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HomeMy WebLinkAbout0309 LONG BEACH ROAD - Health 309 Long Beach Road Centerville A= 185 - 035 4 I No. 42101/3 ORA ESSELTE 10% 0 O O O o - Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 309 Long Beach Rd Property Address Haseotes ! Owner Owner's Name information is required for Centerville t✓ MA 02632 12-21-17 M. every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information �/ � When filling out -2 7qq forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 'ed0" City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-21-17 Inspector's nature 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I1ly-el-rs Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Citylrown 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: At time of inspection system met all passing requirements. The pump breaker had been shut off when the house was winterized for some reason so the pump chamber had filled up.When the breaker was turned on the system pumped down to working levels. Also the alarm was unpulgged in the garage I did plug it in to test and it worked line. It should be plugged in at all times. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every 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 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is Centerville MA 02632 12-21-17 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters El 0 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 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 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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 P p 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): 7 Number of bedrooms(actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 785 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 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: According to as-built card system consists of a 2000 gallon septic tank 1500 pump chamber both h- 20 d box and a 7 bedroom s.a.s of infiltrators. 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 usage(gpd)): house vacant Detail: house vacant Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owners Name information is required for Centerville MA 02632 12-21-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed in 2009 per permit 5-14-09 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2feet 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 2000 h-20 Dimensions: Sludge depth: light to moderate t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every 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 Scum thickness light 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? scour pole Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): If tank hs not been pumped in the past 3 yrs I recommend pumping and cleaning the zabel filter. 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 M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•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 M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box was functioning properly at time of inspection 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.): Pump chamber was shut off at the breaker when the house was winterized. It was turned back on and pumped the chamber down to working levels. the alarm was also unplugged it was plugged back in and was working. It is recommended that these are left on at all times. *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: no observation ports found t5ins•3113 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 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: infiltrators ❑ 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.): according to previous insp report s.a.s consists of 2 rows of 11 infiltrators with stone. no observation ports were found so I was unable to determine exact level of ponding and staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. Citylrown 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 vegetatioh, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every page. CityrFown 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 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 M 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every 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: 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 12-2017Date ❑ 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: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 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 M , 309 Long Beach Rd Property Address Haseotes Owner Owner's Name information is required for Centerville MA 02632 12-21-17 every 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 309 long Beach Road Property Address Owner Demetrios Haseotes I information is Owner's Name required for every Centerville _ MA 02632 September 14,2015 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 4es 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: 0 hand-sketch in the area below ❑ drawing attached separately jI I - ` � � �1 � 1G �a � 3S' 3t ' ' ��^ �✓, �t �j J WSJ p � f t f I f T CS Q 0 0 j I i j Mns-3113 Title S QWa[bwpecwn Fenn:SUM=face SeWaga Disposal System.Pape 15 or i? i f Commonwealth of Massachusetts f Title 5 Official Inspection Form { Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 309 Lang Beach Road _ Property Address _ Demetrios Haseotes Owner Owner's Name information is 1 required for every Centerville MA 02632 September 14, 2015 page. CitylTown - I State Zip Code Date of Inspection D. ,System Information (cont.) � Site Exam: { ® Check Sloe p i ® Surface water { ❑ Check cellar i ❑ Shallow wells Estimated depth to high ground water: 5 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: April 19, 2001 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: I i ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: -maps.massgis.state.ma.us/oliver php { — I You must describe how you established the high ground water elevation: Test hole in 2001 found agdusted ground water at 76" (elv= 1.5). Base of SAS pumped up to elv=6.6 der engineered plans.Accessed local round water contours and topo mapping. — I I I f t , — _ f I i Before filing this Inspection Report,please see Report Completeness Checklist on next page. i t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 16 of 17 i i i Commonwealth of Massachusetts u Title 5 Official Inspection Form COP Subsurface Sewage Disposal System Form -Not fo r Voluntary Assessments ,. ,. 309 Long Beach. Road Property Address Demetrios Haseotes ,.�. Owner Owner's Name information is required for every Centerville MA 02632 September 14 2015 ;. b page. CitylTown State Zip Code Date of Inspection C11 r"'I 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 forms 51 Ill ' on the computer, c� ) tJ�7 use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return key. Name of Inspector Ready Rooter Excavating rda Company Name P.O. Box 89 Company Address Forestdale MA City/Town 02644 State Zip Code 508-888-6055 S112843 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 Inspector's signature — September 16, 2015 Da e 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. 15ins•3/13 U, ?A V's Title 5 Official inspection I p coon 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 309 Long Beach Road Property Address — Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. 6tylrown - 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: Recommend pumping and cleanin of septic tank before winter. 