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Home My WebLink About0352 LAKE ELIZABETH DRIVE - Health 352 Lake Elizabeth Dr. A = 227 -030 Centerville 1 ®j C® R T C G' MEMBER REPORT Level, Wall:Header PASSED r 3 piece(s) 13/4" x 5 1/2" 2.0E Microllam@ LVL Overall Length:6'5" i INS- 0 i'ianSiv,.: Z _iw�,+`- sN .' e .. by e.±2N^•<.2'�'.'6Nr' 0 F All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal. Actual(ip'LocaLon „zAilowed `s ,Result h; lDF I oad Combrnatwn Pattern < {) System:Wall v Member Reaction(Ibs) 908 @ 0 5709(1.50") Passed(16%) 1.0 D+0.75 L+0.75 S(All Spans) Member Type:Header Shear(lbs) 743 @ 7" 6309 Passed(12%) 1.15 1.0 D+0.75 L+0.75 S(Al Spans) Building Use:Residential Moment(Ft-lbs) 1456 @ 3'2 1/2" 7333 Passed(20%) 1.15 1.0 D+0.75 L+0.75 S(Al Spans) Building Code:IBC 2009 Live Load DeFl.(in) 0.057 @ T 2 1/2" 0.214 Passed(L/999+) -- 1.0 D+0.75 L+0.75 S(Al Spans) Design Methodology:ASO Total Load DeFl.(in) 0.080 @ 3'2 1/2" 0.313 Passed(L/963) 1.0 D+0.75 L+:0.75 S(Al Spans) •Deflection criteria:LL(L/360)and TL(5/16"). Top Edge Bracing(Lu):Top compression edge must be braced at 6'S"o/c unless detailed otherwise. Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 6'5"o/c unless detailed otherwise. ''�Beann LPJr x >'" r `nx LOadS1:OSu tts Ib5 .rti. r+ : +� `v ° 9� i .Su r tS t z a f �t x a e{ ROOr n a d < s. 34T x zpP° s r o� x Total AVadable bRegw_red Dead Snow fTotal* AorRssones ,.51d LIVe 1-Trimmer-SPF 1.S0" 1.50" 1.50" 258 289 578 1125 None 2-Trimmer-SPF 1.59, 1.50" 1.50" 258 289 578 1125 None 1 $,N ' s 2 k TnbuFary , 3DEad e r FloorLive ySnov� } fi r 's LOa[�S a rvLoaCon($rde) Wrdffi t0 90),; (lAOJ +, (115) a comments 0-Self Weight(PLF) 0 to 6'5" N/A 8.4 1-Uniform(PSF) 0 to 6'5" 6' 12.0 15.0 30.0 Residential-Attic and Snow SUSTAINABLE FORE5TRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. 111 Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC FS under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASFM standards. For current code evaluation reports refer to http://www.woodbywy.com/services/s_CodeReports.aspx. The product application,input design bads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator Job Notes 4/13/2017 2:37:19 PM Brian Bourque Forte v5.2,Design Engine:V6.6.0.14 Bourque&Reine Rebello lake ElizabethAte (508)400-5105 bbourque7l@gmail.com Page 1 of 1 _ AA r Commonwealth of Massachusetts J - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �s M 352 Lake Elizabeth Drive Property Address I,, Carol Van Gervin Owner Owner's Name information is ` required for every Centerville Ma 02632 4/25/2015 .; page. Cityrrown VState Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any t... way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information I on the computer, l use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return key. Name of Inspector S.M.Jones Title V Septic Inspection �11 Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority <�& 4/25/2015 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. L15m. 113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ;+ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is Centerville Ma 02632 4/25/2015 required for every page. CityrFown 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: The dwelling located at 352 Lake Elizabeth Dr Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 1000 gallon precast leach pit. