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0271 SKUNKNET ROAD - Health
271 Skunknet Road, Centerville TOWN OF BARNSTABLE LOCATION '/ rj�Gio�/� C�:L �� SEWAGE# e3of VILLAGE.� j ��,t� ASSESSOR'S MAP&PARCEL 7/- a Q3A�_ INSTALLER'S NAME&PHONE NO.Z • A , P fo,,X3,AJ :E ,X SEPTIC TANK CAPACITY y�, LEACHING FACILITY. (type) (size) NO.OF BEDROOMS CSC,' 3 C, � OWNER Met,ko,,l PERMIT DATE: 10 . l 0^ I COMPLIANCE DATE: /Q -61b—I ct Separation Distance Between the: .' to bf,�C C.J— tu,4 F Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r, 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 Aw- i thor-1.7 Oc7t'—le"C f n ,, p " No. /-[J �� � �Q� Fee 160— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rnfltation for Misposal 6pstrm Constl'urtion Vermit Application for a Permit to Construct( ) Repair(•,<Upgrade( ) Abandon( ) []Complete System individual Components Location Addrgs or Lot No. 7/ SkW 1CN�'f�f- 1�i Owner's Name,Address,and Tel.No. As�sessorrss Maplarrel 171 a, oLNeelyw Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1),A .c� Nkasc" Type of Building: Dwelling No.of Bedrooms 3 Lot Size 17,15-7 sq.ft. Garbage Grinder( ) Other Type of Building ffni ,41c� 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3� , gpd Design flow provided 1f57S'_ gpd Plan Date J_ �IO M Number of sheets ` Revision Date Title Size of Septic Tank � /X f)h' 19 ( 16 dd r'-t1111 Type of S.A.S. ('4b ffi S Description of Soil Nature of Repairs or Alterations(Answer when applicable) T 3ct 1 CK & Cinrdy� S w jA N` stcx,)f— a S s� ) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of -- Compliance has been issued by this Board of Health. Date Application Approved by Date o 0 Application Disapproved by ' Date for the following reasons Permit No. (�" 4 Date Issued ° M c 0 U _IT.: No. 2 G/ — f' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppIitation for Missposal 6pstrm Construrtion 3orrrnit Application for a Permit to Construct( ) Repair(01 Upgrade( ) Abandon( ) ❑Complete System ,Individual Components c Location Address or Lot No. a 7/ 5 k oo lC r�c-t+ —1�V Owner's Name,Address,and Tel.No. (� ai-�r V 1 P kssgssor s Map/Parcel 171 D Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. IDA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building & r_„t}��� No.of Persons Showers( ) Cafeteria( ) S Other Fixtures r Design Flow(min.//required) '12 "� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ' Size of Septic Tank Cy j5/-j1V f /()dd Type.of S.A.S. r : Description of Soil - Nature o- , f-Repairs or Alterations(Answer when applicable) 1�+n G ��j°,1) r Y � r r, �t't� r4fLtS LO 1�1 u' s+cr 11P ce 5 C-6CAA-) /�1A ,f1 C.,1) Date last inspected: Agreement: ". t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in .r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i Sig Date /O /O Application Approved by Date Application Disapproved by Date for the following reasons Permit No.— 3 a(� 3a Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( jr-'Upgraded( ) Abandoned(4)by7,A,T3faLh,)"CPi at a`f� 'S��taN�i .� l / �� a* has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. u( /'3e dated r,� � r Installer e ��,[ J� Designer � 4<A,6� #bedrooms Approved design flow �1? gpd The issuance of this permit 11 not be construed as a guarantee that the system wilL ctio as designed. Date 101, v` Inspector �1 No. Fee 16o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ' Zisposal 6pstem onstrurtion permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 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:Construct n m st be completed within three years of the date of this permit. Date U t'o Approved by { t11,✓ c l hDsf'as F, ;il Qa Wroeftbr flulb lie yyp J f��Z'J" T�r�d fl inns� tli: -6h 17,i� v1141* "o;," Somur r y Als'estor�`%A)InipR'Ar • �l1rs���fi�I� l�n rs��'�r�i�i��s:i�r�;F"�+s��: I Lao Oft /0 --1 -fti f Iooj` Q �0 M -.� .J;I' ������� s�-i�s; d,�-����� � :���,�us�r;r�cc���i � �[,,��, sr�5�!lso����s���s�sr�l l- ��•�t�l�lir��.� ° •� s al oOft 66Z(11�� orrty P wisia, ` r CF. M i, F'r, s s �r NI +, A �, 5} K u I`��iM'1 ie a lttl 1�11 to i1 rl�Suit. ,3� 1(vo M '��is n or Cg�u .- �it r � i -r fo.fall omu< -5 F OATD a ELY + • 'L �t i Fitz THE COMMONWEALTH OF MASSACHUSETTS `� BOARD OF HEALTH �.. .. ..............OF......�1t-1�� Y-1.-V.-ram. ...................... ,t ppliratiou for Disposal Ularks Tonstrurtion Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System t: T .�. �.. .�� -1�� ... ......... ./� .1 = .................... »... .... Lo�ti />�d es ... ................ r r Lot No.......................... ........_.....U •. t �� 1 y ` Owner .Address w 1 • = ----------------•••--......•.. -••-•-•••---------••...... Installer Address �^�"'� �� i Type of Building Size Lot............................Sq. f ..� Dwelling—No. of Bedrooms...............::..........................H�lExpansion Attic ( ) Garbage Grinder , A4 Other—Type of Building No of persons. Showers a yP g P ( ) — Cafeteria ( ) QOther fixtures .. .... b� '-•..................................................................... ........ W Design Flow.................j_ .0.. gallons per peer(yiay. Total d� flow......._... .....--....._. 11os. i� Septic Tank—Liquid capacity. gallons Length. ....�l..... Width . ...... Diameter................ Depth_..._.l Disposal Trench—No..................... Width..... ............. Total Length............ Total leaching area... .......... sq. ft. 3 Seepage Pit No....0..1------..... Diameter.......T Depth below inlet...- Total leaching area.�.�.l.�.sq. ft. Z Other Distribution box ) Dosing tank 0 -4 Percolation Test Results Performed by...._.f.,_. ,�;r. ...l.� .... Date.....lQ..z--pj)t.!t_�?"r .. Test Pit No. I................minutes per inch Depth of Test Pit...1.1.�7. ...... Depth to ground water.... .. f=. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w •---... .