The URL can be used to link to this page

Home My WebLink About0427 NOTTINGHAM DRIVE - Health 427 Nottingham Dr. (Centerville) A= t NoP H1630R- �� •CONS HA8TIHQ8.MN TOWN OF BARNSTABLE LOCATION 7 Vo i-trove c.�. 1�di J'f SEWAGE# )Q/ k" L/0% VILLAGE C PiJY/yrl1t° ASSESSOR'S MAP&PARCEL ► �� i (� INSTALLER'S NAME&PHONE NO. �Nc s 13rr�"' nl 1NL sty )_�l53y SEPTIC TANK CAPACITY LEACHING FACILITY.(type) s ofiak�A "[ KS (size) NO.OF BEDROOMS OWNER Y► Y.,2c, +lc��(� PERMIT DATE: 11 COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility w��"�s a�'C 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 35' ►73ox -�`3 r3 z -'1 o 3, F 1 Town of Barnstable Barnstable OF SHE Tp� WPC r,, ti* ty i y Regulatory Services Department AlAm edcaCi RARNS'ss. o!I public Health Division �m MASS. 0 i63q &, prEDMPt 200 Main Street, Hyannis MA 02601 �007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6796 October 3, 2012 Kelly A O'Brian 427 Nottingham Drive Centerville, MA 02632 The septic system located at 427 Nottingham Road, Centerville, MA was last inspected on 9/5/2012 by Douglas A Brown Inc, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health Document] Sa o �r�� ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Ctty/Town State Zip Code Date of Inspection b. 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 filling out A. General Information forms on the computer,use 1. Inspector: only the tab key 14 to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145VQ ��/j Company Address 1 y g CENTERVILLE MA 1� 02632 `�" City/Town State E Zip Code m : 508-420-4534 S 14297 ' Telephone Number zj License Number ,la B. Certification sly 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 l% 9/5/12 InspectorwSignature 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. tSm s 09/08 Title 5 Official Inspection Wsurface ge Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 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: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. Cityr own State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Ma ssachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y < 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Cdy/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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow /Sins•09108 Title 5 Official Inspection Forth: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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 every page. Cityrrown State Zip Code Date Date of 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system em receiv ed normal Y flows in the previous two � p 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 dwellinginspected for signs o P f sewage 9 g 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Cltylrown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND LEACH PIT Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. City/Town 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-09/08 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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: SYSTEM APPEARS TO BE ORIGINAL 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: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) TANK LOOKS TYPICAL FOR ITS AGE If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: APPEARS TO BE 1000 GALLON Sludge depth: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 A— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•09108 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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (Cunt.) 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) p tlon) (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•09= Tide 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 '< 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. &1 y/Town 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 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 LOOKED TYPICAL FOR ITS AGE WITH CORROSION ON THE INSIDE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH PIT WAS OPENED AND WAS FOUND TO ONLY HAVE A COUPLE OF INCHES UNDER THE INLET INVERT OF USABLE SPACE INDICATING FAILURE 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•09/08 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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Cltyffown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Tide 5 Official Insp ection 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 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Cdyrrown 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•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ~'` 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is CENTERVILLE required for MA 02632 9/5/12 every page. Cltyrrown 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: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 '< 427 NOTTINGHAM DRIVE Property Address OBRIEN Owner Owner's Name information is required for CENTERVILLE MA 02632 9/5/12 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1 Assessing As-Built Cards Page 1 of 1 c 7'7 V zj/oZ-j LO CATIO N S E W A G E7PERMIT 110. - VILLAGE INSTA LLER'S NAME & ADDRESS K_ I rr�4v,•t I 3 U11 DE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �n j j L o i http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=148025&seq=1 9/5/2012 No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Tipplita.tlon for Disposal *pstem Construction 'Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Y,9 7 "' 'hem em D( O�er's Name,Add r s,and Tel.No. Cc,�Te +l l f�t r r1 Assessor's Map/Parcel a S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L)o-.z,icsA 3�0 y _ CO! , G.►�. i,ice s,; ►$ boks -® V77-5-31,3 Ill"Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building t�P No.of Persons_- Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �n gpd Design flow provided '3 31 , D gpd 1 Plan Date -10 1 2___ Number of sheets °L. Revision Date Title Size of Septic Tank CtCl51-11M 3 Type of S.A.S. !CW c b�1 C1 In�f s Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 n 15J]�, jjeco S �, 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 Boar f Health. .