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HomeMy WebLinkAbout0119 INDIAN TRAIL - Health 119 Indian Trail Centerville A = 211 034 Commonwealth of Massachusetts d 3 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail_ — Property Address I Paul Crosby Owner Owner's Name / information is Centerville ✓ Ma _ _02632 _ 10/8/2020 required for every City/Town — - State Zip Code Date of Inspection page. 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 p. Inspector Information 6l*' 1�f q qq filling out forms on the computer, Sean M. Jones use only the tab - key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection _ use the return Company Name key. 74 Beidan Lane Company Address ^ �-� Ma 02632 Centerville_ U/6", CitylTown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sm'onestitle5.com License Number sean � 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 - 10/8/2020 —7-1! Inspectors 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. Time s official Inspection Form:Subsurface Sewage Disposal system•Pape 1 of 18 t5insp.doc•rev.MM018 Commonwealth of Massachusetts Title 5 Official Inspection Form OWN Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F. 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every State Zip Code Date of Inspection page Cityfrown 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 119 Indian Trail Centerville is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 4 500 gallon precast leach chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doo•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,., � safety and the environment: t5insp.doc•rev.7I26r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville _ Ma 02632 10/8/2020 required for every C /Town page. itY 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 a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic.tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7126i2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 18 Commonwealth of Massachusetts Vo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is required for every Centerville Ma 02632 10/8/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cons.) 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/28/2016 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 16 r Commonwealth of Massachusetts p Title 5 Official Inspection Form „ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail _. Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as 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 information 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 Ak Commonwealth of Massachusetts -� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every page Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 gpd Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes E No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes E No Seasonal use? ❑ Yes Ej 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.7126=18 Title 5 Official Inspection Form:subsurface Sewage Disposal System•Pape 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail - Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every CitylTown State Zip Code Date of Inspection page. D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No discharges If es, d es to:g Y Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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.7/28/2018 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 119 Indian Trail _ Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information. system repaired 11/10/2003 Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): 1.5 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.N26=18 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 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 _ 10/8/2020 required for every page. CityfTown State Zip Code Date of Inspection : D. System Information (cont.) 6. Septic Tank(locate on site plan): 1 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 gallons Y Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3.5' 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 7" 10" Distance from bottom of scum to bottom of outlet tee or baffle Opened covers and took Now were dimensions determined? 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. t5insp doe•rev.MM2018 Title 6 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 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is required for every Centerville Ma 02632 10/8/2020 page. C4rrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5ifap.doc.rev.7/262p18 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 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Ma 02632 10/8/2020 required for every Centerville page. Citylrown 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): 0" 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 video inspected and found 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 AIM18 title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail _ Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every 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.