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HomeMy WebLinkAbout0185 OAK STREET (CENT./W.BARN) - Health (2) 185 Oak Street Centerville A = 173 014002 C y� b r *Effefio 1521/3 ORA 1001. P2 • l-73- oly-ooa, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 185 Oak Street„ West Barnstable,'MA 02668 Property Address James P &Sarah R O'Reilly r Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection Ij Inspection results must be submitted on this form. Inspection forms may not be altered in any a way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 451 on the computer, REID C. ELLIS use only the tab key to move your Name of Inspector cursor-do not ELLIS BROTHERS CONSTRUCTION use the return Company Name key. 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code 508-362-6237 S121891 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address I listed above; the information reported below is tale, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintlance of on-site sewage disposal systems. After conducting this inspection I have determined that the stem: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspedorrs 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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 syst6nj will perform in the future under the same or different conditions of use. t5insp.doc.rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: //,X ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upoi i completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not deter ined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or xfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced w th a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if i t is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less t ian 20 years old is available. ❑ Y ❑ N ❑ ND(Explai i below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts j� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w< � 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): El Pump Chamber pumps/alarms not opera onal. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 3 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 repl ced ❑ 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 appro jal of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Boo rd of Health: ❑ Conditions exist which require further ev luation by the Board of Health in order to determine if the system is failing to protect public hea th, safety or the environment. a. System will pass unless Board of F ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun tioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of z bordering vegetated wetland or a salt marsh b. 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 abs rption 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 an J the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS an J the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an J the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failui e criteria are triggered. A copy of the analysis must be attached to this form. c_ Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P & Sarah R O'Reilly Owner Owner's Name information is Centerville MA 02632 09/06/2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 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 ❑ 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 water supply 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 2000 gpd- 10,000 gpd. ❑ 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 th/e ilure. 5) Large Systems: To be considered a larg' 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 CA. Yes , No ❑ ❑ the system is within 4 0 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 n a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a m pped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form f;1n Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ., -.r 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for a//inspections: Yes No ❑ Pumping information was provided b the owner, occupant, or Board of Health Y P ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? .V ❑ Were all system components, limcluding 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. El 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): �J DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: I . A? "AlI Goa/ Number of current residents: Does residence have a garbage grinder? ❑ Yes Does residence have a water treatment unit? ❑ Yes ;/Noo If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes information in this report.) Laundry system inspected? ❑ Yes V7No Seasonal use? ❑ Yes Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Da e t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: XV® 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 syste ? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): .