� Date 2 `Z_._ Application Approved by Date cT Application Disapproved by Date for the following reasons Permit No. Date Issued e No. �/ Fee THE COMMONWEALTH OF MASSACHUSETTS ` ": Entered in'computer- "Y y Yes .t`�-- C PUBLIC HEALTH yDIVISION ,- TOWN'OF BARNSTABLE, MASSACHUSETTS f .; ftplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual"Components w Location Addre§s or Lot No. YA �' "� 1�inn {�( 07ner's Name,Addr ss,and Tel.No. Assessor's Map/Parcel ) 0 a S- Installer's Nam-•e�,Address,and Tel.No. Designer's Name,Address,and Tel.No. Do�G5A ��fouk !n►C ivfC�+Ge'�r45 GJkS �4 3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building h 005C No.of Persons+ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3() gpd Design flow provided 31) , b gpd ' Plan Date 111(. 1► 'L Number of sheets I_ -Revision Date Title / Size of Septic Tank C X I �TYP~ e of S.A.S.J <C" &IIC,�J Description of Soil - ,- 'r f rf Nature of Repairs or Alterations(Answer when applicable) 1 to!5 tC(� 0 eta} S ,A, Date last inspected: ` ,.. f, Agreement: The undersigned agrees to ensure the construction and maintenance'of the afore described on-site sewage disposal system in? (' a 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 Bo of Health. - ,1 i e Date _ A _ /' Date ; H Application Approved by (Z + Application Disapproved by/ ' ( i , Date x -r! / for the following reasons Permit No. Date Issued ' 4iy ---------------------------------------------------------.---------------.--.-;---- .---:-------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ' THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(WTI Upgraded( ). Abandoned( )by L a o��4-, L1 f c��✓..a f 1 nrC - at "7 Ain t t has been constructed in accordance - ;' ti a with the provisions of Title 5 and the for Disposal System Construction Permit No. -dated tt lnstaller�,x6-� A J"N b j,J T NC Designer ,oc��"t C�( �C . #bedrooms Approved design flow j j LZ. gpd ' The issuance df this permit shall not be construed as a guarantee that the system will ftYnctio n as design Date 1# CAI I Inspector ----- No.-- - --- � � ---�----�-------------------------------------------------------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS . �is�osaY �pstem,(Construttion hermit Permission is hereby granted to Construct( :) Repair'(✓)/ Upgrade( ` Abandon( ) System located at � 1-7 Q t t-c-S d r.n ,l k,+ s 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. Provided:Construction rrAst be completed within three years of the date of this permi 1 / Date / /�/ Approved by j 01/29/2013 07:56 50e4775M ENGINEERING WDRKS PAGE 01 Town of Baimstable 1eatory Services Thomas F.Geiler,Dirotor Public Hem Devi oe Thomas McK ,Director 200 Main Street, Hyannis,MA 02601 0,0ice: 50&862 Fax: 509-7904W Date: t� Sewage Permit#,` ` . -�© Assessor's Map/Pared 140 -02.�- ifiWaller A Designer Cerfiftaft2n_FoEM Designer: S ,..n.e�-v+�r,4 We V"IAJ, IAC . Installer: j�fow✓t ( ►� Address: 12 W, C ft ¢i > t c.1 i d. Address: j' G . l atC 14 S on (-,A , `-^' 1 f was issued a permit to install a ( � (ir�sta er septic system at -427 (Vbo n5 kot �r . ��nt based on a design drawn by (address) P dated (designer) _ 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strlpout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow, Stripout(if required)w ted and the soils were found satisfactory. PETER T. sta er s ignaiure) WENTEE CIVIL p No.36109 let (Designer's Signature) (A ax Design ) PLEASE RETURN TO BARN '��$LE PUBLIC HEALTH DIV AN CERTIFICATE F C C WILL NOT BE ISSUE H THIS FORM AND as- BUILT ARE RECEIVED BY THE BARNSTABLE PUBLIC DIVISION. THANK Y q:loffice f:xmsldesignercaTtif'fcatian i<ofrPl.d4C . 1 Department of Regulatory Services ._ Public Health D>< o>r ; Hate. is se3p. 200'-Main Street,Hyannis MA 02601 Date°Sclleduled Time Fee Pd; Soil Suitability Assessment for . a; e Disposal Performed By: Witnessed By: LOCATION&;OENRAL INFQRi�IA4TI�11 Location Address . er' N , 4 7-7 YVo{}i v� r Own 's time Address !l E✓itJ�� Q�Cf' /ZG, Assessor's Miip/Parcel: En 'neer's Name NEW.CONSTRUCTION REPAIR Telephone# .5-0 9'--73 7--y'74 i Land Use. Slopes(%) 2 Surface Stones / Distances:from: Open Water Body /,i f ft Possible Wet Area �` ft Drinking Water Well 221—V - ft Drainage Way ft Property Line }/ft .Other ft SI0,'TCI :'(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in:proximityto holes)' COD Z f� e= PIP, 01.a5 rr, Parent material(geologic) Depth to Bedrock / 4-- Depth to Groundwater. Standing Water in Hole: AJ A - / Weeping flour Pit Face Estimated Seasonal.High Oroundwater tl DETERMINATION FOR SEASONAL HIGH WATER TARL E' Method Used- Depth Observed standing in obs.hole: W in. Depth to soll:motilest In. . _ Depth to were±�g.f rm s� ::�f Vt: � !C in (.rr:�uieGS�uLeP./�t1aU861Y11.°nt �'t. .' aex.Weli.# Reading Date, usd Wei'.Ieve!,�.,._„ Ads.factor G.touitdwaEer'1.®val— PERCOLATION TEST bete, Vme— Observation Hole# P(-,rL d',/% Q Tlme at V Depth-of Perc 1 i 113 (1`17 2 Time at 6" Start Pre-soak Time® �- .Z M /(��!�TSme(9"•6") ., ,r End Pre-soak Rate Min:/lnch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division } Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be,conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPCIC\PERCFORM.DOC 1 DEEP:OBSERVATYONrtOLE LOG Hole# Depth:from Soil Horizon Soil Texture Soif.color Soil Other Surface(in.) (USDA) (Munselp Mottllag (Structure,Stones,Boulders: � :F73a , rz g DEED'SOBSEIIVATON'ROLL TO'G Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonese Boulders.; . 3 Z...: ..._ i 7Xk C s.� IG DEEP OBSERVATION HOLE`LO_G Hole# Depth`from Sail Horizon Soil Texture Soil,Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoles;Boulders. i DEEP OBSERVATION HOLE LOG Hole# Depth#:from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones;Abulders. Flood Insurance Rate.Man: Ahove 500 year tl W'boundary .Nii Yes -- Wtthln 500 ear boon No_, Yes ..�:.� Within wyear flood boundary No w Yes Death of NaturaHv`Occurrine Pervious Material Wattle-ast four feet of naturally occurring pervious inatertal exist in all`arees.observed throughout the. area ; os ro ed for the sotl abso tion sy stem? p P rp ,. .. ----f Ifwhat>is the.depth.of naturally occurring pervious matoltial ..._. Certicatfion �� °� I certify that.on (date)I-have passed the.sotl evaluator examtnation approved byathe Department of Environmental Protection and that the above analysis was performed by me consistent wtth h: the reyutred tirai 'ng;expetfise and experience described'in l0 CIViR 15:017 Date Signature Q Xs gpT1CVPBl CFORM:DOC I 2-II196 JA I 0 PM 119 DATE 115106 _... .� ...