWNER 5 PERMIT DATE: �} p l o x COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O/) Feet Private Water Supply Well and Leaching Facility.(If any.wells exist on site or within 200 feet of leaching facility) Wl Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) C., Feet FURNISHED BY Q�c,✓1 f X%!A y', ce O :- 7 THE COMMONWEALTH OF MASSACHUSEM' Entered in computer: �, ? / Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS' Zippftcation for Migaal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(1/)Abandon( ) ❑Complete System aI vidual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's a azcel Installer's Warne,Address,and Tel.No. Designer's Name,Address and Tel.No. ,//i Cdr?�5 -7 7/ �D�1 Cat r�i/�qC = 7DD Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building Ce No.of Persons Showers( ) Cafeteria( ) \ Other Fixtures �' ® ' n e �, ✓n 2r mveorb — fr if" C .Y1ac ) Design Flow gallons per day. Calculated daily flow .y710 — gallons. / Plan Date Z4 Z. Number of sheets Revision Date Title 4 ® n Size of Septic Tank /D®®la'l 44A" '-- Type of S.A.S. Description of Soil Nature of Repairs or Nterations(A swer when applicable) A41 M413 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by Z/7 D Signed Date - Application Approved by Date Application Disapproved for Fe following reasons Permit No. Uo_� —O'7 ,V Date Issued .. t-•f No. V 2 —(�? ,� C Fee T THE COMMONWEALTH OF MASSACHUSETTS Entered in omputer: tie i Yes f �P,,UBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ;�- 01ppYicationdor' i� ogar p5teut �Cott�truction ernYit Application for a Permit to Construct( )Repair( )Upgrade(1/)Abandon( ) O Complete System "In vidual Components Location Address or Lot No. xv Owner's Name,Address and Tel.No. Asses41 sor's ap/Parcel � � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: f Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( � --Other Type;of Building RR<O&WCC� No.of Persons Showers( afeter,pia( ) # Other Fixtures ® 1` On e r-4e e✓A r Pr+rAw�v �� i . £•�%/�t =, r ,4Design Flow //� gallons per day.-Calculated dailyyflow 3340 gallons. h ; ; 'Plan Date Number of sheets ,/,� 7 1 Revision Date ` Title J�% Q� f©/� ! .�IOIy� A19-111V ✓1 Size of Septic Tank APOO 9!,il Type of S.A.S. Z f Y :%y�X 7 1 Description of Soil 1' 2—.. 6,00 04/ L4owZ I I t Nature of Repairs or Afterations(Answer when applicable) Ald k! . mid Y -. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title•5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t i Bo '.d-a HeaYt Signed Date - '; Application Approved by j..7 44'_ Date W b Application Disapproved for g following reasons E " Permit No. 2 U 0? —U 7 Date Issued , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .. Certificate of Compliance THIS IS TO CERTIFY, that th On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(✓) Abandoned( )by , &11— /O�D//W-1 at 22 /�lDG1�' �y /Y/i �t° has been constructed in accordance with the.provisions of Title 5 and the for Disposal System Construction Permit No. 7Ud?