Loading...
HomeMy WebLinkAbout0028 LAKEWOOD DRIVE - Health 28 Lakewood Drive Centerville P A 212 022 �l - t gar 17 2016 22:13 Jim The Inspector Man 5085349919 page 1 ova- ■} Commonwealth of Massachusetts / Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 28 Lakewood Drive N Property Address r r; Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out fortes on the computer, _j"OFAggs use only the tab 1. Inspector: .`��s�`r� ' sq V''a key to move your •;�'yG cursor-do not Jears D.Sears g; JA M ES , use the return key. Name of Inspector Capewide Enterprises, LLC *` o o 'o- V�—u Company Name 153 Commercial Street °''�o;,S INSP111111 �11'0.t`��� Company Address Mashpee MA 02649 Cityrrown State Zip Code 508477-8877 S1623 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 3-17-16 ,00nspector'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. t5m•3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 o VS Mar 17 2016 22:13 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. Cltylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is two pits piped in line. 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): 151m•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Mar 17 2016 22:13 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner pwner's Name information is required for every Centerville MA 02632 3-15-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms 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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Mar 17 2016 22:13 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. City/Tcwn 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 NA '❑ ❑ 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 [Bins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Mar 17 2016 22:13 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F y 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information for every on is Centerville MA. 02632 3-15-16 required page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year Nd.T 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 orless 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 falls. 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 ❑ a 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 Tille 5 Official Inspection Form:Subsurface Sawage Disposal System Page 5 of 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16- 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 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 rmanholes uncovered, opened, and the interior inspected for the condition of the NnUMM&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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330 r5ins•3/13 Title 5 Official Irspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16• page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is two pits piped in line. Number of current residents. 0 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usa e d 2014-62,000Gal g (gP )�' 2015-76,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Dale Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sci t., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•3/13 - Title 5 Official Irspection Farm:Subsurface Sewage Disposal System-Page 7 of 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 . 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping; Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a.copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ` ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page a of 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y.r 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. City/rows State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 34"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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 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: Sludge depth: t5ins•3113 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 9 of 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. City/rows 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 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 4. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Till@ 5 Official Inspect on Form:Subsurface Sewage Disposal System-Page 10 of 17 Mar 17 .2016 22:14 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts v: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owners Name information is required for every Centerville MA 02632 3-15-16 .