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HomeMy WebLinkAbout0031 HARVEST LANE - Health 31 Harvest Lane Centerville 209 067001 No. 4210 1/3 ORA Pendaflexo 10% 'W ;I iN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address rti7 John Bartlett Owner Owner's Name 7 information is required for every Centerville V1 Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection h7 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. Excavation Company � Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-5-15 Inspector's ' ture 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. 0 V-5 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal SywemPage of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 s TOWN OF BARNSTABLE OCATION L 3 Ul,cus: /T E#3 v S P If �;dILLAGE bm7-Qr 6 Ill ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO.?'fir C IL h PlA ,I �-f a£°j' l�l'1 rJ SEPTIC TANK CAPACITY 150 C C® LEACHING FACILITY. (type) V �b4erS (size) NO.OF BEDROOMS OWNER ha 01 rd PERMIT DATE: CODE DATE�✓1 S09 9 90 f;; 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 I trt;tr r J f f f r r r f J f ! lyf4ltftltftltftltf4l4ftf4ftftf\�\�t`.,f.,ft Jtr.tif4f4r4r�f r J"r r \ \ \ \ t \ 4 4 \ k 4 r f ! f f f f t 4 \r\f\f 6 I f f f f ! f \ t 4 t t 4 \ t f J tl4ft t \ 4 t t 4r4ft f i ! I ! f I \ i r l4 f4f%4f t QQQ \ 4 4 \ \ \f41tl4ftf4l\Jt Y 4r\f"6r4 f rt 4f4f4ftltr4l4l4r4f4/\ i f r r f f r r f r4ft 8 y fr Cover 36 @ grade Front Yard Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the-distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is Ma 02632 11-5-15 required for every Centerville page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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? El ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gp ))� Detail: 2013-94,000gallon 2014-96,000gallons Sump pump? ® Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Last pumped 5-2013 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 4'6" 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.): Septic Tank(locate on site plan): 3'6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 8" t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order, tees present with no sign of back- up.Liquid level equal with outlet invert. Tank is in need of pumping at this time and should be pumped every 2 years for maintenance. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•'" 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in working order with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (4) 500 gallon chambers Elleaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching did not show any sign of back up. Leacing was not opened as no ties to covers were not given and SAS is located near gas line making probing difficult. Outside area of leaching probed with no sign of damp soils. D-box inspected with no back up present. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'T 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information Centerville Ma 02632 11-5-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to -at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: Z hand-sketch in the area below ❑ drawing attached separately \ ♦ \ ♦ \ ♦ t ♦ \ tt ♦/\ittttt% ♦ hilt \ t/tt'•/\/\ twt\t\t\ \i/�/ti X. M Cover. 