—07 r dated .2::A-0 Installer Designer The issuance of this permit shall not be construed as a guarantee that the systefjwill function as designed. Date' ?i — i�_ D� Inspector dL/ �. �✓. .. A --------------------------------------- No. _AU d 2 — _07 9l Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migaaf *pgtem Con5tructiou Permit Permission is hereby granted to Construct )Repair )Up_rade(Abandon( ) System located at 7 1=g��®y ������U/��� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p it. Date: a ' d Z Approved by �''� ' TOWN OF BARNSTABLE L i LOCATION /gam/7 1a ti RD SEWAGE # X,®7% VILLAGE � , �/� ASSESSOR'S MAP & LOT ° _ i j INSTA�LER'S NAME&PHONE NO. SEPTIC TANK CAPACITY JdEL�/Gam/ LEACHING FACILITY: (type) 1: ") lv�� (size) NO. OF BEDROOMS BUILDER O �6WNER �r�^h PERMITDATE: ea--$'B-" 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) Feet Furnished by _ L�ca�1114e- ,�S I C O 3'71 ,2s' TOWN OF BARNSTABLE err LOCATION /9�/7 /,ati RD SEWAGE VILLAGE 7` v�/ ASSESSOR'S MAP & LOT /00 INSTALLER'S NAME&PHONE NO. & SEPTIC TANK CAPACITY 1 d�GAL LEACHING FACILITY: (type) S�A g:&W g?� (size) NO. OF BED�,R/OOOMS BUILDER OtS V WNER .a n-V— PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the=Bottom of Leaching Facility 5-74 Feet Private Water Supply Well and Leaching Facility (If any wells exist ` on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) - Feet Furnished by eall g G '4�5 (93 - O - 37- t i i JOB NO. B01-25 N QTES Berry.dwg I 1. LOCUS IS A.M. 189, PARCtL 3. 2. ELEVATIONS SHOWN ARE ASSIGNED. q t°ge Rd' 00 3. LOCUS IS IN FLOOD ZONEiC ON FIRM DATED AUGUST 19, 1985. o'ss pia S 4. ALL PIPES TO BE 4" SCH �40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) (� 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. Rd' n 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. °��r GI�GIf 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". F°gym 8. IF TWO OR MORE LINES, ?ATER TEST D BOX FOR EQUAL FLOW D—BOX EXIT PIPES TO BEILEVEL FOR FIRST TWO FEET. 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. NOT TO ' BUILD UP COVERS TO WITHIN 1 OF GRADE. MORTAR CHIMNEYS IN PLACE. SCALE m �J✓ref o UJ� ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. LOCATION MAP `_ 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2 WITH 2 MIN. 1/8 TO 1/2 PEA STONE ON TOP. a fe 11. IF UNSUITABLE SOILS, OR 'SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. �4p �m �� 12. IF AN OVERDIG IS CALLED;'FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 13. PUMP AND FILL ANY EXIS ING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN +"'�n�l LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(feet) �lr`� 14. ALL CONSTRUCTION To MEET TITLE 5 AND LOCAL REGULATIONS. 0 A layer 10yr 3/3 40.0 \� L TEST HOLE DATE: January 9, 2002 891 sandy loam BENCH MARK—TOP REAR CENTER PERFORMED BY: Ron Cadillac, Soil Evaluator SEPTIC TANK = 38.18 ASSIGNED WITNESSED BY: Barnstable Perc Exemption Form B layer 10yr 5/6 a d PERC RATE: <2'-00"/inch (Cl layer) sandy loam NO GRADE CHANGES SOIL SURVEY(1993): Carver loamy coarse sand 32" GEOLOGIC MAP(1986): Barnstable plain deposits 37.3 ARE PROPOSED 40.68f w op Foundation Invert 36.93E 54"n Y WELLS Use Gas Baffle 2 DR C1 layer 10yr 5/4 Invert 36.35 Proposed loamy coarse sand 37.0=Top Conc. EXlstin S=1/4"/ft 36.7=Top Peastone 100" 31.7 1000 Gal. S=3/8 /ft C2 layer 2.5y 6/4 Tank —1 coarse sand S=1/8"/ft — — — T 24" 29.0 „ 132 no water i