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HomeMy WebLinkAbout0951 OLD STAGE ROAD - Health 951 OLD STAGE gD•,Civ�,,,.. --- -=� A=172-005 _J Rio. 42101/3 ORA (AR Q 0 ESSELTE 10% 0 0 0 0 MMORSWNo Z7,--7 NO. " PARCB._N.� FEE,1_4�a_-SMP �THE`COMM 11'rFAL-TH-OF MASSACHUSETTS MASSACHUSE- TS' ��}�li�ctt#tDn for. Pispoent *Uotem Cgoins#rur#ion Permit Application is hereby made for a Permit to Construct ( )or Repair( )an On-s:te Sewage nisposal System at: Location Address or Lot No. OT 6 Owner's Name.Address and Tel.No. jS/ OL;D Si-�G,E F���� ToSE��H t3�c�'/✓ Installer's Name;Address,and Tel.No. Designer's Name,A04 Type of Building: Dwelling No. of Bedrooms — Garbage Grinder( ) Other Type of Building _ No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �o gallons. Plan Date Nu er sheets Revision Dat Title /� HIV Om Description of Soil O G — = ��H S�iy�l a�/ — — F Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 is b this Board of Health. Signed Date I'M Application Approved b Date '" �"� Application Disapproved for the following reasons Permit No. '"° Date Issued `r'.�z �a No. 1�z-yam �� 00,�, / �i6✓ ` FEE _r �^ / THE•COMMQNIdEALTH OF MASSACHUSETTS ��(�3L� , MASSACHusETTS jNpplication` far pispoon( Sgs#ent Cnons#rur#ion Permit Application is hereby made for a Permit to Construct ( )or Repair( )an On-site Sewage nisposal System at: I.ocation Address or Lot No. OT Owner's Name.Address and Tel.No. Ic Installer's Name;Address,and Tel.No. Designer's Name;Ad;±•• //&/ref' r--V1�h; lK(: • ��14'GuT� i9 p o'�TY� . Type of Building: Dwelling No. of Bedrooms — Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria ( ) Other Fixtures Design Flow S gallons per day. Calculated daily flow3© gallons. Plan Date C/`/ylg� Number qf sheets Revision Dat Title 11I) 01 Pfz� S A t � S ee M Description of Soil 4 /O/�H ,�qHQ/ act !� I rSkit/ Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the-.aforedescribed 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 Booarrd' of Health.,� Signed \ " l�`' C -�-, — Date Application Approved by Date C_-D Application Disapproved for the following reasons Permit No. __ 'a�� Date Issued THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS fQer#ifirtt#e of flnmplinure THIS IS TO CERTIFY, that t e On-st Sewage_. ' posal System install° or repair° /re •ed ( ) on F ,ll/ f� r, by for- at jaeeen constructed in .accordance with the provi ons of Title 5 and the for Disposal System Construction Permit No. dated �1—' � Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as h signed. This Certificate expires on DATE //J /` Inspector �" �'� rt THE COMMONWEALTH OF MASSACHUSETTS No. �'' �� o . MASSACHUSETTS FEE .,¢ ���ispos�l ��s#em �olns#rur#ion �ermi# Permission is hereby granted to Av. I S �G' to construct ( )or re ,air( )an -site Sewage System located at 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. All constructions must be competed within three years of the date below. DATE �/ Approved by '�"' 12-1?-1995 12:0e0PM FROM YANKEE SURUEY TO PIZZUTI P.01 5Q�+a (D l "C IVJ f0 4: -- i, �n r 5 36.5' 16' PORCH 10 side and rear 20 front 0' 20' t 1 F show fence on plan c 1 , 4z , x 140' LOT ,74' pya5 �0 tj 0. CO6�Q�J 54' LOT , 5 pe rice NOC'61 , { U , , Ee,ti►aG-�+� 6 _ 10, (i 5 LOT,T i 1 , y 1� it RLS. ZOX 'fl?F" This MORTGAGE. INSPECTION Plan is For FLOOD ZONE.' "C" Bank Use Only ---------------- REGISTRY OWNER: C_0_ IT fi'E'41JY'Y_TRUST DEE:D REF: _J_Q'41,R1L� --____-- ...