�_ Df' iSiOr� PROPERTY ADDRESS 427 Nottingham D.,zive Cent eay.i.��e lass 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1.1 1-1000 ga2.2on septic tank., I 2., 1-1000 gai eon ieach.ing. p.it., Based on inspection, I certify the following conditions: 3., 7h.is .is a 7.it ie T.ive 3ept.ic .system . (78Code) 4.1 Septic system .is .in paope2 woitk.ing oadea at the paesent time., SIGNATURE f�, ✓ J`C^ Name: Robert A. Paolini Company: Joseph P. Macomber-& Son Inc . Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 I JOSEPH P. MACOMBER & SON; INC. . Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 026:32-0066 775-3338 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a TITLE 5 OFFICIAL INSPECTION FORM—.NOT.FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION Property Address:427 Nottia ham Daivg ente2v�2.�e Owner's Name: Janine 7a.inaue Owner's Address:3 a m e Date of Inspection: 115106 Nance of Inspector:(please print] Robert A Iiaolini Company Name: ?- P. .l'lacom&e2 .S:o.n Inc. Mailing Address: en eavi e, RaTT..02632 -�.. Telephone Number: 5 0 8-7 7 5-3 3 3 8 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 15340 of Title 5(310 CMR 15:000). The system: XX'X Passes Conditionally Passes 040 Needs Further Evaluation by the Local Approving Authority fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the.Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system,is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent tor-the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This'report only describes conditions at the time of inspection and under the conditions of use at that �. time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title S Tnspection Form 6/15/2000 page I g Page 2 of 11 OFFICIAL INSPECTION:FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r` PART A CERTIFICATION(continued) Property Address: 4.27 Nottingham DIt.ive en e2v.c e Owner: aan.ine Iz n ue Date of Inspection: 715106 Inspection Summary: Check A,B,C,D or.E✓ LWAYS<tomplete,all of Sectiou:D A. System Passes: NQ I have not found any information which indicates'ftt any of the failure criteria described in 31.0 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below: Comments: Septic zybtem i.3 .in 122oRe2 wo2k.ing o/tde2 at the z22e3ent ;time., B. System Conditionally Passes: NO One or more system components as described in the."Conditional Pass"..section need to be replaced.or repaired.The system,upon completion ofthe replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not-determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The septic tank is metal and.over 20 years old*or the septic tank(whether metal or:not)isstructurally 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: N. Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled br replaced ND explain: NO The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS -� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 427 Nottingham DILiye Cent e2v.i.2.�e Owner:.Jai,ine 72 inque Date of Inspection: 115106 C. Further Evaluation is Required by the Board of Health: NO 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: rz o Cesspool or privy is within 50 feet of a surface water rz o Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i 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: n o 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. no The:system has aseptic tank and SAS and the:SAS is within a Zone 1 of a.public water,supply. no The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. n o The system has a septic tank and SAS and the SAS is less than 100 feet.but 50 feet or more froN 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 colifotm bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM PART A ,>> CERTIFICATION(continued) Property Address: 427 Nottingham [hive en eay.� e Owner: aan.ine 2.tnque Date of Inspection: 71510T-- D. System Failure Criteria applicable to all systems: You must indicate"yes".or"no"to each of the.following:for all inspections: Yes No _ X Backup of sewage-into facility or system component due.to overloaded or clogged SAS or cesspool _7 Discharge:or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'%,day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. X Any portion.of a cesspool or privy.is within a Zone 1 of a.:public well. X Any.portion of a cesspool or privy is within 50 feet of a private water supply well. �. Any portion of a cesspool or privy is less than 100 feet but greater.than 50 feet from a private water supply well with no acceptable water quality analysis.[This system.passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates.that the well is free from pollution.from:.that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered:A copy of the analysis must be attached to this form.] NU (Yes/No)The system fails.I have determined that one or moreiof the above failure.;criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner uld 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• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no . X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 sh.41 upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 427 Nott-ingham Dzive en e2vitee Owner: aan.ine a.7nque Date of Inspection: 6 Check if the following have been done.You must indicate`yes".or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? i _ Have large volumes of water been introduced to the system recently or as part of this inspection? N/,4 X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS,located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes ii , _ Existing information.For example,a plan at.lhe Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSALSYSTEM.INSPECTION FORM r PART C SYSTEM INFORMATION Property Address:427 Nottingham D It i v e en e2v.U,ee Owner: lanine 72.inuue Date of Inspection: 115106 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2. Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n 00 Is laundry on a separate sewage system(yes or no):n o [if yes separate inspection required). Laundry system inspected(yes or no): n 0 Seasonal use-(yes or no): n0 2004_84, 000gateons Gl'D=230., 13 Water meter readings,if available(last 2 years usage(gpd)):2 0 0 5=4 4, 0 0 0 ga—01 o n s Cj')D=12 0. 