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0032 QUIET WAY - Health
32 Quiet Way Centerville A=208 098 �'.. oCYC(�c� ��1�•y�/wD/eI/w�I• UPC 12534 No- 2R MA8TMOS.HY i No. d b Fee BOARD OF HEALTH TOWN OF BARNSTABLE L 3pplicatiou f or Vern Cougtructiou Permit w Application is hereby made for a permit to Construct(1 ,, Alter( ), or Repair( ) an indiviauai-wett•at—�, Location-Addres , Assessors Map and Parcel Doc� lo SA u ITZ 3J Qute7' wcjy Ceti /vie//r Owner ` Address �C�wy�s 3CA,,j0 rf( Q/'�,/�i/' .ZS.?e� /'&J- 144034 * AIA, oaGSr9 Installer-Driller p,,, .ag�,�ytT Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 'Y Capacity Purpose of Well /01^ei Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Complia ce has en issued by the Board of Health. Signed 2),nr,� Date Application Approved B PP PP Y Date Application Disapproved for the following reasons: Date Permit No. Issued Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(✓', Altered( ), or Repaired( ) by CNrv/S 5C,&")nJf / Installer at 00 be 7— tj a V C e•v7C/ has been installed in accordance witA the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector a Date Permit No. Issued, Date m_e__m_�._..00-_� ___ -- -vo_d-roe®d------------e_-eva------------ damevaam4�e�eae mvae�. e .., r B.OARD.OF..HEALTH .,.,,: .. .. TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired O f �l' by i,"j. s. , Installer at QJi E I y— G 'e n 1y- / ur//P ^ 1 has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated. u..� THE ISSUANCE OF THIS CERTIFICATE`SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH r� C.r•�d- � � TOWN OF BARN STAB LE J Veft Construction Permit No. Fee Y Permission is hereby granted to Gp"'U/ S SCIs r1-1 AJ P Installer LN onstruct.(0 Alter( ), or Repair O an individual well at: Street y the application for a Well Construction Permit No. ^�" 4 /� Dated! Approved By ti s I' No. , „� -tt 2 b 0 Fee r ,BOARD OF HEALTH TOWN -'0F B'ARNSTABLE ZIpprf catton for ell Cow6truct on Permit Application is hereby made for a permit to Construct(`); Alter(•.)„ or Repair O an iadividual�`well ;' *' n/ Location-Addresss" Assessors Map and Parcel 0 o u S n U I T 7— (,J Cs C 2 Owner Address / CrL.viC SCo -jiL-&,8 '/r ./ e /o QrG tt•- 5::� �S /o S S ,a:-f'nInstaller. Drillers.,. # .�s:�l� '[` �` t' F r>t s� h=a�� Al s ^.R;. ., :e, +art dies i Type of Building Dwelling Other-Type of Building No. of Persons Type of Well I/ � Capacity Purpose of Well Agreement: The.undersigned agrees to install the afore described individual well in accordance with the provisions.of the Town of Barnstable.Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the. well in operation until a Certificate of Compliance has been issued by the Board of Health. / Signed Date Application Approved By V Date Application Disapproved for they following reasons:` 1 .. ._ - 97--EXISTING CONTOUR / 7EL./ELEC.o, PAVED \ x 100.98 EXISTING SPOT GRADE BENgINIWI(SET CDMM. 'le . L, NAIL& CAP ( -W-EXISTING WATER SERVICE c \ PROPOSED SEPTIC TANK EL 31.17 HYDRANT 3lA � IE.T WAY 1 �u O OSEO HYD AN _ 0 "Qb 1s E TEST PIT / I 2 COMPARTMENT TANK - � ?' I 1000/500 GALLON CAPACITIES / LOT 32___ ;,?•',;�. BENCHMARKS I < coMM. LEGEND / QUIB'f WAY, LLC CRAH a .Y FOUND \�Sti s1' N39'30146'E r Wpm t93.15 ` Founo CJ I ; ,' w f x�4,5 3. �/y� NNREI FUTURE LNOT TO SCALLEP KSHOP/ GARAGE/ DECK 1 BEDROOM `p5 / ABOVE I ABOVE �� SEWER ad 3 3 ' Qp GENERAL NOTES: 32.4 -�" ��M^ CONNECTION!r l I `y 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL / _-:-- q x6gr FENCE t BOARD OF HEALTH AND THE DESIGN ENGINEER. V 3 io 32.4 .33. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, 8 GARDEN 30'-- �f f 3 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 333 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 31'2 /? 0. HOUSE�32 f + DESIGN ENGINEER. o N z IIFF v�4:14� ' m 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 31.a Q } // FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N$ � 32.3 9YF ENGINEER BEFORE CONSTRUCTION CONTINUES. $ J Ion �` Ensr. Iry 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). / -4� / f% 32b PA770 ST it 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF y r--- ( 11 ( PROPOSED ADDITIONS THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF PLOT PLAN FOR PROPOSED HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 1 h O�' 33.1 33.0 ADDITION TO BE FILED SEPARATELY i i IN 7. WATER SUPPLIED BY TOWN WATER SERVICE. 307 1 O„ I I BLOCK WALL 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. / 50' .v-----.. � � '� + �' (remove) 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS / 8' 2B-i �O. �rosrN 8 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 33.2 s DIRECTED BY THE APPROVING AUTHORITIES. -1 e-ea 1 m EXIS17NG SEPTIC TANK 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY I / i �33.e TO BE PUMPED, RUPTURED, THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING FILLED W/SAND &ABANDONED l SHED' CONSTRUCTION. 