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 443 gpd provided t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b °r 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Lt5in. /13Water meter readings, if available: /13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: original system 1986 - Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" I' Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be cleaned now and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet cover is on a riser. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found to be in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 x1 000 gals 3'stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is h-20 and located under paved driveway. Pit was video inspected and was observed to have 1.5'of standing water with a stain line only a few inches higher. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•''rt 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately T,I�N A-f Z Y roc G-f ►3 P` A•Z Z4 �� a 0 2 �' A 3 3 3 c , 9-3 I g r bi A&k Pr Af ys 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is Centerville Ma 02632 4/25/2015 required for every page. Cityr town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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 elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 352 Lake Elizabeth Drive Property Address Carol Van Gervin Owner Owner's Name information is required for every Centerville Ma 02632 4/25/2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 ............. No.E_C......I....... Fic ''4MXOMMONWEALTH OF MASSACHUSETTS =91 B AR® OF SAL` TH OF... .................................................. ............... .................Amifiration for Ropaiial Workg Tonstrurtion 1hrmit Application is hereby made for a Permit to Construct ( )-<Or Repair an Individual Sewage Disposal System at: 'P30 Z 4,k-.j� E-1_1 7/90,F;�,T�Z, ............... .............................................................. .......... --------------------- . ................. ............ J5.. ...PT...�c ;A ne Addm ........... . .. ................................. Installer Address k. Type of Building Size Lot... ---------Sq. feet Dwelling—No. of Bedrooms..............13 .......................Expansion Attic Garbage Grinder—k -jam Other—Type of Building .... ......... No. of persons_....__...(a.............. Showers Cafeteria-(---T— Other fixtures ...'"Design Flow________________________�57 gaI'i""'..lons .pe."r..person....p"e'r'* day. Total...d*'a"il'y'...fl,-o...w..................3*":-q,...."2-----------------g'a"1'1'on-,s- Septic Tank—Liquid capacity-1.09.9gallons Length Width__'V...cj.... Diameter________________ Depth_t-5.... Disposal Trench—No..................... Width.........._..___._.. Total Length...___.............. Total leaching area....................sq. f t. Seepage Pit No.........J eiameter..... ....... Depth below inlet.....:�5�... Total leaching area...Z!��.sq. ft. Z Other Distribution box Dosing, tank Percolation Test Results Performed by...........il-'Z3. ............ Date._..4� .......... .. ..... ............. ............ Test Pit No. I......!�—.,_2—.minutes per inch Depth of Test Pit.... Depth to ground water_.___.__....... is Test Pit No. 2................minutes per inch Depth of Test Pit----1..'2......... Depth to ground water...1.2 .................... 4Q ................................ --- .......................... ----------------------- 0 ................*--------------- .... .... ... ....Description of Soil............. ............ ...... .......................... U ..............................................................................................................!)