--- --... Vo Description of Soil................!-Cd1 .... ...... - - .. ... OVC.. 1 ..... ..Znl:.. ......................................---------•---------•----- ..._... ----------.................. ..- --.._ . W ----------------------------------------------------- ----•- -----...------------.._...... �:`. .[.�0 :� _.� :._.�.. VNature of Repairs or Alterations—Answer when applicable.............................................................................0.........._...... •----•-•--.......--•--------•--....-•------•------•------.....-•-•-•------------------------------------------------------------------------•-•......................................................... Agreement: The undersigned agrees to install the aforedescribed Indi idual Sewage Disposal System in accordance with the provisions of LITLL 5 of the State Sanitary —The idersigned further agrees not to place the system in operation until a Certificate of Compliance has e o d of health. Signe .............................................. /f......... ... (�N ate Application Approved By.. ...�.............................•-- - �.� �0 s S.......... Date Application Disapproved for the following reasons: ............................................................................................. ..... ..............................................................................................................................-...................................•.................................... Date Permit No................... 10,/ .._ Issued......................................... Date lira ate i. /) , 1� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.. TO.. �.�...........OF...... -�:(C��"�'�-r�.�::�-: ................ Appliratinnafor Disposal Works Tonstrudion flrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: J �= Location A ddres���� !�� / �Cor Lot No. t ..... - ( (- .. --•............. .........7 !! ......--•---.......................-•- ,�- - -- a . ........ W ...................................... Owner / •- Address / Installer Address ��� Type of Building . ..................... Lot.]" —No. Attic ( ) Garbage Grinder Other—Type T e of Building ............................ Showers Gv YP g ...................... No. of persons...... P ( ) — Cafeteria a' Other fixtures ..................I a V"t ......----•-...........A..........................�..�.................................. Design Flow.................. . . ... gallons per person per relay. Total daily(flow............._._. ......._....._gallons. Septic Tank—Liquid capacity]CADgallons Length.(_ .. Width.�'l,r .... Diameter.... Deth EI.O. .. x Disposal Trench—No..................... Width................. Total Length.................... Total leaching area-.*"...* ...sq. ft. 3 Other Distribution box �� Dosing tank P� !r ;, et...'.� al.......... Total leaching area.����.I..�sq. ft. Seepage Pit No.......A._..__ Z ( ) -i g-- ( ) . 1 Diameter �De_th below inlet ••� ••...... .:..... . ...- ......y'...; / Percolation Test Results Performed by...... Date.._.... ..........::............ Test Pit No. I................minutes per inch Depth of Test Pit.°.1.. �.�?�.... Depth to ground water....g fl' .�:--.. G,. Test Pit No. 2................minutes per inch Depth of Test Pit........... ..... Depth to ground water........................ a+ rP :....r!........ Description of soil...J�._...:_....WAM �( 1 �)C4 � .... ` F!rf`r9 ••\nJ� kr)C�L.. . O v...- r........... .... P" VNature 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 TITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Aden issued,by theS and of health. ` �..---- Signed/� . / ' '�'.......... • ........ f,' /�_.S �.�.-�-�'� w........ ... �.. Application A roved B =�'�*'� n' A f Date r Date Application Disapproved for the following reasons:............................................................................................................ _.. ..-•-•---•---••...........................•-••--••---•-------.....-•----......._......----.....----...........................--•-•---...-•-•----..................... ............. . .. - toles Permit No........... Issued__......_...........---..........._.......Dau...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrtifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )or Repaired ( ) ). / ICP`/ I /k �allei' at.......-•---- -- ..•-- �---•-----.-----�ll/`-----�--------- ' ..........................•'.................................................................. has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code pas described in the application for Disposal Works Construction Permit No`=� .......... .................. THE dated........ .j.� .�.`3 ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector - ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF AHEALT�H OF.......::.::.�%�'/. /���'........................................ a� ' Disposal Forks Tunstrurtiun Frrntit Permission is hereby granted ......--.............. ;............... ...... to Construct ( )nor Repair (,�) an Individual Sewage Disposal ystem la ` e - 1at No...................... ..................1..........`;.........,..............1......... ....... -..._...... ... .................. .......Street as shown on the application for Disposal Works Construction Permit No�:S_:J.0_`1 Dated...... .LA, c�................................ _ Y Board of Health DATE.............� .................................... t Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information 1. Inspector: �I �1 I Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I 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. 