� d5 3. Pumpin ecords: ' Source of information: , Was system pumped as part of the inspection? ❑ Yes ['Y/No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type o ystem: 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): roximate gme of all components, to installed (if known)and source of information: � / a - ff Were sewage odors detected when arriving at the site? ❑ Yes L"J No 5. Building Sewer(locate on site plan): -� - Depth below grade: feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4WV d, 02i_�41 04 12�/Je t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 185 Oak Street;, West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owners Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Ma rial of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tan is me Ist ge: ;year Is age c Ir a Certificate of Compliance? (attach a copycertificat. ❑ No Dimensions: Sludge depth: 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 baffle14—A 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.): 10 /4� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 u Property Address James P &Sarah R O'Reilly Owner Owner's Name information is Centerville MA 02632 09/06/2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): /1 4 Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of oi tlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, ir let and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumpE d at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts :. ,p Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) ® " s Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float s tches, etc.): x Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)) (locate o ite plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of s (j carryover, a evidence of leakage into or out of box, etc.): t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ,to Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .. � 185 Oak Street„ West Barnstable, MA 02668 Property Address James P & Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan).- Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, c)ndition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, rtern is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: !1. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length- leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): e 4�j 12. Cesspools (cesspool must be pumped aspart of inspection) (loca�eon 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts (o Title 5 official Inspection Form i� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information cont. Y (cont.) 13. Privy(locate on site plan): �7 f Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I1. Subsurface Sewage Disposal System Form-Not for Voluntary � ry Assessments 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name required for is every Centerville required for eve MA 02632 09/06/2019 page. Cityfrown State Zip Code Date of inspection D. System Information (coot.) 14. 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 ilding. Check one of the boxes below: W hand-sketch in the area below r �, ❑ drawing attached separately 0 e,A L. d G 67 �. 6 :3 ,, ► ��. W 7 r� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Sri 185 Oak Street„ West Barnstable, MA 02668 Property Address James P & Sarah R O'Reilly Owner Owner's Name information is Centerville MA 02632 09/06/2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: E�Check Slope �G Surface water ` [f Check cellar T�L �R� -7, L'J Shallow wells X11,4 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: 41 You must de§cribe how you established the high ground water elevation: v5z- �/�� �?• q ,ram',O7`ye S Z W Z 5_ 4✓+7c<� 4f?71 ! d V � 61, Z' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments c., 185 Oak Street„ West Barnstable, MA 02668 Property Address James P &Sarah R O'Reilly Owner Owner's Name information is required for every Centerville MA 02632 09/06/2019 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 7. Inspector Information: Complete all fields in this section. Certification: Signed &Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate (Failure Criteria)and 6(Checklist)completed D. System Information: For 8: TightlHolding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 l� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °r 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29, 2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your Ilk I cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental YQ Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority t'04 t- �n4' March 29, 2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP .The-original should be sent to the system owner and copies sent to the buyer, if applicable, and`the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection doer 4rot address ho.,wthersystem will perform In the future under the same or different conditions of use. ; , f I � ✓ I Vv t5ins•11110 Title 5 Official Inspecdon Form:Subsurf age Disposal System•Page 1 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street Property Address , Matthew P. Geminiani Owner Owners Name information is required for every Centerville MA 02632 March 29, 2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5.The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29, 2012 page. Cityrrown 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•11110 Title 6 Offidaf Inspection forth:Subsurface Sewage Disposal System•Page 3 of 17 GomrrionwealtFi of Massachusetts ,r Tile 5 Official Inspection Form Subsurface.Sewage Disposal System Form-Not for Voluntary.Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner O%vner's Name information is required for every Centerville MA 02632 March 29, 2012 . page. Cityrrown State'. Zip Code Date of Inspection B.. Certification (corit.) 2. System.will-fall unless the Board of'Health (and Public Water'Supplier, if any) determines thatthesystem 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 aprivate water supplyweli. ❑ 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 wateranalysis; performed at a DEP certified laboratory, for fecal coliform bacteria indicates;absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered_. A copy.of the analysis must be attached to this form. 3: Other: D) System Failure;Criteria Applicable to All Systems You must indicate "Yes" or"No"to each of the following for all.inspections:. Yes No ❑ Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the-surface.6f"the ground or surface waters. due to an overloaded or clogged SAS or cesspool ElStatic,liquid level in the.distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less. than'h day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts MW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29,2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone I I 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 or 17 Commonwealth of Massachusetts -- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29, 2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees material of construction P � , dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 gpd t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts - - Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is Centerville MA 02632 March 29, required for every 2012 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes M 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))); 4$6 gpd Detail: 2010 -355,000 gallons, 2011 -O,gallons Sump pump? ❑ Yes M No Last date of occupancy: never Date Commercial/industrial Flow:Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203); Galloris per day(9pd) Basis of design flow(seats/persons/sq.ft.; etc..): ,Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins:^11110 TitleSwicial Inspection Form:Subsurface Sewage Disposal.System Page 7 of 17 . Commonwealth ofMassachosetts - _ Title 5 Official Inspection Form Subsurface Sewage DisposaLSystem Form -Not for Voluntary Assessments M., 185 Oak Street Property Address Matthew P.Geminiani Owner Owner's Name information:is required for every, Centerville MA 02632 March 29, 2012: - page. cltyrrown 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: .agent 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: z Septic tank; distribution box, soil absorption system El Single cesspool 11 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 corWact.(to be obtainediftom 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•11110 Title.$0t.idal Inspect ion: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 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29, 2012 page. CityTTown state- Zip Code. Date of Inspection D. System. Information (cont.) Approximate age of all components, date installed (if known)and source of information: Age 7+ years. Certificate of Compliance issued 1/18/2005.,(permit#200.4-355). Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2 feet. Material of construction: ❑ cast iron ❑X 40r PVC ❑ other(explain): Distance from private water supply well.or suction line: feet Comments (on condition of joints, venting, evidence of leakage,.etc.): Sewer line:appears structurally,sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): Depth below grade: feet feet i Material of construction` 0 concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank;is metal, list age: years Is ageconfirmed.by a Certificate of Compliance? (attach a copy of.certificate) El Yes ❑ No Dimensions: 10.5 x 5 x 6- 1,500 gallon tank Sludge depth: 0 in. 15ins•11110 Title 5 otGciei Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Gommonwealth of Massachusetts t Title 5 official Inspection Form _ — Subsurface Sewage Disposal System Form =Not for V,oluntary Assessments 1`85 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for Centerville MA 02632 March 29, 2012 ' page. City/Town State Zip Code bate of Inspection D. System Information (cont;) Septic Tank:(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34 in Scum thickness 0 in Distance from top of-scum to top of outlet tee or baffle 10 in Distance from bottom of`.scum to bottom,of outlet tee or baffle 14 in How were dimensions determined? Design plan.. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related tooutlet invert, evidence of leakage, etc.:): Pumping not required.at this time, but.maintenance pumping is recommended within and every 2 years. Tank and tees appear structurally sound.and'functioning as intended. No evidence of leakage in or out was observed. Liquid level atoutlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction. ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ Other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins+11r10 Title 50fficial Inspection Form:Subsurface Sewage.DisposalSystem•Page 10 of 17 Commonwealth of Massachusetts _u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 185 Oak Street. Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA. 02632 March 29, 2012 page. Cityfrown State Zip-Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle,condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and'float switches, etc.): "Attach copy of-current:pumping.contract(required). Is copy attached? ❑ Yes ❑ No 15ins•:11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11-of 17 Commonwealth of Massachusetts " - _ Jite-1 5 Official Inspection Form Subsurface Sewage Disposal System Form-:Not for Voluntary Assessments 185.Oak,Street Property Address Matthew P. Geminiani Owner Owner"s.Name information is required for every Centerville MA 02632 Marc 29,2012 page. Oitylrown 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 at outlet inverts. Comments(note if box is:level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.)` D-Box appears structurally sound and functioning as intended. No evidence of leakage in or out was observed..No solids in sump. Pump Chamber(locate on.site plan): Pumps in working order: ❑ Yes ❑ No Alarms:in working order: ❑ Yes ❑ No Comments(note condition of pump chafnber, condition of pumps and appurtenances, etc:): Soil Absorption System (SAS)(locate on Site plan, excavation,not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 12 of 17 Commonwealth of Massachusetts -- j Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Notfor'Voluntary Assessments 185 Oak Street Property Address Matthew P. Geminiani Owner Owner's Name information is required for every Centerville MA 02632 March 29, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number:. ❑ leaching chambers number ❑ leaching:galleries number: ❑ leaching'trenches numberi length: ❑X leaching fields number, dimensions: 1 -40 ft x 16 ft ❑ 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.): Soils above leaching field appear unsaturated. No evidence of surface ponding, breakout, lush .vegetation, or other evidence of hydraulic failure was observed.An observation hole was-dug into leaching field stone and no standing effluent or effluent contact staining was observed in the stone or overlying soils. 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 15ins'-11110, 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 v y` 185 Oak Street Property,Address Matthew P. Geminiani Owner Owner's Name information is required for every CentervilleMA 02632 March 29, 2012 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs:of hydraulic failure, level of ponding, condition of vegetation, etc ): Privy (locate on site-plan): Materials of construction: �I Dimensions` Depth of solids .Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.), i5ins-11110 Title 5 official Inspection Form:Subsudace.Selvage Disposal System•Page 14 of 17 Commonweattfi._6VMassachusetts _ Tftlb 5 fO fficial Inspection Form, Subsurface Sewage Disposal System Form-Not for WILintary.Assessments 185 Oak Street Property Address Matthew.P. Gerrtiniani Owner Ownees,Name information is required for every Centerville MA 02632 March 29, 2012. page. Cltylrown State Zip Code Date of Inspection D. System Information (cunt.) 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 El drawing attached separately t1S `U t � T��tJr p � ! 2 �.� F1 156is S1Llo Thlo 5 Ofrical Inspection Form:Subsudaco Sewage Disposal'Syslem.Papa 15 of 17 C rnonwealth<o.f Massachusetts Title 5 Official I:nspectior Form. — Subsurface-Sewage Disposal System Form.-Not for Voluntary Assessments «„ 185 Oak Street Pioperty Address Matthew P.'Geminiani Owner Owner's Name information i e required for every Centerville MA 02632 March 29, 2012 page. Cityrrown State Zip Code bate of Inspection D. System Information (cont.) Site Exam: ❑ Check;Slope ❑ Surface water, ❑ Check cellar ❑ Shallow wells Estimated depth to;high ground water: 5 feet Please indicate all methods used to determine the high ground water elevation: X❑ Obtained from system design plans on record if checked, date of design plan.reviewed: 7/20/04 Date ❑ Observed site (abutting pro.per.ty/observati..on 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: Approved design plan on file with the Board of Health shows bottom of system to be 5 feet above the adjusted high groundwater table. Before filing this Inspection-Report,,please see Report Completeness Checklist on next page. t5ins-11/10 Title 5'-0fficiall 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 « — 185 Oak Street Property Address Matthew R Geminian Owner Owner's Name information is required for every Centerville MA 02632 March 29., 2012 page. City/Town State Zip Code Date.of_Inspection E. Report Completeness Checklist XZ 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 15ins- 11110 Tille 5.Official inspe0on.Form:Subsurface Sewage Disposal Sysfem•Page 17 of 17 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mtopooar *pztem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �g S—0 XLs #l Owner's Name,Address and Tel.No. o A 4 y a S — Assessor's Map/Parcel A �t (,(1 rEM /V l fJ-�✓> 6-7$-'70 /-7 3 1 `f 0 0,;L A)° y9llleg o M M R. Installer's Name,Address,and Tel.No. Designer's Nam Address d Tel.N D C,�G (CO G s.