-ESfG41NG--E----------------------------------------------------------------- NGINEER MUST --------- ------- ----------------------------------------------------------------------------*-------------------------------!NGTALLATTO-MAND-'C-ERT jFy—QuPeRvisie--------- U Nature of Repairs or Alterations—Answer when applicable____T�YF. ...I.N -SYSTEW-WA-------N...S.... .......... .................................................................................................... r.) S I .......... Agreement: The undersigned agrees to install the aforedescribed IndividuoSewage Disposal System in accordance with the provision,,wqTI'1T_Z- 5 of the State Sanitary — The tjAde g e further agrees not to place the s stem in operation gg�LkCv;tificate of Compliance has en b e health. 7K Si ne . . .. ............. .... ..... ..... ... . . -----------................... D t� zi . j PPion Approved By...................... ................................................................... .........7 --------------- Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo........................................................ Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........✓.... 'n/. ......OF...... ........ (Intifiratt of Toutpliatta THIS IS (0, CERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired by.................. ...................................................................................................................................................... F . ....... Installer at.....2.. ......... ....... ... . . .......'ZEZj.09...........T. ... . ...:Zn.......... .............. . ..kn.f..f C. has been instilled in accordance with the provisions of ='j'LIE 5 of The St a de ap described in the application for Disposal Works Construction Permit No.__..... ............. .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR EDfAS A UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... {y 3 _'a O C iAIG r 4� SHORT v� �" CIVIL 4 r ,® NO. 27483 \rd/ 'IAL Zri1 I tf ♦W f / l "f tl No. --- ..�} Fss.. THE COMMONWEALTH OF MASSACHUSETTS ' /BOARD OF HEALTH P _ �,-- Appliratiou for Disposal Works Cna nstratrtilau 11trutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: _ _ _it__ p j 2- G r�Y, L'- Z 2-l 'Z i-/Lj 2: " � "� ................_»..».......................................................................... --•--•------•-•--•------.....••--••-----•-•----.....---...------•-----......_..................... Location-Address or Lot No. »----------------------------------- --------------------------------------- .......................... ....... f + i ...._� :.... ................. ................................................. Installer ............... Address U Type of Building Size Lot_._. .........»�..Sq. feet —No. of Bedrooms........................................_...Expansion Attic-( ) Garbage Grinder—(-- Dwelling ) a Other—Type of Building ............................ No. of persons._..._._.�........ _.___. Showers ( ) — Cafeteria- ) dOther fixtures-.... '..-�-•---------•-----------------•--�---.(..............---•--.......J------..._............:;-�---v---•----------�.--------.- W Design Flow......................................gallons per person per day. Total daily flow...........•---_....__....._................gallo s,, W Septic Tank—Liquid capacity............gallons Length................ Width..ft.......... Diameter................ Depth_....._.._._._.. x Disposal Trench—No..................... Width...... Total Length.............. -- Total leaching area---............ sq. ft. Seepage Pit No................yr Diameter..... ............ Depth below inlet.................... Total leaching area......q.-`-�..sq. ft. Z Other Distribution box ( ) DosingC tank (� ) �� Q�� `� , c- WPercolation Test Results L Performed bY ---------------------------------------/-'�F----•---------•------. Date .y �. :_-. Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water......_.:.......... _K G� Test Pit No. 2................minutes per inch Depth of Test Pit....._......__.._... Depth to ground water........................ t • a+ ...............................................F . .---- --- ' J....................... O Description of Soil...........•......t� c.. ' 1 -- i V ...........•--••••--••-••••....-----••••-----•••-----...--•-•-•................••-•-•......----••-•••.....--•-•-••---•-•----••••-•-•••••-•-•------•--••--•------•-•-•----•--•----•---•---••-•-------..... W V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------•--•-------•---•-------------....-----....................-----..... Agreement: The tt signed agrees to install the aforede ribed Individua ewage Disposal System in accordance with the prov' of T�TLf 5 of the State Sanitary od The der urther agrees not to place the stem o un 'I a Certificate of Compliance has b s b h 1 Signed........................... ...................................................... ..... /....:....__.... Application Approved BY �.��-.-.�'.:-�_'% --------- ----------------- Date Application Disapproved for the following reasons-----------------------------•-••--------------------•---------•---------------------.........•.... -----------------------------•-----....---•-•---••-•--------•----......--••--..................-----••-•-•-••-•-••--•-•.....•••-••••---••---•--••-•••••••--••----•---••-••--.--••=•---•._...--------••- �.__.. Date — X �� PermitNo......................................................... Issued......................................................» Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................OF..........I...................................................I...................... %T.rrtif iratr of TaaaatpliFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) bY---------------------�- t G+ •-----------•----•---------------•- -----.---------------------•-••-----------•------- Q..r �� r !' L .� G r7 -,4=7/ I`/ �r Z C r7 / �; V,1 L L 4� at-•••-•.................••......Z_ .C-,4=7 been installed in accordance with the provisions of TIT ThOSD aSanitary Code-�s/dps in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f 7,1fL, 77 7 G- °-3 ...................OF.......................... �.. No..............••••....... FEE........................ Disposal Vorkp Toats#rudiaatt Errant Permission is hereby granted._...._.,...-j.�..�_.. ........................ -- ••..- - ----------•---------...........---••-......... to Construct ( or R�pairC( �� Indivi age D posat�Sys L, jl r�JCZ7 Y L"- atNo..........................•--•-----•---....--------•-----•---......_........-------•----•------•--•-•-----------...... t� `� Street -ems shown on t e application for Disposal Works Construction Permit No.. Dated _..-----.-•-----------==--- �? .-.- Board of ealth DATE................................................................................ FORM 1255 HOMES & WARREN. INC., PUBLISHERS 1 t ' rci mi l Nunber: gUatc: Completed by HIGH GROUND-WATER LEVEL COMPUTATIO14 `43 7 9 Site Location: L- o T 30 La/Fe F/iz c. • tb ter-; C rpYot No. ,3 o Owner: _5Ct . v t a-+ Address: Contractor: /21-c k-u r" So llww-s Address: Notes: STEP 1 Measure depth to water table -��// /8G to nearest 1/10 ft . _ 9 date STEP 2 Using Water-Level Range Zone and Index Well Map locate . site and determine: T�v�/89 A) Appropriate index well . . . . . . . . . . . . B) Water-level range zone . . . . . . . . . . . . FE STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well . . . . . .IsIts r" mo yr STEP 4 Using Table of Water-level Adjustments for index well STEP 2A , current d&pth. to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine water-level adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estinate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tom@ FIQ 'j 7 e, ass, 17vf 19 ,7 ,4>e11v, V1c, 4er- 3 & .7 //iw. I3vT, Leo�e.h 4Aa-7 is z -s>,-mc� x•.- +ca nx,+a•r •... 3r,c-s -l;i w n a.e cgr v'. 7-i. waw 1:ru r.,t ury�¢�,.a .a c>• ci,x+a>axL lrr� yn .�.e '-razz -s.:w - rw;. �ors:+=Ic .ra r'� � -�,s.:t1 Y M+ ■■ ■■ 'F'ru96 K tat4 sbs IAk._5"rY.tl 12I:- �'2 i£"I.YK CMu ffiA 4'l k?'+�U _ -. SJ 41.1,][ �..M'Ai i+K ttM G,. 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Irlrlmlr/m.rlmlm■.1..mlllml �� as��o��® �� .1r1mlr.m ulm/mlru u/muu.■ulrlmlr ulruuu■mu ulruulm uemuuuu uer ul.u..lruuuulml.0 ulrl.Irlmlruu m lrlm u\.uuu ulrlm u111mem1.u11■.Irulm.rl■Imuuu/ \mlmtr ull.m ulml■uer ulruuuulruuuuuu. i1i\ililili\ii\ililililiu.iuliuliul�m�mm�mmm u�uuuuuuu�u�uu�mmuu uuuuum uuu * } i 5 •s+;+2.��.�� -______-`___` ..../\mll■.lrlmlrem.m/.I.Ir1.lmlr/.1.111.I...11 u.mlml.l. • 1 \ • 1 1 • \ \ 3 20'-2 1/2" N I f Sloped Ceiling d z ' t i ) N � N C O Cu O 0 o U o .N o N of o c O d o Attic Space - i ' � o J mN m � u m - � x O � m Ufinished Area ! ' N Existing First Floor Conditions Z o (D - U) o o Cr �2) U) •` U) - - - ' :3 ti m r 3 I e !'l 1 Living/Dining ! Hall Sloped Ceiling > c - 1 - _ � - IL CD O N a O W O �.. .._. . .. ; N C -�� Existing Second Floor Unfinished Space M w s s � T-11" a _. ..- /. S-W Sheet Scale • Drawing No. 2 Of I q i. N Z 20'-2 1/2"XT— --—-- —- -- -- w Zr t-- l as - - fi o 0 Z C � L m • m m O O N I o_ U W o OI Of y O }qY > f- c �p CD New Family Room No o I' U Attic Space a o m I 1a I i S m m m C o0 _---_-._--.----__ ---_--__.__--_-_._-_._•_-_--_._.._.. ....-___.___ .__ __ -..............._._-. ___.._-- i .J 04 Proposed First Floor Alterations --- =i U) o o •O 7 Sloped Ceiling 0 cc 2 v EL U CU >cc O r U.)L Attic Access m - ----_-= 3'_T' 0 Living Dining _ U.) Attic Space. Hall c ` c i O 0 to a� o LL O N U W N -a a ca Proposed Second Floor Space n - F >n a o` 3'-2 3/4" s�le I sheet Scale i a—VNo. 3 ---- ---------------- ---- ----------- i of j i 4 II 1 Continuous Handrail General Notes 1.3/4"Advantech Sub-flooring glued and nailed with 8d Ring shank. 2.Wall framing:2"x6"KID SPF z (D Calculation Provided for Joist, Rafter, & Header Spans 112"Zip WSP nailed 6"edge, 12"field;8d Ring shank See Attached Sheets Fasten bottom plate to floor framing with Simspon Screws Sister new full length studs in existing exterior Gable end walls ------- Stud on top of Kneewall interior gable at Attic Space 3.Ceiling framing:2"x 8"KD SPF#2 or better. Joist sacing 16"O.C. 4. Roof framing 2"x 8"KID SPF#2 or better. Joist spacing 16"O.C.H2.5a connectors 5. Provide Cricket where new cheek wall meets existing roof 6. LUS28 Joist hanger where not direct bearing. 