6) 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 determ7111�(Yl N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 year§'old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration 6r 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. / i *A metal septic tank will pass ins/pection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that thetank 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 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14 2015 page. Citylrown State Zip Code Date of Inspection B. Certification (cost.) ❑ 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 broken, settled or uneven distribution box. System will pass inspection if(with approval of Bo of Health): ❑ broken pipe(s) are replace ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is I eled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 ti es a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval f the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND lain Ex ( p below): ❑ obstruction is removed ❑ Y El El 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. I. 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 °� ,•y 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 _ September 14 2015 page. CitylTown 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 ags-8rption system (SAS) and the SAS is within 100 feet of a surface water supply or tribu ry to a surface water supply. ❑ The system has a septic tank and SA'Sand the SAS is within a Zone 1 of a public water supply. / ❑ The system has a septic tank and AS and the SAS is within 50 feet of a private water supply well. ElThe system has a septic tank and S S and the SAS is less than 100 feet but 50 feet or more from a private water supply V ell**. Method used to determine distan ** This system passes if the well ater analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates abser and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provide hat 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 Member 14, 2015 page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"ye "or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is with' 400 feet of a surface drinking water supply ❑ ❑ the system is w hin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system i ocated in a nitrogen sensitive area (Interim Wellhead Protection Area— IWP ) 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. 15ins•3/13 Title 5 Official Inspection Fonn: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 309 Long Beach Road __ _ Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14 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 7 7 (design): Number of bedrooms (actual): . — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 785 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 309 Long Beach Road Property Address --- -- Demetrios Haseotes Owner Owner's Name information is Centerville required for every MA 02632 September 14, 2015 page. Cltyrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2014= 498 GPD 2015= 559 GPD Detail: High usage reading in summer months due to irrigation. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pr ent? ElYes ❑ No Non-sanitarywaste dischar d to th � e Title 5 system? El Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. CitylTown 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: No previous records found Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is Centerville required for every MA 02632 September 14, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed 05/14/2009. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1'4" 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: 12.5' x 6.5' x 5.5' H-20 2000 Sludge depth: 8" l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA _02632 September 14, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 10"at inlet, 6"at outlet Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 8" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet(2) and outlet PVC tees in place. Liquid level at outlet invert. Risers bring metal H-20 covers to grade. Zabel 1801 Effluent filter in outlet tee. Filter needs to be cleaned every 6 months to prevent clogging. Tank needs to be pumped. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal / ❑ fiberglass ❑ polyethylene pol eth y y ❑other(explain): I Dimensions: Scum thickness Distance from top of scu 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 �.. 309 Long Beach Road Property Address — Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 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 ❑ Iberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: I/ - 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 �.. 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. City/rown 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.): One inlet, 2" PVC w/tee in place. Two outlets w/equal flow. No high water staining over outlet inverts. No solids carryover. Cover is within 10" of grade. 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.): 1500-gallon H-20 chamber w/metal covers to grage. Pump,all floats and alarm in working order. Pump run through full cycle during inspection * 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 D' _g Disposal System Form Not for Voluntary to Assessments M 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® -- leachingfields 1-70' x 15' x .6' 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 field is two rows of 11 infiltrators with 3' of stone all around and between. No sign of past hydraulic failure. Normal vegetation (grass) over SAS. 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 constructign Indication of ground a/ter inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 _ September 14, 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.): / I Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, si ns 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 309 Long Beach Road Property Address - — Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. CityfTown 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 .I , , r , t I ' 1 O O O t5ins.3113 TWO 5 Official Inspection Forrre Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disp osal posal System Form Not for Voluntary Assessments 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14, 2015 page. CitylTown 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: 5 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: April 19, 2001 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: maps.mass is.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2001 found agdusted ground water at 76" (elv= 1.5). Base of SAS pumped up to elv= 6.6 per engineered plans. Accessed local ground water contours and topo mapping. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ••'�� 309 Long Beach Road Property Address Demetrios Haseotes Owner Owner's Name information is required for every Centerville MA 02632 September 14 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 Form:Subsurface Sewage Disposal System•Page 17 of 17 No. ® Fee ®THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pprtcation for Mioogal *pgtem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 clq Z 0 h 6&qc b wner's Name,Address,and Tel.No. Caw Assessor's Map/Parcel > Installer's Name,Address,and Tel.No. loLP!%Z /k� � Designer's Name,Address and Tel.No. 5-Go�x �'ca���� c of � «���di'k Type of Building: Dwelling No.of Bedrooms Lot Size li`7 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided / ! gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the EE.ronmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this r o alth. Signe Date Application Approve r " 1 Date f f Application Disapproved by: Date for the following reasons Permit No. ����o�� Date Issued 5 0 No. Fee THVkCOMMONWEALTH OF MASSACKU�SETTTS Entered in computer: Yes PUB'LI,C HEALTH DIVISION.