5 4 Sump pump(yes or no): n o Last date of occupancy: P a e-3 e n t COMMERCIAL06USTRIAL NSA Type of estabohment: Design flow(used on 310 CMR 15.203): �pd Basis of dbsign'lflow(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 Source of information: NIA PAP Was system pumped as part of the inspection(yes or no): n 0 If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM. X Septic tank,distribution box,soil absorption system Single cesspool T Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approxi t e of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site.(yes or no): no 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nottingham DItive Cent eay.i.2.2e . Owner: lan.ine 72.inuue Date of Inspection: 1/5/0 6 BUILDING SEWER(locate on site plan) Depth below grade: 2 Materials of construction:_cast iron X40 PVC_other(explain): Distance from private water supply well or suction line: 20 f Comments(on condition of joints,venting,evidence of leakage,etc.): ,Jointb aRReaa LULL Vent Ofy fhnnllg- hou ,4a wauJ SEPTIC TANK: y e-4locate on site plan) 10 0 0 ga U o n 13 Depth below grade: 18" Material of construction: X concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_' 'is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8' 6"X5' 8."X4' 10" Sludge depth._. Distance from top of sludge to bottom of outlet tee.or baffle: t 2 a c e Scum thickness: t2ace, t2ace Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: to a c e How were dimensions determined: m e a 4 u 2 e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid.-levels as related to outlet invert,evidence of.leakage,etc.): Pump tank even 2 eaa,3., Zntet & ou 7ank i,6 ztauctu/ta eQ .6ound.1 GREASE TRAP: n o(locate on site plan) Depth below grade:_ Material of construction:._concrete_metal fiberglass__polyethylene_other (explain): Dimensions: Scum thickness; Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Gaeaze btap .iz not Paezeat 7 Page 8 of 11 OFFICIAL:INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nott.in ham Dzive eri e2v.i�.�e Owner: lan ine 7/t inque Date of Inspection: 1/5/D 6 TIGHT or HOLDING TANK:n o (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_..polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: ' CQ�me 7(condition of alarm and float switches,etc.): /.eg o/c -ho ed.ing .tanks aae not /22ezant DISTRIBUTION BOX: n o (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Dizt2.igat.ion Sox .i.a not pAezent PUMP CHAMBER: n o (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i um a cha m& o.t RnvAonf 8 Page 9 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 427 NotLt.in ham /Olt ive en e 7 V i-e i'e Owner: lan.i.ne 7/t.i.nuue Date of Inspection: 1/5/0 6 SOIL ABSORPTION SYSTEM(SAS): .(locate on site plan,excavation not required) If SAS not located explain why: Located See 12aae 10. Type X leaching pits,number: 1 leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, j etc.): Loamy .to med.i.um nand., No 3-ignz o� ,Pa.i-euae o2 /2onding., So.iez a/te 2y., eye a .ion :iz noamai.. CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes`or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ces,slzoo2,3 ate no.t 122e,3e n PRIVY:no (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.): l a iv.y .ins no.t paezen.t 9 Page 10 of 11 OFA*'C,IAL INSPECTION POW—NOT FOR VOLUNTARY.ASSESSMENTS SU$S1JR�F'ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION(continued): Property Address: 427 Nottingham It ive Cen.te2v.iQ.�e Owner:aan.ine 71t.ingup Date of Inspection: 715106 SItETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at.least two permanent reference landmarks or benchmarks:Locate all wells within 100 feet.Locate where public water supply enters the building. a 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) . Property Address:4.27 N o t.t.i n gh a m DIt i v e Centeayiiie Owner•aan.ine 7ainuue Date of Inspection: 7%5/0 6 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: y e-s Observed site(abutting property/observation hole within 150.feet of SAS) Checked with local Board of Health-explain:a z R L i Q t c a a d no Checked:with local excavators,installers-(attach documentation) ye , ®ccessedUSGSdataliase=explainAttp•.town.,9a2n�ta1$e. ma.-us • You must describe how you established the high ground water elevation: ilsed. : Cape Cod Comm.is.ion ldatea 7aeee Cohtouaz And l ul2.ic ldate4 Suppiy ble2.E head paoteet.io•a a2eazs ma/z o SeRt 1995 Vate,t 2e,3ouzce_,3 o,Mice cal2e cod comm.cszon , T1 op of OrouM Leaching Pit ;eet Groundwater. Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method . Therefore,the vertical separation distance between the bottom , of the leaching pit and the adjusted groundwater table is 3� feet: 11 • •r.nnr+.�wre�•.•e�a.rarnsw►�•n.r anrwvr�wewns� A7rm+A%�•'} TOWN OF „(3 it RN,S.7'i3(F 130ARD QF 11RA1411 SUBSURFACR SZWAOR DISPOSAL SYSTEM INSPECTION FORM - PART D•r CERTIFICATION •••arp,�a••sNir++u�MnM "W"W" pvw rna +r -TYPE 01 PRINT CL OW- PRO,PERTY gysPucTFl1 STREET ADDRESS 427 Nottingham Dzive '. ASSESSORS MAP, BLWK AND 'PARCE'L # 148-025 OWNER's NAME aanitze 7ainque PART` D CPsRTIFX0AT;I;ON ; Ro Be.tt P.a.o.9-in i NAME 'OF INSPECTOR ' ' • COMPANY NAME ;ozaph :P., Macomlez?I. S-on Inc COMPANY ADDRESS Box 66 " C.en�ezvi:gte r,a.6.a 026.32 stro Toxn-or City Sla • L1P COMPANY TELEPHONE ( 508. )'�75 - 3338 FAX 508• )190 f578 . CERTIFICATION. STATEMENT I certify that I hAva peraonahly .jnspected ..the Sewage 'digposal. system at Xlecommendai his address and that .th:e' information reported .is trues. aoeUra•te•, and omplete as of the time ..af�insp.ection,, The in.qpectio�n was performed and any ions regarding upgrade, .ma•intenance I' abd repair .are- eoneis'tent with my trainipg and exp.grience in the proper function' and maintenance of on- site sewage disposal systems , Check one: XXXX Systed PASD The inspection whie.h •I have .condu(;ted has .,n-at •found any information . which indicate: that the system' .fails to ' aded•uately. protect .publiv health or the enviropment as defined in. .310 CMR. 1$' 30.3., Any failure criteria riot -evaluated are as stated in the FAI-LURV CRITZKA section o•f this form. System FAILED* ' The inspec-tioh which I have pan ted 'has '•found that the system fails ,to protect the public Health and the eny,1ronmen•t ' in aogo'rd•ance with Title 61 310 CMR 15 . 30, and as - specifically noted 'on .PA'R.T, O —. FAILURE CRITERIA of this inspection .form , 1 Y' I f Inspector Signature' Date sk ne` copy of this eerti f i.cat•ioh must -be 1 rovi'ded 'to : the .pWNER•1 t•ht BUYER' where aypli.osble) and Lh� DQARD 08' HEALTH. * If the inspection FAILED,, the . owns'r' .ox"hoPorator -a.haii, . upir.