33.8 / 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS � EXIS77NG LEACH PIT IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND i v TO BE PUMPED, FILLED KITH REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). / - SAND&ABANDONED 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE rto INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 13• SITIS PLAN IS TO BE E PLAN FOR ADDITION USED D FOR SEPTIC To BE SUBMITTED SEPARATETEM PURPOSES ONLY. f PARCEL 98 �r` PETER T. ' 1 38'sB'f S.F. v McEN EE GVIL PARCEL ID: 208-098 No. 35109 h PROPOSED SEPTIC SYSTEM UPGRADE PLAN ,°°"° x 5.3 L ` 32 QUIET WAY CENTERVILLE MA + 185.67' S48'24'52"W �? g .t�)Zjf Prepared for. COTUIT BAY DESIGN, 43 Brewster Rood, Mashpee, MA 02649 36.0 m NEBAR 35.3 Engineering by: SCALE DRAWN JOB.NO. FOUNDI OWNER OF RECORD 1"-30' P.T.M. 174-19 PLAN REVISION 4/21/20 SCHULTZ, DOUGLAS B & LAURA J Engineering Works,Inc. 23250 SW WUNOERLI CANYON ROAD 12 West Crod Road, Forestdole, MA 02644 DATE CHECKED PIPE INVERTS AT HOUSE AND TANK SHEET N0. aafial SHERWOOD, OR 97140 (SOB) 477-5313 6/26/19 P.T.M. 1 of 2 7 i No. �� y I2-3 Fe ,-� -HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _o✓� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(t//Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. _?,I Q yr e P- w/ly Owner's Name,Address,and Tell..No. S[ 41/f z PO y *J' ee-�re�vr/�tj M/�< 1 25-0 �i�/ 1/1/dNpje/�e Assessor's Map/Parcel Installe Tel Installer's Name,Address,and Te No. Designer's Name,Address,and Tel.No. 4,4 4w- o7c4 d-, / �N�l.vCtiv.�� w0fl X., X�we_ 9 Jo.�e.-i e or A.1,.Iki i M e` li, o.46 Y 9 0 _ Type of Building: Dwelling No.of Bedrooms 3 Lot Size .3 Z 910`1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required), 3 o gpd Design flow provided -7 gpd Plan Date •L l Number of sheets Revision Date Title / ` Size of Septic Tank !,f'o o y -f��,i✓ Type of S.A.S. G l� ,¢,r�b e-/ .Description of Soil Nature of Repairs or Alterations(Answer when applicable) - 06,f r el k_. A�,�/, w,g je -1 S/c -- e t,7 'eve— rfy o r44/ems Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o th. Si Date 0,0 Appl ication Approved by Date `14J Application Disapproved by Date for the following reasons Permit No. ZID Date Issued-4Zy ,1 !, l r � i No. �V Z� ��� w Fee `?4 COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Misposal *pstem Construction Permit Application for a Permit to'Construct( ) Repair( ) Upgrade(►.4bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.Ll / Assessor's Map/Parcel e N i«vi/(e/ M/ //. y,� 1 ez f O fW �v,/iv Ins�t�aller''s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. r f`h'i cl o I4- � G N /N�//r.v wollex" •7/wz- u J,,—el rG r e 47 0.16Yf q 7?—f l Type of Building: Dwelling No.of Bedrooms 3 Lot Size y sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 U gpd Design flow provided !y k, 7 gpd Plan Date ,1 / Number of sheets .L Revision Date Title --- ~- Size of Septic Tank /;S-o O „ Type of S.A.S. _`,2 r O o�f Description of Soil P � Nature of Repairs or Alterations(Answer when appliclle)� h le a u n en/ ¢ ItIJ L¢—r�—��• / . % /n ! r.'"o a rA//d. phi � s �p L .��2 r!>G 9 ���ir i ��I ,.- 5��/ w (�( �/ r��A jai i A1/ �/dv.✓ a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board olth. -Si ed - = > - __ _ Date 0,2 _. y Application Approved by Date ��.-�~ -00 Application Disapproved by Date for the following reasons Permit No. (.'U Z y (Z Z Date Issued ? y )'% THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded ) r Abandoned( )by "f at 3.2 0 v 110 V vv k re (rT, llp has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer r i/' r/n. r Designer ,✓,,r. wo f J�, #bedrooms 3 Approved�d^es�ign flow gpd The issuance of this permit shall not be construed as a guarantee that,the systerh will functi n si ed. Date / Inspectors - ---------------------------------------------------------- ---- ------------------------------ ------------------- No. i _ Fee O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem'ConstrUrtlon 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade ) Abandon( ) System located at 3 (,�v i v✓A.y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 147 A)- 1) Approved by 1 Town of Barnstable Regulatory Services Richard V.Scali, MIUMUMSM Interim Director Public Realth Division Thomas McKean,Director 200 thin Street,Hyannis,MA 02601 Offic� W-MZ-4644 Fax: 50-79D-43W Installer&Designer Certification Form Date: Zd Sevvage Permit# Assessor's IMap%,Par,,l r M C Designer: Installer: A r+6 Address: )2- W, )c/ j Address- On A r*4 was.issued a.permit to install a ---(d-ate) (installer) septic system at C-Q�4., based on a design drawn by (address)' dated 4 -Z V (designer) that the septic system referenced above was installed substantially according to the design, -which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the -soils Were fatind satisfactory. I certif}f that the Septic system referenced above was installed with rnajor chances !�Ireater than - (i.e. in 10' lateral relocation of the-SAS or any vertical relocation of any coj�lpol�elll bf the Septic system)but in.accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. .1 certify that tbe'.systpm.referenced above was constructed in Frith the terms of tile M approval letters(if pplica. e) Im glare) W-Vi-TeS ,-L taller's S' civil- t4o,35109 GIs (Designer's Signature) (affix Designe PLEA S T- O R i ST- BLrL�L C HEALTH D S'O' C E"T""'C 1T, E0FECN1N�EVLLOTBE I ED TTTILOTHTHIS0R�AN�D 6S_qLT � ARE.RECEIVED BYTH "R_ ST_ BLEPUBLIC HALTHDINJISIT 0U. Form Rev 8-W-113.de,; Engineers note-Tti.