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0129 NOBADEER ROAD - Health
129 Nobadeer Road Centerville P A = 251 227T00 i UPC 12534 No.2_ 1� HASTINGS,MN t 3 1 t No. Fee 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. r A wboisp, Poo Owner's Name,Address,and Tel.No. X(C-C-1_(SA 7-0H"NS®W Assessor'sMap/Parcel ;L�5( 4-_7 -rao C`vitt-as, l;t9 CV06406-aZ 'k1) Cev(t_ A�5- Installer's Name,Address,and Tel.146. 5pj.(E'7'1-g'j-r7 Designer's Name,Address,and Tel.No. c'APs(ei)G F0TW4k5bSL(.C- N1A Type of Building: /( Dwelling No.of Bedrooms /t/ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided N 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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued �_No., t ro 'vQj/jf Fee E THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF, BARNSTABLE, MASSACHUSETTS •f' 0[ppl cation for Voposal 6pstem ConstCUttlon Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. 19,9 W 9_1D Owner's Name,Address,and Tel.No. N�(CC.C„i5�1 TOM[.�IVSAI✓ Assessor's Map/Parcel A51 0-g7 T00 G'V(�c.� 1;19 t o InAbG-,q " G'rV I Gc C- Installer's Name,Address,and Tel.14. 5pq.(4'T1—$1Z'r`r Designer's Name,Address,and Tel.No. GAPsce2ApC— EPJT_ZQ445sS t_L c. 153 C&At"4&AQ1W-C 57 MA5M PG9' NI A Type of Building: /{ / Dwelling No.of Bedrooms /y Lot Size sq.ft. Garbage Grinder( ) > Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) AZ 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) i r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe gzl, Date —sZ0( Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 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 CAPEwTG EwTis:0 ,ls& LLB+ at 0 a9 N Q�C�ER R D C/1//[.L� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoP�l6 —V V—dated �'� —t Installer C406-W(DiE Designer ;i #bedrooms Alit— Approved design flow gpd The issuance of IiMit shall not be construed as a guarantee that the system wi 1 functi rial designed.Date / Inspector (/ - i -- ------------------------------------------------------------------------------------------------------------------------------- goC( — 01� No. Fee THE COMMONWEALTH OF MASSACHUSETTS I PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar 1*pstrm Construction permit Permission is hereby granted to Construct( ))- Repair(N Upgrade( ) Abandon( ) System located at ( ag �� IJc�� ,0/4� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I Q Provided:Construction must be completed within three years of the date of this permit.—I— Date �� �$ ' Approved by r 24 2016 19:27 Jim The Inspector Man 5085349919 page 1 Commonwealth of Massachusetts a 6/_ 2 a — Tp . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ''C: r W 129 Nobadeer Road Property Address 07 Melissa Tomlinson ` Owner Owners Name r,- information is required for every Centerville MA 02632 4-22-16 page. CitylTown 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 Arms . General Information (� ^� �1 olio the comng out puter,r, JI I/ S TT ``\`\�����jN�OFrMgS4i��� use only the tab 1. Inspector: key to move your gam:' , G JAMES cursor-do not James D.Sears = '': ' use the return Name of Inspector U key. `* , Capewide Enterprises, LLC ko; tffi 5 Company Name . ''���!F??Tf>•:''G` ` 153 Commercial Street °/i, .S�±NSP�E�w�•�� Company Address Mashpee MA 02649 CityfTown State Zip Code 508-477-8877 S 1623 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.J am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-22-16 spector's Slgnature 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. ISins•3J13 _ - TNIe 5 Official Inspection Form:Subsur ece Sewage Disposal System-Page 1 or 77 oyla r Apr 24 2016 19:27 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is Centerville MA 02632 4-22-16 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and pit. 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): 15ins•3i13 - - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Apr 24 2016 1927 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name Information is required for every Centerville MA 02632 4-22-16 page. Citylrown 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 ndt 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 Apr 24 2016 19,27 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is Centerville MA 02632 4-22-16 required for every page. City/Town Stale Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3: Other,. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in dERM is less than 6" below invert or available volume is less than 1/ day flow P�'r` t5ins•M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Apr 24 2016 19:27 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts . Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is Centerville MA 02632 4-22-16 required for every b page. Ci !Town State Zip Cade 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. El ®. 