-TOWN OF BARNSTABLE, MASSACHUSETTS--- 01pplication for Mi5po5al *pgtem Con5tructiou erMit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 70 L O h 6#0qc/j /wner's Name,Address,and Tel.No. Assessor's Map/Parcel Ti t�A 3044 zCN � �/ A) �yJ Cy/ G//7 r/ Installer's Name,Address,and Tel.No. a/�jjt-G f Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size o L`7 s . ft. Garbage Grinder _ q g ( ) Other Type of Building (<'y S�'!f o✓t'Z— No.of Persons Showers( ) Cafeteria( ) Other Fixtures r7 !�j Design,Flow(min.required) gpd Design flow provided / G gpd r Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Egvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this o: o, eeaalth. Signe Date Application Approve CS2 r Date �f ;�5 Application Disapproved by: Date for the following reasons Permit No. � J off® Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by L &-W S e�k e-a✓4 t �i o h C at 709 Z—cz,4 G 1-3Pae-1, fa). has been constructed in accordance_ with the provisions of Title 5 and the for Disposal System Construction Perruit No. dated Installer iQrj S �Xf'a dQ'�r yt��l�+ c Designer Y\ 7 #bedrooms Approved design flow /" gpd The issuance of this permit shall not be construed as a guarantee that the system will 276 un�ion°�tta�s desiA . Date I�I�✓ Inspector t �v ` , .c� ---.---------------.----------Feed No THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi!5po5ai bpgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 3'0g' P44' e- Vi and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction ust be completed within three years of the date of this pe t. Date -57/ / Approved by FROM. :,down cape engineering inc FAX NO. :15083629880 Jul. 08 2009 10:57AM P2 G a�'CH RQAd ,''O� j 52 10/ INV. OUT S. TANK 5 5.32 5C_ INV. 1N P. ER — 5.28' INV. OUT P.. CHM CMMBER — 5,10' _Eft O— 7 INV. — 7 ".•+ tNV. OUT 0-80X — .40' INV. IN SAS — 7.20' TOP SIOFILTER — 7.70' EXISTING DWELLING N Orel( Lo N ` J c1+ F� M HW NANTUCKFT SOUND oCE #01-052 SEPTIC ASBUILT PLOT PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT. NOT FOR ANY OTHER USE LOCATION 309 LONG BEACH ROAD CENTERVILLE, MA SCALE : 1" = 40' DATE : MAY 15, 2009 REFERENCE ASSESSOR'S MAP 185 PARCEL 35 PREPARED FOR: REF: DB 1311 PG 907 D ME IOTES I HEREBY CERTIFY THAT THE STRUCTURE `S SHOWN ON THIS PLAN IS LOCATED ON THE o� ARNr-: y GROUND AS SHOWN HEREON. H. N,I OJALA N -� No.7..6346 P0 down nape engineering, inc. �•, .4 rsv 5 CIVIL ENGINEERS _�1�•� _ '"_�,__ L LAND SURVEYORS .. 939 Main Street — YARMOUTHPORT, MASS. DATE REG. LAND SURVEYOR FROM down cape engineering inc FAX NO. :15083629880 Jul. 08 2009 10:57AM P1 'Town of.Barnstable Regulatory Serviccs Thomas F. Geiler,Director Public Health Division Tb.omas McKean,Director 200 Muin Street,Hyannis,MA 02601 Offtcv; 508-862-4644 Fax; 508-790-6304 Tnetallcr&Designer Certification .Fornn Date: Sewage Permit# &-sesnsfor"s Ma pn Parecl �OYh Designer; Tngialler: k o f%4 FCC CA y 0" �P Address: . y on.. _ (inst ,()er.) was issued a pen-nit to imall a (date,) q septic system at 30 9 1-0 e d�c �f aC.4.. 1U, based on a design draveni by UWv`. _ Q- ..._.._.._... dated (d signer) I certify that the septic sYMUM rei:erenrced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box a d/cir septic tank. T c e:. 'fy krt the septic s ste refercuectl_Ajul. installed wit ajor changes (i.e. gretlte. , 1.U' Ioteral rclo r.'on oi't1� AS v is . ertical relocatao fi'auy corutwnc.nt of tb.e se system)but in rda�ue i state cal K.egulati an revision or certified rt-b� 'it by designer c►. 1(,)W. r ARNE H. (lbatrl.l.er.'s Signature) OJAIA mi CIVIL �No. 30792 0 4t. (De;i iicr'ti igraturer` x T)e.. is Smtnp Here) PLEASE, B TURN r'l) 8AYt1�STA'BLra t-u[;l xC' ]EAi,TH DIVYS�Ori' C�Ir1'IFICATe (w C014-Y iANCI; WILL NOT BE jSSUED UNTTL 11101t)R TM8 Y ORM AND AS-l31jtLT CAI Q_AgX REGETVT,T)BY f.TTI F4Al2.A1$'I'A1RY.l?.M);:7x{'.1:1EALH DT.6�iJN� `CtV (�:i fenitt�lgepi.ic/f>CaA 1.HI CeTtifiA aion Foan 3-26-04,doe s -t _.._..._....._..._.._..._... _....._..._._...._... _............. ...._.....__.._ .__........ ..- ----......._. _ . ._._ --''-- o — -- - - ....._._.............................. q z w a s -tA l o 0 U rp _.._........