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 7 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 151ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page f 1 or 17 Mar 17 2016 22:14 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts w r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. CityfTown State Zip Code Date of lnspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NO BOX Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: 15ins 3/13 Title 5 Official Inspection Form.,Subsurfaoe Sewage Disposal System•Page 12 of 17 Mar 17 2016 22:15 Jim The Inspector Man 5085349919 page 13 Commonwealth f o Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '< 28 Lakewood Drive Property Address Pen Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-1546 page. City/Town State Zip Code Date of Inspection D. System I nformation (cont.) 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.): Leaching is a 1000 Gal. Precast pit w/1' stone. Pit at 28" below grade w/cover at 14". Pit is dry w/no sign of over loading or solid carry over. No high stain line Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 5t Depth—top of liquid to inlet invert Depth of solids layer, 2 Depth of scum layer 0 Dimensions of cesspool 1000 Gal. Materials of construction Precast Indication of groundwater inflow ❑ Yes ® No 151ns•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 13 of 17 . Mar 17 2016 22:15 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments note condition of soil signs ( g of hydraulic failure, level of ponding, condition of vegetation, etc.): Main Pit 1000 Gal. Precast.Main at 22" below grade w/cover at 14". One in w/no tee. One line out w/tee. No sign of over loading 2"water. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 or 17 i Mar 17 2016 22:15 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately vPof,� ScR££f-E� IN JI'�' 0 A t I 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Mar 17 2016 22:15 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owner's Name information is required for every Centerville MA 02632 3-15-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: _Auger T.H. 12' no G.W.. Bottom of pit at 8'-4"below grade.. Bottom of pit at 3'=8"above T.H. Depth. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. thins•3/13 Title 5 Official hspedion Form:Subsurface Sewage Disposal System•Page,116 of 17 Mar 17 2016 22:15 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 28 Lakewood Drive Property Address Peri Wentworth Owner Owners Name information is required for every Centerville MA 02632 3-15-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater' ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I� t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner O r&,fs Name information is required for every Centerville MA 02632 11/07/11 page. City/Town 'State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be afbered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections sy Company Name P.O.BOX 896 Company Address r East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 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 P P P accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/08/11 Inspe or'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. LZq, 0 111 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disp I System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owners Name information is required for every Centerville MA 02632 11/07/11 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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): t51ns•11/10 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 y` 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑, N ❑` ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page" Citylrown State Zip Code Date of rspection B. Certification (cunt.) 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 its 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 Cl ® 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 thniii 11/2 day ofC"ivr' t5ins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. Cityrrown state Zip Code Date of inspection B. Certification (coat.) 