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 E 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. t5lns•3/f 3 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Apr 24 2016 19:27 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 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 ❑ 0 Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t51ns•3M 3- - Title 5 Official Inspection Form:$uhsurace Sewage Disposal System-Page 6 or 17 Apr 24 2016 19:28 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form R s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 page. CitylTown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal Tank D Box and pit 2 Number of current residents: 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 2014-B7,750Gais Water meter readings, if available(last 2 years usage (gpd)): 2015-143,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow.(seatslpersonslsq.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•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Apr 24 2016 19:28 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is MA 02632 4-22-16 required for every Centerville page. City(rown 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: e Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Svstem•page a of 17 Apr 24 2016 19:28 Jim The Inspector Man 5085349919 page 9 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 page. CityiTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1983 Permit#83-742 2016 -New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan), Depth below grade: 14" p g feet Material of construction: ❑cast iron ®40 PVC ® other(explain): . Distance from private water supply well or suction line: feet i Comments (on condition of joints, venting, evidence of leakage, etc.): Pipein is 4" PVC SCH 40&SCH -20. Septic Tank(locate on site plan): 1, Depth below grade: feet Material of construction: -® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) I i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal:Precast H-10 4" Sludge depth: 15ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 Apr 24 2016 19:28 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title. 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is Centerville MA 02632 4-22-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26". 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 12 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined?' Asbuilt Tape J Sludge udge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 1" below grade. Note: Inlet cover half under stone wall but can be opened. Inlet tee. outlet baffle. No sign of leakage or over loading. 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•2/13. _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Apr 24 2016 19:28 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts t Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 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 El other(explain): Dimensions: Capacity: gallons r 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 15ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Apr 24 2016 19:29 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection FormI a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is Centerville MA 02632 4-22716 required for every page. 6tyfT'own 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.): D Box is 16"x16"-22" below grade wlone line out. Box is new 2016 w/cover at 6" below grade. i Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Apr 24 2016 19:29 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 page. CityrTown State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: k ❑ 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/2'stone. Pit and cover at 28"below grade. T water in pit. 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 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 tying-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Apr 24 2016 19:29 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 129 Nobadee Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 page. City/Town 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: t Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of pond ing,•condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Apr 24 2016 19:29 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owner's Name information is required for every Centerville MA 02632 4-22-16 page. Cityfrown 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 Af C '� 3 �•S l� 13.E _ I��r Al 3 - a-�:3 57aNi f 4 D o , a � t5ins•3113 - Title 5 Officia Inspection Form,Subsurface Sewage Disposal System•Page 15 of 17 Apr 24 2016 1929 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owners Name information is Centerville MA 02632 4-22-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /V6 Estimated depth t high ground water: et 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: 5-10-83 Date ❑ Observed site (abutting propertylobservation 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: T.H. on Design plan 5-10-83 no G.W. at 12". Bottom of pit at 8' below grade, Bottom of pit at at 4' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Apr 24 2016 19:29 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Nobadeer Road Property Address Melissa Tomlinson Owner Owners