-certification is limited to an as-built inspection of SYStern components as installed Prior lo backlill.The eer.neerdid not supef-vise constricton of the system.Tl,.e installer assur-nes resporsiUMy for ail materials,worltmenship,backfIlling to specWod grades wil-n-proper compqction and i-'btting-6--ersicovers is shown on the de-sign plan. M TOWN OF BARNSTABLE LOCH' ON � Q T Gl y _ SBWAGE# �LLAG)+ Ce�cfe v tl e:. ASSESSOWS M" LOx INSTt�1. R NAME&`Pt ME NO. (}?TD _ 1 C TAX&CAPA: rn L1EACION 1Pt�,C1ILI''Y .E ).. --- ----- ,, jq UMDER OK OW - t cowalC.YAI�tt -E ..,;,.�. Sig wtid Dis ahi ce BstvIWO the 1Vlttxirnum:A�justierl Grautactw�te�: 'ablel tltc SauornoXahinity Prhrate wi.x.tc a Qup.pty w w aw t cmd0 V.141w OfanY v�sils�xtst f�a�a9 otit e c oe withi 20 feet o gai lwod and* acry`wellbib WsY fee wittaisi'30t!feet pf teaa ing 7( i (DO TOWN OF BARNSTABLE LOCATION rt32— 61JQ t% SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL Q09 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY f yUe1�L1I'�i LEACHING FACILITY: (type) ,10 1 LA 4e (size) l d oo !,t4 L NO.OF BEDROOMS ) j OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �.c L 2 3 P(Z 131 TOWN OF BARNSTABLE LOCATION ✓y+ SEWAGE# ;10 VILLAGE Cely re�vc �l� ASSESSOR'S MAP&PARCEL 20 - O INSTALLER'S NAME&PHONE NO. �rDy��o Q——p bJ� c 4 ink m LAC/ SEPTIC TANK CAPACITY f LEACHING FACILITY.(type) ck¢ ��i i,� °PL (size) Ze,4' NO.OF BEDROOMS' 3 �y��-ew 4,1 OWNER.f"C4,,/ram Doug (A-_f 1 0 /"—, '? ?1,{c) PERMIT DATE: !y Z D 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) ol Feet FURNISHED BY / `' 0 A U ya a a tiq ..Sao rol l� 3Y s6- 8 ® 6�- � Commonwealth of Massachusetts ,. Title 5 Official Inspection Form �l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ''.0 r 32 Quiet Way r- Property Address ° hMi Mike McNally A Owner Owner's Name lam information is required for every Centerville MA 02632 8-9-18 ., page. City/Town State Zip Code Date of Jnspection 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. A. General Information 1. Inspector: i I Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number i 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 Ev n the Local Approving Authority 8-9-18 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.5/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form w. hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is Centerville MA 02632 8-9-18 required for every - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: System is in good working order with no sign of failure. Leach pit operating at high level. Recommend pumping annually for maintenance and to prolong 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.' Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 s Commonwealth of Massachusetts a Title 5 Official Inspection Form �I w' I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is Centerville MA 02632 8-9-18 required for every - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(S) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): - ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ET ' obstruction is removed ❑ Y ❑N ❑ ND (Explain below): I ❑ 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)m 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts � a Title 5 Official Inspection Form i.'I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: I **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup,of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts ;W Title 5 Official. Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r ,.T,, ;`I 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town 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 316 CMR 15.303,therefore the system fails. The t system owner should contact the Board of Health to determine what will be t necessary to correct the,failure. E) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes! or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts 3 Title 5 Official Inspection Form 41 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 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? Z ❑' Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 - Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r , Commonwealth of Massachusetts ,. Title 5 Official Inspection Form ! i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Yes ® No Laundry system inspected?' ❑ Yes ® No Seasonal use? ❑ Yes ® No I Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? El Yes ® No Last date of occupancy: 8-2018 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 c Commonwealth of Massachusetts .; Title 5 Official Inspection Form ` it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,'i 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 4 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology:Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts s f� Title 5 Official Inspection Form 10 Subsurface Sewage Disposal System Form Not for.Voluntary Assessments �_,.•T, , 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site.plan): Depth below grade: 12"feet Material of construction: ' ® cast iron ® 40 PVC ® other(explain): Orangeburg Distance from privaWwater supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 1 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form 0I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is Centerville MA 02632 8-9-18 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) s Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" - How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts w, Title 5 Official Inspection. Form �1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Y 9 �.