•t� .�N JL one r'. o Jf• r Type of Building: Dwelling No.of Bedrooms _ Lot Size 3 sq.ft. Garbage Grinder( ) Other Type of Building f? No.of Persons Showers O Cafeteria( } ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title A A Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensu the constru enance f the a re described on-site sewage disposal system in accordance with the provisi ronmen a ce the system in operation until a Certifi- cate of Compliance has been issue by this oar f Signe t a Date Application Approved by I / , Date �? Application Disapproved for the following reason Permit No. r Date Issued 404^.No: �> Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS I 2pprication for Oigaar 6 15tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./a S_ v A-s y^r � Owner's Name,Address and Tel.No. I 47TA 6 w BEM� tii fi�i gas -78 Assessor's Map/Parcel /-7� �I c[ Q� r� �6,_b�G_ �l✓b N 19 /,- �d�.�� Installer's Name,Address,and Tel.No. T pi,. Designer's Address and Tel No. '7„ . 0 o�. Iry eu��t Type of Building: �` 1 Dwelling No.of Bedrooms Lot Size 15 3'�'4?g sq.ft. Garbage Grinder( � ) Other Type of Building No.of Persons Showers Cafeteria( ) Other Fixtures Design Flow q�V gallons per day. Calculated daily flow gallons. LN Plan Date Number of sheets Revision Date Title �. Size of Septic Tank Z pe of S.A.S. ' �v. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ✓ Agreement: _ --- The undersigned agrees to ensZ��theconstru and-main enance f the a re described on-site sewa a dis osal s stem g gg P Yin accordance with the provis' s�e-A* e--of ..nviionmenta17Code an -to- ace the system in operation until a Certifi- cate of Compliance has been issued�by this Boar 2of alth. Signe 1`. j. t/" a /1 Date Application Approved by e W. 114_01g � Date Application Disapproved for the following reason ✓ v v Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by -�_ �.��� "��✓� at U k S U n4 y,Lit has beets constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nam, "� dated Installer Designer The issuance of this pe t shall not be construed as a guarantee tha�e syst ''w'hfu ction as designed. s Date ✓/Z� a$5 ° Insp btor t 7 ��_No. —--- -----------------------Zee _ �-J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mizpogal *pgtem Congtruction Permit O Permission is hereby granted to Constructtk ) epair,��54 Upgrade( ). ban .on( ) / /_' System located at /X�7 ��( %'C a C_t' A ;ZA VV IU,C._- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction lust be ompleted within three years of the date of this e . it! i Date:_. Approved by / TOWN OF BARNSTABLE \, LOCATION 165 OA-V- 6 65E17 SEWAGE # 2t e 35S VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. C.C•CSTLUC.TI©►J I ( �' �1 SEPTIC TANK CAPACITY J 4 w LEACHING FACILITY: (type) t' 54 (size) �I � 14P I X( � NO.OF BEDROOMS BUILDER"' OWNER 141'f PERMIT DATE;�`I1j / �,00� COMPLIANCE DATE: Separation-Distance Between.the: ,,.?,-,:-,-- Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and;Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 i OAV- ST-, I QAOA4C ^ I -p Q Ge Z,j' +�� 43' cl" D Z�� E to' 4- i "I q T � H � TOWN OF BARNUABLE - LOCATION 05 OA-V 61-4901- SEWAGE # 4(1Y - 3S� VILLAGE �s.�, ASSESSOR'S MAP & LOT IN /2— INSTALLER'S NAME&,PHONE NO. SEPTIC TANK CAPACITY 150 LEACHING FACELrTY:-(type) " EN -� —(size)- NO.OF BEDROOMS ee B UII,DE)f C)k'OwlvEif 1' '� ! Yaw 'PERMUIKA5 ,/ �tL: COMPLIANCE.DATE: Separation Djstance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by •.' _ 01.1 011 e ' tl 1). it Al e( r1 1l •1 is !0 �� '� e� to OA LA -0 G 1n $ -�+ ,p► CAI ttt; a _ t 04/25/2005 13:43 5084205553 YANKEE SURVEY PAGE 01 Feb 11 05 11 :05A CC Construction 508 ' 896 8130 p. 2 1•,Orr[ dHJ<MIPELE BOARD OF HEALTH No,580 F.1/1 I 4 Town of Barnstable ' Regulatory Services. Thomas F.(Wier,Director' Fabric Health DMIion nomm Me tow,Dinemr 2001Kda S&sd,RpmWe,MA OZ601 Oftr 50&162.404 Ftve 90$-�90-6304 Lhta�ller Dgaiaaler Ccrtitica�oltBotm Date: 1 U C7 DeBiper: 0Iv l �G Addrme: (2D &_)-j ^S4,5 — A"reoo: ��C.` i was imed a pmmmit to WWI.a date , msWlex septic"am at L^ � � based on a dew drawn by- � O I I calif►tbat,the eeoc'system teferenced above sae bvWled substantially ac to the dwip, which may isolate for eppzmt d obanges ouch as lateral reloo tm 0 the i du11dIti ioq box and/or evir.auk. I cam$that the aeptia eystem reftenced above was ias%W with=ajar charges (Le. greater ts�]0'laEexs!reloce�ae:cf the SAS a any veatacd ialooattoJa of aeyco�peeaenc f the septic system) accaJ 4W16e with State&Looal�, Plan roviaian ar trifled as built by ge to AoW. cF .