�60e,'.the system. within one year of the dat-e of the inspection, unless. ai'lowed Qr- regAt rad nt-bPrw{se as vrovided in qjO CMR 15 , 3051 -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION _ [RE E 'E�`� Property Address: 427 Nottingham Dr. Centerville, MA 1�Owner's Name: Paul Halloran 0 7 2001 Owner's Address: 29 Tyler St. 1�I Ouinc MA 02171 OF BAHNS'JA8LE r EALTH DEPT. Date of Inspection: I— 3 6^® 1 Name of Inspector: (please print) 1di 1 1 i am E_ Robison Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089' Centerville, MA Telephone Number: (5 0 8) 7 7 5-8 7 7 6 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.1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: y/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: lU' s, fs1 _ , Date: /—3 0 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heals er DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I Title 5 Inspection Form 6/15/2000 page 1 I Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: 1 —3 0 •-0 f Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys�t m Passes: i I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. S stem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaire .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answei yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the exist' g tank is replaced with a complying septic tank as approved by the Board of Health, *A tal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indi ting that the tank is less than 20 years old is available. ND a plain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approv I of Board of Health): broken pipe(s)are replaced } obstruction is removed distribution box is leveled or replaced ND exp ain: e system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass in pection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND ex lain: -1 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: 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 fai ' g to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the sys em 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 froril a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. Other: 3 Page 4ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 427 Nottinqham Dr. Centerville Owner: Halloran Date of Inspection: /-3 6 o D. System Failure Criteria applicable to all systems:.. u 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''/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. I(YesNo) Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or'less than 5 ppm,provided that no.other failure criteria are triggered.A copy of the analysis must be attached to this form.] 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. Large Systems: . T be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gP Yo must indicate either"yes"or"no"to each of the following: ( following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped .. Zone II of a public water supply well If ou have answered"yes"to any question in Section E the system is cansidered a significant threat,or answered "y s"in Section D above the large system has famed.The owner yr operator of arty large system considered a si nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304.The system owner should contact the appropriate regional office of the Department. 4 m J :t Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 427 Nottingham Dr. Centerville Owner: _ Hal 1 oran Date of Inspection: 1--30-6 1 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 G d Number of current residents: 41,A Does residence have a garbage grinder(yes or no): 106 Is laundry on a separate sewage system(yes or no):rg [if yes separate inspection required] Laundry system inspected(yes or no): o Seasonal use: (yes or no): e� Water meter readings,if available(last 2 years usage(gpd)): 2000 11 ,000 gal. Sump pump(yes or no): i�o 1999 10, 000 gal. Last date of occupancy: C MMERCIAL/INDUSTRIAL T e of establishment: Des gn flow(based on 310 CMR 15.203): gpd Bas s of design flow(seats/persons/sgft,etc.): Gre ise trap present(yes or no):_ Industrial waste holding tank present(yes or no): No -sanitary waste discharged to the Title 5 system(yes or no): er meter readings,if available: L t date of occupancy/use: O HER(describe): GENERAL INFORMATION Pumping Records Source of information: IV Was system pumped as part of the inspection(yes or no): � If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):A/v 6 r Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 427 Nottingham Dr. Centerville Owner: Hal loran Date of Inspection: /—37 G 0 j , Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o 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) t/ Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? '✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: �a�y B LDING SEWER(locate on site plan) Dep below grade: Mater als of construction:_cast iron _40 PVC_other(explain): Distan a from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:—V—(locate on site plan) Depth below grade: 7 Material of construction:=concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) 1 1. J , Dimensions: u;. 4 Sludge depth:3— tl Distance from top of sludge to bottom of outlet tee or baffle: LJ Scum thickness: O—/ 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: O �� T� �- Je Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): GRE SE TRAP:_(locate on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_fiberglass polyethylene_other (expla' ): Dime ions: Scum hickness: Dista ce from top of scum to top of outlet tee or baffle: Dis ce from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: Co ents on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as lated to outlet invert,evidence of leakage,etc.): 7 t Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: J--319—c> TI HT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) { Dept below grade: Mater al of construction: concrete metal fiberglass polyethylene other(explain): Dime sions: Capa 'ty: gallons Desig Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Date f last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: b✓/of present must be opened)(locate on site plan), . Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PU P CHAMBER: (locate on site plan) Pum s in working order(yes or no): Al s in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: 1-9 6 0 SOIL ABSORPTION SYSTEM(SAS): Z(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): s CE SPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Nu er and configuration: Dept —top of liquid to inlet invert: Dept of solids layer: Dep of scum layer: Di ensions of cesspool: Ma erials of construction: In ication of groundwater inflow(yes or no): C mments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): L (locate on site plan) f construction: : lids: note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) R- Property Address:427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: 1—3 0�- ® Z SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 3 1 e 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 427 Nottingham Dr. Centerville Owner: Halloran Date of Inspection: l—3o—o l SITE EXAM Slope Surface water Check cellar Shallow wells 1 Estimated depth to ground water 6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) hecked 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: O A " i 11 A No........ .... ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH "!rL✓ ............OF.......��.. .......................... Appilra#ion for M-4#niia1 Workii C ontitrttrthan tIrrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System�� Ti�/GiF rvi PIZIvE &0Y ................ l... - ............ ----------- ---- - --.------------ --- ------------......_. `A Lo on dress �, / /� or No.'� /QjVner Z Address ----•--• ........ ......................... ........... --•-------•........................••--••-- 2nstaller Address d Type of Building Size Lot..../--5--_®Q..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder QVO) pa, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... . . • Design Flow..............S5......_........__gallonsPer person per_da• Total daily flow......... 0---------------------g . -W SepticTank—Liquid ca acit /6QQ allons Len th$... `•... Width.�D/0-_- Diameter.4 "--- Depth--5.1...- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No._:____±------------- Diameter........._�o_..... Depth below inlet.... ......... Total leaching area.• ®..sq. ft. z Other Distribution box ( ✓) Dosing tank Percolation Test Results Performed by.................................��:._..___.._...__.__::__.____ Date_____.. ,aa Test Pit No. 1_L_ '___minutes per inch Depth of Test Pit....®. ------- Depth to ground water_e��-____. 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.---.____:.____..______ P4 ------------------------------------------------- --- ........................................................................... Description of Soil......0.-A...._.6.6n)-,... ._S . .. L -- ---------------------- ---------------------------------- ------------------- x ----------------------------------------------- --------------_----............................... -••--•-•-------------------------•----•------••-------•------------------•------••-•------...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------"---------------•--------------------------•----------------------"------------•----------------.....--------- ---------------"----- ................................................... Agreement: The undersigned agrees to install the afore escribed Indivi ual ewage Disposal System in accordance with the provisions of 7TTLE 5 of the State Sanitary — he u er ned further agrees not to place the ystem 'n operation until a Certificate of Compliance has ee sue b -d of health. ev Si ---- ---•---•------ -- ---- - ............................. ..• .. .. ---•-- cc� Date Application Approved By....... r...... ............. � ---.......... ..._--- ...... -----_1-; .. .......... Date Application Disapproved for the fo reasons:.....................___________......... __________________.................................................... ......_..-•---•----------------------------------------------------------------------------•-------------'-------------------------------------------------------...._._._._....------------•••--.------ Date PermitNo......................................................... Issued-........................................................ Date a f 1 No......... Fics......... )... .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `............OF..... c 5 t ` ApptirFation for Di-spu.5a1 Workg Tnnitrur#ion Pumit Application is hereby made for a Permit to Construct (%/) or Repair ( ) an Individual Sewage Disposal System at: /Vo. ;'� .............................•--....... .......---•---•-----•---••----••-----..... ------••--•-----••----------•--•--..__.....---------•-• ................ • r� /, %. ® L to on:; jZress �i�'/ f or ... ner Address nstaller Address Type of Building Size Lot....J ..Sq. feet aDwelling'—No. of Bedrooms___._._..___--�'�.............................Expansion, Attic ( ) ; Garbage Grinder (W) � Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................... W Design Flow............. r?.,..........._......._..gallons per person pe (day. Totaldaily(flow--------__- � allor} . WSeptic Tank—Liquid'capacity n�Qgallons Length. ?.__..__ Width'.�___,�0 ... Diameter4_-�?_-___- Depth._- ..�.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.............___._._sq. ft. ._. Seepage Pit No..................... Diameter.........-. ...... Depth below inlet_._jG__.......... Total leaching area.2:P!�2..sq. ft. Z Other Distribution box (V) Dosing tank ( ) _ ~' Percolation Test Results Performed by.......... ----- ___ ' _ ___ '° _�._._____ Date_ !/°_'/�_.�__? FT 4 Test Pit No. 1-!-"°-__ .....minutes per inch Depth of Test Pit___-11'.-_,---- Depth to ground water!��P_^ .�------- LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground waterF^r ^� x + P4 ...................................... •--••-•-•••••--••••--••----------••-•------------------•--......................................................... D Description of Soil..... -- 416 0) 41 1 -----•••.. U W U Nature of Repairs or Alterations Answer when applicable...___________________.......................................................................... -----------------------------------------------------------•---------------------------.......---•-----•--------------------------------------•------•-•••_._._.