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 otherfailure 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered'yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments `t 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Flame information is required for every Centerville MA 02632 11/07/11 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? ® Cl 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 (f 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): 4 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 440 t5ins-11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Vj, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Herne information is Centerville MA 02632 11/07/11 required for every page. City/Town State Zip Code Date of inspection D. System Information Description: 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? El Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 07/11 Date Commersial/lndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-1 V10 TSBe 5Oftial Mspscbw.Foam: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 '< 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. Citylrown State Zip Code Date of inspection D. System Information (cunt.) 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 It 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) (f yes,attach previous inspection records,if any) ❑ Innovative/Alterative 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 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R s Subsurface Sewage Disposal System form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 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: 11 f20108 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 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 ❑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: Sludge depth: t5irs 1 I 0 Tide 5 Oftial Irs?,ec5cr Form:Subsurface Sewage Dspml System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. Cityfrown 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 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 How were dimensions determined? Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction:. ❑concrete 0 metal 0 fiberglass ❑ polyethylene 0 other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page, Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Aarm 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-11/10 Title 5 Official Inspection Form:SubsuAace Sewage Disposal System-Page 11 of 17 N Commonwealth of Massachusetts w Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 11/07/11 every page. CitylTown State Zip Code Date of Inspedion D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS) pocate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 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 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: Cl leaching trenches number,length: ❑ leaching fields number,dimensions: ® overflow cesspool number: 1 ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc): This system has a 6'x6'precast pit surrounded by a foot of stone.The pit was dry with a stainline 18" up from the bottom. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 inline Depth—top of liquid to inlet invert 5' Depth of solids layer 2" Depth of scum layer 1" Dimensions of cesspool 6'x6' Materials of construction precast Indication of groundwater inflow ❑ Yes ® No f5ins-11A0 Tfie 5Officiai inspection Form:Subsurface Sewage Disposal System•rage 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal:System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA. 02632 11/07/11 page. Citylrown state Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): This system has a 6'x6'precast pit surrounded by a foot of stone.The pit had 6"of liquid with a stainline at the outlet invert. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspeclion 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 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 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 ' S q 8 3� r t5ins•11110 '7le 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Z Subsurface Sewage Disposal System Form Not for Voluntary Assessments. 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cone.