� Commonwealth of Massachusetts 3 Title 5 Official Inspection Form rC-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert N/A 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts rY Title 5 Official Inspection Fora iIj Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: - Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit in good working order with water level and stain line at 18" belwo inlet invert. Recommend pumping annually for maintenance and to prolong life. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 i Commonwealth of Massachusetts , Title 5 Official Inspection Form liNi Subsurface Sewage Disposal System Form Not for Voluntary Assessments 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts fw Title 5 Official Inspection Form I'll Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r YlM 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately J3 6 t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 c Commonwealth of Massachusetts , ra 3 Title 5 Official Inspection Form Ise IC-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r: 32 Quiet Way Property Address Mike McNally Owner Owner's Name information is 8-9-18 required for every Centerville MA 02632 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database'- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts 3, Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Quiet Way Property Address -- Mike McNally Owner Owner's Name information is required for every Centerville MA 02632 8-9-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 %Barnstable Assessing Search Results Page 1 of 2 1 ' l y ianiA Home: Departments:Assessors Division: Property Assessment.Search Results 32 QUIET WAY Owner: MACDONALD,JOSEPH P&MARY Property Sketch Legend Map/Parcel/Parcel Extension ... 208 /098/ Mailing Address - MACDONALD,JOSEPH P& MARY 347 TILDEN COMMONS LN BRAINTREE, MA.02184 f� r#Y rr tdfllPilii��l'�t'; a3'ii �P� 2005 Assessed Values ................ Appraised Value Assessed Value Building Value: $ 117,300 $ 117,300 Extra Features: $2,300 $2,300 Outbuildings: $600 $600 Land Value: $209,700 $209,700 Interactive Property Map: Map requires Plug in: Totals:$329,900 $329,900 1 have visited the maps before Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: MACDONALD,JOSEPH P&MARY 12/6/2000 13411/259 $ 1 MACDONALD,JOSEPH P&MARY 1/27/2000 12800/291 $0 MACDONALD,JOSEPH P&MARY 1/29/1998 97P1862EP1 $0 MACDONALD, KATHERINE A 3/15/1996 10124/ 129 $30,000 BOHLING, MARY F&MACDONALD,K 610/310 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $59.88 Town Fire District Rates Other I $6.05 Barnstable-Residential $2.12 Land B Barnstable-Commercial $2.80 C.O.M.M. FD Tax(Residential) $333.20 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $ 1,995.90 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 http://www.town.bamstable.ma.us/Assessing/Assess05/displayparce103.asp?mappar=2080... 1/12/2006 Barnstable Assessing Search Results Page 2 of 2 W Barnstable-Commercial $2.10 Total: $2,388.98 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.94 Year Built 1915 Appraised Value $209,700 Living Area 1487 Assessed Value $209,700 Replacement Cost$ 156,442 Depreciation 25 Building Value 117,300 Construction Details Style Ranch Interior Floors HardwoodCarpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 1 Story Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,300 $2,300 SHED Shed 80 $600 $600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/Assessing/Assess05/displayparcelO3.asp?mappar=2080... 1/12/2006 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments / d ^M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your MICHAEL DEDECKO cursor-do not Name of Inspector use the return key. COMPASS REALTY DEV CORP Company Name r� P.O. BOX 2384 Company Address MASHPEE MA 02649 Cityrrown State Zip Code 508-221-5003 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,Maintervttice of on site sewage disposal systems. I am a DEP approved system inspector pursuant, o SectW 15 340 of Title 5 (310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes E]'�-�ails o > ❑ Needs Fu her Evalua 'o y the Local Approving Authority .. .ate _ bJ i`j . 5/21/07 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 does not address how the system will perform in the future under the same or different conditions of use. 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. Cityrrown 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: Z I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 241 pine-08I06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for State Zip Code Date of inspection every page. Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 241 pine•06I06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 241 pine-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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,O00gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use. ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): n/a Sump pump? ❑ Yes ® No N/A Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: n/a Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: N/A Were sewage odors detected when arriving at the site? ❑ Yes ® No 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight yes vented, no sign of leakage. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gallons 3" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 31" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 11" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): no need to pump tee's intact, structurally sound liquid level equal with outlet invert, no leakage. 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 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): 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert equal with outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D box is level and distribution is equal no solid carryover, no signs of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil sand/gravel, no sign of hydraulic failure, ponding dry, no damp soil, vegetation normal. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 241 pine•06/06 P 9 P Y 9 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 241 pine-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °w 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is CENTERVILLE MA 02632 5/21/07 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. J� AL- 13 6zz - 241 pine•08106 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 32 QUIET WAY Property Address JOESPH McDONALD 347 TILDEN COMMONS LANE BRAINTREE MA 02184 Owner Owner's Name information is required for CENTERVILLE MA 02632 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 33'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: elevation look up You must describe how you established the high ground water elevation: usgs shows spot elevation at 33' 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 x ..f .../ THE COMMONWEALTH OF MASSACHUSETTS �l/ BARD O H� TH . ' ........OF.......... ..-.... .. - -........................... 3 a-u�- C- pfirati n -flax 43t iVoti I.l Workfi 6tuitrurfijan Vrrnift Application is hereby made for a Permit to Construct ( /11*10r Repair ( ) an Individual Sewage Disposal Syst t:f��, /-) f n• ddress or,Lot N p__ caner 6� ress /� '..'----'-----. ---- --------- '�-.1 f_ 0-I..._...................... ..................... �_ ( .I/-----__---L_A�-r••-----•--...--- Installer Address U Type of Building Size Lot-..........................1.Sq. feet Dwelling—No. of Bedrooms___--__.3-----------------------__.-_.Expansion Attic ( ) Garbage Grindq ( ) pa, Other—Type of Building p ( ) ( )____________________________ No. of ersons..____._-_._______:______-__ Showers — Cafeteria Outer fixtures :_ W Design Flow..........................��......-_gallons per person per day. Total daily flow---------------------------------------------- WSeptic Tank—Liquid capacity./ gallons Length______________ Width................ Diameter-----.---------- Depth------.__-..._. x Disposal Trench—No. ................... idtli.__ _____._ Total Length-----------------_ Total leaching area---------------.-----sq. ft. Seepage Pit No../.0TZ_ __. ian `?-e-. t.�Be th below inlet.................... Total leaching area----- -------". sc it. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ---•--- --------------------------------------------------------- Date...-----------------------c----------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water._____..--_- .-._-.---.- f3, Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water----------------_-_-----. -= ==- --------------------------------------------------_--`--------- ---------------- 0 Description of Soil---- -------------------------------------- ---- - -----------------� U -------------------------------- ------- --•--•-•-------------------------- ------ ---- -- ----------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable-------------_------------------------------------------------------------------------------- _.. . � i -•---------------------------------------------------••------_-....----....---•-----•-=-----------•-------------------•------------------- --•----=--•----•--•------------------------------.. Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of Article NI of the State Sanitary o — he undersigned further agrees not to place the system in operation until a Certificate of Compliance ha ee i d y thVboard of health. igned --- - -- ? ------------------------------------------------------------------- > ----- -----------•-(--- Application Approved By- -----• -- --- . ----- . 4------------------ / m Dateate 7 f Application Disapproved for flee following reasons__________________________________________________ ----------------------------------.................... .............................................. ...._..------------.....--- Date PermitNo......................................................... Issued....................................................... Date No..... Fia I...`�................... THE COMMONWEALTH OF MASSACHUSETTS y 'J�j 'A � 7,., f OF.......... ....................'......_.......... ---- ............-- Applirafiun -fur Dbtipviittl Work,6 Tonstriartinn Vaniff Application is hereby made for a Permit to Construct (V) or Repair '( ) an Individual Sewage Disposal ,r� t Syst-------tA `=ia n �_......