••-•-•......•-•-----••--...._...... Agreement: � a' The undersigned, agrees to install 'the::afore escribed Indio :ualSewage Disposal System in accordance with the provisions of L i:I" p 5 of the State Sanitar Co — he u der gned further agrees not to place the yste in operation until a Certificate of Compliance has, a sue, b b( �d of health. Si ----------••••••............ -....... ... ........... ate Application Approved By...... • ---•-• ..........-- • ................ ...... -------�""-----_-_•-___ / Date Application Disapproved for the f o reasons----------------•-------------------------.-------------------------------------------------•-------------------- --------•••--------•--•--•...-•-••-----•--••••---•--•--•-•-•-•-=•••---••----------------•---•••--•••---•------•---•----••--•----•-•------••-----•-----•-•-•---•-•-.................................... Date PermitNo......................................................... Issued_....................................................... Date { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `.Fi°J...........OF......... :'^ . �` � ....................... Terfifiratr of ToutpliFanre THIS IS TO CERTIFY, T the Indvid Sev; ge Disposal System constructed ( or Repaired ( ) by----------------------_------ -- --- ............................................... tall -~- � at................ ee ...... ... /*7 has been installed in accordance with the provisions of of he State Sanitary Code as destribe4 in the application for Disposal Works Construction Permit N __. ...L. ..../ .............. ............. THE ISSUANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................1..1� ,� ................................... Inspector_..,..L! ; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH D ............ ...........^ ........_OF .. �5°• ..................... No......................... FEE........................ t �1A Fa nrkiXI�Jv wit, rrmit Permission is hereby granted.......... -• .-----•---•------------- ........................................... to Construct ((,,r}�r p i ) n ndgidual Sev& ge Dispos° stem " at No.. } r-------- ---------------------------------- --- � r~~i� treet .. . as shown on the application for Disposal Works Construction Pe • No__ _____ Dated______�� __r_� ..........................'--__•---_ Board of Health DATE---..._ -7_ .-,�/- -�--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -- -0- CAT10 IV SEWAGE PERMIT NO. TA- G - _ ? VILLAGE D INSTA LLER'S NAME i ADDRESS K- i-� �► 12C . BUILDER OR OWNER DATE PERMIT I S S U E D DAT E COMPLIANCE ISSUED /%�� i � �. �-- � ; 2 , a � �i Jy + � � { � . - �: • � � !E' � - 100 --EXISTING CONTOUR N ° Ra EXISTING LEACH PIT -.•t ® cea< x 100.98 EXISTING SPOT GRADE CONTRACTOR SHALL LOCATE,-;PUMP, FILL WITH SAND AND ABANDON �111 EXISTING WATER SERVICE coot Rd �eo`not Ra G EXISTING GAS SERVICE N ?re B@17CI7/'nC7/"IC Set 0 EXISTING SEPTIC TANK -&./.�,�-OVERHEAD WIRES L T. OUTSIDE COR./STOOP �� (TO REMAIN) Rd 2� TOP OF TANK, EL.=10i1.Olt TEST PIT 5 pre�`o0� ° EL.=103.2 (Assumed) N 587 00 E lNV(OUT)=ss.68f ¢ � BENCHMARK ti° si Q, " atoc ade fence LEGEND Mer`aeh W `I`O 123,20' ° ory `o ° ear°�d N101,29 o RoSer� °tits 0 LOT 64 ,� 101.80 3.2' APN 148-025 + 1 -r-13.2 19'- � a LOCUS 15,400±S.F. 0' `; + 1. 0 101,9'3 (1n�/�1�� ^-\ \ STurIPI: : :..a N �, LOCUS MAP TP•7yyy1 p y o� NOT TO SCALE Kok J 102,3�. / _ 1 +:101,37 4- ti ao, -- 'h SHED �e GENERAL NOTES: 10+ 102.38 102,07 STU( �' + h�' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 102,03 x x �` �L BOARD OF HEALTH AND THE DESIGN ENGINEER. o, 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 102.66 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE T LOCAL RULES AND REGULATIONS. DECK 0 0 1 PATI x 102.32 �\ No 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR O 'TO INSPECTION-AND APPROVAL BY THE BOARD OF HEALTH AND THE i 102.45 102,01 0 O` DESIGN ENGINEER. ui _ N j I 01.741 O 4. ANY CONDITIONS ENCOUNTERED DURING .CONSTRUCTION DIFFERING / I M FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN z j+ 102.10 1EXISTING i r ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. I x 102.47 HOUSE (#427) I �'102.88E T.O.F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF = , THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF j y HEALTH FOR PROPER. INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1� I 102,23 102 01 \•' ,_ �� OF Mgss 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. �O 1 102,21 �Q\ 9cy 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS \ sj� i o PETER T. G AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE � WALK �� + J O1:??.' . o McENTEE P- DIRECTED .BY THE APPROVING AUTHORITIES. W � CIVIL "' 10. IT SHALL•'°BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY Sr No. 35109 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 101,95 CONSTRUCTION. AEG/sZE��°� # 102.15 �0149 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS � PA 01,59 SS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND x 101.84 DRII/EWAY `(�`�f j` REPLACE :WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). "�� 101.47 F 101.79 0 } 2I �� 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 123.20' [ INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL, 13. THIS PLAN:.16 TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND S 58"40'00" W + TOO,29• IS NOT TO BE-..CONSIDERED A PROPERTY LINE SURVEY. 100--100-------------9�9:8-4-- ---a-00----------------- +r;100,38 V ' 100.44 ° ❑HW PROPOSED SEPTIC SYSTEM UPGRADE PLAN 99.14 99,12 catchbasin 99,14 edge of pavement 99.74° 427 NOTTINGHAM DRIVE, CENTERVILLE, MA 99.07 Prepared for: D. A 'Brown, Inc., P.O. Box 145, Centerville,., SOWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. r NO TTINGHAM DRI VE } ?+' rJOBRIEN,'KELLY EngineeringWor 1"=20' P.T.M. 271-=12 %FITZGERALD ROBERT T & CLAIRE ks Inc. 11 ELMFIELD ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. r FRAMINGHAM, MA 01701 (508) 477-5313 12/6/12 P.T.M. 1 Of 2 t NOTE: TO P;ElIrKIT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:99.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. 3 5" DIA.OUTLETS SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND I 15.5" 1 16 �2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT EXISTING 102.4t 101.8t 102:0f ` • v : .