Invert 36.52 Invert 36.20 34.2 / 39 27 39,37 6" Stone or campact Proposed Proposed I 5.2 Bottom N/F r-20' i i N i 3 38 CALLAHAN 15 Bottom TH1=29.0 /-- LEACH . AREA 39.19 \ DESIGN DATA USE 2 500 GALLON DRY WELLS / x 38 5 SET 4' APART WITH 3' OF STONE BEDROOMS: 3 ON SIDES, AND 4' SON ENDS FOR / �OJ� \ GARBAGE GRINDER: No x 39,0 \f A 29 LONG BY 10 —10 BY 2 OZ x 7.7 38 6 •`3 9 �( B REQUIRED CAPACITY: 330 GPD DEEP LEACH AREA. x 39,3 OJ U • \ Y CENTERLINE OF EXISTING SEPTIC TANK: 1000 GAL. 5 �1 �38 84 39,43 � OLD9,42 OAD BOTTOM LEACHING AREA: 314.1 SF [(a29' X 10.83')] ----"3 / x �8 78,09 / / \ SIDE LEACHING AREA: 159:3 SF -- 39 28 J757� ± PAVED PARKING / A [2(10.83 + 29 ) X 2, DEEP)] i PAVED PARKING DESIGN CAPACITY: _ - - - — 350 GPD _ �38,74' \ [(„.14.1 SF + 159.3 SF) X .74 GPD/SF] i 38.41 \I � 38,98 2N� 39.43 / 2 / x 39, o 0 -� x 39.5 ' 3�4,58 -5nU ,, x 39,7 x 38 1 •� 0 39,95 Vv ::. cfl .. x 40,4 n �Q .. ..... :: �,:.:,.. 40,0 � 38,85 X x 3 8,5 \ 40.70 . ..... .. .. . .. MEND / GJQj . �� + BM--BACK & CENTER-OF--TOP x 3 6 PP PRZ t ::. 3 9,4 4 / STONE BOUND= 40.00 'ASSIGNED \ .'�::�;.'.. '(\NG 4� emer .;., -o �- x 41,4 �� •� x 3 91 x NAu 19 \ ... o crow .6 ., x 40. .40 0 1 -a ox 3 .7 �\ x 39.3 c x 39.3 40,8`� d 0, 40.2 X x X x 38.8 ��x \40N9 x 39,3 x 40.9 40A x 39.8 x 39 8 2 }I' 38,1 x x�40,2 x 39.5 y\)4p 2 x 40.5 40,0 x 39,5 /k O �1 t x 40,1 0.7 BENCH MARK--S.E. CORNER OF ^ �OV � V", sv g3 TH I x 0,8 x 41,7 CONC. BULKHEAD=40.70 ASSIGNED x 39,5 \ Cep 4,120 0, \v x 40,1 SITE PLAN x0 3 co FOR x 40.9 X THIS PLAN IS A VALID COPY ONLY IF IT BEARS DR . JOHN F. BERRY X AN ORIGINAL RED STAMP AND SIGNATURE. A ITARY SEWAGE DESIGN FO R APARTMENT LEGEND AT 41.76 TH I TEST HOLE LOCATION NUMBER ���j"°FMgssgcy , � �"°FMgss9� 947 FALM OU TH' ROAD' CEN TERVI LLE MA RONA ' G �° RO LD W WATER LINE MARKINGS x M s JA S E UARY 17 2002 SCALE: 1 "_OVERHEAD ELECTRIC WIRES (IF SHOWN) x 40 8 41,3 C ILL # C � 20' G GAS LINE MARKINGS �F �° �c 5779�� x 9.5 X 8,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) N/F sgNiTAR P�` �qti� �� +0 6---� EXISTING CONTOUR FRATERNAL RONALD J.�-' L LODGE BLDG. CORP.: CADILLAC, PLS, RS g-- PROPOSED CONTOUR ,°ROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN UTILITY POLE (IF SHOWN) ® EXISTING DRAINAGE CATCH BASIN P.O. BOX 258 X FENCE (IF SHOWN, NOT ALL SHOWN) - WEST YARMOUTH, MA 02673 I TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE (508) 775-9700 C 2002 `.BY R.J. CADILLAC PAGE 1 OF 1 I -- ------ - --- -- --- - --- ------ -- - ------ - - ---------- - --- --- --------=--- - --- --- -- - -- -- -------- - i ASSESSORS MAP _., ___ -- TEST HOLE LOGS NOTES: PARCEL: FLOOD ZONE SOIL EVALUATOR : ,,, rtl G 1) The installation shall comply with Title V and Town of Barnstable Board of i J " 4 Health Regulations. ( � REFERENCE: c tt . '' /� �,*�, / DATE: - - 2) The installer shall verify the location of utilities, sewer inverts and septic _. PERCOLATION RATE: G �- l components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first TH- I C � T j�#- two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed,system installation. � "Al � tt� b �.... �� iAl Lblb lia 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 1 t lc� o 7) The property is bounded by