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4x500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doe•rev.7/ASM)l8 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 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma page. 02632 10/8/2020 required for every State Zip Code Date of Inspection City/Town 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 4 precast leaching chambers in a 42'x13'x2'trench. Chambers were video inspected and found with approx 6" standing water and no stain lines higher. 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.71281=8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 119 Indian Trail _ Property Address Paul Crosby Owner Owners Name information is Centerville Ma 02632 10/8/2020 required for every page. City/rown 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.): tSittsp.doc•rev.7f26=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Indian Trail Property Address Paul Crosby Owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every 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 L �eA4- P 132 1 t 'y A 14!"" 133 17 A•4 C4 ` T' t5insp.doc•rev.M2612018 Title 5 Official Inspection Forth: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 3 119 Indian Trail Property Address Paul Crosby owner Owner's Name information is Centerville Ma 02632 10/8/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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. trinsp,doc.rev_7rAW18 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 119 Indian Trail Property Address Paul Crosby Owner Owner's Flame information is required for every Centerville Ma 02632 10/8/2020 page. Citylrown 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 t51nsp.doe-rev.7l2612618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ''^^ r t !� No. µ63— .5.y Q�`�j ` Fee Sv 1' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for M5 ar *p6tem �(Congtruction Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) CO Complete System ❑Individual Components Location15!�� Address or Lot No. -! C�wc&" v�� Owner's NAa/me,Atlddre-s-s-and Tel.No, Ass ap/Parcel 'Q� I ZII — c3L4 Installer's Name,Address,and Tel.No. q 0` Designer's Name,Address and Tel.No. I y 'YYl cIt u+: i U 36.P- L i 4X Q=sft5 1644 5 -� JR`b vot, OA6-S -2?5-0'7 35 Type of Building: Dwelling No.of Bedrooms_5 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow (o 2-gallons per day. Calculated daily flow s4 C) gallons. Plan Date —Number of sheets I Revision Date Title Size of Septic Tank 1 06 Type of S.A.S.// +1ar��� ��i:Z i Q r — Description of Soil , 4&=Ll Nature of Repairs or Alterations(Answer when applicable) .91p� ho�6A^- 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 this Board of Health. ) Signed t1W. P Date 16116 l Q Application Approved by ..� Date /196 Application Disapprove for the following reasons Permit No. ?_0y3r56 Date Issued No. 2-to-3- SOY � Fee SO� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Z(pprication forPigogal-bpztem Qtonztruction Permit Application for a Permit to Construct( )Repair( /Pgrade( )Abandon( ) C Complete System El Individual Components Location Addressor Lot No. � ' Owner's Name,Address and Tel No. Assesso" is MaAarcel 2 a^J o w Installer's Name,Address,and Tel.No. Q GDesigner's Name,Address and Tel.No. WA"9_1'-r -7-75-0-735 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 G s 6 ,!3—gallons per day. Calculated daily flow C,f gallons. Plan Date Number of sheets I Revision Date y Title ts` Size of Septic Tank Type of S.A.S./\a Description of Soil n. ( � 'j` ) ,p �' Nature of Repairs or Alterations(Answer when applicable) QkoQ,Qg � Ati 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 this Board of Health. Signed Date 0 R Application Approved by Aq , L _7 Date / l 4 0 Application Disapproved for the following reasons ' Permit No. Zoo 3-SG V_ Date Issued i r)If Q ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ; Upgraded( V) Abandoned( )by at - has been constructe o in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 24&3-E_O? dated 10 r1i io A-, 3 Installer `" 0� 1 c, Designer o .. 614 nt , The issuan of—this pe t all not be construed as a guarantee that the systeinX (uric n as esi e . Date 11�A 3 Inspector _ ./� v No. 'LOO.���56� ---------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS Migogal *pMem Congtruction Permit Permission is hereby granted to Construct( )Rpm r( )Upgrade(Abandon( ) System located at 1 q ��Q 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 ule completed within three years of the date of this pe t. Date: (U G1 U Approved by • �• TO OF BARNSTABLE LOCATION 11�•�04C& BAN j/{nIZ SEWAGE.