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 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: USGS maps show an elevation of over 20.0 feet Before filing this Inspection Report,please see Report Completeness Checklist on next page. thins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Lakewood Drive Property Address Federal Home Mortgage Corp. Owner Owner's Name information is required for every Centerville MA 02632 11/07/11" page. Cityrrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Trfle 5 Official Inspection Form:Subsurface-Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCAnON a3 �Akg- WOd8 AVc SEWAGE # `VILLAGE lrytk ASSESSOR'S MAP & LOT aka Oda. INSTALLER'S NAME&PHONE NO. LdT S SEPTIC TANK CAPACITY G � LEACHING FACILITY: (type) P,T G X (size) /OEP G"/. NO.OF BEDROOMS o°BUILDER OR OWNER ~' • ��+ � 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 300 feet of leachi�pg facility) Feet Furnished by �/1 jPcYyon FOr a { A 3, � � 1 I P S0 31 a a y� 38 TOWN OF BARNSTABLE 'LIOCATION � ���,1�1� SEWAGE # tl VILLAG1�\L�� ASSESSOR'S MAP 6: LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY ��C�F1L�(' 30LA tb (T w 1 S vEACHING FACILITY:(type) �� 1 (size) NO. OF BEDROOMS 3 PRIVATE WELL O BLIC WA�T BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE.GRANTED: Yes No .� � � i � � ��9 � C -� ` S1 Z�2- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION-V APR 1 2 2005 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 28 Lakewood Drive - RC'L R b Zq- Centerville, MA 02632 Owner's Name: Alice Ca,nnbell Owner's Address: 80 Richard Road _Needham. MA 02492 Date of Inspection: April 1. 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (S08)862-9400 CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: tj Date: April3. 2005 The system inspector shall sub ' 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. Notes and Comments ****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 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2005 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 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: 2 Page 3 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Cmnpbell Date of Inspection: April 1, 2005 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 I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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 'h 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Camnbell Date of Inspection: April 1. 2605 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping infonnation 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Pumped in August 2003-per owner Was system pumped as part of the inspection(yes or no): 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: Approximately 1971 -per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: 6" Material of construction: concrete _metal _fiberglass _polyethylene ✓ other(explain)_ Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 6'W x 6'T x 7'bottom to arade Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 2" 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: Measuring stick Cormments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The cesspool had 2'ofliauid on the bottom. An outlet tee was present GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 ' Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2605 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Lakewood Drive Centerville. MA Owner: Alice Campbell Date of Inspection: April 1, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 671000 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.): The nit was dry. The scum line was 2'un from the bottom There did not appear to be any signs of failure The bottom to garade was 8'. The cover was 20"below grade. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1, 2605 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. a I � deck 15031 oL a y� 38 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Lakewood Drive Centerville, MA Owner: Alice Campbell Date of Inspection: April 1. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 18+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 18'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the system, the inspection and/or this report. 11 �1 9�F p,�\..• Q G POND WAT 201.00' I'I C.B. FOUND \ \ i EL. 39.7 �^ EXISTING SEPTIC SYSTEM t p NW 2 - 1000 GAL. PITS (1 o^' ZN SOLID WITH TEES) PER , cpi�! 