Name information is , required for every Centerville MA 02632 4-22-16 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems),completed E System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•W13 Title 5 Official lispeCion Form:Subsurface Sewage Disposal System•Page 17 0117 nTOWN OF BARNSTABLE "' LOCATION IC;Fq K GO SEWAGE# r o VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO:OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I t COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION JAAP RECEIVED PARCEL 22� T4 � LOT OCT 1 q 2004 TITLE 5 TOWN OF HEALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION a� ,/D Property Address: 9 y /� `.w� Owner's Name: Irv,, r.::, Owner's Address: #Q 0.4 set Date of Inspection• OG r rt :: Name of Imtspectar:,�R�lease Company Name-4,4y,"v� Mailing Addre"'. CTelephone Numb _ ic I 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_ C/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: v Date: q o p 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 Pow of l0,()0() gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 9EP.The original should be sent to the system owner and copies sent to the buyer,f applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of insp ection and under the conditions of use at that time,This inspection does not addre4.r. how the system will perform in the future under the game or different conditions of use. u Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property.Address: /d- ¢ /t/ab.s lie e,- Rd 0k(o j— Owner: Date of Inspection: 0 Inspection Summary: Cheek A,%C,D or E!ALWAYS complete all of Section D A. Sy m Passes: I havc 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 evahiated are indicated below. Comments: B. Sy m 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. Amwer yes,no or not determip_ed(Y,N,ND)in the for the following statements.I_f"not determinned'please explain. The septic tams is metal and over 20 years old*or the septic tank(whether metal or not)is st_nicturaLly 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 pipes)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 explaist: 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: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; b a�2Et� Q CC vdo Owner. a✓ Date of Inspection: Q 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 failinpo protect health,safety or the environment. L System will pass unless Board of Health determines in accordance with 310 CMR 1&303(t)(b)that the system is not 11metiaaing in a-manuer which will Protect publk health,afety and the emvire t: _ 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 sak marsh 2. System will fail unleIs 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 l 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 jrivate water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certificd 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. Othcr, c� Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /d / er CJ4 9d Owner: 0a or Date of Inspection: / p� D. System Failure Criteria applicable to anjy4tems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No/' _gyp 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. � tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ,,LigWd depth in cesspool is less than 6"below invert or available volume is less than'/?day flow - of tpumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number espumped_- Am v portion of the SAS,cesspool or privy is below high ground water elevation. . Aiy portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ,-water supply. d portioa of a cesspool_or privy is within a Zone 1 of a public well. y Pam►of a cesspool.or privy is within 50 feet of a private water supply well _ T Amy portion of a cesspool or privy is less than 100 feet but greater than.5o 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 S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this farm.] �(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, L Large Systems: To he considered a large system the system must serve a faci�.ty with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`Yes"or"no"O 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 I he system is within 200 feet of a tributary to a surface drinl�ng water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone Ti 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 15304,The system owner should contact the appropriate regional office of the Departmcm 6 C��) Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. C'4 r Date of Inspection: Check if the following have been done.You most indicate"yes"or"no"as to each of the following Yes/�To ✓✓— — ping information was provided by the owner,occupant,or Board of Health — Were ay of the system components pumped out in the previous two weeks [/ Has-the system received.