# 0 3 r 5d� VILLAGE ASSESSOR'S MAP & LOT '2I 1-03q INSTALLER'S NAME&PHONE NO.A 0 SEPTIC TANK CAPACITY Sam i LEACHING FACILITY: (type) 1 �c ,2�.r -� (size) NO. OF BEDROOMS 5 BUILDER OR OWNER PERMITDATE: O o 3 COMPLIANCE DATE: I D Q3 Separation Distance Between the: ^�`� Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac n facility) Feet Furnished by04 q I I I I I 60000 TOWN OF BARNSTABLE LOCATION /l� ..�✓t C a" r" SEWAGE# VILLAGE LL24&V fUle ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S6� LEACHING FACILITY: (type) r!G�l2� C'r's (size) NO.OF BEDROOMS J n,� _ ----- - -- - / C� Q�) BUILDER OR OWNER NEW lea-,ute Yie✓1�� De `t,se naa PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 30CI feet o leaching faciL +) / Feet Furnished by �-C l K S p 1 j � f aGC K 6 O G r aa,, ✓( �JV1 TOWNS� I�OF BARNSTABLE LOCATION l 9 Ci Mcn& SEWAGE # Q3-5®S VILLAGE ASSESSOR'S MAP & LOT 2 I-03q INSTALLER'S NAME&PHONE NO. !vim C7 MG �� 5760 SEPTIC TANK CAPACITY 1500 LEACHING FACILITY: (type) ��J �J � (size) NO. OF BEDROOMS 5 BUILDER OR-OWNER PERMITDATE: 0.3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leac n facility) Feet Furnished by r a � `Q�° °16_g Fres.....l...iS�..: THE COMMONWEALTH OF MASSACHUSETTS s BOAR® OF HEALTH .......OF.............Lg-��'�w�-y. 't- !`.. ................................... Appliration for Mipaa al Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System ate� / ` Location-Address pr t No- .....� .,... r ems.. ss----------------------- Own r dress --- Installer Address UType of Building Size Lot............................Sq. feet t Dwelling—No. of Bedrooms._-____.____�..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons------------_--_-_-__------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ------------------------------------------------•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width...................:Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------- ---------------------•-----•------ -------- Date-.------------------------------------. ,a Test Pit No. l--------------tminutes per inch Depth of Test Pit.................... Depth to ground water------------------------ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.__------_-----------. P4 --------------------- -------------------------------------••-••--------..._._...--------•--................................................................. 0 Description of Soil-----------------------------------------------------------•-----•----••--------------------------------=---------._...----•---------------....._..._.__.....--__•-... x w UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- -----------------------------------------------------------•------------------------......-•--------------------------------------------------------------------------------------------...-•--•-------. Agreement: The undersigned agrees to install the aforedescribed Individual ge Disposal System in accordance with the provisions of r"iTL 5 of the State Sanitary Code—The u er lfurt yr agrees not to place the system in operation until a Certificate of Compliance has bee issued by e d he th/� Signed... ......... ......... ...... / Application Approved By.............. I e - q Dat!' Da � ---____••--••••---------------•-•--•- .............. Date Application Disapproved for the following reasons----------------•----------------------------------------------------------------------------------•---•--•_...-- .......................................--------------------••-------------•••------•-----•••--------------------------------------•---- ----------------------•--------------------------------------- Date Permit No.......... EQ_ro.................... Issued....................................................... iL No---- FRs...: ..5� ...r.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ . ..............................OF...................................... Appliration for Dispati al Workii Tayaaitrurtion 11vornfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal stem Sy . att Z �[ /Ge........... 1. ...� ............................................... 1.../d.I...., ...... ----------------------- Location-Address pr t No* c/- /,� y -- Ow r / o6ddress /C v Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......------X..........................Expansion Attic ( ) Garbage Grinder ( ) W Other—TyP e of Building ------------- P ............... No. of ersons............................ Showers Cafeteria a ----------------•------------- --- ( ) — ( ) � Other fixtures .••••••••. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity........---.gallons Length................ Width................ Diameter-------------.-. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.........---.--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..-.-------------------. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..----..........--.:---. R+' •-•••••.......•-••--•--•-•--•••••••••••••-•••-••--------•-•........••••..........•-•........................