7. Exterior Trim:PVC soffit,Fascia,Rakes,and comers 0 8.Wall Cladding:White Cedar Shingles over Triflex max.5"Exposure z ---------- re Typical Header Detail Roof Cladding:Certainteed Landmark over Triflex 9. Interior Finish:Walls&Ceilings 1/2 Blueboard and Plaster Flooring:3/4"prefinished hardwood 7(3 MDF/Pine baseboard and casings 2 C� 0 W ;5 ---------------- > C,4 2 1 i C) 0 it 7 i I' 1J0 �If ifif M M 0) M 0: If ifI. �e �c ----------- —-------- (0 Second Floor Guardrail at Stair Open" Headers: >4 3-2"x6"KID with 1/2 WSP flitch single jack I i i' iCn 4'0"-TO" 3-1 3/4'x5 1/2"LVL with double jack 0 0 = M <: it 0 t5 < 0 M 2 if ifO II d- C U CIO In If if if r U) V) Shed Roof Cross section Detail J. A T Ii it 0 M ---------- .. . . . . . . . . . . . if-------• f it i First Floor Stair Guardrails Existing Front roof A and Ridge to Remain New Shed Roof it Ceiling 2 0 and Back Wall . it It Co o cc 03 a) CY) 0 (D E CIO IL C'4 Mir I Existing Joist Existing 1st Floor .6 Sheet Scale T z Of 4 '0 Mumma 111 .~ ^ SO I LOG �4 9 DATE_ WITNESSED BY: 2/12 /'✓, e.S- T l N POLEr 27 I 4 / � � . �/y CST? T. N. - '[. •rl.3 ..G At3 rr= F*. E�dS4 2 �• E-L, / ,�, -- ' ¢ i 1pt7°�Q . C L JF,A,\! ks 4t �39,3 -----• �` © ' I_ VJ r57 'Sc" �Z t 4 Q" Ji/ c'� vlf A 'T� �"L 5 ON C G U N T'8'1Z D 1AANHOLES AND COVER TO BE BUILT vvirHim ` -i ,�-•• i` E L E V. 'TOP OF , JAC � o FOUNDATION ��,.�� IP" OF FINISHED GRADE . -•7.., ; • Y .! y � . - ,.•#A N 2,*-'* SLOPE FINISHED :GRADE I M 9. 4:s 4 AOSRTIRO e i C -. . , • ,, .... .•• ., PVC g� . 5 • 40 iST Z0,,PA•'I E SU5S01L 7 :4': PVC SCH. 40 ,✓ PITCH "I FT. 2'1EYEL MIN. 2`� LAYER f Rd�'C -:rAD , (j�� Z" F' �'/y C L1�.J�`•/7 E/Z I� s ,p4 P i w C Hv _ i }. fl ` f�l g " I/ P PEA AS' TO 0 N E � 4-y t GAR. �, �} 7. 2 *• �4f FT ©oaG . .5' b.9� = fl AEGflW iN ART T� 1 - INvE T DIST. � 'p ! d" f INVERT . - •� GALLON iNYERT .+►= �i�'- rr rr . vJ r� 'rr v -z� i c� INVERT 4G►�c B o x A,.P �/4 - 1 1lz a.I A �. I � , r4. . SE PT IL TANK ' z < 2 �1"w WASH STON nn11 �} Io .�,�'x�► D.�, � � � ..,., ... •... ; •. I Nt Y E R T H-$4 � , :•+, �• u �,T� • E G E • IY , `•,..•"../ - !-•� L L. � .:;o t N V E R 7 �'�Q ,� _t +� A L 1 AROUND G A R B lit G E ---- ..� Q 2 IECY, fl�+e. �e 'r:' �"r!`'""`_ '"" '..: a.J C1.; E L.l V. OT T O KA MIN. i; RrNDER -- --a' o IT q�.7. F P. w_ _ _ , 1 --- „'. PROFt`LE 'OF; : GRouND WATeR''rAet"E ,r'c,/S7": S A.N I T A R Y D 1 S �' O SAL S Y S T E I� ,•-'' �---- : NOT TO S CA L.E _D E S I G N D AT�A B E D'R O O M S- ,/'' • CONSTRUCTION OF SAN TTAR Y 0IS POSAL GG DESIGN , FLOW 33 © GAL./DAY SYSTEM :SHALL CONFORM TO MASS. _ L-E AC H RATE 2 MI N. INCH ENVIRONMENTAL CODE TITLE '7 (REVISED 7- I - 77� PROPOSED LEACH CAPACtT'Y : . /�,� A N 0 THE TOWN .,OF . C3 i9 R Iv+,S T F3 a L �' ,� 7T G HEALTH R EG ULAT1 ON S. >2) t- /. O • SEPTIC TAN Kj'DISTRI BUTTON BOX AND LEACHI NG PITTO BE -OF REINFORCED CONCRETE : GAL/DAY � _ MtN. CONCRETE :STRENGTH 3000 PSI A `ems {� ' ' MIN. STEEL STRENGTH 2 0,0 OOP S I DESIGNING ENGINEER MUST SUPERVISE G 1410 DESIGN . LOADING INSTALLATION AND CERTIFY IN WRITING • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE TO PLAN. UNLESS H - 20 DESIGN LOADING IS USED. • ALL PIPES AND FITT I.NGS TO BE .WATERTIGHT AND TO BE OF CAST IRON OR SCHEO 40 P.V.C. SITE P �.. A N SHOWING PROPOSED CONSTRUCTION SH.l0F !sHs LEGEND L 0 C A T ! O N: FOR = ,5A� V A L� P JZ E•,5 7'0^-/ Ar P, P R O V E D CAS. : z-© 0 A BOAiD OF H ALT' H ATE: s� REGULATIONS, PER EXISTING CONTOUR . ..�.I6 _ REFERENCE BUILDING .SETBACK, - T R. O R B U I L D I•N G 'PRO 4 , !Z J _, r•Cy T- z BUILDING tNSPEC O - ., , PR0P05ED CONTOUR I6 DATE AGlE•#4T C OIVItVI ISS t ONE R � G b 1 VATI O t 7. • , ,:. acrsrlNG s t�OT E LE 6 , O , . . . . . NT ETE3ACK .✓ � -:ate N M I-N, F�2 O S F ".: Z tl 1N OF tf . P:ROPOSEO ,W E , • E T C K C' MIiV. 5I0E S BA : . CF?A G O a O C A T t O �l ,IosE� 1 ,... TI=ST :HOt. E Lb s�loR TACK . . I�IN. REAR 5E , w , .t. 27483 ! CI TER �• , y S R • roJtz P R a F£ .S 7►N A L L:A N b 5 tJE t V£Y.O#t S .,� : N±G 1 N E,E R _ : u K . • , : • , , goo JUL. 171 j - .',. .a