property corners and property lines. LOCATION MAP l � 5 'Jb_ 8) The property owner shall review design considerations to approve of total g P J / � design flow and number of bedrooms to be considered for design. Receipt �nt�-rvl.ta installation based on the an shall be deemed of payment for e plan and install e 1 approval of the design flow by the owner. _ w CL GZqQT1 9) The existing leaching or cesspools shall be pumped and filled with material r r � per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed Y. U sand per Title V specs. -� 10)System components to be 10 feet from water line. Sewer lines crossing the i ` water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the OZ owner to ensure such. / FLOW ESTIMATE 12)The installer is to take caution in excavation around the as line. 13 The installer shall verify the location g ,- / ) y , quantity and elevation of the sewer F .. ` 7flI offlzl�l I �? ?(Z_ .._2r�17 lines exiting the dwelling prior to the installation. S E PT I C TAN K - �! :' Z GAL/DAY x 2 DAYS -600 GAL °,. USE/. GALLON SEPTIC TANK .�iBSORPT I ON SYSTEM- SOIL !SIDE AREA: .2 �7 7 �p t BOTTOM AREA: _ � � . .u se ,�/ k All } --SEPTIC SYSTEM SECTION / k ` JrALM 42 kb V D3 . SEPTIC -TANK TANK r0 . I TNT Ca a 'Y J , 1 F , r 31TE AND SEWAGE PLAN LOCATION I FA WIN VD '023� , -- PREPARED FOR : ` } SCALE: a _ W DAV I D B . MASON DATE: DBC ENVIRONMENTAL DESIGNS w EAST SANDWICH . MA 3 DATE HEALTH AGENT ( 508 ) 833- 2 177 W Z i L... _ `y.1• ry' .,. 1.".i p. GENERAL NOTESB" A X TE R"' IN"Y" Em" .: .. , ,_i s::,,Yr st ia-•. Y• _,. ,..,,�... ,. _.. „ ,�.. �. .i ....., .. - .. r ....E 9. UTILITY INFORMATION SHOWN F ,, �. } , .. � N r - -• T . OF THIS PLAN IS TO DETAIL SEPTIC SYSTEM UPGRADE AT 1949`FALLO N ROAD. p f} 1. THE INITENT PER MASS ps OLIVER AS of 08/16/14: • THE CONTRACTOR SHALL CONTACT DIG SAFE (AT 1-888-010-SAFE) AND U71UTY COMPANIES TO r.}•,•,'7 . 2. LOCUS AREA IS COMPRISED OF WNTiNI AN A C: AREA OF CRITICAL ETVWtONNIENT aoNCERN LOCATE 111E LOCATION of ALL E)ISTNiiG UTIITES, AT LEAST 72 HOURS PRIOR TO THE START OF PER CURRENT ASSESSOR'S DOES NOT APPEAR TO BE GE: ( AL ) CONSTRUCTION. EXISTING UNOERGYIOII�D INFRASIRiJCTURE: UTILIXSr CONDUITS AND LINES ARE SHONN iN AN APPROXIMATE WAY ONLY, MAY NOT BE LIMITED 10 THOSE' SHOW HEREIN AND HAVE • SITE DOES NOT APPEAR TO BE M1HN AN AREA OF ESTIMATED HABITAT Of RARE WILDLIFE AS . w. .. . BEEN ResfaRalED BASED ON TFE AV�1A�f..ABLE UTILITY RECORDS NOTED HEREON. THE CONTRACTOR ;� . . � `: ,� .; ;{: ,.. ; rr Vie,-.��� B)UCTER NYE INNER: DAMES H. (3tOCKER, �. TRUSTEE OF SYLVAN LANE REALTY TRUST MAPPED ON MASS pS OLIVER PER NHESP "ESTIMATED HABITATS OF RARE MHr.DLIFE" FOR USE WITH fa ® BOOK 30404 PAGE 329 AGREES TO 8E FULLY RESPONISDLE FOR ANY AND ALL DAMAGES WM1CH MINT 8E OCCASIONED BY D - THE MA WETLANDS PROTECTION ACT REGULATIONS (310 CMR TOOL (UPDATED 10-26-17) THE CONiRACTOR'S FAILURE TO LOCATE SAID INFRASiRUCTURE AND UTILITIES EXACTLY. E FIELD RECORD PLAN BOOK 348 PAGE 99, MA HIGHWAY LO. 12748 CONDITIONS MR FROM PUN THE CONTRACTOR SHALL NOTIFY THE aNaNEER ;= � ENGINEERING & ASSCZWS MAP 189 SITE DOES NOT APPEAR TO CONTAIN A CERiM VERNAL POOL AS MAPPED ON MASS GIS OLIVER INFORMATION. _ IMMEDIATELY FOR POSSIBLE