•--•--•-•-•••----••------------------------------ 0 Description of Soil........................................................................................................................................................................ x U •-•-•••-•-•••••-•••-•-•••--••••--••---••-••-------••-•••-•••--------•--•-•--••-----••-••••.....••••-••••--•-•-•••••••-------••--•••-•-------••••-----•••••-•-------••-------•--•-•------••--...-----•--- W .--------•-----------------------•-•------------------------------------.-...-------------------------------------------------------------•------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------- -----•--••--........•••-----•-•----•-•••••••••••---------••-•--••-••••--------•-••••....--••---_....•--------•••--•--------------••••-•-•------•••••---------••--•--••-•••••••••-••-•......_.__......... Agreement: The undersigned agrees to install the aforedescribed Individual ge Disposal System in accordance with the provisions of'TTIE 5 of the State Sanitary Code— The u e 1 fur`'. agrees not to place the system in operation until a Certificate of Compliance has beery^issued by e d he Signed•••= ......Z ......... .... ... `...... ............................ ................................ Date Application Approved By...............� -- - - D ate Application Disapproved for the following reasons------------------------------------•------------------------------------------------------......-----........._ ---------------------------•------•------.....----•------.....-------•-------------.......-----...------•..----------------------------------------------------------------------------------....._--•--- Date PermitNo..........F.�-------2�4................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .. 'Gl/1!l..........OF......... .. -............. .. Id. Ar %-EntifirFatr of f�uaxt li�aaarr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by-------•---------_ •-•-•• .....61- s ------ st er at- 5............... ---------------------- has been installed in accordance with the provisions of TIT E 5 of Thee State Sanitary Code as described in the application for Disposal Works Construction Permit No........eg----.--.... _�...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............••----...............-•----------------•-•---------------•-••...._. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS .nr BOARD OF HEALTH ti�---=----5'Q.6 ...........OF.......... �n . .................................... No.- • FEE.ZS�....---- 1 Dioposal Vorb �aa ra ialn rrizti Permission is hereby granted........--- ...... ................................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.`-----•-•-•------------••-•••-••---•--••••----------•-----------------...•-•---••-----•----..------•---------------•---------•••------•... Street i as shown on the application for Disposal Works Construction Permit No.-fe:.Y26._ Dated.......................................... .................................. ....................................................... (! ( Board of Health 91-DATE------------------------ ..... .................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS., LC I O ,5 `7Ac. ca � 209. 3Co cs �aZ 9�• 1 Ica/ TA SCG NK }}9 1dM 6u43 TvL)uoa�Z.,� �'J 33�t tdl 19 ji 0 I . J r� jH of I AD No. 29733 �� I v �A,-r 21z Klea -ae� c�G—�e►�.� R �Da��Y�i.�•-( ; 3 x 110 X = 330 c�D ��-a N � tGRlk ' 3k 1 I o >< I sdy6 = 'g954t�i . OF 4fgS 1�►5�%bS�L � .�... USA bC.���/�T}{ s, .. � o< ,� :' W�4>_>r.. P TER e)�t4: 1 SpF" `��t ; 1i�Cl(Ai'?J v SULLIVAN No. 29733 nAXTE °'' r. J w�a. T F� Ric �e '3csc'r�� �Z<=A � 15q s� :i :� o,�F /57i C—AQAC RY; 15q(?— 1,p = 15 C�trJ � ``rare ' • ssrONAL LNG 10*146,1,7 I EL 98.0 9g r �P T WD .a 96,7 -- - 9510 9S•4 95 �o Si c �S•Q iNY 1/.114 1NV Ta,kAv, INV SAND Gz4v%1, - C + ►FI ET? . g.0 �oGb 6�al,lA►..��T W rr}i q, l._oz S, \�� �,�L so-rD -S'cOu� —{x�.�noti1 F►.►TEZ.�I�I.�E GOAaS� s�..a`L-� l�s�oTED `?7aTF 10•t fa•$'C SANS L�fL"TI'F`( TtIAT T1�1�E �o�>u'oATo� Si{t�ll�l L L1 ovr T s-'TZ>N4d IsA I e t l�Vi z. T��.� a:� S�` z4pYo e s i Z—,;F I AZ M6T&3 t_E I�.tsne.— ti��►,� stt�oc���7 Ncsc'8� us�p� r TOWN OF BARNSTABLE �- LOCATION = �„��1,,; r � SEWAGE # VILLAGE— CpM .nb ASSESSOR'S MAP & LOT / t INSTALLER'S NAME&PHONE NO. 6.�� SEPTIC TANK CAPACITY 100 LEACHING FACILrrY: (type). (size) NO.OF BEDROOMS BUILDER OR OWNER i PERMITDATE: U U COMPLIANCE DATE: i 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 t 1 a la f 1 9 TOWN OF BARNSTABLE �� �' )0 fiv LOCATION La1' S .L T SEWAGE # S� VILLAGE ASSESSOR'S MAP & L INSTALLER'S NAME&PHONE NO. , SEPTIC TANK CAPACITY Ib� LEACHING FACILITY: (type) i (size) 4>00 NO.OF BEDROOMS 3 BUILDER OR OWNER�b5tt PERMIT DATE: 9.— �f — 0 0 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 `cR �;f' _ ,p SS u �G+ ��` . 