00 AS-BUILT CARD o (INSTALLED 1971) EXISTING GROUND I \ O 2DX b05 UPPER DECK O +EL 46.5 22.0' PROPOSED +EL. 54.5 LOT 5 m 21,800 SF o EXISTING EXISTING 4 BR �� _ s; DWELLING y +EL 54.8 ! �s c ti \ \.EL 61.1 ENTRY-P CH �J,o t -ADDITION 20.5' X 7' \ -off � o ORIGINAL STEPS \ P OPOSED STEPS po"� p��0 132.3S i per. R= \ \• BENCHMARK: NAIL s� �, SET EL 55.6 (ASSUMED NGVD29 FROM POND ELEV. 35.1 t) Q i IdD-G 1 a- D a 3 9., f;, c�j 70'G1/11o,.•tf -h 3 121o101 04�d, . LOT B General Notes 21,Btw SF ,o stji5p i<UH6 x+�ttl �(i I Ground Snow Load-Barnstable 30 PSF Weathering Potential-exposed concrete: Severe O AS gut uno Roof Dead Load 10 PSF Use 5-7%air entrained concrete: 3,000 PSI MMAUm 1Br) Total Roof Load 40 PSF 1 � O Assumed Soil Bearing Capacity 3,000 PSI DO*I Deck Live Load 40 PSF y I Deck Dead Load in PSF Basic Wind Speed-Barnstable 110 MPH Total Deck Floor Load .50 PSF Wind Borne Debris Region NA Mean Roof Height(addition) 16'-0"t Deck s 30"Above Finish Grade: Guards Not Required Roof Angle 30"3 Wind Exposure Category B ctn±ttural Lmber. Height and Exposure Coefficient 1.00 Floorloists and Roof Beams t Our Fiber Stress>_ 1,100 PSI All exterior decking and exterior stair treads to be 1"x 51V pressure �o Modulus of Elasticity z 1,100,000 PSI treated southern yellow pine. _ Floor Beams: Parallam Plus 2.0E PSL Cdt�- All Lumber Exposed to Weather to be Pressure Treated Climate Zone(all of Massachusetts): SA U value(maximum): Windows .35 1`� Z All structural connectors as manufactured by Simpson Strong-Tie Co.and Ceilings .030 to be manufactured from Type 316L stainless steel including naffs and Walls .060 bolts-rated for high level of corrosion resistance. Floors .033 In=ZO-D " y/ 4-4•,_ „ U (fit 1 9Ene40M :*t i K fctlF�N t>S I n tAl1ND1=Y-_ E'DMIt.`i eDDM�Z � i tRJ• C(jgl I i O F6Mlty PAaMI _�, q: 30 i UVIMCt RAM tU Fur:rl I t3tiPr-c-K 44 I 6FDt?oDM �2 s; I Rap-INItJG WDU.-LCn HIGH t - $PSlSiMfsrl'( Ro•n( (wpl+<-off �es-r 'rt.ta�� 1�.n-rl b51.Z5 gf �c,2o59� 11�7•ZI SF LC,¢osh� Alterations,.Renovation and.Repair to a Home for ShI I and Maxi.° 1. ZD)Y�•`t�o s «�55� ., ,zo,� e AKRO ASSOCIATES ARCHITECTS � ;+",.`„ .3 28 Lakewood Drive,Centerville, Massachusetts 27 EastAew Terrace.Marstons Mills,MA 02648 0114MW0 NYYpOI `w n;rno l pF 1201 ——— [Tel.and Fax: 508-4. -1217 1 - _� G•1 $n ZI b° fir-7 5N o WALLI SIISA WAt •to...n...".•?. .•.J 4 '' Ild' 13-IOn I<f IDn �eL° Coe 6- Gu IZI� Q GLo>. '� CLoSEf '0„ 4 �!OII Izr-o (IVTeE6`c7 10 — ' Im&A&P.T.POST&W. / UP I•fej N I I I .lia�C01.157>z.TUg$ d•1 I 2 ZxR1�BILnn.c. I &c�Co-(SY31 ETn� MoPEb mz-b(T/Pe ALt pF--'S i�{ 11 A USf slMPSoN e9bL CorINEtTOR u�Z-s�+aoLTS I Q ee _ 4 I I I I N 4 ,g,, M.Bf.�tzGCM 3 - - x - 3010 I n I MI _o x � J (: N CWi3 .--_--_-- I z PN V ,Q• N1 l�f GZ35 FIJ Z9 GB AIL GWZS N 5 gDGh IlaaL (i 1 1�l Vy I gfSe�R9C N O P O ��Ej N z, 1z11o.c•Vti�ficow/UhE ((]J I a At1 " a tr CROMN6 ADWI'V6 C t 9 4 $ 4-Io F7flh1�G ffvpippT lON WALE `� - - -- � Z(Nd.. ` THD¢dL1G H��/GteDrr AlL a�•IG ' c — - v. HI, r SVRFeceA.�n-fiH ttL Hcv'�h i I 0 =o Li WND-6-7V-MM ceccKh W/vwr sETTuiC HYD�Iu/u„ V U. .� - —— _, U (5 PE h>'EG`i. n r , P d- r nn 5-6 4 5-1 G x ro SL`T I 13 15I I 41 GII Z,o a I,b , 3 +IlGlo ,-,n IZAI SE EK•5t5.f1.$M. -O <.G r L I_ I L L , •y- �p Q FLuSk FRcr�g I I � ' ... ZgL(o AMIL RLYJM A I _ Z I ,V,- d' LIVIN4 '� rJ _ I v a ' p(.W L%IL P•T.LE7C,{;Z- A== LAC, BalA Y9 X.�yy��eeeeeeuuuuuul. . ��(zX.We4tG[a hL eVIG&i sEE� GW Z4 cWs4 GW LS' . . �• a P-T.RBTVIM'1NG wAU: - . 1 _ I I GxG YT•P�iS(j4P� �rl Ir$a it —— `. G° 1'.p�"I �d C�/•+I"ePGTo2 -ro fEtD C�IEcK A'V w-Pal OTfhNG9 PKroz-'In DWG SiE11VC.FiE. �DN. Z�Ln 7-Ce _ PKoPOh�rJ' �`�('iM�PC` �WOR.PLPIy _—_ PR/�PGSFCt� I%i29T �2 PLAN -- Flt;ly GH�Gk Dll. �71MEN'�ION7 Alterations, Renovation and Repair to a Home for -0 °� PrcoPwsEi� P/.� L f no e�zt ti r�7 wra MAX 201L acv�so Shelly and Max 727Easivle.Tterra,e, OCIATES ARCHITECTS im s� 28 Lakewood Drive,Centerville, Massachusetts Mal'stons Mills,MA 02648 Tel.and Fax: 506-419-1217 Z eF 1 L01 AWH,CL-f 51`104CLSy_ ASrllpur SHIN4LE4 IZ' �- _ 1%3 ON 1x 10 ff+9G1 1{3 ON Ix10 RAKE 7 _. _. -Gx0 roar _ de. . d — - miff- EN ---- wN Kti c>:a�•e SAIUL,I.ch� !� - - - I I I i 1- ---- ------ _ II I WT1I(i GEDPZ i111NG�Eh i t I - E IhfINC. LK- NkW=. I. ❑ ' EE —— %WrFz U` r. 1A NEW Ain 1-(IDN IhTINcr C-Oms'Tfcucrr IoM NEw AWIT101-1 --�'�' i 1 I 1 J --— ICJ'x ZA°CENT•corlG�ftG. �—�STEP FaMING F5 PLQ {I-- l � n RIGHT SI Dl; EI.V-YAToni ' —1 �mNsA--rrr.