36 @ grade Front Yard t5ins•3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 120" 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: 12-29-99 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: Plan on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts gaftg�W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 31 Harvest Lane Property Address John Bartlett Owner Owner's Name information is required for every Centerville Ma 02632 11-5-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS appl Lation for Ve-posaf 6pstrm Carietructiun permit Application for a Permit to Construct( ) Repair% Upgrade( ) Abandon( ) ❑Complete System NrIndividual Components Location Address or Lot No. 3( kAftKY LN (56W, Owner's Name,Address,and Tel.No. C-X�6leE ALX%01L-ram —2061 eV IQ3Z,��T7- Assessor's Map/Parcel .10 00 i S` Installer's Name,Address,and Tel.No. JO9--q77_t?rS77 Designer's Name,Address,and Tel.No. (,AAPe,0tD6 (FPTa4Tkjs5 ".,c. sr twAswpea Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) P)r_—?LACG aps t�6 N-io i5co(2 c"O ) 5EXrt C -tApy, w kTa 4-'act ison CALL fj ;S 6PT 6<_ G 6J e5Ak,&,e;- t_0<4T e 0Nj 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 d Date sI- ad1-6 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. "'� Date Issued No. Fee i , THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for IBisposal.6pstem Construction Permit Application for a Permit to Construct( ) Repair Q� Upgrade( ) Abandon( ) ❑Complete System WIndividual Components Location Address or Lot No. 3( Rk-5-r LN �-tiT. Owner's Name,Address,and Tel.No. LX�u4t.�c A4Tr%kott_"%j —JouAj eAZ,T4.#__-1-T- Assessor's Map/Parcel j0 (0 00 / 9 SLEWW Installer's Name,Address,and Tel.No. 50g-q77-I;�S7 Designer's Name,Addre-ss,and Tel.No. CtAP�tivID�,�Tt�PRISG'S c.C.c.. AS �- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 1 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures " Design Flow(min.required), gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil d Nature of Repairs or Alterations(Answer when applicable) ' gG?c Acx__ 'EX f St(wG N I (SGb cy4c r) 5EYTl C -rAxj1_ t-y ITI -�O l�o[� C-u4�c.�� S Ep7 �- 7341sJ1G G tJ yb�k[F L o c�47 c 04 Date last inspected: Agreement: t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in • _ t 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 LL 9�3)d ''Date 'T,.2" a0 1-:5 Application Approved by (� Date Application Disapproved by OF 7 Date for the following reasons 44 Permit No. Date Issued - _ ------------------------- -------------•--------- - ------ --------- - --------------------------------- 0 1I THE COMMONWEALTH OF MASSACHUSETTS ( /VI go BARNSTABLE,MASSACHUSETTS 00qCertificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( ) Abandoned( )by CAP&-Lj1')9 t✓07MXP&< S �•�[! at Wfl WEg—C -Liu c'a&nsm/L-�- has been constructed inWaccce with the provisions of Title 5 and the for Disposal System Construction Permit No ed Installer &k �06 Designer #bedrooms Approved design flow iyJn gpd The issuance of this permit shall not be construed as a guarantee that the system w li lofancftioonas/dgesiigned�/ Date , Ins ector ------------------------------------ ------------------- ---------------------------- ---------------------------- No. �/�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal 6, pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at --; Aku� 4 ANe <4MLMMV1Uk5 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ction mu it be completed within three years of the date of this permit. U Date Approved by f 4 • Commonwealth of Massachusetts -` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is required for Centerville MA 02632 September 20, 