(�.4wV/jt: •----•---------------------------.............................................................. I'y�n/ BPS (I� kffr f4 � . 't•s q Installer Address UType of Building Size Lot----- ..................Sq. feet a Dwelling—No. of Bedrooms--------,. ------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons._:_------___.--.--------- Showers ( ) — Cafeteria ( ) a Other fixtures ---- .--------------------- W Design Flow.......................... .................gallons per person per day. Total daily flow----------------- .�----_------...gallons. WSeptic Tank—Liquid capacity/.gallons Length---------------- Width................ Diameter------..--...... Depth.......---_--- x Disposal Trench No----------------- idth- .----_ __..'-- Total Length-.-.-:-:-._.----.-. Total leaching area..---_-...._.--.-sq. ft. Seepage Pit.,No...0."__- Dia �I___._..._�tt �e th below inlet.................... Total leaching area-------..-..----.sc ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water....-.--------------.:.. (� Test Pit No. 2'-_-_-,._---___minutes per inch Depth of Test Pit.................... Depth to ground water--------------------- r O --• --------- -------------- •----------------------•-----------------------•------------------------------------------ Descriptionof Soii-:,. ----- -------------------------•-------------------•-•---•------------- --••--------------------......-•---•---- ••-•-•--•------ ------------------------ ----------------------------------------- V Nature,of Repairs or Alterations—Answer..when applicable........................................................................:......------.._...------ Agreement: The undersigned agrees to install .the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article Xf of the State San tar o e— he undersigned further agrees not to place the system in operation until a Certificate of Compliance ha �, e i~t d y thyboard of health. tgrie A.' j J at Application Approved By'" L ...- E •-•-----•--- �F --------------- F' Date 1 ,wqr' APPI>catron;_Disapproved for the following reasons: P 4= f Date Permit No. ................ --------------------------------- Issued........................................................ �. Date - t THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH, } 1 t , ...... I' . ............OF....... ... .. .....:..................................:......................... Tntifirat a of Tomplittnrr T S IS`T0. CERTIF That the I di 'du Se a D' sal Syst t c ed ( ) or Repaired ( ) by ` � ti .t.. �y �' ° _ ( - ► , Installer has been installed in accordance with* the provisions of Article XI of.The„Mate.-Sanit .Ty�Code as .described in the application for Disposal Works Construction Permit No...... ,-... , 'dated ........ ::............................ r THE ISSUANCE OF THIS,,,.CERTIFICATE SHALL NOT BE CONSTRUE10'AS A GUARANTEE THAT THE SYSTEM: WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector------.--••-----•---- 1` THE COMMONWEALTH OF MASSACHUSETTS- BOARD OF OE LT J �" OF .....No.......... . FEE........................ 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DOWN TO HEADER 2K2J 3-1 3/4"x 78"LVL BEAM ' r- O ' I LL I — A l C V —I Z IL J --- NEW BUILD OVER I x W/2 x 6 RAFTERS��o.e W ORI 0 2 f .J EXISTING DGE aZ (.)Z rZ O w W 1 4 x 8 POST FRO IDG Q v; DOWN TO HEADER w 2-1 3/4 X 14'L BEAM 2-2 MH 1 EL ION � I J z w 04 i 1 t SCALE : - A ROOF FRAMING PLAN DATE : � 3.2 x B BEAM 6/27/2019 FASTEN P.T.B x B POST TO BEAMS NOTES: W/SIMPSON ECCLR/R Posy CAP 1.) ALL ROOF RAFTERS TO BE 2 x B's 2 x B RAFTERS @ t8"o.c UNLESS OTHERWISE NOTED FOR GAS FIREPLACE 2.) USE SIMPSON H2.5A HURRICANE CLIPS A5 AT ALL RAFTERS ENDS 2T-7(' 3.)VERIFY GUTTER TYPE/LAYOUT W/OWNERS i NOTES: NAILING SCHEDULE J 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS 110 MPH EXPOSURE B WIND ZONE &DIMENSIONS IN THE FIELD JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL SPACING Z 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, ROOF FRAMING: 0 DETAILS,&FINISHES IN THE FIELD WITH OWNER BLOCKING TO RAFTER(TOE NAILED) 2-Bd z•10d EACH END p RIM BOARD TO RAFTER(END NAILED) 2-18 d 3.18d EACH END W Q 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT 0 cV(D FIRST FLOOR TO BE 6'-11"ABOVE SUBFLOOR TOP WALL FRAMING: A INTERSECTIONS(FACE NAILED) 4 18d slew AT JOINTS w 0 W g 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STUD TO STUD(FACE NAILED) z-18 a 2.18d 2ao.o. WQ4 STATE BUILDING CODE,9TH EDITION AMENDEMENT&IRC2015 HEADER TO HEADER(FACE NAILED) 18d 18d 18"o.e.ALONG EDGESFLOOR FRAMING: ~ ~ 5.) 110 MPH EXPOSURE B WIND ZONE UJ N 6.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, BLOCKING TO JOISTS(TOE NAILED)ER(TOE NAILED) 2-8d i 100dd EACH END ~ LJJ a OR HORIZONTALLY W/BLOCKING AT EDGES,3-EDGE/12-FIELD NAILING BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3.18d 4-18d EACH BLOCK Lu d C LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3.18d 4.16d EACH JOIST MMLO 7.) ALL LVL LUMBER/BEAMS TO BE 1.9e L/360 LOAD JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-10d PER JOIST m C SEE CERTIFIED PLOT PLAN DEVELOPED BY WARWICK ASSOCIATES FOR ALL BAND JOIST TO SILLJOI O END NAILED)ATE 3.18d 4-18d PER JOIST O M Q= 8. ) BAND JOIST TO SILL OR TOP PLATE(TOE NAlLEDO 2-18 d 3.18d PER FOOT PROPOSED&EXISTING DETAILS ROOF SHEATHING: 9.