�� . ;,� NZ Z'� ►,�;; ./.. r3r�i,1!"E.ALL �,�\LC v M1;RPHY °a gtgaahLLe J No,749 1 I7 AA (DwipWx Sip ( Ded&es tamp toe) . WON C C8r B1 Q:Aald�l8e�ltd[1as�ge+s Cead6adl�l+am . � C7 O N m O it F S t„7 . � z IFMI S� EH 000 n m N z a e� z n z Cl) c W LOT 185 OAK STREET Q °' NEW RESIDENCE AT CENTERVILLE, MA. O GENERAL NOTES (see also Project Specifications): e. Existing surfaces disturbed during the course of the work shag be mca¢+tmoted and ABBREVIATIONS SYMBOLS SCHEDULE OF DRAWINGS O finished to match adjoining surfaces. Patched areas shall be finished In much a memer as to provide visual and structural eantinulty across the entire affected surface. Ate Amex DOLT AT am � T-1 TITLE SHEET Arr. AecTT rsrnD noon LAo Im DOLT 8 so=ARWO' A-1 ELEVATIONS 1.The G¢eral Conditions state that the Contract Documents are compUcamtary. g. All volds created or surfaces disturbed resulting from cuttint, removal or Installation d ACT AooOrrcAL Was; ••T. LAIAT �\ dements as part of the Work shall be(Wad and finished to match adjoining construction. i o AAPOOCCED�w . LAT. uvATaar A-2 ELEVATIONS 2. Provide the services of a Massachusetts Registered Surveyor to layout Structure on site • a ins 11"MAACTmmt Bernoe INDBUTOD-LATTIS s TOP and establish existing elevations. Elevation of finished floor shell be established by 10.Except as provided in the Documents,no structural member or dement shag be out Derr ueamrr ILO. rANOW apses DLr a miss.Team Tie A-3 FIRST FLOOR PLAN Z ANDL CY aeCTW" lie ILAL \ Architect with elevation information provided by Surveyor. without written approval of the Architect. .The General Contractor shall cecrdlnale DLL sn SLOCK 0Y0 rAT• WA�'AA .-e AND TIS Dr TBe Dotter rAv A-4 SECOND FLOOR PLAN & cutting end shell advise the Architect of any potential Conflicts with new or existing .am SL mW CK. �'ul p1¢"a"°"6°mO'"'' ATTIC FLOOR PLAN 3.The General Contractor it responsible for ail the work. am Borrow sot rOeWnr .AWs SEW am nwam A. Build and Install parts of the Work level, plumb, square and in correct position. structure. as.T. Boner a TALL mW. room O ECTUND A-5 FOUNDATION PLAN B.Make ts tight and neat. If such ts impossible, dings,sealant or other !l. Demolition wort shall only be carried out once DLL temporary Who and brawl ts 1¢ SchemeN- AaB LeM use a VON=� FIRST FLOOR FRAMING PLAN W � loin imPoms mPPV mot DO shoring nil am a�mro sere AL Joint treatment me directed by Architect. place.Removal of all temporary supports shag be completed only after new work to secure ter CAAraT r+.C. rmT r CONTRACT A-6 SECOND FLOOR FRAMING PLAN & C. Voider potentlelly damp cendltlons,provide galvanic Insulation between different and complete. - a :se al CASCXW BIC ON cAL Put tma scas 101 w+rl r61eBR i� .stab which are not adjacent on the galwa de Pods l2.Ail materials,equipment and workmanship shall conform to the requirements of aloe - CL40 tir °Ten. °°yam 1 DOOR atiiesa ROOF FRAMING PLAN - d' F T D.Apply proteoLM finish to parts of the Work before Concealing them. For example, authorities having jurisdiction of the work. Ce. COLTaw Per'• PALRr O TOMOW type A—'r CROSS SECTIONS Gs7 � ewe paint door tops,bottoms,staging stops,Stasing rebates, and hardware cutouts before csee CM2211 flD PALR� hanging aeon and print corrodible mounting plat.. lesion Wtettt¢g Parts aver than. 13.All materials and equipment shall comply with the Occupational Safety and Health Act. Co sous reaaarc am ucrom ter• i�a �� WALL rim A-8 SCHEDULES E.Where soesewrio an required In order to install parts of the Work In usable form including all amendments. Owr.M. °0NT18OUS ;> Tour. corwvoua ti rue O 7 and to make the Work perform properly. provide such massaoriw. M special tools a Corramdooerra AW Pus. PusTS1 61'elmr It= ,vS', are required to metal" adjust and repair products, Provide team. 14.All materials and equipment shall conform to the requirements of authorities having CTat COV"molm P.wL PEASM LArmTas f, !. Follow manulecturers Instructions for assembling, installing and adjusting products. jurisdiction regnrdmg not using or installing asbestos or asbestos-containing materials. M. DIANOTER MAILPfY PLYWOOD PARTITION to W Do not Install products In a manner contrary to the manufacturers Inetructions 10.All l used on all products and assemblies shall Conform to A.N.S.L Z66.1, M. 00OiTi01� P.T. QVAM7 A PA ON pain P Ds sac Q.T. emmm ins GL7 GO Onto"authorised in writing by the Architect. Specifications for Paints and Coatings Accessible to Children to Minimize Dry film Toxicity. ON DotarAeueo Beph TSRUMED conform Own WALL z (she G.Adjust and operate all items of equipment, leaving them fully ready for use. Vona Dorm ®. Bvatsaaa lL The division of the Documents Into Architectural, Structural, Electrical, Machaalcal, 16.All of Substantial tia Comp]antees and service Work or f agreementsItbeing shell commence is !see OrD(sl aasew r gov. msweOae O+NC>AQLa-PIA.0a sRT10r [—A U date of SuDstantlat Completion of the Work or of the item b uasantsed, whichever le or °�G 10Ya� a sOe O .Plumbing and Civil compensate ts not intended as dlvtsion.of the Work by trade or P °�t a saCOCC(A so wow DaAs CO BRICK-PLANS et PLANS 00 