2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out I / forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further aluation by the Local Approving Authority Im September 20, 2012 Job# 12-139 In ector's Sig ature 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""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. J s IT t5ins•11/10 Tit, 5 V,,n n Form:Subsurface Sewage Oisposat System•Page 1 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is required for Centerville MA 02632 September 20, 2012 every page. Cityrrowri State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Tank was not in need of pumping at time of inspection. Leaching system showed no evidence of saturation. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" 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): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for P every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health).- broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 3 o1 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for p every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is p required for Centerville MA 02632 September 20, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any:portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is required for Centerville MA 02632 September 20, 2012 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health El ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): N/A Irrigationsystem. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-1 Ill 0 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped 6/7/11 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for p every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain).- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) Tank located under paved driveway is not H-20 load rated and is not designed for vehicular loads. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 2" l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is p required for Centerville MA 02632 September 20, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert and tees were intact. 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 t5ins 11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for every page. City town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is required for Centerville MA 02632 September 20, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Four 500 gal drywells. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Area of SAS was minimally probed and not excavated due to buried gas line in area. Stone and soils surrounding SAS showed no evidence of saturation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is P required for Centerville MA 02632 September 20, 2012 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name --------------------------- - information is p required for Centerville MA 02632 September 20, 2012 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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 J +J 8 Cover 36 @ grade Front Yard Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is September 20, 2012 Centerville MA 02632 Se required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater map shows water below el. 30 and topo map shows property above el. 50. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•111110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I • Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Harvest Lane Property Address Gary Shapiro Owner Owner's Name information is Centerville MA 02632 September 20, 2012 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 17 S P7 - t% l reel...ayu •^^,'—'•+"� ;I C 4 I: t .