REDESIGN. PARCEL 003 PER NHHE'SP '(.ER11Fl0 VERNAL POOLS" (UPDATED 10--26-17) SURVEYING • SOURCE INFiORMA70 FROM PLANS HAS BEEN COMDMO WITH OBSERVED EVIDENCE OF UM70 1H) = is 3. PRUCT BEJttCHMI M AS SHOWN ON THIS PLAN SITE DOES NOT APPEAR TO BE WIIFNW A PRIORITY HABITAT AS MAPPED ON MASS GIS OLIVER PER DEVELOP A WAE1M OF THOSE UNDERGROUND UIIJIIES. HHOIEVER, UCKNVG EXCAYATION, THE EXACT 4. ZONING UIFORM ADON: MEW `PRIORITY HABITATS OF RARE SPECIES" FOR SPECIES UNDER THE MASSACHUSETTS LOCATION OF UNDERGROUND FEATURES CANNOT BE ACCURATELY, COMPLETELY AND RELIABLY DEPICTED ADDI INFORMATION IS RE THE T IS ADVISED - ENDANGERED SPECIES ACT, REGULATIONS 321 CMR 10. UPDATED 10-26-17 NFERE TK)NAL OR MORE DETAILED p1ItED, C,�1 ( ) ( ) Registered Professional Engineers ZONING DISTRICT : RC THAT EXCAVATION MAY BE NECESSARY. _ 9 9 • SiTE DOES NOT APPEAR TO BE WITHIN A STATE APPROVED ZONE I GROUNDWATER RECHARGE _ > � ": CURRENT MINIMUM ZONING RED and Land Surveyors PROTECTION AREA. UTILITIES N070 HEREON AS CW ARE SHOW BABIED ON SOURCE MMMTION y ' w _. MkLOT AREA = 87,180 SF (AM) a (RECORD PLANES) OBTAINED FROM UTILITY COMPANIES AND/OR MUNiCI'ALM LOCATIONS OF t MIN. LOT FRONTAGE - 20' SITE APPEARS TO BE WITHIN A ZONE OF CONTRIBUTION TO A SALTWATER ESTUARY (BARNSTABLE COMPILED UTILITIES SHOWN ARE TO BE CONSIDERED APPROXIMATE ONLY ��_ 78 North Street - 3rd Floor MIN. LOT WIDTH = 100' BAH. REG. 360-45). " LOCUS Map Scale. 1 =2000 Hyannis, Massachusetts 02601 MIN. YARD FRONT = 100 (RUE 28) 510E 10 RFJIR = 10 EXISTING SEPTIC SYSTEM INFORMATION OBTAINED FROM SEPTIC SYSTEM AS-BUILT TE CARDS MAXMVIHH BiNlDNVG HEJGHT = 30 OR 2 i12 STORES WHINER IS LESSER SEWAGE PERMIT P008-138 BY SCOTT FRAW AND SEWAGE PERMIT PO-078 BY RCN Phone - 508 771-7502 MAXIMUM LOT COVERAGE _ - CADILLAC RS ON FiLE AT BOARD OF HEALTH. ( ) Fax (508) 771-7622 OVERLAY DISF ICTS: RPOO, SWEP , TOWN WATER SERVICE SHOIN ON PLOW PER FIELD LOCATED DIG-SAFE MARKINGS JULY 17, 2017 www.baxter-nye.com 5. A TOLE SEARCH HAS NOT 8E'DV PERFORMED FOR THIS WE THERE MAY BE RIGHTS BY OTHERS, EASEMENT, TAIQNGS, MORTGAGES, RIGHT OF WAYS GAS SERVKIE SHOW ON PLAN PER FIELD LOCATED DIG-SAFE MARKINGS, GAS METER, AND M. NOT DEPICTED. E M7ERMN O TO BE NECESSARi', A ME MARCH NATIONAL GRID MAPPING SHALL BE PERFORMED BY OTTERS AND SUPPLED TO 94M NYE ENGINEERING & SURVEYING. ELECTRIC LINE SHOW ON THIS PUN WAS FIELD LOCATED INDICATING OVERMEAO Mum FROM UTIUTYAMT POLE 333-101 ON JULY 17, 2017. 6. THE PROPERTY LIVE IVFORMATiON s m IS BASED ON CURRENT AVMABIF W RECORD INFORMATION CONSISTING OF PLANS AND DEEDS THE OEM FEATURES SHOWN HEREON WHERE OBTAINED FROM AN ON THE GROUND FIELD SURVEY PERFORMED BY BAXIER NYE ENGINEERING & SURVEYING ON JULY, 2017. 7. COMMUNITY PANEL NUMBER: 250001 0563 J, EFFECTIVE DATE JULY 16, 2014 THE FLOOD INSURANCE RATE MAP OEM THIS AREA AS ZONE X (UN-SHADED) a f- STAMP & CONFLICTING BDUKIARY PLANS, DEEDS AN) DESCRIPTIONS ALONG NORTWASIERLY PROPERTY LINE 'ANCENT WAY". NO FEID EIADENCE OF THE ANCIENT WAY WAS FOUNDo S E:n1 ALLYN WAY SHOWN APPROXMMinY ONLY. C) wwsON ' DURING SURVEY. ' AN(30N1` . BEING � No.30216 d CONSULTANT UP 333--103 UP 333--102 ._�.... _ _ - G -- G - UP/LP 333-101 CONSULTANT OH W------, off v-------- 0H*--- off V, ----7 OH ___ OH W--_- off w------ "GE;vv- -- �r c w -- aN aH W-- •, CC B {, i 3 C CB 1 CG ' Y c �, rs, i STATE HICHVJ , . L.U. 2748 , r F1�Mtfi1T1ROAD ( ROU E 28 s c� 'tea i , � O j N 4�1 .p I � 141- 5 6 i � r ik be � �k c� . _ ccl� r t.c� i BENCHMARK < WATER GATE- cs _ PREPARED FOR : ,-- r' �'`� •- __ 4i'4 RIM EL.