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL WORD STRUCTURAL PANELS(PLYWOOD) SIMPSON COMPONENTS RAFTERS OR TRUSSES SPACED UP TO 18'o.Q Sd 10d 8"EDGE/8"FIELD RAFTERS OR TRUSSES SPACED OVER 18"o.Q 8d 10d 4"EDGE/e FIELD 10.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG Sd 10d e"EDGE/8"FIELD TO BE 3000 PSI AT 28 DAYS GABLE END WALL RAKE OR RAKE TRUSS 8d 10d 8"EDGEW FIELD M W/STRUCTURAL OUTLOOKERS lul 11.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8d 10d 4 EOGE/4•RELD DURING FRAMING CONSTRUCTION CEILING SHEATHING: 12.)TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE,900 PSI MIN. GYPSUM WALLBOARD Sd - r EDGE/1("FIELD m 13.)PROVIDE UTILITY INSTALLATIONS FROM STREET TO HOUSE WALL SHEATHING: VIA UNDERGROUND CONNECTIONS TO COMPLY W/ALL LOCAL CODES WOOD MUCTURAL PAPILLS(PLYWOOD) STUDS SPACED UP TO 24"o.0 8d 10d (•EDGE112"FIELD Sy 14.)FOLLOW ALL REQUIREMENTS OF THE IECC2015 RESIDENTIAL ENERGY 1/2•&25W FIBERBOARD PANELS 8d - 3"EDGE18"FIELD WCHELB EFFICIENCY REQUIREMENTS&VERIFY ALL DETAILS WITH THE INSULATION 1/2"GYPSUM WALLBOARD 5d - r EDGEM("FIELD Sepµ INSTALLER/CONTRACTOR FOR THE STRETCH ENERGY CODE FLOOR SHEATHING: M 34774 *OR 15.)ALL WINDOW AND DOOR HEADERS LESS THAN CO"TO BE 3-2 x 8 W/1 K,1J 1 STRUCTURAL PANELS(PLYWOOD) LESS THICKNESS 8d 10d 8"EDGE/12"FIELD 16.)THIS STRUCTURE IS DESIGNED TO THE AF&PA WOOD FRAME CONSTRUCTION GREATER THAN 1"THICKNESS 10d 1ed 8•EDGEIB"FIELD O P MANUAL FOR 110 MPH EXPOSURE"B"LOCATION PER SECTION R301.2.1.1 LL 1 TYP. ROOF CONST. NEWBUILDOVERROOF Z -2 x 10 ROOF RAFTERS Q 18"am W/2 x 8 RAFTERS C 18"o.a -5W PLYWOOD ROOF SHEATHING J -ASPHALT ROOF SHINGLES 15LB.FELT PAPER 3 1 3/4"x1S•LVLRIDGEBEAM TYP.WALL CONST. 0 -10"HI-R INSULATION 0 SLOPED CEILINGS(R=36), 2 x 8b Q 18'o.a 1.2 x 8 STUDS Q 10"o.a x vs 18"ext -l l'BATT INSULATION 2.1/Y PLYWOOD SHEATHING ®FLAT CEILINGS(R--" 12 3.W(R-20)BATT.INSULATION 12 Lj -2 x 12 RIDGE BOARD 6 4.IW GYPSUM BOARD •SIMPSON H 2.5 HURRICANE CUPS 5.W.C.SHINGLE SIDING 8 AT ALL RAFTER ENDS -ICE/WATER SHIELD AT BOTTOM 8.TYVEK VAPOR BARRIER J 3'0"OF ROOF 7.MID-HEIGHT WALL BLOCKING 1 1 1 -PROP•A VENT BETWEEN RAFTERS 8.BALLOON FRAME GABLE END WALLS ■ ■ ■ > -WIND WASH BARRIER BETWEEN RAFTERS TYP.1/2" .BD.ON �y -ALUMINUM DRIP EDGE 1 x 3 S W" MULTI LVL HEADT U L TOP OF PLATE 1- LE TOP OF PLATE O z 'Z uj Q LU Q UNR M K� El , KITCHEN DINING ¢ N L FIRST FLOOR FIRST FLOOR r SUBFLOOR SUBFLOOR-GLUED 6 NAILED SUBFLOOR W -- 2x10's@18"o.c. L 2x109®18"o.¢ MUM 2x10's 18'ox, P.T.2 x B SILL W/SEALER /'� R30 BATT INSUALTION R30 BATT INSUALTION 3-1 3/4"x B 1/4"LVL GIRT W �J V N 8-CONCRETE WALLS W/(2)94HORIZONTAL FULL M Z (o co FULL BARS AT CONCRETE F OF FOOTINGS 2 4KEY' S BASEMENT � SCALE 5 BASEMENT co"°BETE FOOTINGS,2 x 4 KEY INSTALL(3)A�5 BARS IN FOOTING TYPICAL 3 1/I DL4. ' STEEL LALLY COLUMN 1/4" = 11-011 i CONCRETE SLAB W/ APPLY BELOW GRACE DOPING 10 MIL POLY UNDER DATE 10 MIL POLY UNDER • 95%SOIL COMPACTION 6 6/27/2019 REQUIRED L_ („_--;-TYPICAL 38-x Nr ALTERNATE: CONCRETE FOOTING TYR 10•CONCRETE FOUNDATION WALLS W/10"X 24•CONCRETE NOTE:DROP TOP OF NEW FOUNDATION FOOTINW(2)04 HORIZ TO ONTAL TALOW BARSGRADE TO MATCH NEWLOOR,(OORW/THE SECTION KITCHEN/DINING A� �S ECTI O N @ SUN ROOM TOP a BOTTOM OF WALL SAT FXREQU REDBFLOOR.(VERIFY IN FIELD A6 A6 - 97--EXISTING CONTOUR / BENCHMARK SET TEL./ELEC.,, PA VED \ x 100.98 EXISTING SPOT GRADE COMM. NAIL & CAP o L PROPOSED SEPTIC TANK � QUIET WAY W EXISTING WATER SERVICE 9� O"9 0 \ / EL. 31.17 HYDRANT 31'4 ,a 10' WIDE ° 1 TEST PIT 2 COMPARTMENT TANK o� c, D. 1000/500 GALLON CAPACITIES / LOT 3 __��__ o BENCHMARK r I COMM. a QUIET NIF A LEGEND Y. LLC 32.8 H 2.3 CB/DH FOUND N39'30'40 E . LOCUS ce/DH I FOUND �P 193.15' j :,,\ X ----� I Q W :a C4 LOCUS MAP I FUTURE 1 3 �rl NOT TO SCALE FUTUREJ / (WORKSHOP/ GARAGE/ BEDROOM 1 ABOVE I a Qc,`° GENERAL NOTES: DECK I I O / 1 ABOVE I I FUTURE SEWER a 3 1 i -� i CONNECTION ,4 �-32 -- - _ A a. .� - -�'� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �C�i L j I x 32.6 I FENCED t e� BOARD OF HEALTH AND THE DESIGN ENGINEER. Z V 3 I 32.4 33.6 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS -ci-�- . I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE � ~ I I LOCAL RULES AND REGULATIONS. CD /O � GARDEN O s� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 31.2 2 r� /EX/ST/NG 33.7 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 2 Z �/_ HOUSE #32 ov DESIGN ENGINEER. 4h o z F.F. 34.14x m 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING CA V N m 31,4 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 0 �, �/V .3 _ � ENGINEER BEFORE CONSTRUCTION CONTINUES. 0fliCR TP-4 �2 �� 32.3 RINE PORCE Exisr. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). J PA TIO F 32.6 ; 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE 0 r-- r-� PROPOSED ADDITIONS THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ITT -3' t� `•;'1 / PLOT PLAN FOR PROPOSED HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �i j �1¢ j. 0 33.1 x 33.0 ADDITION TO BE FILED SEPARATELY cn 7. WATER SUPPLIED BY TOWN WATER SERVICE. 