=nW flows in the.pwviovs two week period Have largelmlames of-watcr-b=mooduced to the system.ve=tly or as pact 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 v — 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 conditiea 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) 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 nZ 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)P 10 CMR 15.302(3)(b)] P s 5 page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .2 9 AV Owner. G 4t Dale of Inspection; q FL CONDITIONS RESIDENTIAL Number of bedrooms(design):,.?--Number of bedrooms(actual): o�- DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 0)-'�"O Number of current residents: I _ Does residence have a garbage grinder(yes or no): /�10 is laundry on a separate sewage system(yes or no):�V [if yes separate inspection required] Laundry system inspected.(yes or '0 Seasonal use:(yes or no): Water meter readings,if available past 2 years usage(gpd)): Sump pump(yes or no):LO Last date of occupancy: C 01 Cv)7 - (16-" COMMERCIAI./1"USTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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 O� O (A-"��,/Source of information: Was system pumped as part of the inspection(yes of no):_ If yes,volume pumped: pallons-How was quantity pumped determined? Reason for g TYP F SYSTEM ptic tank,distribution box,soil absorption system —Single cesspool _Overflow cesspool ffivy —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: Were sewage odors detected when arriving at the site(yes or no):I/V 'I f page 7 or I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conummM Property Address: ti Q W �2C yr ,9 Owner. CIC-r Date of Inspection: 7 ,9 BUMDIN6 SEWER(lo�cate qn site plan) Depth below grade; t7 / 'PVC of construction: cast iron �4 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage;etc.): SEPTIC TANK:_L ocate on site plan) Depth below grade. Material of construction.—&mcrete metal_fiberglass_polyethylene . other(explain) If tank is metal list age:— Is age confirmed by a Certificate of C certificate). Compliance(yes or no):_(attach a copy of Dimensions: �'� Sludge depth: Distance from top of sl�}dge to bottom of outlet tee or baffle: aZq Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to of outlet tee or baffle: How were dimensions determined; f,,Ol /e fZ v� � Comments(on pumping recommendation inlet and s, ou tee or baffle condition,structural integrity,liquid levels a�r�elated to outlet invert,evidence of lei etc.): pl, .n• t nee�L c ' ,j G GREASE TRAP:/&(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, as related to outlet invert,evidence of leakage,etc.): structurallty, liquid levels i i I �j r page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUB. SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Pr ,-q Address: 4 1,o. jO o, led v� Owner: G, Date of Inspection: 9 0 TIGHT or HOLDING TANK:IZ(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction concxete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: U,,,A Design Flow: Alarm presets(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: �(ifntl/ must beopened)(locate on site plan) � Depth of liquid level above outlet invert P101 01 G Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage inN or out of box,etc.): v So/ICJ . I/-0 4eca kc PUMP CHAMBER (locate on site plan) Pumps in workng order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): r . Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DIS POSAL SYSTEM.INSPECTION FORM PART C SYSTEM/INFORMATION(continued) Property Address: 6o.c� � la Owner. t✓ r Date of Inspection: SOIL ABSORPTION SYS M(SAS): (locate on site 1 p an,excavation not required). If SAS not located explain why: ,6 c leaching l� number A .I � number: leachinggafleriM number: leaching trenches,number,length: leading Gel(s,mmiber,dimensions: overflow cesspool,number: innovativelalternative system 'IYpe/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of etc.). /l Q �� o pon�ng,damp soil,condition of vegetation, CESSPOOLS• (cesspool must be pumped as part of inspectionVocate 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.constmction Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of n po ding,condition of vegetation,etc.): � PRIVY%1G_(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.): t page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimmd) Property Address: 9�0�1 Owner: C�G r Date of Inspection: /9 0?,- 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 m here public water supply enters the building, 4 10 -�-- 0? �� 1p page 11 of 11 • 4 • OFFICIAL INSPECTION FORM' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. c�a, D ste of lmpmdoe: p40 SJ=1EXAM 11Cqz surfi=water x �� Check cellar Shallow wells , 33 — (o N 4o✓+ Estimated depth to grolmd water 3s feet .s Please indictee(check)all methods used to determine the high ground water elevation: from system design plans on record If checked,date of design plan reviewed: site(abutting property/observation hole within 150 feet of SAS) with local Board of Health-explain: V Vf Maino I ©� Chocked with local excavators,installers-(attach documentation) Accessed USGS database-explain: . You mu cribe ed deshqw yw established the high ground water�devatiou: ,� 3S . yip? fAM a1 S ! 