� ut ` 40 a.r..aww 'rao�.'° Cl I ��Ippp111yyya���aaa Jg d ... .wtm e. e,r. 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ON..W-- Fee------- ------------ BOARD OF HEALTH 0 TOWN OF BARNSTABLE Application-*rVe[r Con5tructionpermit Application is hereby made for a permit to ons r ct Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Ma�cel —--- Owner Address Installer Driller— Address Type of Building Dwelling--!_1QY j2'-— - ----------------- Other - Type of Building------------------- No. of Persons-------------------------------- Type of Well--— -— —---------- Purpose of Well---- -'��-cJ��-1 Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .o Comp 'jance has been sued by the Board of Health. Signed - - — date Application Application Approved By ------------——— - —- date Application Disapproved for the following reasons: date A Is/-o Permit No.- — �- Issued— ----- ------------ dat BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by---- - - ---------_-------- Installer at- -- -- --------------- -- - _=___------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated------- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------—— —--- --- Inspector-- - — - - - - ------ —---- BOARD OF HEALTH TOWN OF BARNSTABLE melt Construct ion]permit 1--- No. - 0ap J Fee- -- --�Permission is hereby Slanted ------------------------------ to Construct ), Alte ), or Repair ( ) divi gal Well at: - -- - J�" ----_-------------_----_------ No. street as sho on th a lic ti n for a Wel Cons ruction Permit _2 No.- -- Dated—� -"' —-- ---------------------------- !f J ---------_ y — ,tea--- -----------•----..__ l r' oard of Health DATE-- T -- No.w- ----- VVV Fee------- ------------ BOARD OF HEALTH TOWN OF BARNSTABLE App[icat ion ArWell Con5truct ion Permit it to onstr ct Alter or Repair an individual Well at: is hereby made for enm ( ), ( ), ( ) Application p P Y ,c r; Location — Address Assessors Map -- tt Owner Address - � ___�_ �_i!V!1 �t__ =1'•G�:- o> � Installer — Driller— <----� Address Type of Building Dwelling ---------------------------- Other - Type of Building-------------- No. of Persons--------------------------- Type of Well---- —------ Capacity--- - - -------- -—— Purpose of Well---- ''�r ►—- F►��------- Agreement: The undersigned agrees to install the aforedescribed individual well in-accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate o Compjlance has been issued by the Board of Health. Signed / _ —©- / date Application Approved By -—---(-J---— ---- Gate Application Disapproved for the following reasons- -------—--- -- - -- —----- -- -- - ------ /'� date — Permit No. __ ,%,� `�— Issued— -- ---- ---- dat BOARD OF HEALTH TOWN OF BARNSTABLE fr- Certificate Of COMPliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) ------------------------------ ------------------------------------------------------------ by — Installer at- --------- ------- - --- - —_—_- ---- ------ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------- —-- —-- Inspector---------------------------------——-------- -TOWN OF BARNSTAkE LOCATION �� S SEWAGE # (00-00a VILLAGE ems'` `"'`Z'2"`i' �V/�_ ASSESSOR'S MAP & LOT O — INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) y 5VO e,"J pry W t4,S (size) NO. OF BEDROOMS BUILDER OR OWNE �'�`' s� avPL=C IPERMITDATE: COME 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 r. / 3 ` p Sol 011, �� No. ' lIG,/ ' ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN'OF BARNSTABLE., MASSACHUSETTS ZIPPYira%ion or rtopo al t Mt aCttott erinit Application for 4Xermit to CUn-struct'( Repair Upgrafle )A�an onplete System O Individual Components Location Address or Lot No. Sr:5A d-3-b Od 1064,t R owner's Name,Addres�l.Np. -7 7 Assessor's Map/Parcel �g/ nr, 1 Installer's Name,Address,and Tel.No. 3/JT `! Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size s� sq.ft. Garbage Grinder(XI() Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures l/ Design Flow d c Y 0 gallons per day. Calculated daily flow �id gallons. Plan Date r'7—,)—,q f Number she is Revision Date Title 5 T_C R r 5,6 Size of Septic Tank 5 Type of S.A.S. Description of Soil a,4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees pen a construction and mai to ance of the afore described on-site sewage disposal system in accordance with the Provisions of Title viro en ode and not to place the system in operation un a Ce 'fi- cate of Compliance ho b issued by t ' f H a ; ned Date 1� _,� Application Approved by Date Application Disapproved for the following reasons Permit No. d 14�1_1 Date Issued Ir" Ae No. ' , '; i.- r - ,t► -- ;w4 Fee "�'=' °'��: tf} 1 ! E COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 ! Yes, y UBLIC HEALTH`DIVLSIbN - TOWN Of BARNSTABLE., MASSACHUSETTS "~m 01ppYicati or i5po ar �t ion traction eiCtriit y A'pplication for a Peet to Construct(� Repatr( )Upgrade"( )Abandon�) L'�'Complet�em C�RTndt�idual Components Location Addre ss`or Lot No. `�5��!�y0(W%( � Owner's Name,^ �Address and 1.N 'j 7/— ID YG Assessor's Map/Parcel y " Installer's Name,Address,and Tel.No. q�� L/ Designer's Name,Address and Trl.No. Type of Building: w ✓" Dwelling No.of Bedrooms Lot Size sq.ft. 'Garbage Grinder Other - Type of Building w OdAj No. of�ersons Showers( ) Cafeteria( ) Other Fixtures _. c � Design Flow D gallons per day. Calculated daily flow yd gallons. Plan Date /Z— — N mber of sheets Revision Date Title t A7 ,3 ; Size of Septic Tank Type of S.A.S. Description of Soil aA eat 'LJA� ` Nature of Repairs or Alterations(Answer when applicable) 4 Date last inspected: Agreement: x The undersigned agrees tt-o- he construction and mai a nce,of the afore described on-site sewage disposal system in accordance with the p isG ion�ss of Title 5 viro ent ode and not to place the system in operation unti a Ce 'fi- cate of Compliance ha b issued by th• H 1 ,- � n S ned Date Y V Application Approved by % Date av Application Disapproved for the following reasons i Permit No. Ogg a 0 It I. x Date Issued 4! OF ------------ --=— ----------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C TIFY,tat t e On-site Sewage Disposal System Constructed( V IRepaired( )Up raded( ) Abando ed )by at 5, 57,q 3 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 100 a 4044 dated 1- Installer Designer The issuance of this permi shall pot,be construed as a guarantee that the syst vill fu i designe . Date �1�! Inspector 2---�r------------------------------------ No. �!�" c �� r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digozar *pgtem Construction Permit Permission is hereby g anted to Construct( tJfRe a�iirlI( )U grade( )Abandon( ) System located at S -1 5"A y t3 .(�G� and as described in the above Applicatiofilor 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 t. Date: -Z 7 O Approved byEAI�l �Z?'