__BUYER: _LQBI50 _I2 --____-- _-- DATE. _12,ft7/P�S ----------- ----- nLA�`T REF:_4441872 C. ,_ -----;--- t I H:r P.EBY CERTIFY TO IVD_AMHIIER 7 ____________ _THAT THE BUILDING �w,OF 414. YAIVKEE SURVEY SI O;°TN ON THIS PLAri IS LOCATED ON TIDE GROUND S -SHOWN AND THAT ITS POSITION DOES _ CONH'GRM ���c ��L ��� CONSULT4NTS TO THE ZONING LAW SETBACK REQUIREMENTS OF Ti-IE � 0 6AE�1T1iEi�R �„ 40B INDUSTRY ROAD i 1'0 iV�2 OF _ _B_ARNS TAP,T_i—_—__ -------AM THAT No. MARSTONS MMIS, 1W 02648 . f:! IT DOES NOT L E WITHIN THE SPECIAL FLOOD HAZAI<D TEL: 428-0056 0 r AREA AS SHOT'NI ON THE H.U.D. i4_P DATED B,1�19�85 �FGfsTE� J I'AK q.20-5553 f _ nits-Pan 1 250001 0015C p��t f __ THIS PI AN NOT MADE FROM AN UIKF.NT ' 1 aUL MER 9. PL SUt?V£Y. LOT TO BE USED FOR FENCES. ETC. 200B8 lilRG TOTAL P.01 12-17-1996 12:OOPM FROM . YANKEE SURUEY TO PIZZUTI P.01 3 1 .o 63�� �' PiPo/�os PORCH o �` .......... DECK' o \ , LOT ,,6 �� ,'�•�p�y'I 1 'pp1b�4•' � j OT #5 °° V • ti / 1 , a Sy9 1 LOT /7 ot�) �1 - l . RLS, ZONE. 'RF" This MORTGAGE INSPECTION P1Rn is For FLOOD ZO/VE.- "C" Bank Use Only u TC 1 ------- __ REGISTRY OWNER: COTUIT_RZALl .Y_TRIiST-------____-- UZ,ED REF: __�'_Q1} 1 =__ ..___BUYER: _L�81_I2• _ �LQ _IOf�L '1 _. D�,TE: -f-'------------ ---- nj_A�T ZEF _¢ 4/BZ. ---------------- I -0 HT.REBY CERTIFY TOf ________ ____ -------- CALF:1 '__THAT THE BUILDING Y�°F m YANKEE SURVEY HIS FLAN IS TOCATED ON T�:E GROUND AS i ZC PAUL � CONSULTANTS5,.0WN A(vD THAT ITS POSITION DOES _ CONI''OR.M �'THE ZONING LAW SETBACK REQUIREMENTS OF TIRE 41 MERTHEN ,,, 40B INDUSTRY ROAD is TOV IN OF )94R__A=aP,I_.,17- _,______ __ AND THAT .o No*am MARSTONS MILLS, MAL 02648 IT DOES_!SOT_ LIE WITHIN THE SPECIAL FLOOD HAZAKD 'b 41st TEL 428-0055 AREA AS SHOWN ON THE H.U.D. MA1� DATED_BZ9195 _ FEa° f C.. nits-Pan l 250001 0015C FAX: 420-5553 THIS PLAN NOT UADE FROM AN _l,79TRTJMFNT 2 al �UL MERI ?V. PL -- SUY.VEY. NOT TO BY iJSFD FOR FENCES. ETC. OOBB .t/RG TOTAL P.01 1 _ awGt vwrt .. ia.w..w.vY.0_..._ �� .•�Iwrt \ \ ol i - • Y I»bM I LEST EMNATrlaN. ... R'CHT V-6VnTIpN ✓b�a�osc-�. Nam'w / —o • -_ - Mans _ sar�p�t O uM ed f. mm00 Q I v!.�•. ,.f- 1. :- Dn rM SOlvfV`IMY I CM AI Id �'. 10 Y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 l f S.. . V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 d05 P Y I Owner's Name: LORI JOSKA Owner's Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Date of Inspection: 12/1/00 Name of Inspector: (please print) �JOHN GRACI °as�� ° Company Name: SEPTIC INSPECTIONS c h. goo o Mailing Address: P.O BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX608-564-7270 CERTIFICATION STATEMENT, , I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Pass _ Needs Further Ev ation by the Local Approving Authority Fails Inspector's Signature: Date: 12/1/00 The system inspector shall submk a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent;to the buyer, if applicable,and the approving authority. Notes and Comments '°t THE SYSTEM PASSES TITLE V INP.ECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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 Page 2 of 11 S OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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. r Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup di•break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more ihan 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board7df Health): _broken pipe(s),are replaced _obstruction is removed ND explain: n/a s. li•L t ^ llili. I ,1 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) s., Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 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 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: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "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. goo„ 3. Other: n/a t,y 1.' 1 i Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 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 _ X 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'/Z day flow X Required pumping more than 4 times in the last year NnT due to clogged or obstructed pipe(s).Number of times pumped nLa. 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. X 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.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 to ibutary 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 •dsa "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'Se'eto upgrade y i n D shall u rade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. ;tr d Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 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? X Have large volumes of water been introduced to the system recently or as part of this inspection? 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? `R 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 no X _ Existing information.For example;a plan at the 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)] t l� 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOS" Date of Inspection: 12/1/00 E FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:2 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] { Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no):NO Last date of occupancy: n/a , COMMERCIALANDUSTRIAL Type of establishment: n/a i Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes,or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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.'Atvrach 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): n/a Approximate age of all components,date installed(if known)and source of information: 1996 PERMIT96-408 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete—metal'—fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10'6"H 5' 6"W 5'..8.11" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations',inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):' n/a Page 8 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if preseamust be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) ~ Pumps in working order(yes or no): NO" Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a Pttl li l r, R Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cont rued) ,Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a INFULTRATORS leaching chambers, number: 4 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a Teaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil;signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,TE..E.SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,ccndition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a U Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 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. D Pot& AA �3 Aa�$ /Ic 3L EA 31 , 34 r; 6C 39 in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 951 OLD STAGE RD CENTERVILLE,MA 02632 Owner: LORI JOSKA Date of Inspection: 12/1/00 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+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: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of'Health-explain: n/a NO Checked with local excavators;installers-(attach documentation) YES Accessed USGS database-explain; n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET 5 r ., 11 F- ,L �----'—�-`�--� I i 1 i ; i I e. - � f I I --.I I I .L I .i. . 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CONCRETE FOOTING S'-D' PROVIDE APPROVED SIMPSQV SRE ADJUST TOP OF FOUNDATION WALL TO AUGN HCUD 00WN ANCHOR(r(P.) T_6. TOP OF NEW FLOOR JOISTS IN LOCATIONS AS SHOWN AND HEIGHT OFf fND.fND.WALL TO P11GN CONC.SLABS BASEMENT.NDOW TYPICAL 3G'GAS FIREPLACE INSERT IN W0OD FRAME BUILT IN BUILT IN PROVIDE 2 ROWS OF SOLID BLOCNNG I °� 0 I I I ! I 12-DIN.CONCRETE SONOTUBE5 >J P.T.4x POSTS 01 I 4---- --- < ATTACH P.T.4x POSTS TO SONOTUBE5 _ O AND V45I5/&DIA ANCHOR BOLTS ¢ SEr IN SONOTUBE5 W/15-MIN.EMBEDMENT Y u°i ° L b am z b ° FULL BASEMENT RED I I I , 1 , D 3 W TI-II U.CONCRETE SLAB FLO OR v t I I I ro O Q h 0 § I ' I ON C MIL POLY VAPOR BARRIER OVER I I w o ww X I I I I b Proposed 0_ K N CLEAN COMPACTED GRANULAR BASE m W E S N �A FAMILY ROOM Q DN I In w I I 9T72 FLOOR JOISTS Q 1C O.C. I I I I I I I I I$ w � r WOOD DT-IXCK T I PreP elgx l°P°r Aew n�.wL+L,w/AxIxBxB I .. I I I I I I I I o WOOJ—LJ 'o DECK I I I I d I I_I_L I PROVIDE AROUND NEW FOUNDATION WALL PERIMETER+ L 1 J i R=——7 S,g'GALVO ANCHOR BOLTS Q MA%.51.O.C.4 G'-12-FROM ENO OF PLATES,USE 313'x I/4-PLATE WASHERS I I I I I P.T.3xB'S I I N BOLT EMSEXENT MIN.T ®Iro.c. i I II o PROVIDE CONTINUOUS(2)JI5 REBAR5 Q TOP t BOTTOM I I I • �( I I I N 4 CONTIN.(2)A5 REBARS IN FOOTING I II d REMOVE IXIST.WALL I I aSsDING DOOR —�_ I J � NSTALL NEW w CUT IN 317 OPENING i9 001VVfi5 FlY�IIW 00.5FMfM WINDOW 4—� x FOR BSMNT ACCESS ORILLL GROUT DVER1PY lOCATON i LVL BEAM = TD IXISTNG(OUNLMnOx BIDCK 1N IP NEEDED S 1 O TOP{BOTTOM TYPICAL ®BOTH WNL INRRSCCIIONS 0 LJ I _ _ 0 KITCHEN I m SUBJECT TO RENOVATION - - existing DINING O l�1 I (CC� FULL BASEMENT I ° G rn -�-- - ------------- z 2 ROW5 OF SOLID BLOCNNG ®48'O.G.AT GABLE Z LIVING L LL 5:12 LL FOUNDATION PLAN o - 14,=V-0" proposed 1 - FIRST FLOOR PLAN z w w EX15TING WALL$ J Z ___= OEMOUTION uj 0 0 NEW WALL$ C F Q M O 9 W Z. z o LL � x $ W 4ma z J w IL_ � Ja o T LVL BEAM below V' U) O TO SUPPORT IXLST.END FLOOR 4 ROOF '3 LL 0 m p F- CL �♦ a V Of LL iV w O ,11 EXISTING ROOF a r H ROOF FRAMING PLAN DATE: 04/10/2017 IXISTING ROOF RIDGE SCALE: AS NOTED r DRAWING# f A2 - 2 r 777 T—i -m It q, '7117" OIN CD CONTRACTOR TO VERIFY THE 67 LOCATION OF THE EXISTING W R SERVICE ATE (b '59 A THE CONTRKTOR SHALL EXCAVATE 5' ALL AROUND THE LEACHhG FACILITY AND DOWN TO THE C2 SAND LAYER. UNSUITABLE MATERIAL AND REPLACE WITH REMOVE AL�� CLEAN GRk4ULAR SAND CONFORMING TO THE SPECIFICATIONS SET FORTH ]N 310 CMR 15,255 (3). 60 4 TP 1 x6 15 x 61.4 N 461 5x P 2 SEPTIC TANK 1500 GALLON DISTRIBUTION Box 4 INIFILTRATORS WITH 4' OF STONE ALL AROUND AND 1' NOTES OF STONE BELOW. 