0 0 p4 } y {t; 9J,[� f O 0 pZ�•7j Se e✓ aTk�� �r 7 0 L A / ho \b 1 O '( 17 &i N 0 T— z ,� a v- N V� 0 0 /...•- `h -� LPG 5 l0V--ViINLV- Lz ZD,op• �s(u000 .A inf rmation and F PA G On the 'basis of my knowleabeg o ouN T�o N e SIG?T1.o tJ belief, I certify t 1-7 N P a'b 5.t�IV, K,94--V, that a result of a survey made on the ground mac- v�u�E, PaA•1���TA►�4.f� ,MA• Ton 3 , Z find that s '.she txRaeture(s) are located on the site as shown. //7. A0/ M 4he,7T•0ri•zehon !3 q .Laws 1i the'title l .nes and linen`of •oocupat�Q f the ��i . M.w.A.szxJICV, i A,-; x lnlG- site are :'as shown. hereon •t�ry `Ikie site"is situated in Flood �o�a®r�/a�- r G:: A�AH orM CoMMUTiity Pan el. lgo. gio � wauAM Irk sy s, Late. JI&IZ10 ..' Sr�};y ��ti _ '•.' .. W,I�jtWICIC• .... -. 42 ' /J 0 . Commonwealth of Massachusetts Executive Office of Environmental Affairs RfC�Vf'0 Department of DEC 6 1998 Environmental Protectio William F.Weld Trudy Coxe S. S �ury,EOEA David B. struhs s Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 129 MOARdeer - rlk Address of Owner: aox 224 N1Y2rin/S Date of Inspection: 17-/7/9L (If different) CZrC of DBA Cattle pert M?+nt. Name of Inspector: Richard La-tAmjo Company Name, Address and Telephone Number: A1/ rJjk- 5ePt'r"C 16SP. 2 d Long y,rw Driec', ot4eans CERTIFICATION STATEMENT 24-0-09 27 1 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _✓ Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Qo� Date: The Svstem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of i0.000 gpd or greater, the inspector and the system owner shall submit the repo^ to the aopropriate regional office of the Department of Environmental Protection. Tne orieinai snouid oe sent :o :ne system owner and copse: s2r:: to the bu•.er, if applicable and the approving author;-. INSPECTION SUMMARY: Check A, B, C. or D: A] SYSTEM PASSES: ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 81 SYSTEM CONDITIONALLY PASSES: I 1 One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Irevtsed 8/15/95i One Winter Street a Boston, Massachusetts 02108 a FAX(617) 556-1049 is Telephone (617) 292-55W " Vnnted on Rayded V.pef SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 129 NOba4NCl"' R�• Owner: NI.f P DoiJ a 0a Date of Inspection:/Z/7/rj,(, 61 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 CI 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The SvStem has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The systen, has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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• DI SYSTEM FAILS: h" I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged 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. (revised 8/15/95) 2 i I . ' III n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM v` PART A CERTIFICATION (continued) Property Address: 1 Z9 At&bzd cer ' Owner: M f P Do 1sn Date of Inspection: /Z/7/V i D] SYSTEM FAILS (continued): _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day now, i 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: 1 The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /Z9 Mdbadeer4� Owner: M I P Dols n Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. Adf-None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with WA. It-'The facility or dwelling was inspected for signs of sewage back-up. If-The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. P ✓AII system components, excluding the Soil Absorption System, have been located on the site. ✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ✓The facility o%%ne, Land occupants, if different from owner) were provided \vith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/9S) 4 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 129 t"jjeer AL A Owner: M¢ P 001471) Date of Inspection: IZ,/7/96 FLOW CONDITIONS RESIDENTIAL: Design flow: 2 O—gallons Number of bedrooms: 2- Number of current residents:Q Garbage grinder (yes or no):_IQ Laundry connected to system (yes or no):Ye$ Seasonal use (yes or no): No Water meter readings, if available: Last date of occupancy: 3Z3119X COMMERCIAUINDUSTRIAL: JJIA Type of establishment: Design flow:__gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) �S If yes, volume pumped 1412e gallons Reason for pumping: 1A;P n(.- taA� TYPE OF SYSTEM _p,,"- 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: �e- Sewage odors detected when arriving at the site: (yes or no) Nd (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /29 A106ddeet Rd, Owner: M I P PO A?n Date of Inspection: 1 Z j7/9 SEPTIC TANK:1,� (locate on site plan) H Depth below grade:$ Material of construction: �ncrete _metal _FRP other(explain) Dimensions: BO Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: �mP� 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,.structural integrity, evidence of leakage, etc.) Goner kjft -ICJ all 1r7 400d r�►ae�=B' level GREASE TRAP:�� (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: .. Distance from too of scum to top of outlet tee or baffle: Distance from bottom „i «nrt+ t� bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 6 (revised 8/15/951 _! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION (continued) ,i Property Address: y Owner: M q.P Dot,1i Date of Inspection:/2/7/94 TIGHT OR HOLDING TANK:-9/k (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: Rallons Design flow: Rallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and Float switches, etc.) DISTRIBUTION BOX: �— (locate on site plan) Depth of liquid level above outlet invert: O Comments: incite ii level and distribution i, equa:, e\idEnce of solids carr)o\er, evidence of leakage into or out of box, etc.) Box in good -ea - 40 G2rrYoyer or /ead«ar PUMP CHAMBER:WA (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWA GE DISPOSAL SYSTEM INSPECTION FORM v PART C SYSTEM INFORMATION (continued) Property Address: 12,? Mob ,Jeer Rd. Owner: t4 j p Dol=n Date of Inspection: /21719X SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries,.number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) 6x ` ait r}ry d'clean CESSPOOLS: _L�IA (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc) (revised 8/15/95) 8 J _ Q L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :I PART C SYSTEM INFORMATION (continued) I y Property Address: /Z% AWaJ'eer Owner: M q P Da Is» a Date of Inspection: /Z/7�9� i I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i I I A C-2I' BC-t5'' A A E-3S' Bf-zo` 0 E /4 F�4-zs' 8F-�a,S' CF j4jM9e N . Ent Ne�a�eer 2�. D �e a 1e DEPTH TO GROUNDWATER Depth to groundwater. f 30 feet be/ou,pit. 1 method of determination or approximation: U.S S dG G C Cnnrr�, wund W r-ra rnad r_ (revised 8/15/95) 9 No..40...-2J.^?' � � F�a..T. ................. THE COMMONWEALTH OF MASSSACHUSETTS BOARD OF HEALTH + w1 .............ofr.......... l��'.�!1GS'f .-_---------.-.-_--_--- Ativilration for Dwposal Works Toustrurtion Prrutit Application is hereby made for a Permit to Construct (t/) or Repair ( ) an Individual Sewage Disposal System at f._/.7 /1.0a,6a-�/c��.. ,�.. � ,� eruf lC �.. 7rL ns -d t .a__=�............... - . Loc tion-�ess g op Lot No. ......v`. ._.. �?-1.. .. / s ......................•. IZ /�O }.'--------- res .............yZ ....<7Zzsh-,.......C....................... ......... .41s S:_ ----Q-^....r..-.-<-.•,-�•,•,..............s..s. Installer Address Type of Building Size Lot.... .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PLI Other—T e of Building ............................ No. of ersons......_............. .__. Showers -- W � .....-..-•....................P..._ •--• ( ) Cafeteria ( ) Otherfix_tu es ......------•...... ---•-•-•----------•••••••-•---•------•---------------------•-........--•••--•--...........-•-• W Design Flow..............5.�.....................gallons per person per day. Total daily flow.................�e.............gallons. WSeptic Tank—Liquid capacity_t! gallons Length_:.... Width................ Diameter___________....- Depth................ x Disposal Trench—No. ..................:.Width.................... Total Length........r..._.__._- Total leaching area............. sq. ft. Seepage Pit No---------,j--------- Diameter.&.:'4-____ Depth below inlet-J__'A.'(.... Total leaching area- �...._�sq. ft. Z Other Distribution box ( vj Dosin ank ( ) ,, •• // _ Percolation Test Results Performed by k � ... _Mw-_4.S-S�aL. Date------ - ----- __.... P/977 Test Pit No. 1... _.minutes per inch Depth of Test Pit--------.l 9.... Depth to ground water.._i_p_ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-._____--.------_---___. P4 ..........I..................................................... . . .•-- . O Description of Soil...... ........./Of?�S_c�, S.... ..---•--•�.....6------C9�!''� ��� e.�.............. x -- t' ...... e� -------- VW •••-••••-•••------------•----•••------------•-•---••-----------•-•-••--•-------------••-•---......................----------------------------------------------------------------------------•------- Nature of Repairs or Alterations—Answer when applicable...__........................................................................................... -------------------------------•----------------•---------•---•----•----------•----.....---.........-•----...........----•-----.....---•-•-----•---.......------------......--•-••-----•--•-----------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL 5 of the State Sanitary ode— jheyndersigned further agrees not to place the system in operation until a Certificate of Compliance has be y e board of health. G� II p Application Approved By--- ------ ........................................... ! ... Date Application Disapproved or a following reasons-...........................................------------------------------------•----------•-•--••......-••-••-- ...................•--•-•-.....•••---...----•••---....-••---.......•-------._.........._...._..----••=-•-----••--•--•---•----------••---•-•----....---•-----------------------------•....-•----••------- Date PermitNo......................................................... Issued-....................................................... r Date t� No ............_....... Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® QF HEALTH Appliratiou for %gpoiial Workii Totes ur#iutt Vanat Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Lo_f.. 7 Ve %err / �� ....._... ..... - ..... ............................ ... ...--- .... Loc tion-�ess o Lot No. ._ / f.� ............................. /z.9_,I F� c.--� ,. �f�w���Js� := Owner ress a ./G 'erg �T/K.S fi�'......C,9. ................... . _Gft H.n C ��.5_S:...................................... .... / Installer Address Type of Building Size Lot...Z ----Sq. feet 1-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fi u es -•-•••••--••-•------•--••-•-•-••-•-•••••-•-••---••••-•..................................---•---•---•-----•••- W Design Flow............. �............._..__..gallons per person per day. Total daily flow---____.____..___3✓._.v.............gallons. WSeptic Tank—Liquid*capacity_��%�gallons Length.-� ...... Width_____-.•_-______ Diameter________________ Depth................ Disposal Trench—No..................... Width.................... Total Length.._...__;•..._..___. Total leaching area_______.••--.__.rr sq. ft. Seepage Pit No----------/--------- Diameter._40.-.4----- Depth below inlet_.?_:.d_..._.. Total leaching area.2���.�?. . tt. z Other Distribution box ( ✓j Dosing nk ( ) '—' Percolation Test Results Performed by....Al.I/<4-.. -• M .-�4� �•. Date---- :. 0 3..._•_.__-. aP1977 Test Pit No. 1___.L_Z__minutes per inch Depth of Test Pit--------- 2_----- Depth to ground water....Aj 0/j�._.. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------_............ Description of Soil...... '4...... C l�r •5 +��Sc'I L ----� .....-----�'G G^ S j vC x f• .. -----•-•------ -•--------•------- ---------•-•------------------------------------------..---- W UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ----------------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------•••. Agreement: The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliancehas been issued by the board of health. Ifollowii igned---••••--••.. ��� t�Da4eApplication Approved BYDate Application Disapproved forg reasons-------------------------------------------------•-•---------------------------------------------------------•... ..•-•---...-•••••••-••--•--•••-•--•-•---••••••-•--•-••-•-•--•----•-•--•••-••-••-••-••-•-•--•-•••---•--••------•--•••-••••-•--••-•--•----••-•••--•-----•••------•--••••••-•-----••----.....-••--••------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifirtt#r of Toutsdiuttrr THIS I T E. I Y That the Individual Sewage Disposa System constructed ( -)``or Repaired ( ) bl ' f ' .... ---------------------------•---------.......--•---.............-----••............ Y .. - g Installer at................................................... X has been installed in accordance with the provisions of MI�I, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------------__. __. ___...... dated- --------------------________-------______--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE........................ Disposal ,,Permission is he4* ranted_._e..r ``'."`�" to Construct ( e ua e Disposal System .. ., � .. ,.. atNo.--•••-.... = --------------------- Street .. ...., Y ................ as shown on the ap li ion for Disposal Works Construction Permit'NFo ,.__ ___ Dated................. ..... DATE. ��_.7_ _lJ' Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS STAMP: P EAVE SPACE 3'-0'x4'-0' 3'-0 •z4'-0' I I BATH W.I.C. I C I CL. 2'-O•x 00 DR m I EX. BEDROOM 2'-6°x&'-0° 2'-6'xb'-8° .11 DOOR i m z o• 6' 6' EX. BATH °cL. r x (fl( o PROPOSED m NEW 0--N ---I _ N o _ EX. BEDROOM � N m o x EX. BALCONY DN. Jc DOOR z U 0 7n Q 1aJ'- z v �2 pp 3Q 0 N OPEN TO LIVING RM. o P.T. 5TOOP m 4' o' 7-11' W EX- KITCHEN z WL Q z � W �J 1 - EX. DINING W I 6'-O°x6'-8' FR. DR. RM. W Q W o C m J ADDITION IXISITING - ^ m C) V O O O S`` Lu - of z 0 N ol w ,SECOND FLOOR PLAN a r U SCALE,I/4'=I'-0' W -- - -�s - -- T m O i 2 R O S% Z 1 1 AMI M• 6 - 1 r EX. GARAGE o 1 v o TITLE: On --------------- 3'-O°x4'-O' 3'-O'x4'-O' i 1 1 • i I EX, LIVINGLIVING ; ; FLOOR PLANS 1 O i m 4'-0' DATE ISSUED: 06/26/07 REVISIONS: ADDITION IX151TING DRAWN BY: PROJECT#: FIRST FLOOR PLAN DRAWING NO.: z SCALE 114'=1'-O' _ . Al r STAMP: ' • CONTINUOUS 2x6 P.T. SILL PLATE/SILL '-' 2x12's @ 16° O.G. INSUL. w/1/2" DIA GALV. A.B. • W-O" O.C. MAX _ a v -------------------- DRILL 8 GROUT - L ---------- ------ 2-#4 DOWELS @ 12" O.C. I II o IIIIIIIIIIIII I I U 1 II Illllllllll 'I I s S 6 I I CUT OUT I , FLUSH FRAME d WIOx35 ST. BEAM I I N ACCESS TO CRAWL SP. I I ( I I I 1 N I� I I IIry.�II. 1r 3 I/2" CONC. FILLED I I 3-2xi0 GIRTI ' STEEL LALLY COLUMN BELOW DOWN TO FND. z � o IIIIIIIIIIIII I t 3 I/2" CONC. FILLED p I I BM. PKT-TYP. o I I MIN. BRG. 4" STEEL LALLY COLUMN , , I I ON 30"X30"X12" CONC. 1 1 FTG. TYP. IIIIIIIIIIIII �_ CRAWL SPACE 3 1/2" CONC. SLAB OVER I I I I I I I I I I I I I m U O I I b MIL POLY VAPOR BARRIER OVER 3 Q O 3 I I 6" COMPACTED GRAVEL I I III I I NOTE: i L------------------ i. STEEL BEAMS TO BE ENGINEERED BY DRILL d GROUT L - - STRUCTRUAL ENGINEER. ——————————————— ---- 2-1t4 DOWELS @ 12" O.G. - - CONT. 2x12 RIM. JST. CONTINUOUS WxW-0" CONC. WALL m ON 16"x8" GONG. FTG. W 2x12's @ 16' O.G. W Q W W ADDITION EXISTING ADDITION D(ISTING Q Ly Of Q J C) o C Go QLL0 OC LLJ SECOND FLOOR FRAMING PLAN � U � I,_ FOUNDATION PLAN SCALEt!