/,Zp 47 - taS`,- � --- ;,C "%t �'}z.^;��e;::w7. }. 4.5.:ri A r�•r .,j, ..` : .;Q'�;sl � AH }.r r fif F X �s°r�. �r.?, 4� y1., arl t�,�,"�.�"r h`x' -�a. �..g y�i t' ya3,R C '�. i:°p �', : y ` 4 T h I TOWN OF BARNSTABLE E Cb LOCATION L 6 f S SEWAGE # ®O^ ; VILLAGE ASSESSOR'S MAP & LOT ' INSTALLER'SNAME&PHONE N0: SEPTIC TANK CAPACITY /S Oo G,a :.. LEACHING FACILITY: (type) y ° .y�� PtyL tEl1S y (size) NO. OF BEDROOMS S BUILDER OR OWNS ;,I PERMUDATE: I COMPLIANCE DATE: tF , 3 tY •: �! Separation Distance Between the r Maximum Adjusted Groundwater Table to the Bottom ofLeaching Facility Feet , { Pnvate Water S Upply Well and Leaching-Facility. (If any wells exist 3 Y; on"atte.or within-100 feet of leaching facility). Feet t � . Edge of Wetland and Leaching Facility(If any wetlands exist ' thin. feet of leaching facility), h , S Feet 3 t Furtushe t d by 77 -17 cr i YY' tK i , t d 1' � I s v.. - i �.�� s � i g rLL a -�..K .,y s �, i ,•- t.,.a'a�' y �•• .,r C S.s" �^ . �,tt w, ;:.r`,L ••y;'?il.�'•� � -'�'s<'�:;;.� .( .'"7,t t va fp a '' w r' z ,s• *.'�u.,?...a.�,�a .n�-- s'.�.,r ,c t y!-r <'"',".'r,.�C. ...y..._x;_+�• ,�.,A-1.• r x,' lY,• :.,'h ....�.., s' - ,�xa -t.s r `�' r a 7y. EPr3r t..€.r-. ,a, ,-�' xi �... r �. n.,�. rr,,,,.. ��t,a ,,..os .' ...�..r�.s•,. N Win.. .. �,, 'fR .y �--^ w:rf ,r § ,� c .,�`tl':,, .y- aY .-.;-si '•.. ...'�--t- � s,{ x -x,�Yx :.r'.�P.o'F '•.r''}tFV,a,i�..�.r;-b.- � "�} .•y.'_ �.�C�}.. .h:,w°-�t^.� N b < < ^ 4- 3f HARVEST LANE M � - 45 �bb EXIST. / FOUND. l� v� I N � L Cd�C IFIED PLOT PLAN ON CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN IS LOCATED ON THE FOR GROUND AS SHOWN AND THAT IT CONFORMS LOT 5 HARVEST LANE CENTERVILLE, MA. TO THE MINIMUM BUILDING SETBACK REQUIREMENTS OF THE TOWN OF BANSTABLE. PREPARED-FOR BAYSIDE BUILDING INC . �ytNOF �S� SCALE: 1" = 60' DATE: APRIL 30,2001 � o STEVEN W m UMBAI ~ 5 WELLER & ASSOCIATESOFEss�o�,P�� 1645 FALMOUTH RD. - SUITE 4C CENTERVILLE, MA 02632 �No sil (508) 775-0735 J I own of Barnstable rrI Department of IIcallh,Safely,and E[IV irollIII ell(aI Services ofT"��x Public 11e'1lth Division gale 367 Main Street,I lyannis t`tA 02601 nAnNBTAtnF- d MABI •p. 1639. X\d Dale Scheduled /Z '3 "I'inie lice Pd. Soil Scr'itabilitp Assessment fnv Sewage Disposal I'crfunncd Ily: ® WituesSed 11y: Vm,/m /_— LOCATION & GENERAL INIFWWATION Location Address Owner's Na �i`5 Address'pz> Assessor's N-hp/I'nrcel: �� I:ngincci's Name d a NEW CONSTROCTION _ •/ M-PAIR 'telephone II Land(Ise Slopes( o) d 3 Surface Slones.n miz Distances from: Open Water Dolly 11 Possible Wel Arca N n Drinking Water\Veil fl 1 Drainage Way II I'roperly Line it Other Il S K ETC11: (Street name,dimensions of lol,cxncl locations of lest holes&pere tests,locale wcllnnds in proximity to holes) Y Y I'ment material(geologic) ✓64C;t Ci O Depth to Iledrock Depth to Groundwater: Standing Water in Ilole: "is Weeping from Pit Pace �/\Q Estimated Seasonal I ligh Groundwalcr DETERMINATION I OR SI ASONAI, IIIGII ��VA`I'I�IZ 1'A13LL Method ilsed: Depth Observed standing in obs,hole: in. Depill to soil mottles: Depth to weeping from side of obs.hole: in. Grnimdwater Adjustment 11. Index Weil 11 .. IinndinR Dnle: _ Index Wcll Icvcl. _ _ Adj.factor Adj.Groundwnlcr Level I'IJRCOL.A'I'ION`['LS`I' ii�ile 1� I,� 'ilrire I(S.' Observation A e tole 11 1 d` •Dime at 9" Dcpih of PCIC b ^ Time at 6" F Slarl Pre-soak Tinrc (01 16• time(9"-G') _ End Vre-soak Rate Min./hrch Site Suilabilily Assessment: Site Passed I/ Site failed: Addidonal Tesljug Needed(YM) Original: Public Health Division O Ilse I-vafion Ilolc Data 'I'o Ile Colnplefed on Ilaclt j Copy: Applicant OIISI;ItV�1'I'IUN I[OLL 1�0(1 hole 11 Depth Flom Soil I lot izoo . Soil l•cxlurc Soil Color Soil Olhcr Surlace(in.) (USDA) (Monscll) I lollliog (SUoclwc,spmcs,Iloulderes. . 