- f 1 12„ 15.5" u L 29' L = $' � 2" LAYER OF 1/8" TO 1/2"OS=1% (MIN.) ® S=1% (MIN.) ', DOUBLE WASHED STONE4'SCH40 PVC 4SCH40 PVC (OR APPROVED FILTER FABRIC) 6" 10"I 96 as u '4° s eaa�aea H—10 LOADING ? EXISTING 48" LIQUID �INV.=99.68± aaaeaaa LEVEL IV. 4' 5.2' 4' D—BOX GAS �� INV.=99.27 INV.=99.10 PROPOSED D-BOX EFFECTIVE WIDTH 13.2' EXISTING SEPTIC TANK INV.=99.00 H-tORATED N.T.S. 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN TOP CONC. ELEV.=99.7f BREAKOUT ELEV.=99.5 INV. ELEV.=99.00 Baas NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO eases aaaaa ®®®® 0 GRADE ON A MECHANICALLY COMPACTED SIX Baas aaaaa INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=97.00 ®®®®®® ® ®®®® 37" 310 CMR 15.221(2). 4' MIN. OF NATURALLY 3' 2 X 8.;5'=17.0' 3' 2) INSTALL INLET & OUTLET TEES AS REQUIRED. OCCURING PERVIOUS MATERIAL EFFECTIVE LENGTH = 23.0' N z ®�® 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5'(MIN.) ABOVE G.W. — AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. BOTTOM OF TP, EL.=92.0 SHALL BE 36". EST. DEPTH TO G:W.=22' BELOW GRADE 102" " SEPTIC SYSTEM PROFILE (BARNSTABLE G.I.S. DATA) N.T.S. }}4 4" KNOCKOUT DESIGN CRITERIA SOIL LOG 20" DIA. COVER NUMBER OF BEDROOMS:, 3 BEDROOMS DATE: NOVEMBER 13, 2012 (REF. P#13789) 4" KNOCKOUT. / 4" KNOCKOUT 62' SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) 0 WITNESS: DONALD DESMARAIS R.S. DESIGN PERCOLATION RATE: <2 MIN/IN HEALTH AGENT DAILY FLOW: 330 GPD Elev. TP- 1. Depth .Elev. TP-2 Depth 4" KNOCKOUT 102.0 0" 102.0 0" DESIGN FLOW: 330 GPD A 1 A SANDY LOAM SANDY LOAM GARBAGE GRINDER: NO '10YR 4/2 $' 1OYR 4/2 101.3 8" . 101.3 8" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY B B 500 GALLON CAPACITY, H-10 LOADING SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 99.5 10YR 5/8 3099 3 10YR 5/8 32 CHAMBERS .74 GPD/SF C1 C1 N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIEs PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND +r• M-C SAND SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. 2.5Y 6/4 2.5Y 6/4 427 NOTTINGHAM DRIVE, CENTERVILLE, MA • BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 TOTAL AREA:............................................. 44 8.4 S.F. 92':0 ` - Engineering by: SCALE DRAWN JOB NO. 1`20" 920 120„ Engineering Works, Inc N.T.S. PTM 271 No cRouNDwaTER , 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(448.4 SF) = 331 :8 GPD PERC RATE: <2 MIN./IN.(11/13/79 RECORD) (508) 477-5313 12/6/12 P.T.M. 2 of 2 /-0 T• S 77 10'5 IStG => L - •''7 i 1 L- Er ��•• J �x Cl { a s -DIS7` bx •• � � � *r �A Y� r� a ty F �, '{, •^2 �� '«#R i`. SF.. .li yp.y f,.rr \ ` •v •- y.. '"' -t, • , ax. /. S'.{ .:x• ' : '•� _ . Y S i'0. d x. 7' �!✓ ./ - /((1.�:rJul G/J'{ft� *.'. , `' J.� s Ck�;}�',�irf, �t'f. w .. :i <fs r ,• `a' �J•«t,(Jw'��9. ,.$. . •/ `y Q•' "� ..f. 4l r'♦'.I V y.n }} TIT' s' .l ({//�`.ry.. V V• ^V F 2 Y- p h+-�' fz ia..t- � L: s ..y r` .r' a♦• 'iu .d(a ,',t }Y �' r } i .-},r x .z'"• �}� r, 3' 7` •M� �. _.,t}�i A.e 4-F- p.1- -O<., �" Ai';,, �jj d l�'�♦- .�- "'t Y �yc. .7't.•�.. f.r: t .?� •�F .Ro •F• ,1.I- �. 1 �. - �.,+. h • «r _ dF"i. : - h .•h.. }ST . t / 67,--43 i ii Q � 2 s hT . :K,<, ,/ ,) .� s`'#.;Pr.� -�-.x� •Y e .,�.s .�. `- � p i •.-� 't: -.<'; t.'SS. a .-,�: ��, yq IA.. .�, � 4 t_f h f , J .Y.k. /4 •��• k M^. y1 — - f. • , - �_ .r ,;�, �-�y .tom. �� ,;� �.r `� +r-•ya J'.:,.�+ ^«�c .•r•�,f rr~•;r•+Y x'�`t . c,.. .i-:C.r rn „fib" .. s!.•. .E, ?.�h:p.. ..�'.,�. x •:I-'� � y' .a�a�.� ^�/ ;4. - e.n F+'ytit`:. 6 - f'". ..,. '#"� °� , A' V/r'Y.' . 4. •yk m,A a,.y. Y •y. 4..�:,�� JI' �✓+�•' ;*: w•.'... .Y: •.� r' .7. >r '> '1. �j�� y ':g wa!r:XV :�y� YY...��` U{//�'.� Lw�- /, r ` s �. y,£",t.� .� �:{p r.a (1 — ,s:.t P'. (�' _� ✓ .., r.-x t,h � �� 1 `� �. ��V r �ti��LA � -; t , - nk s - Y+/ 1-ta`• T'qn v `. '� _ _tom a. ,i.'v,- #S •.. r A -A. •5` �} - _. _ .J �`' s. Mr .�,- - +• ..� +F.. ,j' ,,,� `'k�s � x ;�.d. "a "` 'S. ns : s .r . . {. t'- k qs• - F.�'X' Y ., µ*. �' }'t .�vt'"3i+''x°' .. •..s'• �•+. _ &'' :-,.. s t - 0 %$7`tt py+'+,R_ 'i' -,r• .. S ,� s •«. °'f,.s•�• 1.,s Q7 .v _ • • 'r'i Jeo .. 4�'/�(' �y !/ � O'~ ••!. 4, d R s.« 'A T jr�•.' y_Y mil! (/�/ / P/? � .. `• _ < � "•IG tI'�/� �`b'^�� j • � - � � � ,�.1 J irr WW1/ �) �/ I�c�E ~- r y •.. v _ [�,/ -yam _ f. ��3�T"i.�;� ' -�1../R•� /V♦.��_•�`�� /'!�� i r ,. � • 's.,� ,}�� y�T�fy�w w� - rrvY�-x A /• - �O.',LL...// `.YT-/f'Y..(}.- ��G.� �Vim+. ' _ . y d - - 'i+E-('r_— k , -.. .. .•,.. J`• , _ �) T`o LV 7` 43 , x /"S?DEC o� -.. . M /n/// !U /"/ r3L' � l jNG SE7 BRr'K. 2EOU/ 2`E/-IENT,S x, p .• � f� : , O.N T zQ s °zv ;lC� /D VE !-✓ 3Y NC> ' TO Z3E �'UC TED 8 EZ520`O%`'I.S' .' 3 4 VE P S E l✓ �,G E DE Sis'N -r�,4-O k/ F4 . 200 S 7-E /"I, Co yST1E'`ue r/`OAv t< COtiFbY - RV/ ON A/-r,/f? � C'o D y Df� TE .7> _ TULy!` / /9.17 R/�JD T0k11V O� R'ES'C%LTS''4 M/ti// "q relVs7 � a.r. L?Z; •�,kl�'77iof� , _ .. � /� R�0/SHED `c ToP of 4 T" P � tZ L pR o. FI: LE > . t. FOUNDF?T /y. -/ .r: y G�C?pf�DE f3 VE FA f/ Mf�NH'04 E 00VF_ ,e to Ex7�'n/ZD i'o w x N' { R.€VE/,/�- �l M/NU/''I 1 in/ITI�1N l OF F/iV/SHED GFD hQ /NF/LT�F�T,N(� ` /''IUM fS ONE' :STD- 14' 24"�,OVE2'S D I ST.. �. CO vE,e w(9S NE D s7-0 y .* A�L 4 7(J rr.Mlia/' �[. Z^•,y'in./ -'¢ .,D/A, WATEFE'. '/ `„ rC. } ,^ ' y �' .^•; P-7 U/y �'J.�"CII FLQt� ^L/nNE .+'7%J ��T..D �4"/F-00T �� M/nl. j7'Cl-f. _x / M/(V j �� FOf3T` �' ;,r�aR Z-L O/V Q.l✓HSH E J` • < o - r I /n!I/Ee'T . ` L EF :�_M• sTo.v /n/vE(2T cA nAC /7-Y r� " . , .� - ,9,eouND rs N k/Ar�,eT/G NT,, /N V eT /A/vE _ C , 2 O` M/'N/.tiI U/`!/ � '..c I i yc : . >4 J/ [�i20UN,Z) . l\/AT (2 V. Pk 07 L Cj C F� T / :O t=: ^1T/ -� C.�// � / yr�%�?ems )- y y„ S C /� lam. E /. . - , 0 D,,: (',C� �C:.Y ! i _�P f � "ill b :IM •� //�/C•E .(J E O T_ L"..� :J' �"7�j •�7 l"1 Q c'�/ as—Do - c�i + r �k.,,k# � j A t Yt ,�:• �, -w`�s?• +� .. • ,d,�.� O,�J •� ?�� r 1 '�/ ' E.'C o ;2 , • r` Jr-'Tiq B l E. �'O r U �TY �'�„� /$T(�' y 'O r= D � E D.S _ ..� : , x •z:. ,' -• � TJL '-✓ !3:C,0 2;52 :P, � ,� • " - .. `. �, ,a�,:t�aS�PST/,C �T A ram'�C��.'7`-.v ..8E -/•-�, `. 'r�I i it/.- ; T "7-1 / 7'.S i 4j y R - Y�7 '/ �- /�� 5.. , � C•%//tip :,`1'/ - TO _ `' �• ,>2 7- / y. I` /f/'7 -, 7--,-4 t 7 n7n A/,C)'4 T7c'��l 4 L / AJ�:S R, 7� ��`" 7>7 /0 7-�J A/*" 5h O T'f l /,S 7�L f7 5 "k 5 T om' t f A; . 7 o' F,, ?44/`?• (F O cJ A/=D fi 7T/ JA 7fl'.c Q ' O U/`/ 7� fS . Sf I"O �✓N f-1b�EO.ti./. ,9 N Z) 7 C' "7"O 7--HE Ll/ D / ^�G SE 7' 73 �. C,� ,�E ,fG,� / ' *F `srf /i�` 2J LET E $,4 F1 2 Z) :O F. f/ E.�J L•7`N : D F�7'E XeE G . L .7