00 Cq 1 . HOUSE NUMBER: 951 00 2. ASSESSOR'S NUMBER: 172 0 10 3. ZONING DISTRICT: RC v 4. FLOOD HAZARD ZONES: C 0 01 46 5. TOPOGRAPHIC INFORMATION COMPILED FROM TOWN TOPOGRAPHIC M AP. COA.0 JR, & ASSOCIATES 6. REFERENCE: PLAN OF LAND BY J.M. MONUHA 50' IN (CENTERVILLE) BARNSTABLE, MA. 9/30/19�6. SCALE: 1 " � ' ' LOT 6 60 .1 .0 ACRE NOTICE x 60.3 607 DENOTES PROPOSED SPOT ELEVATION -as the original (red) stomp of the Unless and until such time DENOTES EXISTING SPOT ELEVATION responsible Professional Engineer, or Professional Land Surveyor <1 x 60.4 appears on this plan: other (A) no person or persons, lincf�uding any municipal or x 60.8r-,' 0 public officials, may rely upon the information contained herein; and DENOTES PROPOSED DRAINAGE FLOW LOT ,�� 5.' (B) this plan remains the' property of Holmes & McGrath, Inc. 00 LOT 7 lDrawnIChecked DESCRIPTION DATE R E V I S 1 0 N S PLOT PLAN E DISPOSAL , SYSTEM U JOSEPH BREEN Ln LO FOR LOT �6, OLD STAGE ROAD IN GRAPHIC. SCALE MA CENTERVILLE BARNSTABLE . 20 10 0 20 60 DATE: AUG. 14, 1996 SCALE: 1 20' IN FEET 1 inch 20 ft, holme inc. s and mcgrath, MICHAEL J. civil engineers and land surveyors BORSELL 200 main street CIVIL No. 35 054 falmouth, ma ISTE SJS CHECKED: . DRAWN: —4-7- HEET " ���F 2 LON-8' 96242PP.DWG JOB NO: 96242 S DWG. NO.: 64 Finish grade above and adjacent to system shall slope away at a min, of 2%, 4" diam. cast iron or Schedule 40 PVC pipe (tight joints). 20' min. distance (building to edge of leoctting system) 10' min. distance SOIL TEST First floor 3•—Removable covers within THE CONTRACTOR SHALL EXCAVATE 5' ALL AROUND Date of soil test: 8/15/96 Elev. = 63.17 6" of finished grade THE LEACHING FACILITY AND DOWN TO THE C2 SAND LAYER. Test taken by: M. BORSELLI - Acces,§ Holes in Tank to REMOVE ALL UNSUITABLE MATERIAL AND REPLACE WITH Results witnessed by: ED BARRY be 20 in Diameter CLEAN GRANULAR SAND CONFORMING TO THE SPECIFICATIONS Percolation rate: < 5 min./inch P- 8759 Dist. box SET FORTH IN 310 CMR 15.255 (3). Ground water NONE ENCOUNTERED s=0.02 2' s VARIES x. ' s=o.oz CLEAN BACKFILL Q,. 2" layer of 1/8" to DEEP OBSERVATION HOLE LOG N0. 1 level 'o 1/2" washed stone OTHER 4 ft. of 3 4" to 1 2" washed SOIL SOIL TEXTURE SOIL COLOR SOIL (STRUCTURES, N L / / DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING STONES,BOULDERS, r` r� x� � r, stone all around infiltrator and CONSISTENCY, x GRAVEL SEPTIC TANK Foundation � 1500 GAL: o00 no 00 �,, 1 ft. below. 0» 60.5 a.' or = design II � II Ln r. ,U Elev.= 55.17 59.8 0 A by others a� u > II II ', 0"-8" / _ 8"-24" 58.5 B LOAMY SAND 10 YR 5/7 a', a', 4'-0" 34" 1 40" c 55.0 LOAMY & MED. SAND STRA T/FIED `n 6.7' 4"-66" Cl 2.5 Y 7/3 LAYERS `r 66"-144" 48.5 C2 COARSE SAND 2.5 Y 6/4 509 GRA DEL PROFILE 6" LAYER OF CRUSHED COMPACTED STONE Not to Scale PROVIDE 12" LAYER OF a COMPACTED GRAVEL UNDER THE DISTRIBUTION BOX Bottom of Test Hole Elev.= 48.5 DEEP OBSERVATION HOLE LOG NO. 2 OTHER SOIL SOIL TEXTURE SOIL COLOR SOIL (STRUCTURES, DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING STONES,BOULDERS, CONSISTENCY, %GRAVEL 0. 