=47.31 NAVD88 Sylvan Lan �. 471 �� y e Realty Trust _ w MHB �� �,- 68 Wianno Avenue o x 47 F , < r Osterville, MA 02655 � X 47.3 BENCHMARK' , L \ \ `,x 47 5 x 47 8 , HYDRANT S�REET SIDE �r -t-3�45, 7 � ,,� ���5•, \ x 47, . B NNET BO NT I �--- j`-- �� �\ \ "�,. %�NN\ EDGE OF \ EL:=48.53 ( AVD88 , , �-, � �,. \ `RAVEL. DRIVE TP #1 O x 4i 9 ' ,'� N/F RICHARD P. CALLAHAN, TRUSTEE OF _. 0 46. 1927 FALh10UTH ROAD REALTY TRUST PsL 0�K Cv EOP x 47.9 S y �•. �`` DEED IMC. 27960 PG. 93 i y ` i� r� - `�``t PARCEL 189-067 47.3 � ���; x4,1 r .41U PROJECT TITLE ` pRo r, ___ -- J x 473 N F qN crr v 1949 FALMOUTH ROAD x 47 7 PARCEL 189--003 y r ; , r - o ERA ARM NE \ x 46:9 _... &o °N T Fo 67,101 t S.F. ,8_ y \, Ok Is q), LLo \ Centerville MA _ /X 7 I '� 3 D , f , { 47.4 /G S s 6 , r CONC. £ D N E ` I R 4800.GALLON i r r Q � EXISTING t 9g R '9pp L/N �\ c, Two- P i , �, •.. M R 60MA ARTMENT < BUILDIM1 4/. 1 �S O r G F R ki t r � E` E sEPTI TAN _. '�• c M e4v N O .�� KIP 2 f 149141i 7 D F 2 q t r a q 47.0 ♦ 8 pL i \ NOTE. INTERNAL P4°UMBING o r f - ExIST. 4 d 4 N .- I 8.t% r TO BE REWORKED Y /F FRATERNAL LODGE BUILDING CORP. - DECK` 47 9 DEED BK. 7467 PG. 2$2 EX. SEP'iTC SYSTEM TQ BE r _,•,_ - PLUMBER TO MATCH NEW , PAR 89- - PUMPED, D REM021D TARY SEWER,E)OT SITE BENCHMARK. •.� \ PARCEL 1 002 001 y _ f x 47 � 46. CENTER OF EAST ENDS 1' mod, `�,•..�t �_.,f,:�'1 CONCRETE PAD � \ 48 EX. TIC SYSTEM,TO Eel ELEV--4]1..W7(NAV[)88) ' �- / r PUMPED. AND R OVE9' f r X474 ' ,TP #3 � � rf ` �..- ,--X 48.2 C TP41#� t x 47 4 - ; Xi48. x 48.2^'_.__. _� ( �:(� RESERVE AREA D-00r ; i 4.6 ~' . S 1 x 4. 3 ,� �� ` / N/F CYNTHIA H. CALLAHAN, TRUSTEE OF CENTERVILLE VILLAGE REALTY TRUST o o ;o 8688 v r r 48• -o -a o ; o ; i DEED BK. PG. 243 PARCEL 189-129 ai f- > x48.9 a. "- 476 N x49.9 X 4F.4 - 12'Wx112'L LEACHIN C14o CHAMBER WITH 13 � ;� (PAD 'INC� -..` �.. NO BY DATE DESCRIPTION FLOW DIFFUSORS \ (� N ROB SHEET TITLE 800/ r L fJ Septic Upgrade Plan Ln N/F STEVEN M. BRITO do PALA J. WOLFE SHEET NO 0 �. ' KEVIN B. SHEARER do NANCY L SHEARER DEED BK. 29520 PG. 73 - N �- \ PARCEL 189-002-004 s `� C150 0 CL DATE : NOVEMBER 8, 2017 55 30 0 30 60 o SCALE IN FEET o0. SCALE : 1"=30" cv E DRAWN BY: JKL CHECKED BY: SAW JOB NO: 2017-015 FILE: 2017-015(JT.dwg O .G O m ------ --- -- ---- _.--_ - e._ --- --- ----- - -- - SEPTIC CONSTRUC110N NOTES NYE TYPICALSYSTEM PROFILE I. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V F N G) I N' F F R I N�:i & S U1 R V I Y ( N G OF THE STATE SANITARY CODE DATED SEPTEMBER 9. 2016. AS AMENDED NOT TO SCALE THROUGH THE DATE OF THIS PLAN. do ANY LOCAL RULES do REGULATIONS SEPTC SYSTEM NOTES: APPLICABLE. 