otherwise. later,ec that the Owner may rocelw full use of the item for the guarantee or warranty sue sayff" I nit Seer ra period. a arsrrtroa tea. awoer oPrsem msoaTx woes rues e.ME. ` L Provide utility installations from lot line to house Including underground electrical. asv. TeETn°a Beer' sSCROXRZ arTmm ®�sc. PLYWOOD 1 water,telephone and CATV to comply with all loco]coda and requirements. lye GENERAL WORK TO BE PERyORMED A9 PART OP THE GENERAL CON8IRVCTION: Do NQUAL seer ar ' spv:WrA MO J. Concrete shall have compressive strength of 3000 pal• 26 days for wage and A Seat cracks and openings to make the exterior skin of the building tight to water and ow. Izzm a SIDWORT ® ate.LANCE SCALE M COD. all. mw MI ® Baum Uxm 3000 pet• stab work.and reinforcing rods k woven wire fabric(WWF) per drawings. air entry. r �Aasom Tarr uw Seat FAM When noted, provide hard steel trowel finish on slabs. � B. Provide adequate blocking..Draeleg,nailer*, lastertl¢gs and other-supports to Install in em'ee® a++. suss ® _ �=rpm . Oampproofing shag be factory manufactured mewl-meetic conetatency from asphalts parts of the work Securely. Blocking. bracing. milers,fasteninge and otber supports sl*• mssoW emP• scersamao and mineral'fibers,and(metalled on all wage and footings. shall be of a type not aubject to deterioration or weakening as the result of iA r�iLAM ten TOP�awRwn INSULATION-°� Pious for docks shall be concrete filled Sonotube forme. environmental conditions or rs.°' rm LITINcolD ter SID The° Toeomeamsm+vT ® asvtsrtmr-MTT . aging' R rIorneo sn�aTrnaT�avmam TA.I. TAP or raCenAnam C. Part*=cutting and patching for DLL trades. Patch hot" where ducts, conduit. pipes R rlulaBeetEert TA.W. TOP cur BALL ® TARrx 4.The General Contractor shall verify all dimensions at the site and shall notify the and other product pass through or are being removed from axi+ting eonetruetlon. 1Rtuae romm TT•rP TRW ® oWo•aa oerau, - Archlleet o! any discrepancies before proceeding with the Work or purchasing materials D. Provide chases. furred mpeaee, tenches, covers. pits, foundations and other rm. roam. arree. aewaemsc or.equipment.Verity critical dimensions In the field before fabricating items which must M. WOMATrOa T.I.T. VIRMY 4<Imo Bans.Wes me" fit adjoining constructiou. construction required In CagjuncLan with the Work. I!such construction in not rwa r4a mon) Tao vmn shown on the Drawings. Coordinate with Architect for Sizes and placement. o CAN ICY vWn compoempr Toe ramPQRT roe tie All details am typical unless otherwisnecessarilyencoordiaccessoALT. OALTAIRM Two nxn WALL OM MO otherwise noted and sera not necessarily shown In the B. Provide d coordinate access doom end panels as required for xcees !o equipment oc camax"""ACM cane L. DATE Oy/OI/Oa. . Documents at ail locations where they occur. requiring adjustment, inspection, maintenance or other access and an required for aeeem aL - eILSO/oe11M w ��R to spaces not otherwise accessible, such ex attics and crawl spaces. 01P.S OCSAm`rOw� ./ ems REVISIONS 0. The Architectural Documents govern the location of all Electrical and Mechanical items P. Check Drawings and manufacturers' literature for requirements [or bases, pads,and B/a WmKW Installed as a part of the work. wings soon sAACmc= W.wx. Wean T=eeBe other supporting structures. Provide such structures. Remove supporting structures am rAm.ow To Soon 7. Editing items which are not to be removed and are damaged or removed In the course asecclated with removed equipment end patch remaining eurfmcas. R`'AOA,Am coevorexrO _ of the Work shag be mpalred and replaced in like new condition without cost C. As part of one year warranty specified In the General C.mnditimns, repair cracks and RM rARDTAN other damage which occur as a result of settlement mad ahriakmee during the first year NOT RCMM rY.art. �unom WW DRAWINGS ARE DRAWN BY after Substantial Completion. was wromma JMT I6.All work shall do Conform to the applicable sections par of the Massachusetts State d to Chapter Ar Ao¢w REPRESENTATIONAL ONLY DRAWING N0. Code,Sixth EALLLoa you residential projects, particular attention shell be paid to Chapter 36 -One k Two Family DesWngs, especially Table 3006.2.3 7astenar Schedule for Structural W DO NOT mb.n'. SCALE T 1. DRAWINGS 25'-0' l0'-�" 24'-0" cv o 0 CD t- co A DIL 81ZE "B" H cn 0 BULKHEAD A7 A7 F 1 D' 14' - a ® z Ix4 MAH ANY DECKING © � z J z�j � PIDERGL O O 2 r o --� OI L�---- BREAKFAST l i i i j�� b o b D -a' r DW b I I I I m u z Q z O to �'-4" w cveN KITCHEN ~ x z x C/2 o c n BATH LLIINB 0 REP UP W ca .I A a _ b Q ON b u N. --- O � m I/2 WALL b - - - - b CL.n - _ ---------------- -- - n 1 _ " --- ----- e n Q I Q CL. 'p en tt' e•'o.w.e. ON K*LL9 a CLG. BEDRM. v 1 cL.O GREAT RM. HJ 1 1 1� ie W 6 o W O 2-4a '- aUP I I C F v Q W W ..7 BRICK STTOP �+ a' CO -ia ��- • p-ia T-ia T- a 4'-i" 2'-i" q'-O" "-O' �-0 W z w 24'-0" F U O - a FIRST FLOOR PLAN SCALE:1/4'=1'd DATE or/o+/oa REVISIONS DRAWN BY DRAWING NO. A3 b 11 "v ' L—KNEE WALL c� 0 44 � DN. ATTIC SPACE c UNFINISHED CENtMR ON co GABLE 0 O o Ln � F KNEE W LL O 0. O o v O 10 N 0 r z ATTIC FLOOR PLAN 0 " •2'-0* 10'-o" 10'-0' 91' « 1-0 O � O C F o W BATH 0 12'-0" ON. 1 72'X42" in - F iv I M. BATH JACUZZHli V) SHONE W rW.7 co G (IDCONBO BEDROOM #3 it LIN d a O xo�-E L 17 2'-l0" ON. 14 ® St✓D-!f-Ali-C), ME ROOM Z ~ W �b - g O U it M. BEDROOM m ^� chi _ 0GAs F 210 f O Y ------� ACCESS PANEL O BEDROOM s:2 in 3 1 i Q Q OF ^ o DATE 0710110a REVISIONS T� 24'-O" DRAWN BY DRAWING N0. SECOND FLOOR PLAN F , EL.