_..._.._....._............_.._-._....__._......................____...__..........____.-' --...._....._.._...... Z __- I N J _..____....-._._..._......_......._........... -.._.....--.__._.. Z 0 Q a Z a a N /� 6 O I ---—...-- - --._.—.._._... ------...._. _..—..__.__ ._ _._._.. _......- —-'--....._.... -...__...__._.. - --.....__._..._........__......._......__...-......._......._..._...._.........-... _......._...._ -........_...........----. _....._....-_........................... 1 TOWN OF BARNSTABLE LOCATION 30f::kB��y SEWAGE# VILLAGE �•L,� ,rt.�y1,\-e„ ASSESSOR'S MAP&PARCEL cS/C>3 s IT 'S NAME&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY: (typeJ-X,o4%x7\Nr_,,r— (size) -'n' k 5 x 4 �' NO.OF BEDROOMS OWNER'�� ��,�,� PERMIT DATE: COMPLIANCE DATE: /� D 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) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY q se t,,r7 O O O �'�1 � � � � � ' ,....._1 � � i ' _ _ q" \ 1. _ _ _ ____ 1 � � �7 ��� ;� 1�J e�� :-S� t � 2�� 1 � Y 'li� �y TOWNN OF BARNSTABLE LOCATION '� `'1 L0�9 9 a C - SEWAGE# �-`ILLAGE CQinfA- l a'f i�� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. ',, -l'� SEPTIC TANK CAPACITY '?_oon i'ZO'�f L&O0 jq y -rA;4 j LEACHING FACILITY:(type) 7V,7S X 1,5:!,x (size) NO.'OF BE OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table.to th, Bottom of Leaching Facility g Feet Private Water Supply Well and Leaching Facility(If any wells exist i on site or within 200 feet of leaching facility) f o�✓K�^''+�Feet Edge of Wetland and Leaching Facility(If any wntlands.exist within 300 feet of leaching facili ) y e S Feet FURNISHED BY � � ��,� 2 ��° �� 3 �Lo .��� 2� �° ��, ��------ h-"�'1. 1 \ 4. 3 2 �� __ _ TOWN OF B//ARNSTABLE q?e LOCATION ,�pI,G rh OOr//SEWAGE # VILLAGE�p_� 2�'r�,`�j� �i ASSESSORS MAP � LOT A i INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY/Oco, LEACHING FACILITY:(type)j1�/-2e � (size) 4�5— oA- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWN R DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 0 c r Pumps �' co/o7mIts P�'E CQ S T PUMP r N.4 b6R FRECAST SEPT/C TANK SECT/ON LEACH/NG TRENCHS _ /JDr _ MYERS IJuPLx PU/i?P5 z- Sf�,li► A+11C f1utRM"rTCoMEAN (©QQ rALCCaN ((1.20 LQ�41}1NG) (NOT TO SCALE) �o[X> GALLONt�O<411+�lC,1 (NOT TO SCALE) 2"D1SC NAkc-4 w�Tl� �''Ct4ecK W+TH LACx ��'' (N r.5.) /, ° ( Vr}r�ES� SC 8) --ff J -3 x I -°� WA�TER?'WF -70e`KT1a1,( SOx JV&ri,q 1✓ _fit.„__ ._ _ 6 =., _// X } — - /�/ 0/ 1- � /' Do rlmln 12" 3 min COVER MATER/A L /2" MIN Ti YRAt:KE]T SU#'PT /- STiFLCIAI_,$" �c:NCT1GW ,8ph 2" WASHED STONE //B" TO 1/2" //` /�/ + L 10 /!Y C 7'4 4 o 1/d 51 UE �U I�I N�,) RL!4 R/ri __ ? + r b /n 18" EXP /B EXP ! EXP _. _. I „ F�'t� P AREA ARE c� �AREA SWi T'CHS ' �� �/ WASHED STONE 314"TO ///2" a/ I • ' - NOTE /F THE LIQUID DEPTH OF THE SEPTIC TANK /S 5FEE7, THE OUTLET TEE SHALL EXTEND /9"BELOW THEFLOWL/NE. SECT/ON THRU SYSTEM (NOT TO SCALE) MH COVER TO FINISH GRADE GENERAL NOTES 0 ALL CONSTRUCT/ON TO CONFORM TO TITLE 5 OF THE i .-_—�._ -_ -- _"'_//�_ ll/ =' MASSACHUSETTS STATE ENVIRONMENTAL CODE, AND THE _ 1I BOAHL) OF HEALTH REQUIREMENTS FOR THE TOWN OF :_�_ - _ ---- p - -� ig -- _.__ -i 2) NO PERMANENTSTRUCTURE MAYBE CONSTRUCTED OVER FI - - - - Fos«tiaar,pN VAQ+RaP LEACHING TRENCHS � I THE 1G10% EXPANSION AREA. aEFTtC 'rAnt iC D/ST. BOX _ - - ' i? - - - - --� 3) THE DES/GN OF THIS SYSTEM DOES NOT PERMIT THE c N IIO186 R 1 J USE OF GARBAGE DISPOSAL UN/TS. H 4) CONFI IRMATION OF CONSTRUCTION /N ACCORDANCE WITH THIS PLAN /S REQUIRED, THIS OFFICE AND THE LOCAL BOARD OF HEALTH SHALL BE NOTIFIED PRIOR TO BACKFILL/NG TMI S SYSTEM. 5) SEPTIC TANKS SHOULDBE INSPECTED AND CLEANED ANNUA -�-ER, `SAPS SHOULD BE INSPECTED MONTHLY AND SHALL p BE CL LEANED WHEN THE L EVEL OF GREASE I S 2YIo OF THE �$ EFFECTIVE DEPTH OF THE TRAP OR AT LEAST EVERY PROPOSED FLOW LINE GRADES AS BUILT "GRADES THREE MONTHS. 7) CONS 7-RUCTION OF TRENCHS= DI ST L/NES SHALL HAVE A ,rA�K /NV AT FOUNDATION _..