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY THE ENGINEER. ggXTER NYE 1. ALL MATERIALS SHALL MEET H-20 LOADING REQUIREMENTS. ELEVATION INFORMATION MUST NOT BE CHANGED WITHOUT WRITTEN PRIOR TOP OF FINISH FLOOR = 49.4 RADE COVERS TO FINISHED G SEr MANHOLE FRAMES APPROVAL BY THE ENGINEER. RISERS & COVERS SHALL WArr 3. WHEN CONSTRUCTION IS COMPLETED. PRIOR TO BACKFIWNG. NOTIFY THE ENGINEERING & BOARD OF HEALTH AGENT AND ENGINEER FOR INSPECTION. FINISH GI . mot SffM oI& C TO GRADE SURVEYING FINISHED GRADE = 48.2t RSER # COVER SFWl 8E WW11El7T16IiT 4. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE C SCHEDULE 40 PVC. UNLESS SET ONE COWER TO FINISH GRADE. OTHERWISE.NOTED HEREIN. RISER do COVER SHALL BE rA2X LF 4" SCR 40 PVC ! GRADE - 48.2t WATER'TOff 5. EXCAVATE UNSUITABLE MATERIAL AS NOTED, TO THE 'C HORIZON" . FOR A SLOPE FROM TOP OF TANK•47.7 3" MIN. ENSURE PROPER PIPE H EXISTING SEWER LINE •. .• BErWEENORIZ. DISTANCE OF 5 SURROUNDING THE LEACHING FIELD, AND REPLACE WITH Registered Professional Engineers 40 LF 4' SCH (2) 27 t.F 4' SCH 40 PVC 4 SCH 40 • - 4o PVC AT 2x ALL CHAMBERS CLEAN SAND PER 310 CMR 15.255 TO THE TOP ELEVATION OF THE SAS. 9 g'neers �+ 40 �) and Land Surveyors AT 2X SLOPE FROM A!!. TOP OF D-BOX 48.8 2" OF 3�r =3�"OOI�LE GALLEIS C 6. INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN 3' OF NEW BUILDING SEWER W IN- 4&V Q" jam• NN OUT• 46A2`-� 2' (TO WASHED P�IO E w-�Nm� � COVER. FINISH J- OR FILTER FABRIC 78 North Street - 3rd Floor EX. INV OUT-TO REMAIN ` �� 55' LF ( 4' SCH 7. THE SEPTIC SYSTEM DESIGN DOES NOT INCLUDE GARBAGE GRINDER DISPOSALS. lgLllD GAS BAFFlE 2- 40 PVC AT 1X DIFFtI.SORS 1 OW�TE�'o Tor' of DIFF11SORs-4s o Hyannis, Massachusetts 02601 NEW BUILDING INN OUT=46.81 ' �� :�., �_ S-7 - 4' PVC 8. �* THE CONTRACTOR SHALL CONTACT DIG SAFE (AT 1-888-DIG-SAFE) GAS �.' r•'•' SLAB - i � sty otn s �� T o 0 0 0 0 o AND U11UTY COMPANIES TO LOCATE ALL EXISTING UTILITIES, AT LEAST 72 HOURS Phone - 508 77i-7502 REINFORCED C�REIE BAFRE BAFRE 8. CRUSHED , +� BEFORE THE START OF CONSTRUCTION. THE CONTRACTOR SHALL DETERMINE THE • sTONE . .. .Y� . ,.:. Fa - (508) 771-7622 „ .• W. N � ,,. ;=.;', ' .:;;;:�:;"-: = :' . •':,:.::; '' : ' •; ' Y=• EXACT LOCATION, BOTH HORIZONTALLY AND VERTICALLY. OF ALL EXISTING F FOOTING 12 .. :• w •,;:: =: :''•'. : .� ; .,'::,': •: r: UTILITIES BEFORE THE START OF ANY WORK. THE LOCATION OF EXISTING •• "-77 UNDERGROUND UTILITIES ARE SHOWN IN AN APPROXIMATE WAY ONLY, MAY NOT WWWboxter-nye.com 6• CRUSHED STONE tk=MWE SOUS. BELOW THE PE400NE ELEV (flDP BE LIMITED TO THOSE SHOWN HEREON AND HAVE NOT BEEN INDEPENDENTLY BASE OF SAS). SHA BE REMOVED M THE -C HORIZON- y MIN � - t>f- ELEv42 o u. VERIFIED BY THE OWNER OR ITS REPRESENTATIVE. THE CONTRACTOR AGREES TO SEE CONS RwnON NOTE #5 HOOK SEE NOTE f2-�' STOlE BE FULLY RESPONSIBLE FOR ANY AND ALL DAMAGES WHICH MIGHT BE 34st OCCASIONED BY THE CONTRACTOR'S FAILURE TO LOCATE THE UTILITIES EXACTLY. SHOREY ST4ODO_HZ0 OR EQUAL l R T No t.YtotJrIDMY►TER OBSERVED To E1E1I. �X IF ELE.AT10N INFORMATION DIFFERS FROM PLAN INFORMATION, THE CONTRACTOR TO BE SWALLED ON A LEVEL STABLE BASE SHOREY DB-9 H-20 OR EQUAL SHALL NOTIFY THE ENGINEER IMMEDIATELY FOR POSSIBLE REDESIGN. AT UTILITY SEPTIC TANK TO BE INSPECTED & CLEANED ANNUALLY TO BE INSTAl1E1) ON A LEVEL. STABLE BASE L6A�i �C�WIBi Q�.�DFf�Oi� CROSSINGS. VERIFY IN FIELD THE LOCATION / INVERTS OF ELECTRIC, GAS, H-Y0 TELEPHONE & DATA/COMM AND RELOCATE IF CONFLICTING WITH PROPOSED INVERTS PER THE ENGINEERS DIRECTION. THE CONTRACTOR SHALL PRESERVE ALL UNDERGROUND UTILITIES AS REQUIRED. 