/4•=P_o• z O cv U 5CALEtI/4'=I'-0' W CON'T RIDGE VENTS 10'-B°+/- \ TYPICAL ROOF CONSTRUCTION F- 2x12 RIDGE BD. ASPHALT SHINGLES ON I5tt BUILDING FELT ON 12 12 1/2"CDX PLYWD. +/-5 —�+/-8 PROP-A-VENT BAFFLE AT MATCHH IX. MATCH IX. SLOPED CLG.S 2.10 RAFTERS @ 16' O.C. w/ SIMPSON 142.5 CLIPS @ 16.O.C. ALUM. GUTTERS 9" (R-30) FIBERGLASS BATT Ix FASCIA BDS 2x8 @ 16'O.C. KRAFT FACED INSUL. TITLE: Ix SOFFIT w/CON' z VINYL SOFFIT VENT + ~ TYPICAL WALL CONSTRUCTION BATH BEDROOM W.C. SHINGLES 5 1/2" ExP05URE ELEVATIONS ' CONSTRUCTION 0in TYVEK HOUSEWRAP TYP. 2nd FLOOR 3/4° T6G PLYWD SUBFLOOR U 1/2'CDX PLYWOOD GLUED t NAILED OVER Q 2.4 STUDS @ 16" O.C. 2x12'5 @ 16" O.C. TO MATCH IX. SOLID BLK 3 1/2' R13 UNFACED FIBERGLA55 I/2z°3 STRAPPINGGATT INSULATION G.W.B.-PTO. AT I6' O.G. TYP. 1/2"G.W.B.-PAINTED I -� - DATE ISSUED: . WI0x35 ST. BM. 06/26/07 z N REVISIONS: TYP_ IST FLOOR CONSTRUCTION 6 3/4° T t G PLYWD SUBFLOOR _ GLUED t NAILED OVER FAMILY RM �F 2x12's @ 16' O.G. TO MATCH IX. 61 (RI9) FIBERGLA55 BATT SOLID BLK L INSULATION TYP' 3-2x 10 GIRT FOUNDATION: BITUMINOUS DAMPPROOFING ON DRAWN BY: 8' CONC. FOUNDATION WALL ON L.G.ON CONC. , o z 16'x8' DEEP KEYED GONG. FTG. I �c FOOTING PROJECT#: DRAWING NO.: 3 1/2"NIL GONG, SLAB OVER A3 CROSS SECTION 6 MIL POLY VAPOR BARRIER ON SCAIEd/4"=I' O" 6' COMPACTED GRAVEL S/TE PLAN N T YPICAL PROF IL E NOT TO SCA L F SCALE — l + � �' ' 1✓ " � �-, �=> �� IB"STD. L T WGT C.I. MH COVER - _ _ - . + 4"C.1. F''PE - 4"BIT. FIBER PIPE TIGHT ✓0/N T S _ _ - OUTLET LEVEL - - ---- FLOW LINE - O TO FIRST JOINT _ I DWELLING ( �o" O O �' r- --- r C.I. TEE C-I. TEE STANDARD PRECAST ` CONCRE r£w°n GALLON SEPTIC TANK L_____� __ _1 0I5 TRIBU TION BOX '04-1 c1 _ - B TO BE INS TAL L ED ON TANK L E VFL , STABLE BASE i 4 © SEPTIC AN I TO BE INSTALLED ON LEVEL STABLE 84SE r 1 L. 5 f //B"' TO //2" WASHED PEAS --- !EA CHI NG PIT ALL AROUND IN PLACE F IRONS, FINES BASE TO BE LEVEL ANU D � + BRICK E1 MORTAR COURES 3/4" TO l-//2" WASHED CRUSHED �o`lo AS REOUIRED TO HR/NG STONE ALL AROUND FREE OF I=/,4t COVER TO GRADf 24"C.I. MH COVER IRONS, FINES AND DUST IN PLACE �• a `^+�t AND FRAME r. S T t7' P t2 fcL Ah'[ G U 1JG• -- -- ------ . ..�:�L I•t . �A"h 1.rV \. 4 _I -� _ LEACHING PIT SEC TION- 3b 8` FLOW L INC - -- - --- F✓�cf� �A9 1�o hTP. tvrte_IA.'ST G0r11�. INLET _ -- �� _ PL• ,/tile `\. Iapy e,A-L. haPTi4 (A�.1K M PIPE I � I CONCRETE TO 9E 4000 PS! 2B GAYS V_ I - 6„ 2. REINFORCED W:TH 6" x 6" NO. 6 GA. W.W M. 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER T DEPTH REQUIREMENTS. ' OPENING WITH 4-//8- 4. NUMBER OF PITS REQUIRED i OUTER D/AMFTER a NOTE EXCAVATE TO ELEVATION OR LOWER AS r =� 1-3/4 INSIDE DIAMETER 1 3„ REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATE(' MATERIAL WITH CLEAN + % GRAVEL TO DESIGNED GRADE _r 17 a 21,j(o`7 _ 6 T 6, -4- L-o 7 If, MIN EFFECTIVE DIAMETE I � f�l Z7� k ° R I (NO s T TO EXCEED 3 T/ME EFFECTIVE VE DEF'. H/� r LOT lV 1 1 t WATER TABLE - € qGCU►OJT WZ4i C7 ) .SDi'L AND f-EEC. ��A TA GENERAL NO TES p PERC. RATE _ MIN /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM 0_ I \ 'EST BY: _ ICUL;7 ' �M' wQ��'��ILf`` AhG ) SEPTIC TANK, CISTRIBUTIpN BOX LEACHING PITS TO 8E STANDARD ' --- - - PRECAST 12EiNFrRCED CONCRETE UNITS. WITNESSED BY. J P O IN J J A C a pi (I+' , , r ALL SYSTEM CC"PONENTS SHALL BE: INSTALLED IN ACCORDANCE 10j77 rat- 07 C7 -Io-oo;5 TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR EL.: !,:�96,�2 �1' OATE S' `2 ' �'y MINIMUM NEQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF h,t.P wA�K 1:h► � Iy uI .�E ��. L,Zp,°po' TEST PIT N0. P' I�?`7 TEST PIT N0, I�JToj SANITARY SEWAGE EFFECTIVE I JULY I977, A ___ ANY CHANGES TO THIS PLAN MUST BE APPROVED 8'( THE O" TO('fS:JI�'.51�► y�, 'Ter tsL)0410111., BOARD OF HEALTH. 14+ --- -- eoA►-4W-yANF? t/A A AT COMPL6 TION OF CONSTRUC110N , PRIOR TO BACKFILLING, THE GpAt2sl✓ BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. 0 -- MAD. 5 A Kip PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATEP D 0 1�.1 AA D � 1< � A. L)p 1O fiWIr::; +5AtJt7 �L, x.o OTHERW!` E. DESIGN DATA BEDROOMS ___ _ _ _____ DISPOSAL N D iV a ` ! EST. TOTAL_ DAILY EFF. '_U GALS. E�EI ✓D — SEPTIC TANK 100a GAL SIDEWALL AREA Z'S' GAL./SO. FT. BOTTOM AREA _. _ -__�' o GALJSO. FT SEWAGE DISPOSAL SYSTEM O X 00 EXISTING GRADE LEACHING REOUIKE,'_.�°��'�`7._SO FT ZONE __� _ 0, 0o3 FINISHED GRADE ACTUAL LEACHING AREA 2oil.�i2 SQ FT. FOR _ U o . INVERT ELEVATION • ' ' LO"f t t`! 0t'3AV lcot Cz _ DOMESTIC WATER SOURCE © v �As �'•,. � ,» ,� fc N T C►�V t k.tX,r. I� �. 1Z 10 '!7 T 1.�, M P• 5 S PROPERTY LINE;/ - PLAN REFERENCE L- L O 5 Z___—_ -- ;_-- '/ r wI I M � ` �( .,I_E• AS INDICATED DATE MEAN HIGH WATER Y _A *L 19'►1 � � L � WM M WAfrWiCK & A.SS0c,/AlE 3 I BENCH MARK PATLINI __ � - ----- - ------ Y -t , y; F+;)X 801 - NORTH FAL 1W00 TH I t IA A Z/a tz. i