__ D/A. OF 4"AND SHAL L BE LAID TRUE TO LINE.AND GRADE, I INV INTO SEPTIC TANK AND THE DIST. P/PE SHALL HAVE A M/N/MUM SLOPE OF0.005% INV. OUT OF SE PTIC TANK BJ /F UNSUITABLE MATER/AL /S FOUND,OR INVERT OF DIST. /NV. INTO D/ST BOX 7���� PIPES ARE ABOVE OR /N THE TOP AND OR SUB SOIL. r' l INV. OUT OF DIST BOX �'�� ALL TOP SOIL,SUB SOIL, AND UNSUITABLE MATER/AL TO pAT / INV. AT END OF TRENCH BE REMOVED TO ELEVATION I'S' AS PER SOIL LOGS, BOTTOM OF LEACHING TRENCH s'l4 AND FOR A DISTANCE OF __lD— FEET /N ALL WATER TABLE 1 0 DIRECTIONS FROM LEACHING SYSTEM. THENREPLACED 3 `'i ' WITH CLEAN SAND FREE OFS/LTS, AND DEBRIS, AND R (:)J QM'p C}�AM96Z INCH BEFORE AND AAFT ER PLACEMENT TION RATE INSPECTIONTHAN 2M/N./ INSPECTION SCHEDULE SOIL LOGS 4 ( aA-''G /) AFTER EXCAVATION OF THE TOP SOIL, SUB SOIL, AND \ 1 OR THE UNSUITABLE MATERIAL, BUT PRIOR TO Npvs6 ��, T. P I T. P 2 FP 3 T.P 4 THE PLACEMENT OF THE FILL. 7,0 7.7 2J AFTER PLACEMENT OF THE CLEAN FILL BUT PRIOR Tclt' r ,�, f TO THE INS TALL AT/ON OF THE 5YSTEM. ►i�'at Aub rDki SJ o , 3�FINAL INSPECTION ( FOR AS BUILT"CERT/FICATIO TO THE BOARD OF HEALTH. ) 1/1f rr ,S74L.LA f-f La L .1V01-6 J �GARP'GE ` %.y AREA ` -- _.-- _ 1 /nI57'A7LL.EK U.s7 Vcp-1 p-, ► nC p}+��^i OF ALL x S",n' ✓ - A^4.i? l'n0:9.b:,rf4nL w� u%f C.rTii ?F� je �F�nc►aT'rD.N it E7 / a' t1 _ _ T S D J. -T-J`p��,i.'t 3�\0 so' t — PERCOLATION RATE OF '`- •`: M l U TES / INC ' t ' - DuiCET ES o=ThE SCpi-ie i4U,, Pl u M -r E PRESENT DURING TESTS ON . �4A r .eev�e�ic"ibsI• AGENT SL`�`Z�( 1� ��.�IfnlL +^1oE . ANO 17+ST 1i4)A C -(o I x\t t �royoJ (3 (odC�'E /J`� �}rp55vkE t. rNt MUS �t `S 'JR. ST !J. _ -.� T. A �vn� � F,� �L� t� 4� E:�,�.��` h �E �f? V E? t.^/ Ar L r�,�'N�aT��rC, DESIGN CRITERIA - -- EUts E �_� O� y _ vFvs+ ��1i _ _..� .._ . BEDROOM DWELLING AT G.PB.D = v • ` G.P D. BENCH MARK SF ( TOWN MIN. ) LEACHING TRENCHS r 04 G SUE a c N l �,P (o,evff RXsj, Al� .ZS`� G/S.F = G. S/DEWAL L AREA- S F. X -)'S r' 4? ?)MdAf —" �.� BOT TOM AREA = 140 SFX +L Q G./S.F= L IC' G. TOTAL DAILY CAPACITY= 787 GALLONS TOTAL AREA = SF SAN/TA RP SYS TEMM /N DRAWN FOR: ;t:,MET?i� 14 SEQi`�S DESIGNED BY.- ' VGU tt not Webby Co. F DRAWN BY : � J ENGINEERS 8 LAND SURVEYORS d a4a w 1; CHECKED BY. COUNTY ROAD PL YMP TON, MA SS. 1 � APPROVED BY: PLAN DATE : SCALE VW# /�, 7 AAW LEGEND TOP FNDN. AT EL. 9.4' _ SYSTEM PROFILE TEST HOLE LOGS 100.4 PROPOSED SPOT ELEVATION SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) (EXISTING) C.I. ACCESS COVER TO GRADE (NOT 0 SCALE) MINIMUM .75' OF COVER OVER PRECAST AH OJALA, PE C.I. ACCESS COVER (WATERTIGHT) TO ENGINEER: DESIGN FLOW: 7_ BEDROOMS (1 10 GPD) = 770 GPD FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 8 35' WITNESS: GLENN HARRINGTON, RS 100x0 EXISTING SPOT ELEVATION USE A 770 GPD DESIGN FLOW 2" DOUBLE WASHED PEASTONE APRIL 19, 2001 c RUN PIPE LEVEL DATE: 100 PROPOSED CONTOUR SEPTIC TANK: 770 GPD ( 2 } = 1540 FOR FIRST 2' 7 6' < 2 MIN/INCH USE A 2000 GALLON SEPTIC TANK PROPOSED M PERC. RATE = cRA+cv�uE 100 EXISTING CONTOUR --- 6 2' GALLON SEPTIC 5.95' LONG BEACH ROAD BEACH ROAD C;Ono 1TEE CLASS I SOILS P# 9971 LEACHING: N A (PROP TANK (H- 20 ) BAFFLE 7 24' 7.180-1.3AT SIDESSIDES: / r7.41' "� 80 0.58' AT ENDS LOCUS 70.75 x 15 (.75) = 785 GPD ��$ o BOTTOM: WATERPROOF CRUSHED STONE OR MECHANICAL TOTAL: 1061 S.F. 785 GPD COMPACTION. (15.221 [2]) ELEV. ELEV. USE 2 ROWS OF 11 STANDARD INFILTRATORS EACH, 4.33' (-1-% SLOPE) (_1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE 0" 4 7.9' 0" Q 7.1 ' S DEPTH OF FLOW = WITH 3' STONE AT SIDES, 3.3' BETWEEN ROWS AND 1 ' TEE slzEs: 181, x INLET DEPTH = LOAM LOAM FILL AT ENDS 26" FILL OUTLET DEPTH = 5' 15" LOCATION MAP NTS 19" B A/B ASSESSORS MAP185 PARCEL35 BOARD OF HEALTH LS LS ZONING DISTRICT: RD HIGHEST MW READING (OVER FULL MOON CYCLE) = ELEV. 1 .6' 25" 10YR 3/4 24„ 10YR 3/4 YARD SETBACKS: MA 5 1 APPROVED DATE FRONT = 30' BOX 8 FOUNDATION- 10' ST 10' PUMP LEACHING Bw SIDE = 15' CHAMBER 71 ' D FACILITY C ' LS REAR = 15' 10YR 3/4 FLOOD ZONE: A13 EL. 11 M/C4S 34 4.2' V16 EL. 15 (BEACH AREA) pert PROP. RECONFIGURED ENTRANCES 10YR 5/4 C AP DISTRICT REPLACE EXIST. ST WITH PROPOSED 2000 GAL 76 obs. water 1 .5 MS H-20 SEPTIC TANK 10YR 5/4 "wE RO ��/ S 1209' -2.1 ' 90" -0.4 (� EDGE OF PA SONG Q��V C 1 O 1 8 � 11` 77. ' W +7.47 8 .90 w +5. 