30.7 v Na INta En I 1� O I � BLOCK WALL 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. i IT -2 la: in ry (remove) 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 50 __ c:..ti':.:• J� `\ c o �! AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ,68' 12.8-I 33.2 LOST I ► o DIRECTED BY THE APPROVING AUTHORITIES. j Alt FENCE 1 / 7 TP-1 "" x e'�� r EXISTING SEPTIC TANK 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY / I %33,9 TO BE PUMPED, RUPTURED, THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I SHED FILLED W/SAND & ABANDONED CONSTRUCTION. 33.8/ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS EXISTING LEACH PIT IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND / A D PUMPED, FILLED WITH REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).SAND & ABANDONED I 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 00 / ��� OF i(fgs 9� 13• SITE PLAN IS TO BE FOR ADDITION USED FOR TO BE SUBMITTED DYSTEM PURPOSES ONLY. SEPARATELY PARCEL 98 o PETER T. ✓ 39,994f S.F. CJ. M CIVI L 0 E ILE `� PARCEL ID: 208-098 I 1. No. 35109 CB/DH I � Ec�s1 `° PROPOSED SEPTIC SYSTEM UPGRADE PLAN 1. FOUND I x35.3 CENTERVILLE, MA 18s.s7 32 QUIET WAY, N o 1 S48'24'52"W 36.0 Prepared for: COTUIT BAY DESIGN, 43 Brewster Road, Mashpee, MA 02649 �T7 REBAR 35.3 I OWNER OF RECORD SCALE Engineering by: E DRAWN JOB. NO. FOUND SCHULTZ, DOUGLAS B & LAURA J Engineering Works, Inc. 1"=30' P.T.M. 174-19 PLAN REVISION 4/21/20 23250 SW WUNDERLI CANYON ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PIPE INVERTS AT HOUSE AND TANK SHERWOOD, OR 97140 (508) 477-5313 6/26/19 P.T.M. 1 of 2 J SEPTIC TANK NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:29.0 INSTALL R15ERS & COVERS OVER INLET FOR A DISTANCE OF 15' AROUND THE AND SET TO 6" OF FINISH GRADE. PROPOSED D-80X PERIMETER OF THE S.A.S. PROVIDE ACCESS TO GRADE OVER OUTLET COVER PROPOSED S.A.S. ' INSTALL WATERTIGHT RISER & PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" F.F.=34.14t COVER SET TO 6" OF GRADE OF FINISH GRADE FOR INSPECTION PURPOSES F.G. EL.=32.3t F.G. EL.=32.0f F.G. EL.=32.3f F.G. EL.=32.3t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 30' '• _ O S=1% (MIN.) S=1%3(MIN.) S=1% (MIN.) �Exi. T/NG 4"SCH40 PVC 6' 4'SCH40 PVC 4"SCH40 PVC HOUSE #J2 10•"I 10" LLLs• aaa�aaa 1���� F.F. .34.14� 1a" 14" ? 2' EFF. aaMaaaaa ry INV.=29.50 46" LIQ. DEPTH h. �• LEVEL SAS INV.=28.80 PROPOSED INV.=28.63 4' 4.8' 4' °� BAFFLE BAFFLE EFFECTIVE WIDTH = 12.8' 62 4' 0 R/N E PORCH INV.=29.25 �O INV.=28.50 H-20 RATED 2-500 GALLON LEACHING CHAMBERS PROPOSED 1500 GALLON (H-10) SEPTIC TANK 1 rn 1 cj � (2 COMPARTMENTS) SURROUNDED WITH STONE AS SHOWN 1 N COMPARTMENT NO. 1 - 1000 GALLON STORAGE COMPARTMENT NO. 2 - 500 GALLON STORAGE H-20 RATED `�I a 1 TOP CONC. ELEV.=29.6t A o PROVIDE NEW 4" SEWER OUTLETS: BREAKOUT ELEV.=29.00 =a_ 1 AT HOUSE, INV.=29.80 INV. ELEV.=28.50 ®aaa I-t2.8!-I eases eases ease eases BOTTOM ELEV.=26.50 NOTES: 4' 2 x 8.5'=17' 4' 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25' 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE PERVIOUS MATERIAL INVERTS, PRIOR TO INSTALLATION. 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE BOTT. OF TP-3, EL.=21.3 - TO GRADE ON A MECHANICALLY COMPACTED 6" CRUSHED 3/4" TO 1-1/2" DOUBLE STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). WASHED STONE rEal ® ® ®®®3) INSTALL INLET & OUTLET TEES AS REQUIRED. ®®®®®®®® 37" 4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON E3 Ea Ea E3 E3 Ea Ea Ea Ea E3 3" LAYER OF 1/8" TO 1/2" N > a Ea OUTLET TEE AND REPLACE IF NECESSARY. SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE ? (OR APPROVED FILTER FABRIC) DESIGN CRITERIA SOIL LOG 102 NUMBER OF BEDROOMS: 3 EXISTING PER AS-BUILT RECORD DATE: MAY 2, 2019 (REF#TPT-19-15) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE,PE(SE#1542) 2 PROPOSED IN REMODELED HOUSE WITNESS: DAVID STANTON R.S. HEALTH AGENT 20" OIA. COVER + 1 IN FUTURE BEDROOM FORA Dth TP-2 e Elev. TP=3 De th Elev. TP-4 Deth TOTAL OF 3 BEDROOMS Elev. TP- 1 Depth Elev. _� _� _� 4" KNOCKOUT / 4" KNOCKOUT 58" SOIL TEXTURAL CLASS: CLASS 1 32.4 0" 32.3 0" 32.1 A 0" 31.8 A 0" DESIGN PERCOLATION RATE: <2 MIN/IN SANDY LOAM SANDY LOAM SANDY LOAM SANDY LOAM DAILY FLOW: 330 GPD 10YR 4/2 10YR 4/2 10YR 4/2 10YR 4/2 DESIGN FLOW: 330 GPD 31.7 8" 31.6 8" 31.3 10" 31.0 10" 4" KNOCKOUT GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM SANDY LOAM SANDY LOAM 1OYR 5/4 10YR 5/4 10YR 5/4 10YR 5/4 500 GALLON CAPACITY. H-20 LOADING PROPOSED SEPTIC TANK: 1500 GALLON-2 COMPARTMENT 29.4 36" 28.5 46" 29,4 32" 29.0 34" COMPARTMENT NO. 1 - 1000 GALLON STORAGE C C PERC G C CHAMBERS COMPARTMENT NO. 2 - 500 GALLON STORAGE PERC " PERC PROPOSED DISTRIBUTION BOX: 5 OUTLETS MINIMUM 44"/62" LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 32 QUIET WAY, CENTERVILLE, MA M-C SAND M-C SAND M-C SAND M-C SAND for: COTUIT BAY DESIGN,ared SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 2.5Y 6/6 2.5Y 6/6 Prepared 43 Brewster Road, Mashpee, MA 02649 SIDEWALL AREA: 2(12.8' + 25') x 2 = 151.2 SF Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: 12.8' x 25' = 320.0 SF 2.5Y 6/6 N.T.S. P.T.M. 174-19 Engineering Works, Inc. TOTAL AREA:..............................................................471.2 SF 21.4 132" 21.3 132" 21.6 126 21.3 126" 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER OBSERVED PERC RATE 2 MIN/IN. "C" HORIZON (508) 477-5313 6/26/19 P.T.M. 2 of 2