43 — __ - ----- --�-5-.-- - -to' 'a�. ---- --- - imuo' 013SLO lIvPION 110L1p' LOG Hole 11 . I)CpIll Flom Soil Ilulizan Soil Texhnc Soil Color Soil 011lcr 4 _ Surface(io.) (I ISDA) (Mansell) Nlo0ting (Soodorc,Slimes, Bouldcres. DINT 0118I.F,I0"A`1'ION IIOL,1; LOG IWe 11 _ Depill lionl Soil I lorizon Soil Tcxlure Soil Color soil OMier SurL•rcc(in.) (USDA) (Alonscll) Molllin G (Slnrelure,Blanes,14unlde1cs. i DEAD'. OIISEWVATION IIOIX, LOG Hole/1 Ucpllr floor Soil horizon Soil Texlurc Soil Color Soil 011rcr surface(in.) (IISDA) (lvlunscll) Willing (Slnrclure.Slopes, liouldcres. — hI�n Insurs4imRole Alai_ Abovc 500 year flood boundary No _ Yes Within 500 year boundary No Yes Wilhin 100 year(load boundary No Ycs I)epll) of N_ill!1�;(Ily�ccursii)1;_I'crvi.pr_4s�11�Icrilil Does al (cast four feet of naturally occurring pervious lim(erial exist in all areas obscrvcd Ihroughoul Ille area proposed for the soil absorption system? If not, what is il!c (leplh of naturally occurring pervious material'? Certification I certify Thal oil — q ((late) I have passed the soil evaluator examination approved by Ille I)epartn)cnt of Environmental Protection and (hill (Ile above analysts Was performed by Zile collsi.-je t with the required training, expertise and experience described in 310 CMI( 15.017. Signature I w•-d Ir-d 16•-d ap._�. I 0 i (yJl �'4 T-d .Y-d 6'-O• Y-d 3'-b• I'-b• �'-6• 3'-b• 8'-�' I �p ... F .+r77 `. CRE NEE) H PORC q. a DCC 297_ o m F DCC ays4 29 9/4•.T 3/� �I �I T 3/4•x 71 3!4' - a �7 $$EAKFAST 411 a ii :C• °�°I4� _ . el n JOAK F14m 1 y y y s :� a BEDROOM u2 & tS & I 1 NAL% 'L tS R -- R 2 weaA e711eL error+ g, 2 a ecr r fr.� r-F5—I q P IKY 24 3/4189 3/4• b I KITGW N � IL r I�r I 14 Al F tv-- . LOOR ...... i'..-.i.e. ... a ® _ p — — -- ,— ----- I *W-2 nawAL CE�Ln� , MASTERQM GAS Dcc ass+-a 2- 10 2xb• 1 v F1'll 4p00® 1♦' I � 1� BATH 76 3/4•.69 3/4• ® �7 m DCC 254�. _ 2 V. I o a 41•n x4s W_ n ae m !® { _ �%aa 26 3/4•x41 S/4• BATIJ rt2 PKT I j- TILE FLOOR 1 ® ABO.•E I.t'-O•CA7NEDRAL C94.M - a GRE AT ROOM z m ^ o - —T ---------� OAR FLOOR 2-9 VA•LYLe O v 4'-O• T-d Y-4• A. e•-6• ABODE 6•-0• v.'-9 9/P TV •� n rZ ® xGDCC 292a A ` \ iS HER i i 0 29 3/4',O9 3/4 t. PAN. \ / 2II I DOWN! '! 0 ppQ� c STAMS PKT TV i taEDlA.Rr*l, v _ I 0"F1OM I OAK FLOOR:o o - IZ I - I F I I g _ w 6 TRAY ceLn4 1 u ur I I g Q o s 1 1 I 1 & J-------- -1 o = GARAGES // 3-2110 HEADER \\ ® I I o DCC 2966 § ... . CONCRETE BLAB 1O 1 I a 29 3/4466 SAe 2-2x10's r w•oc. gym�,{{ Prru+roNARD Doures a _Y 4 , COVERED ' I JasT9 ABO✓E n'f A �� fEi-2.1CATNEORAL CEILING "• . F w brnxm_ii r)F iA - � -� o - �I `'-Q• l 1 caecPET rLooR I � ... Tg TV a `+ DOUBLE JOISTS 2R U44%f6 3/4• LMDM DORIVR Y i L Q i FIRST FLOOR PLC N �2 scALF V4l . il-W 6•-b• 11'-d b'-b• 3'-Id 4'-B' T-o• 8'-d D'-D• T-3• 3'-4' 9'-b• ` g 24•-p• p'-b• W'-O' T-b• N:'-d II'-d' T-d ae'd !DRAWN $T. KW DATE: 2 N i 14•-r 1z•-o � - r-r iu FLAT ROOF RUBBER MQ'IORMe P SKY BEDROOM s5 C 1E 1 "r'`iT I i OKY CARPET LN3 306� `Y6 306� - P +car a•-a y'V._e'-+o` ,. ' - — �D P 2ti1 s/4•..5 ar �y _ L }^IORKOUT ROOM - - -■-■ Vf - PEE 6'-V CA1.6w YTV4I� a _ T-4, „ .. 