1 . � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y` 119 INDIAN TRAIL ` �I Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Impodant:When filling out A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not use the return Name of Inspector key. D.A. BROWN Company Name rQ P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 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 insIpection,The,inspection was performed based on my training and experience in the proper function and rnainten6fibe oFon site sewage disposal systems. I am a DEP approved system inspector pursuant td Sectid 5.340 of Title 5(310 CMR 15.000). The system: I c ® Passes ❑ Conditionally Passes ❑ Fails ' _ i . ❑ Needs Further Evaluation by the Local Approving Authority R= `' .. ro ry �' N tom. 7/7/08 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 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. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Il • Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is required re uired for MA 02632 7/7/08 every page. Cityfrown 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. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cdy/Town State Zip Code Date of Inspection B. Cer#ification (Cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Inspection Form.cloc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE re wired for MA 02632 7/7/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 m pp , 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'/a day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System al S g p y m Form Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cit crown State Zip Code Date of Inspection B. Certification (font.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 or 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M '< 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name requirenform ton is CENTERVILLE require for MA 02632 7/7/08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Title V Inspection Form.doc•0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 INDIAN TRAIL Properly Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cltyrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 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)): 06/127-07/240 Sump pump? ❑ Yes ❑ No Last date of occupancy: Date 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: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonw. alth;.o.f,.Mass.achLse.tts- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information-(cont-) General Information '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: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2003 OFF AS BUILT CARD FROM B.O.H Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 INDIAN TRAIL Properly Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cd crown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 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): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 Sludge depth: @8- Distance from top of sludge to bottom of outlet tee or baffle @32" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of.outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Ws�ggqliusett� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is required for CENTERVILLE MA 02632 7/7/08 every page. Cityrrown State Zip Code Date of Inspection D. System Infor-matiton tco-n,.). 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 COULD USE PUMPING Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene y ❑ 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.): 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): Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. City/Town State Zip Code Date of Inspection D. System Information. {cone Tight or Holding Tank(cont.) Dimensions: Capacity: gaMcsns 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 R No 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.): BOX LEVEL NO LEAKAGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Fonn.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cityrrown State Zip Code Date of Inspection D. Sys#ern. Information (cont.). 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: COULD NOT FIND OBSERVATION PORT Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): AS-BUILT DOES NOT SAY WHAT THE LEACHING SYSTEM IS Title V inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is required for CENTERVILLE MA 02632 7/7/08 every page. City/Town State Zip Code Date of Inspection D. System information. (corit.) 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:): 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.): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of.Massachusetts. - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 't 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is require for CENTERVILLE MA 02632 7/7/08 d every page. Cityrrown State Zip Code Date of Inspection D. System-lnformM (cunt.). Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. L � lP2G' y 42- 14` j a - yo �. 