= 62.5' CENTER VILLE TOP OF FOUNDATION OBSER VA TION HOLE 1 ELEV= 57. 4 20' MIN. PERCOLATION RATE �2 _ MINI INCH AT _4Z" INCHES 10' MIN. CONCRETE Co VERS „ DEPTH HORIZ TEXTURE COLOR OTT. OTHER y PEEP'' MIN. PITCH 118 PER FT 1/B" 1/�20F 0-3" 0 R A EL. = 61. 7' CONCRETE CO VER �YASHED STONE pD 3"-12" A LOAMY SAND IOYR 3-1 i , . 7 � iii � � � � � . / / 12"-30" B LOAMY SAND 10YR 5-4 OG a e" MAX EL 3D"84" C1 COMPACTED IOYR 6-4 ti y 4" CAST IRON PIPE ' ' FINE SAND o(OR EQUAL MINIMUM CLEAN SAND 9» PITCH 1/4 PER FT. MIN. PIPE PITCH 1/16"•PER FT.= 0.005 MIN WATER COUNT D AT ELEV.=50.4 ( 84 inches) FLOW LINE ' 84"-144 ' C2 MED. SAND NONE T�c� Y 110" EL 59. 75 INVERT MIN. 14" — 60 25ol ' INVERT LEVEL ° 0 (b o °o o ° 0 0 ° » 0 j 0 °0 0 °o 0 000 0 �qp GAS _ 59. 75' 6 SUM O ° p o O ° o o 0 ° vtt 0 t o o ° ° 0 ° ° ° o INVERT BAFFLE EL.---. INVERT INVERT, 0 0 00 0 0 0 1, o o°0 0 8 0 0 ° , 59.5 5_9.,25 ° =58.6 OBSERVATION HOLE 2 ELEV= 36.5 60. EL. __---- EL.= (To BE PLACED ON F7RM BASE) DISTRIBUTION INVERT, DEPTH ORIZ TEXTURE COLOR MO TT OTHER LOCUS MAP MECHANICALLY COMPACTED OR 6" OF S,' NE E( =59 25 6—3" 0 BOX 1500 __GALLONS � -- - 40'x 16 x 6" � � � 3"-12" A .LOAMY SAND lOYR 3-1 WALKOUT EL =55. 0' -- TO BE WATER TESTED FIELD FOR1�4 TION � � 12"—30" B LOAMY SAND IO YR 5—4 SEPTIC TANK IF MORE THAN ONE OUTLET , � » » PLACE ON 6 STONE » " 30 - 72 ClCOMPACTED 0 YR 6-4 314 TO 1-1/z SOIL ABSORPTION FINE SAND RU PROFILE OF DOUBLE WASHED STONE N REF 48s/58 SYSTEM (SAS ( )WATER EN OUNTERED AT ELEV.=50.5 z inches ZONING: RD-1 ZONE "C » , � FLOOD ZONE.• CSEWAGE DISPOSAL SYSTEM SDW-252 i72 -12o C2 MED SAND » » USGS PROBABLE WATEh TABLE EZEV-_53.6 � - � ---- I ASSESSORS MAP 173 ADJ. 3 2 O NOT TO SCALE OBSERVED WATER TABLE 8 3 00 ELEV. =__ 50. 4 SOIL TEST ! SOIL TEST DO BRUCE G. MURP.F�' R.S. NE BY M _ , DATE OF SOIL TEST . 8/'3/DO WITNESSED BY. ED BA R GENERAL NO TES P,�9532 1 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E. . ` TITLE 5 AND THE TOWN OF _E _'LSE._._-_ RULES AND Fil REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. °' '' CUL VERT 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO PE WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAT4BLE OF ! P� WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER 0) WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHA,L BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AJE'AS. 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE A�HALL '�`` \ BE MORTERED IN PLACE. 22 CULVERT 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE W1"H PIPE s it \ d 1 #2 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TC ,l \ APPROPRIATE A UTHORPY. '�` --_ _ \ \ OBTAIN SUCH DETERMINATION FROM _ _-_ -__DITCH _ - - -- • , I�G AS/LOT 14=-1 \ #3 6) IlT I�TIES SHOWN ARE APPROXIMATE ONLY, EXCA NATION C011 'RACTDR Yq,,, _ \ �/ , IS TD CALL DIG- SAFE_ AT 1-800-322-4844--AT_LEAST% HOURS 5 i tiN r3 - _ LUICE� - . PRIOR TO COMMENCING WORK ON SITE. ��z . �-, 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WALL AS � AS,�L©T .14- 2 � _ a ,�� � � i •} UPLAND AREA=71,859.E S.F. 'o 'S SITE CONDITIONS PRIOR TD COMMENCING WORK ON SITE. i TOTAL AREA=83, 798� 5.F. 8) PARCEL IS IN FLOOD ZONE-__B & _C �0_ MAP 114 AS PARCEL _1� \9 LOT IS SHOWN ON ASSESSORS \ � 11 --- *0 � W ExISTrNc 0 VERGRD WN / \ TO PATH' � C ` / CS ��\ ��, � BE MA1lNTAINED BOG \ \ O DESIGN CAL CULA TIONS: 46 NUMBER OF BEDROOMS . . . . . . . 4AL �' J ' \ / E MARK GARBAGE' DISPOSAL . . . . . . . . . NO / MEADOW �� \ - - \\ ` \ \\ y , ' TOF�bF STAKE O TOTAL ESTIMA TED FE0 W I _ - �, \ ELr.Jh. 0'(G.I.S.) o 110GALIBR./DAY x 4--- BR.) 440 GAL/DAY / 1�� sup 1.5' ��� \ _ #1 i'/ '' 1 O REQUIRED SEPTIC TANK CAPACITY 1500 GAL / �� o� S �o� o i \ ` ,�, ,\� ,;,' o 2� ,� 58 of cv SOIL CLASSIFICATION . . . . . . . . 1 1EA� , � 1oa �\ c�, ��St e 0 - , DESIGN PERCOLATION RATE . . . . . < 2 MIN. IN. 1Of . 74 j �` 0 0 4' cr v� EFFLUENT LOADING RATE . . . . GAL DAY Q •a a 0 / 2 LEACHING CAPACITY (AREA X RATE) 473 GAL/DAY Q4 o� % ��` #10 -'' RESERVE LEACHING CAPACITY . 473 GAL/DAY 04 �� �. w �` ; ��� ;� og s ,'' (40x16x. 74) � % �ET�NING �'o , � :�, � � � �\ �.�j � �, � �' � �g' W . 2 E� ,-'' SITE & ,�' .�' PLC.N\ / 'COD /",0000, Co,, PROJECT LOCH TION Y : ;h - '4S LOT 14—3 _ { � 185 OAK STREET CENTER VILLE, MA. 1 RI�Y APPLICANT• ,,yam- � � \ C}1 � • � � � � - - �t . A \� ' 4 ``' '' MA TTHEW GEMINIANI PAIA x mod, oo o DI MERinH� No, 32M \ AS/LOT 63 ---� YAWEE- SUR VE Y CONSUL TA N TS Q j 1 � o SURVE'�q P. O. BOX 265 AS/LOT 64 UNI T 51 403 INDUSTRY ROAD MARSTONS MILLS MA. 02648 , PH. (508)428-- 0055 -- FA X(508)420—555J OF SCA L E. 1 "=30 ' IDA TE: 2117/01 T. 0. W. EL=46.5' 1 1 REV. REV: POND NOTE. YANKEE SURVEY TO ST� E HOUSE AND. LEACHING LOCATIONS JOB NO. 52428 SHEE T 1 OF 2 i