2 _ — — m 2-4 — PKT - -- -- occ 2526 BATH A4 -- — — 25 3/4•rt25 3/4• — -- _ --- Tv I I -- I I r=2525-9 occ 2525-3 76 a4',26 a4' 1 DROOI,7 Q� 76 aA',C6 314•7. iJ m I ur+ot-r r 0 16,01 I I PNOIIE � 1 ;n 25'-0• � Q i 2•-r 3'-& 6� W� 5� SECOND FLOOR PLAN SCALE, 1/4' o P-W _ F SHEET 1, DRAWN SY+ KW 1 DATE- 2^001 t 1 K'd 20'-A' T-d T-0' Y-O' b'-0• Y-O' 7 • b'-b•WINDOW—j _HELL WALL / Q WALL m A \ \ b'-b•WINDOW rO 361a tv C \ A WFlI NKl 4� / .g = � I - 0 I ri I t u 1 2 6 STUD WALL ABOVE 4-d B' 3-Id ..11 ..,...... G' 0 DROP WALL K•>a COffIWUp13 FmnNc I I TO S6• t I I I GREENED PORCH _ - t I PCC 2v7 I >�7 3/A• J I s r 1 7 2A 3/1• BLCO I I I Ig I I 2v 3/� >n 3i4• I I h:. J 1 DOOR t p %LLLQ------------ \ L J b I (3)a V2 LVL.FIJISH BEAM rue" ______ ___________ ___---- 1 P R 1 I y e'r e w.-CR T> WALLS 1 2a2 CART —, 1 41 P 2N•STUD WALL ABOVE 11 1., 0 1 KYIO'COWTINIlOU9 FOOnWG I 1 CONCRETE KA�5 '>la&dca+rrcu0US FCOnnWc - ` ° b o § e o I I o o - t - ' I b-w I A' ' 4'_b• a b'-r '-d b'-10' b�-11. b, ' I 4 V I I BEAn POOKEi 1 -1 I- T7 r -1 r 1 f 1 r -1 BEa,Paaar <•-o•� L_J L_J L_J L_J L_J L_J L 7iJ L_J L_J -� '-�--- �._— FT F _tea 3-2>I0GIRT L-J L_J L_ L t I 3 U2•LALLT C0.U1'HS 1 b � 50'>90'>L CONC.PADS TYP. V I r——_—__ LINFIN15LJFn n r o I O1 I ------ FULL BASEMENT 1 Y OFF SET 3 1/7•CCPKRLTE SLAB ± I 1 t • r----__ -___-1 CCMPZM ' W-W 2 oPP sBr I I K• 'POT""' s 2no c 1 I I I POCKET P6CF.ET POCKET I I Lu r 1 ---- ---- —� — a DRaP Id FOR -----•-+-- .------ --�-+ice•-}�-{—_ Dom L_J \L_J i I W RT\� 1 GARAGE I t a I ' I I I I .240 cl 1 ' � I L- ----------J CONCRETE SLAB D I I P TOWARD DOORS ' I — < "v Z � tu I I I I a � I • � t � � p-. 1 s c I la FOR i j L---------------' I f� ------------------ I I i °K,w-f pis romw� I j W-d Q 1 1q. 3: I 11'-d T-O• 3 py p r SNIET A5. Y P. FONDATION PLAN oe .J ,. o� I. DRAWN BY- KW . M.M. ! � 'PEST HOLE LOG DATE: .oexc. /3 /r1%y P-9G38 SOIL EVALUATOR: d 'cac.t�h/G/i/ Asa WITNESS: Imo, PERC RATE: ,a /D ye 3 • ,� /o y,C G Z a - /Z" Z'Sy S'Y. e 0 Gc� 7 /Uz G6.1,41 �/Z EX✓C 4.1.J7C'E,0 DESIGN DATA O DAILY FLOW: PDRMS.a 110 GPD=,53;c> GPD SEPTIC TANK: 5 OGPD a 200%=/✓I,o.. GPD USE: /•So o GALLON PRECAST SEPTIC TANK LEACHING FACILITY: USE: : )S,,e9,jr"' Z-L. � ��� CAPACITY: . o}k ' SIDEWALL: Vr /G.Z,B / BOTTOM: /3 X.yL%�ro,7Yr IA O TOTAL: y � rA j 7 NOTES: �P��H OF 1. ALL PIPE TO BE 4"DIA.SCII 40 PVC. 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION. o� DANIEL L yG BOX. - - IRAMAN 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN uvq � ao.n�ebc 6"OF FINISH GRADE 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL 1 G .5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED N ON A 6"LAYER OF STONE. r LAYER OF SR"PEASTONE OVER 6. INSTALL GAS BAFFLE IN OUTLET TEE N4•-I ln'WASHED STONE ALL AROUND TOP OF FOUND. _ f/9 (�ELSyo lo' 14. !. �s y�o0 s y, so,o o y97s �� y�oo , i SEPTIC SYSTEM PROFILE IZ-3�.�yel SITE SEWAGE PLAN GENERAL NOTES ;t{ FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR TO ANY EXCAVATION OR CONSTRUCTION. I. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH PREPARED FOR 310 CMR 15.00:TITLE V. 3, THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE __.. `J"�O.D, L�/�-•C�//���T ��G . DETERMINATION. �D % � SCALE: /�'E,,p 4. ALL DISTURBED AREAS TO LOAMED.AND SEEDED. DATE.. ....._ .�'�. �f/e 5. CONTRACTOR TO PROVIDE 14 HOUR NOTICE FOR ANY - - REQUIRED INSPECTIONS. J IF & ASSOCIATES 1645 FALMOUTH R®AD' CENTERVILLE, MA. 02632 TEL: (508) 775-0735 FAXI. I: (508) 775-0754 - -=- I I L . A PI'1RnvFi1 RY: p r G., Al , i i 0 ti� 2 Sti