3, �7 ' t� 0 Title V Inspection Form.doc•08/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth:of.-Massac h usetks.- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 119 INDIAN TRAIL Property Address CROSBY Owner Owner's Name information is CENTERVILLE required for MA 02632 7/7/08 every page. Cltyrrown State Zip Code Date of Inspection D. Systerhlnformati n1 (corrt:.) . Site Exam: ❑ Check Slope ❑_ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: Please indicate 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: Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r- Town of Barnstable 1HE 1 o� Regulatory Services + BARNSfABLE. Thomas F. Geiler,Director 1639. ,•� Public Health Division ArEp�,�s Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC' JCommonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail \ 3 LA Property Address Fannie Mae �� Owner Owner's Nance information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information i 1. Inspector. Shawn Mcelroy Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr _ Company Address E. Falmouth MA 02536 City/Town state Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification l 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 4-8-08 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 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 perforate in the future under the same or different conditions of use. A5 -bi,,' l�- 41c,5 new IM easc4rervte,,7 s t5insp-08M6 TdL-3 Qf dal hmpec m Form:Subsurface Barrage Disposal System•Page t of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the.failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no signs of failure. B) System Conditionally Passes: ❑ One or more system components as described in the°Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp-GBM6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments y�. 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cunt.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**_ Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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 ❑ ® 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 tributaryto a surface water supply. pply t5insp•08/06 Title 5 Official Irnspeclion Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems (cont): Yes No ❑ ® 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"nos 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 shalt upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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. ® El approximation 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•08106 Tine 5 Official tmpectim Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection 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 Number of current residents 0 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)): Sump pump? ❑ Yes ® No Last date of occupancy: 2-08 Date 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: Last date of occupancy/use: Date Other(describe): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: N/A 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (f known)and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts a . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building.Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"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 Gal I Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 2„ 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 14" How were dimensions determined? Tape t5insp•08/06 Trite 5 Officiai inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��M ,•'y 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 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.): Tank in good condition with all tees in place. Recommended pumping for solids. 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.): 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): t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 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.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number. 4-500's ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aflemative system Type/name of technology- Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with no visible stain lines. t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): 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-08/06 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts N Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name required fu fired for n IS Centerville MA 02632 4-"8 re every page. Cityrrown We Zip Code Date of Inspection Da System Information (cant.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. tL --®� r -13 - IY'f- 9_F- I7. t5insp•08106 R e 5 Of tcW tnsp # Form:Subsufface Sewage Disposal System•Page 14 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Indian Trail Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 4-8-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 10, 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: Original design plans and town maps show groundwater at greater than 10'. t5insp•08M Title 5 Official Inspection Form:Subsurface Sewage Disimsal System•Page 15 of 15 Town of Barnstable �pF tHE 1p� Regulatory Services •' Thomas F. Geiler,Director BARNSTABLK s f MAM 16.19. A��� Public Health .Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection,report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. YmE THE COMMO EALTH OF MASSACHUSETTS _ BOARD OF HEALTH ..__._. c W_NX...............OF... AeK �. �........................... Applirafion for Bispaaal Works Tonstrnrtinn Pumit Application is hereby made for a Permit to Construct ()) or Repair ( ) an Individual Sewage Disposal �,Ystem at: .�1 �.�...:.C ►��:—r .�c.t.� .......... ................ .--�......-----------...---------------------•--.....------.......--- Locati n-Address Ala or Ig No. . .........� . � ............ .. . / -(t�. l (=,1n L:` /'1�,./._3� .•.. Installer � S.IL ----------------- �.�./....�1 l/l�Address sk! 5- ._..,�� _� � Type of Building ✓✓�� Size Lot..0-__5 7._......Sq. feet U Dwelling—No. of Bedrooms...._�1....................................Expansion Attic (�� Garbage Grinder 1 � Other—T e of Building ............................ No. of persons___-•_______________________ Showers — Cafeteria a' Other fixtures ............................ . W Design Flow......55.............................gallons per person per day. Total daily flow......... ........................gallons. WSeptic Tank—Liquid capacity.Y gallons Lengthg.�Cn'..-_- Width !-Jp"_ Diameter._._._.....__...Depth.. . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._.._.I.......... Diameter...l..A........... Depth below inlet...-A. ............. Total leaching area.',5Q�]...sq. ft. Z Other Distribution box _j Dosin ank (go ) _ Percolation Test Results11 Performed by----- ;.Ad(.. . •:.l`�Y•t^ ............. Date._._..... .......... aTest Pit No. 11Z.......minutes per inch Depth of Test Pit.....�P.._..._.._ Depth to ground water_M..,j_— Test Pit No. 2-L9y:.......minutes per inch Depth of Test Pit.....j_A........... Depth to ground water........................ O Description of Soil 2 -• ' ^ x ------------------------ ---------- C o2 u�_�.,_.. - �"�. t� C P .. � U W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------------------------------------------------•---------•---------------------------.....--------------•-------------------------------------------•--•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITLE 5 of the State Sanitary Code—The undersigned further agr es not to place the system in operation until a Certificate of Compliance has been issued,by the boar of health. Signed _.. . �? fG� /a .... Date Application Approved By........ '...... -• - .... Date Application Disapproved for the following reasons---------------------------------------------------------------••--------------------------------.............. ...................•--....------------...----•---------------................---------------•----------....------..........---------------....----------------------------•----•--•••--••-••--•--•..-••-- Date Permit No....... 7.-.. 4:�•9, ---------_------- Issued-....................................................... Date F=`— TOWN OF BARNSTABLE LOCATION L !),d� SEWAGE`#"x. VILLAGE �� y��L--=�! 'ASSESSOR'S MAP & LOT s �O, INSTALLER'S NAME & PHONE NO.�/ //�/J SEPTIC TANK CAPACITY_ �fi�� /���� LEACHING FACILITY:(type) ZG laey (size) /- ,'NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATE BUILDER O I / DATE PERMIT ISSUED: 0 6 DATE COMPLIANCE ISSUED: c/- VARIANCE GRANTED: Yes t No i � � _ . � �, � � ,, z �� y9���' �� � i$ > �� '„ s i�� , ��. "�� rti rlo.. ..7..:.Glo 1_.07- 3 Fss......... ...."� THE COMMOt, WEALTH OF MASSACHUSETTS BOARD OF HEALTH �oY./! ...............0F. 75.t.k e.tLl`, \. �' ..Lam............................. Applira#ion for Disposal Works Tonstrur#ion ramit Application is hereby made for a Permit to Construct ()) or Repair ( ) an Individual Sewage Disposal System at: L.(=.......... ............ �y� Locat n-Address _ or Lot ;�._� ..••.. ................ . ....... ......._�:......... ...S... .. t J.ti...�.... .................. er f Address Installer Address Type of Building Size Lot.-D.`_. ........Sq. feet U Dwelling—No. of Bedrooms._.�........................ .Expansion Attic o�(l Garbage Grinder `4 Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fixtures ........................... . W Design Flow......_�> ..............................gallons per person per day. Total daily flow.......3.3.0........................gallons. WSeptic Tank_Liquid capacity.1060.gallons Lengtle.'--G`___._ Width'-..IC?`.... Diameter................ Depth..:` .:.5. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No .�­______-__-. Diameter..!A.....__..... Depth below inlet............... Total leaching area.'60..?Zx...sq. ft. Z Other Distribution box �is Dosin. tank No) '� Percolation Test Results Performed by... AX.T-F_L-j_..!