605 0»_8" 59.8 0/A 58.5 B LOAMY SAND 10 YR 5/7 53.5 Cl LOAMY & MED. SAND 2.5 Y 7 3 S1RATlFIED 4"-84" / LA YERS 84"-144" 48.5 C'2 COARSE SAND 2.5 Y 6/4 GENERAL NOTES 1) No change to this system shall be made unless approved in writing by holmes and mcgrath, inc. 2) Subject to inspection during construction by the Board of Health and holmes and mcgrath, inc. 3) Heavy construction equipment shall not travel over disposal system during or after construction. - DESIGN CRITERIA 4) Disposal system to be constructed in accordance with Title 5 of the State Environmental Code. 5) A copy of these plans must be kept on the site Number of bedrooms:' 3 Equivalent to 330 gal.'s;day a during the `time of construction. Garbage disposal 'unit: No 6) A copy of these plans must be furnished to the: - Leaching area — caaacity required: 330 gal.'s/day contractor constructing the disposal system. 7) Before backfilling, the contractor shall notify Side area proposed: 168 sq. ft. holmes and. mcgrath, inc., or the Board of Health Bottom area proposed:' 357 , sq. ft. Agent to inspect the system as constructed. Total area proposed: '526• sq. ft. 8) If the contractor encounters any variation between the existing conditions shown on the plan and the Proposed leaching capacity. 389 gal.'s/day • conditions encountered on the site, or any soil . Water supply: Town condition different than shown on the soil log, or Precast concrete units: H-10 loading design INLET HOLE any adverse soil, the contractor shall immediately contact holmes and mcgrath, inc. Holmes and mcgrath, inc. will examine the soil condition and report to the owner any suggested revisions. I � � 16" — - -- �C - - 34 I 6'—3 TYPICAL HIGH CAPACITY INFILTRATOR (H-20 LOADING) NOT TO SCALE 10' —6" 3-20" Diameter Access Holes I ALL ACCESS MANHOLE COVERS FOR INLET 1 OUTLET SEPTIC TANK, DISTRIBUTION BOX, AND LEACHING STRUCTURE SET MORE THAN 6" BELOW FINISHED GRADE, II SHALL BE RAISED TO WITHIN 6" OF FINISHED GRADE. ,_--. —,- NOTICE Unless and until such time as the original (red) stamp of the FRAME & COVER responsible Professional Engineer, or Professional Land Surveyor STEEL REINFORCED PRECAST CONCRETE OVER "T'S" WHERE REQUIRED. appears on this plan: ^��� VIEW (A) no person or persons, including any municipal or other P VIEW w public officials, may rely upon the information contained herein; and PRECAST CONCRETE (B) this plan remains the property of Holmes & McGrath, Inc. 3" REMOVABLE COVERS 3" TANK REQUIRED WHERE ALL OUTLET PIPES FROM THE INSTALL "POLYLOK" FLOW EQUALIZERS DATE DESCRIPTION DrawnChecked 14:t; • � � 4" DISTRIBUTION BOX SHALL BE ON ALL OUTLET PIPES 3" min. clearance required ;.� INLET "T" ;' 'SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER R E V I S I O N S INLET 8 2" min. inlet to outlet 6" min OUTLET _ 5 - 5" OUTLET PLOT PLAN DETAILS 10" min. �— //" ,'�l� \�� KNOCKOUTS 5' -7" Liquid level =B ' 5, _7" OF PROPOSED SEWAGE DISPOSAL SYSTEM E TUF—TITE E� 15.5" OUTLET r��� r��� INLET 19.5" PREPARED FOR -0 GAS BAFFLE o c �� i i � 11.25" JOSEPH BREEN o .2 FOR LOT 6, OLD STAGE ROAD J IN 3.. 20" 1.75' T . 10'-0" 5' -$" CENTERVILLE BARNSTABLE MA PLAN SECTION CROSS--SECTION CROSS-SECTION END-SECTION SCALE: AS SHOWN DATE: AUG. 14, 1996 6 HOLE DISTRIBUTION BOX �� �N ®� �f4cti TYPICAL 1500 GALLON SEPTIC TANK holmes and mcgrath, Inc. MICHAEL IJ. BORSELL! NOT TO SCALE civil engineers and Ian surveyors O CIVIL NOT TO SCALE 200 main street t No. 35054 falmouth, ma. 02540 A'�o �'FC1sTE��� DRAWN: 5.15 CHECKED: Fss�oNMI 96242DET.DWG JOB NO: 96242 DWG. NO.: 64-4-7 SHEET 2 of 2