-ru©,oN $ICrFo�SY'+(EM7 gPzA R�e2 i:LE VaT1Dr1 ' -. f.5Yt11.V'( 3tllr�Gl.E.h—� A5PNa1.T SHIr-1t,LEry —> --_ _ - tx�oA ,xio 26K IZ Ix3 Ord IX 10 1'PhGrA. _ _ - Ix3 Gi`I 1t10 ftiSuP � _ N�1;-6EDS2--SN1t C.I,EA-�- IxG - � WflfCC C AE-6FUrIGrI.Eh - (exG PobT— �i'-1 ... REA11 rI � I � - i I r�2`ry 1a-15C�•-RIe�oN I � �.` _ BwFipyr syhTEMh �Fzg —I co I�-------_ to"<zo" r1T•coat.Ft, ryEw O.bo1T10N F�cISTWG Corlyft�cT10N NeW PDDrT.IOM L>;f f 5 InE 1v�YA'f lorleorlT E L>;yL�tiort I I 0 a Alterations, Renovation and Repair to a Home for � T��,o� [�IYV/X(IDNS . .�ey r? acnar 1 1=1�O° •vrnovee er, �y��, 5 Shelly and Max AKRO ASSOCIATES ARCHITECTS 28 Lakewood Drive Centerville Massachusetts r � 27 EasNfeWTerrace,Marstom MOIs,MA 02648 Tel.and Fax: 508-419-1217 3 OF 1201 THE-PROTECTION AFFORDED BY THIS DESIGN IS LIMITED TO THE NEW 'NjW ADDITION. DOUBLE 2x HIGH WIND 'PROTECTION OF THE EXISTING BUILDING IS NOT COVERED BY THESE PLANS, D.STUDS VERTICAL SHEAR STANDARD I" ANCHOR.BOLTS SHALL BE INSTALLED AT 2' SPACING ALONG SHEAR WALLS BLOCKING WALL IN BETWEEN TIEDOWN BOLTS, AT 4' SPACING ALONG COMMON WALLS AND WITHIN 1'OF UNDER SILL ENDS. ANCHOR BOLTS SHALL BE EMBEDDED A MINIMUM OF 8" INTO CONCRETE. DOUBLE STUDS PLYWOOD WALL SHEATHING SHALL: • FIRST SIMPSON HDU5-SDS2.5 (1) LAP CONTINUOUSLY ONTO CAP PLATE AND SOLE PLATE AS SHOWN FLOOR HOL.DOWN BRACKET (2) MAY BE NAILED ON ALL FOUR EDGES WHICH WILL REQUIRE BLOCKING (3) MAY BE.ORIENTED IN ANY DIRECTION TIEDOWN ANCHOR PLYWOOD ROOF AND FLOOR SHEATHING SHALL: �� II BOLT WITH 8" MIN (1) ORIENTED WITH THE FACE GRAIN PERPENDICULAR TO THE RAFTERS/JOISTS EMBEDMENT (2) NAILED ONLY INTO THE RAFTERS/JOISTS It (3) WILL NOT REQUIRE-BLOCKING L Hoc vowel pf'-w.li, for, 511we Wflu,e FAMILY FooM -® 2x STUD PLYWOOD JOINT 2x BLOCKING IF REQUIRED sag"T5� eon hNEPlrtllrla PLYWOOD SHEATHIN AhPNcL7 SNIN�LEa orl 15#FFaT POLyN'/ZEN£ INSUt••6<`FFLE- BLOCKING NOTE - BLOCKING, IF REQUIRED, MAY BE Ji Icg F NPTEGSHEIA 3d UP)'MP Erx.E• INSTALLED 1N EITHER ORIENTATION SEE SCHEDULE FOR BLOCKING REQUIREMENT. CCC BLOCKED" MEANS THAT ALL FOUR EDGES.OF,A PANEL n Au�n'PuOFkp4f- — WILL BE FASTENED WHICH MAY REQUIRE BLOCKING TO BE 12.CIIAhh r'IPm INS' INSTALLED BETWEEN STUDS, JOISTS OR RAFTERS'AT THE '�� �� -�--IxS ota lz IO FAhGIL PANEL EDGE. "UNBLOCKED" MEANS THAT A PANEL WILL n c= ONLY BE FASTENED ALONG TWO OPPOSITE PANEL EDGES. 1<� srINu e Ihac. • 7 I�]/¢t 60f'FI7 W/CoM•V �/L'1 PLAb7F.e Oos-rzp— - 1 w¢oN Ip BACKBtc. -- - I —...—._.— P�tcYlcwct Drrresit,- Foy. 5f1v_w WnLu3_ A:) F;PK�Al k. Z o r, Ft oe_ Wt LL�ti e.�ad C to"`Imr Io2 N N rw avclz�llNGti E E . -FOe-PLt ¢60f� F16pP- �; W/>I.L STTEGTHING. .� MA SIMPSON H2.5 TIEDOWN: THIS DETAIL APPLIES ONLY TO WHER Wr/LvPp�r_ TYP ALL RAFTERS OR JOISTS ER OR EXTERIOR DECK .JOIST v q r.CpseAu.AM TAILS LAND ON A HEADER tiX' WALL PO/IruOD hHf17PIT TOP AND CAP PLATE 64 a�y� �� _ ON WINA 6[gK1Ee. txG cLG Soly'r'j CI =_ rxc rF c 9OFFrr w��or[f vent Mayfa>: BEPPO�n ` 3A"Y'C.)%T,ytUO"Jp suBfL, ti - FLASHING "'wt, tip 11,� CZ= I 1 HEADER 's (� F t I2 MhuL!tIDN. bUuU °t0 Gil WRAP SIMPSON CS18 a I IG a G.G ZacG PT PLA E aTt SILL h-ii 1/';! I r 1',; 16✓_ TIEDOWN STRAP EVENLY OVER +—tx a �' L CAP PLATE AND NAIL TO — 761K HIw4�3. =�:;'Ii fX•pEaK NSW OEGK STUD WITH 2x4=8 8d NAILS —— TOTAL 16 NAILS.PER HEADER LA4_,CCzz K e Wrwv, "I: I/L" Ld-ih 6f.ONG.-srtez cr L O.C.G 60"r WAtLh 2A3fiMENT _ ZA RIGID rccl iY2Er1E ON wj 7-o10.L. ivriGMC _ pAr�PPeo�PI*IG txIT-Wr• L9I>Crl— - e.�.. Core. FGTf.WAIL w/z-'t6wt-rau 4'&'W.%0,8 Gxo to/IOwIJM . EX.CONC•ti=or1.W RLI- OH G,Mll YIXN VIY Cr1 4"G¢AVG✓ ' t 1 JACK STUD IOa STUD Gt%rATL. c �cT�2Tb1� D�Tz IWrL�zw o tLNGS •�g 1 cIL . kr�r>z�i V uc L>4crGe + IdaLL 4JEC(I011 - SEGfI©N Ttl¢ouc,u Mb,2 3/4'=tI_o° 1 314%_ _Ow Alterations, Renovation and Repair to a Home for 0.1*1 SECr1oNh ` tl r�,IL.S Shelly and Max a ma MA�7G1Z pErl ASSOCIATES ARCHITECTS 28 Lakewood Drive,Centervitle, Massachusetts Ierrace,Marston Mills,MA 02648. 08-419-1217 4- of IZoI _ 1 { 1 � O I —1.].J. I 4. ZcoAMP PcN6L r Icr 4Fi pa�tnc eepvE. III a WN P 14 0 �-- j �•�`.� "P"�S J•_-_yam. ' 3 OWr qp S I O i hl i 1-4 P }1 I Tc rosv Lr -�OR Et&c�lccl,'P�s of NvPrr��� -- 5�C9 t3`/ MEcµCy-I I:c c�-cor(rL'.ac�G�. .Alterations, Renovation and Repair to a Home for � �m . �LEC(✓ICCI LPy�TS - Shelly and Max euuPl n.,,p,P . �� � AKROASSOCIATESARCHITECTS ^ „,� �.,rnti�zzwz 28 Lakewood Drive,Centerville, Massachusetts 27 EastvlewTerrace,Marstons Mills.MA 02648 Tel.and Pax: 508-419-1217