4 75.05' 7.51 .70- 6 CP. INV.=7.1 ' NOTES: PC ST 18 ` TH 1 I 1 1. DATUM IS NGVD 13 6 5, 31 6 ALARM AND CONTROL PANEL 2. MUNICIPAL WATER IS EXISTING PROP. 40 MIL '1 TH2 s LINER, TOP AT EL. EXISTING TO BE INSTALLED INSIDE ` ` 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. � 7.6'. BOTTOM AT 6.08 +7. i $58 PARKING 57 BUILDING. ALARM TO BE ON ' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 20 s EL. 3.6' +7.24 �p AREA -� INV. IN 5.85' .9 I �--- cA SEPARATE CIRCUIT FROM PUMP (APPROX. 33' R'�ER 58 1500 GAL. H-20 S T 2" PRESSURE PIPE TO D'BOX 5. PIPE JOINTS TO BE MADE WATERTIGHT. LONG) +8.36 ' SLOPE TO DRAIN BACK TO PC WEEP HOLE 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 0 GAL. 9 FLOAT SWITCH + . 3 PROP. ADDN. ALARM ON RESERVE + CHECK VALVE ENVIRONMENTAL CODE TITLE V_ 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 7.70 + 5 -� AROUND PERIMETER OF LEACHING FACILITY, +8.1 i .72 � 16.6' ' a, SETTINGS: PUMP ON 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE 8>. USED FOR LOT LINE STAKING. DOWN TO SUITABLE SOIL LAYER. REPLACE 6 - 4" WORKING RANGE ZOELLER "WASTEMATE" 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. WITH CLEAN MED. SAND. ENGINEER TO INSPECT AND CERTIFY REMOVAL j 7 8 7. 4 4 SUBMERSIBLE MODEL M282 1/2 HP PUMP 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 8.45 I; .80 8 4, , 8.7 EXIST. DWELL PUivi;, OFF 4" SYSTEM (OR EQUAL) INSPECTION BY BOARD OF' HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. TOP FNDN = 9.4' NGVD o�000 000�o 0000 0000 +8 47 ' SILL ELEV = 10.5' I 6" CRUSHED STONE OR 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE DUNE 8. 7.9 7. COMPACTION -�� LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR 21, PUMP CHAMBER- TO COMMENCEMENT OF WORK. 2 ROWS ROSA RUGOSA 8.�7 .60 �g.6' BENCHMARK: USE TOP FNDN. (NOT TO SCALE) >> + .1 ' .29 ELEVATION OF 9.4' WATERPROOF TITLE 5 SITE PLAN +8.70 874 25 , °F 309 LONG BEACH ROAD ROW OF (10) 7 IN THE TOWN OF: 4' HIGH CEDARS Ji 1 (TO BE REPLACED AS NECESSARY TO + .93 +8.42 (CENTERVILLE) B A R N S TA B L E MEET 90% SURVIVAL RATE OVER 3 + .1i2 / 1 EXIST. DECK ADDITION SHALL HAVE PILE-TYPE FOUNDATION. LOWEST YEARS) +12.2 +9.01 .34 8 36 .28 STRUCTURAL MEMBER OF FOUNDATION SHALL BE AT OR PREPARED FOR: -E 8.33 -�t 4 8.41 ABOVE THE 100 YEAR FLOOD ELEVATION OR AT LEAST 2' L. VI N 10S DUNE ��, w -__ 39 - ABOVE EXISTING GRADE, WHICHEVER IS HIGHER. PRIOR +9 24 8.21 TO CONSTRUCTION, COPIES OF FOUNDATION PLANS .02+ 75 �- 38 STAMPED AS REQUIRED BY LAW AND CONFORMING TO 20 0 20 40 60 +t 0.78 THE MASS. BUILDING CODE SHALL BE PROVIDED TO THE 9 +8.73 8 s -I-8.64 +8.26 .}.8•24 COMMISSION. 1. +8.17 +10.24 .36 °r. SCALE: 1' = 20 : JULY 2 01 DATE REV. 2/14/02 (PLANTINGS) 8. + .22 REV. 6/2/02 (NOTE) .71 91 EXIST SEAWALL 8.3 8 +10.09 8.8 +8.51 �H OF M 8. 5 IN OF o` ARNE rya o�' ARNE H. G 28 7 H. � OJAIJ� +8 42 _- ALA c�i IV v' N 26348 Na' 792NAL / o 6 A OJALA, .L.S. ^DATE \\ STAGGERED ROWS OF t8' WIDE WOODY SHRUB AND/OR NATIVE HERBACEOUS MATERIAL TO BE SELECTED FROM THE FOLLOWING: ROSA RUGOSA, LOW BUSH BLUEBERRY, BEARBERRY, SHORE JUNIPER, SHRUBBY ST. JOHNSWORT, WINGED SUMAC, HUDSONIA, SWITCH GRASS OR SIMILAR DEPENDING ON AVAILABILITY. PLANT SPACING DEPENDANT ON SPECIES AND PLANT SIZE IN ACCORDANCE WITH RECOMMENDED HORTICULTURAL PRACTICE. +6.77 4 48 4 -` +3.59 WRACK LINE) +2.81 _ ---'-- APPROX. MEAN HIGH WATER off 508-362-4541 fox 508 362-9880 + 3 APPROX. MEAN LOW WATER down cafe engineering, inc. CIVIL ENGINEERS NANTUCKET SOUND LAND SURVEYORS 939 main st. yarmouth, ma 02675 0 1 -- 0 52