`�. _��.�. ._�................. Date.... Q`.1(Q_5 .......... Test Pit No. 1.42--------minutes per inch Depth of Test Pit..... ............ Depth to ground water_ ___. __ (s, Test Pit No. 2 L Z-_.......minutes per inch Depth of Test Pit.... ............ Depth to ground water........................ a ........... ---- .........---........--------------------...---------..........-------- ...... D Description of Soil..... .".Z > rc�,Z �.... �! = �.2. :�GUl.4.-.2z.t`,_---:. V --------------------------------------------------------------------------------------------------------------------------------•---------------------------------•---------------------------------•... U Nature of Repairs or Alterations—Answer when applicable............................................................... ............................... ---------------------------------------•-•-•----•-•--•-•---••••••---•-•---•--•---••---------------------•----•-•--•--•••---•----••-••••-•-•--------•------------•-•-•-•-•-....------•---•-••••••--.•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT!L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board, of health Signed. .;'..... = l. /ltt" ...? -• 44A . ,-•--- e - . ... .. Date Application Approved By--•••... �^^`� .,t. . may. ....:� ........................... ...............�2-: .a-X'.,k_.? l/ Date Application Disapproved for the following reasons----------------------------•---•----•--•----------------------•-----------------•------------...-------•-••..... -••--•-•-•----------------•--•--...................-•----•-••----------•------------------........------.--------------•-._.........•---•-••---------•---•-•-•••---------•--•---•---••--•---•-•••---•••- Date PermitNo........ .�?....... ...'�1_=2----------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ��"Xa....:� .......OF............f� *�-wa ~ ................................. Trr#if iraU of Tomplitanrr THIS IS TO CERTIFY, That thae Individ al Sewage Disp9sal S-stem co;Su ted.(� air -v-. Installer at ----•....L.,:. ?. ._.P�............ t r�C.C_e _ � ? vX�. C .�rL_c.' ...l?..: ...11'e............................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......g-7.:- 692'! �...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ...2 Q ......-........................ Inspector....................... THE COMMONWEALTH OF MASSACHUSETTS �\ BOARD OF HEALTH OF........... r�t... f —� �.. C�. FEE...... ... a....:". Disposal,/Works Tons#r ion rruti# Permission is hereby granted-----------f t .e �e -�.......!..�('c. ....--------------•------------............................................... to Construct ( dr Repairs( ) an Individual �3evtra Disposal System atNo............ ....5 edYY-.� ..... ....----- ---------•---------•-------•----•-------•--•-------- -----•------•-•----•-••--- Street as shown on the application for Disposal Works Construction r •t No.3Z6�3?6 Dated............ Boar ............ .............. /7.. - DATE. .............. ............ of ealth FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 5�k t t i Vz, �a�mot'`�i.c�•-! ; 3 x uo X = 330 a N V4 5x i I o x ►so% L 6a ,�,"�'' 14 ►5"-t:)Sa.L x`P`� ` ' Pi'.TER t ; o c 15ASF ,�ti ;,y.t• o SULLIVAN " RICHAR CAM 1 Sq 0,2.5 = 38S �� ':z A. D `' No. 29733 �Pr.y�4nAXTEA �ZEA � 15� SF �:•t'` 'yfitL'�'iA'�$ ti �OL��GIST�R� ��1. rAc RY; 15- Q— 1,0 f � >�4 1 x 4 rf�,- 6'T 13 s � EL. 98o 7 c= 98 r +C-�= 9 8fi a `tpr-alD To¢.t -r L o.K SE�RG 9s�g 95.E �5,® v ,Nv T{a►a� ANY 3o�ror-t EL. GZA-Wet. 14' S91 .o I✓ $O �odb 6CaL.t1J►..��T l_oT S, .. 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Z' y\ ELW 5a,C.- i E5T" PAY: rN" ep_ACE. Wfl-NE55: uJh117�' /,/�4cT-t�/ c-vr 58• �HA�� PER(RATE: " ( AC�j�t0 G y r f r a.. y8 y 1GS N W TOM P EL. n8 yj 77• f3 IN!'U11.l.r rr , VI71. �i /�• �---`"-- K SEYrI� Tnn►c ac 7,L1, Iv C.. o� DES I CAN PATA II ,�,/d lv��"�lZ G.C/C'ovy/7EY�E,a PA LY FLOW: (5)BEDROOMS x 10 GPD= o 7- 5— SSo GPD S� � B 3 `�'� ` - --SEPTC TANK:�oGPD x2l�!J%�.//ao r PD \„ U6E:/sa5GALL0N PRECAST SEPTC TANK �---_ LEA(.III NCa FACILITY:USE: Cy) 5- e 4,S�,,Z '-L- CAFAGITY: 0,21 \. ID0 TOM: /3' OENERAL. NOT E5 � TOTAL: C- ,=) GOM`RACTOR TO f5E RESPONSJ LE FOR THE LO(ATONOfi=AH UTLFES, ADOVE AND UNDERGROUND,PR oR TO ANY EX(AVATbN OR(ONST_RUGT ON. 2. SEPTI(SYSTEM TO m NSTALLED N GOMPLMN(,E WIFII'V OMR 5,00:TIFLE V 3. T"�16 PLAN 5 NOT 70(5E USED FOR PROPERTY LNL DETE NATON j A. ALL DIST() MP AREAS TO t5E LOAMED AND 5f=LDED 1� CONTRACTOR TO PROVDE 24 MOUR NOT6E f WR ANY F E URE:D NSPE(I- 774n✓Jc To 6 - s".7 lo v �SIi OF r_N UMB / \ I I, �� !,4 '�E'SStO��'4• � 5 T �FVVAC�F FLAB; / LOCATION: //9 /ti1z__v.,9.Y T2�/C h'�a FRF_PARED FOR:. . Sco T-7-- �. SCALE: I DRAWN --� --, -- J � NLUMR: DATE �7,' 5 �-Ire p 1645 FALM0UTf1 RD ti SUITE �O OENTERVILLE, MA 02l/M ---_- / TEL.: (508) 775-0735 N FAX: (505) 775-0754 PROFESSIONAL ENGINEERS & LAND SURVEYORS