9. THE PROPOSED UTILITY CONNECTIONS SHOWN HEREON ARE SCHEMATIC. FINAL UQW DEPTH IN SEPTIC TANK DEPTH OF OUTNET TEE BELOW FLDW LINE LAYOUT SHALL BE AS DETERMINED BY THE APPROPRIATE U7IUTY COMPANY. 4 FEET 14 INCHES ��P 9 STAMP 5 FEET 19 INCHES 7 FEET 24 INCHES o�' SI EPHEN �yG 8 FEET 34 INCHES ALLYN SO 0 wksory N�. 216 V' e�0 ,9FG/Sp,�� �SSf�NAL AMW COMM 6ELOWGRADE CONSULTANT .r �. ,••• :�: ; •' i. v:'.9 • •;� • .�'.i :•i.+ -.. ,'yam .•.A:•. .4• '•' •S.•. �• 41 4 14 • �rW,Vli OR • GE0IEXTKE FABArC ; . •. ,. .c.. F_z •1 0 N= - • 24* _• _ ;• .4 1••',•: WASHED STONE •. " a.r, •`•:ti' •,• • 'r....� ,1. i ^ ` 4 DEPTH .•,.• • �� ♦. yr• . . _ :, :,• . ,: CONSULTANT 4' 104' 4' 112 (H-20 LOADING) ' \13 FLOW DIFFFUSORS NO SCAE 2) NO SCALE PREPARED FOR : Sylvan Lane Realty Trust 68 Wianno Avenue Osterville, MA 02655 PROJECT TITLE 1949 FALMOUTH ROAD Centerville, MA am LM P-1w DATE=OOVIQ,ID SOIL EVALUATOR: BARNSTABLEBOARD OF HEALTH AGENT: STEW WILSON, P.E. DAVE STANTON, R.S. TEST PIT 1 TEST PIT 2 TEST PIT 3 TEST PIT 4 G.S.E. = 45.5t G.S.E. = 47.0± " " G.S.E. = 48.0t SEPTIC SYSTEM DESIGN REQUIREMENTS: ' 49.Of 0 0, ,O, "01, GARBAGE GRINDER (NOT INCLUDED) = N/A NITROGEN LOADING LIMITATION: 4" 3" 4" 6, DOCTOR OFFICE: 4 DOCTORS x 250 GPD/DOCTOR = 1000 GPD BOH REG. SECTION 360-45 (SALTWATER ESTUARIES) Ap; IOYR 2/1 LOAMY SAND A IOYR 2/1 LOAMY SAND E, IOYR 5/2 ; MED. SAND E; IOYR 4/1 MED. SAND a; RESIDENTIAL: 3 BEDROOMS x 110 GPD/BEDROOM = 330 GPD 67,101 SF x 440 GPD/40,000 SF = 738 GPD TOTAL- 1330 GPD* *GRANDFATHERED FLOW PER VARIANCE APPROVAL #1979-54 8" 8" 6" 8' B ; 10YR 3/3 ; LOAMY SAND B ; 10YR 4/1 LOAMY SAND B1; IOYR 5/8 ; LOAMY SAND B ; IOYR 5/8 ; LOAMY SAND PERC RATE = <5 MIN. / INCH (CLASS 1) LIAR = 0.74 GPD/SF • 18" 16" 14" 18" N C ; 1OYR 4/6 ; MED. SAND C ; 1 OYR 5/6 ; MED. SAND C ; i OYR 6/8 ; MED. SAND C ; I OYR 6/6 ; MED. SAND NO BY DATE DESCRIPTION o MIN. LEACHING AREA OF S.A.S. REQUIRED: 132' (PERC/A042�S 132" W/COBBLES wM 138" SHEET TITLE 1330 GPD/ 0.74 GPD/SF = 1797 SF MIN. NO WATER OBSERVED NO WATER OBSERVED NO WATER OBSERVED ez PROPOSED, SYSTEM: 13 FLOW DIFFUSORS; 1' OF STONE BENEATH .CHAMBERS do 4' OF STONE ON ALL SIDES C 2 ; IOYR 7/4 ; MED. SAND Septic System Design SIDEWALL AREA: (12' + 112') x 2'(2) Profile & Details s 496 SF 132'NO WATER OBSERVEDB CA BOTTOM AREA: (12' x 112') 1344 SF o TOTAL EFFECTIVE LEACHING AREA: 1840 SF EL 34.5 EL 36.0 EL 38.0 EL 37.0 � SYSTEM DESIGN CAPACI7Y = 1840 SF x 0.74 GPD/SF = 1362 GPD > 1330 GPD. OK. SHEET NO 0 1 CERTIFY THAT IN APRIL 1995, 1 PASSED THE SOIL EVALUATOR EXAMINATION APPROVED ff SEPTIC TANK SIZING: FIRST COMPARTMENT=1330 GPD x 200% = 2660 GAL BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE ANALYSIS a SECOND COMPARTMENT=1330 GPD x 100% = 1330 GAL WAS PERFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE AND (48 HR AND 24 HR = 2660 + 1330 = 3990 GAL) EXPERIENCE DESCRIBED IN 310 CMR 15.017. D A T E : NOVEMBER 8, 2017 OE 4000 GALLON TWO COMPARTMENT SEPTIC TANK SIGNATURE DATE (P-Zor 7 O LC !( -2622))aL E S C A L E : NOT TO SCALE o DRAWN BY: JKL CHECKED BY: SAW J O B N O: 2017-015 F I L E: 2017-015 PSdwq 0 m