'e inspection was performed based on my training and experience in the proper function and majntenanb'&of oh--.site sewage.disposal systems. I am a DEP approved system inspector pursuant to Pection 4j5.340 of Title 5 (310 CMR 15.000).The system: , ® Passes ,> ❑ Conditionally Passes ❑ Fig z . ❑ Needs Further Evaluation by the Local Approving Authority z- ., t) — r aN M 2-17-09 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. z1 0 1 t5insp official document-03/08 Title 5 Official Inspection Form:S#surface 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 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 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. 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 t5insp official document•03108 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 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town State Zip Code Date of Inspection 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. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 r f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required b the Board of Health (cont.): Y ( ) ❑ 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 '/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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4.1271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system 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)] t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 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 Number of current residents: 0 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)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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): t5insp official document-03/08 - 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 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town 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) 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): Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12" 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" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 0 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 16" How were dimensions determined? Tape t5insp official document•03108 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every 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.): Tank is in good condition with concrete baffles in place. 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): t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town 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: i ® leaching chambers number: Z Flo-diffusers ❑ 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 field in good working order with no sign of back up in stone surrounding flo's. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town 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.): t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal SystLm•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . �M 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 every page. City/Town 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. (l �u ac K r4�}-r- roL � ,.Jre _ - �fCrl t5insp official document-03/08 Title 5 Official Inspection Form: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 271 Skunknet Rd Property Address Fannie Mae Owner Owner's Name information is required for Centerville MA 02632 2-17-09 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 high ground water: 10, 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: Original design plans show groundwater at 10'. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 y <7 Commonwealth of Massachusetts l0��9 &1 Executive Office of Environmental Affairs ti�9tisT 9y] o Department of z �� Environmental Protection Wllllam F.Weld Trudy Coxe Go►.mor 8eereury Argeo Paul Celluccl David B.Struhs U.Governor Commltnbner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 271 Skunknet Rd, Centerville, MA Address of Owner. Dorothy & Date of Inspection: �/ `��" g -7 (If different) Richard N i e m i Name of Inspector. W.E. Robinson SR 61 Trayer Rd. Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 Canton, MA 02021 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: E Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: AI SYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indite yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292.5500 �i Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropetyAddre= 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection r:./_) 1 BI SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipes). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) THER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) propertyAddrem. 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection: vy_/1-'Q q D) YSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for his determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARD SYSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public ealth and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The o or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requireme to of 314 CMR.5.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST propertyAddrem 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection: Check if the following have been done: ping information was requested of the owner,occupant,and Board of Health. _04one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Le built plans have been obtained and examined. Note if they are not available with N/A. _LTfe facility or dwelling was inspected for signs of sewage back-up. _L4�e system does not receive non-sanitary or industrial waste flow ,-(,Tl�e site was inspected for signs of breakout. system components, excluding the Soil Absorption System, have been located on the site. a IIe septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _v The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection FLOW CONDITIONS RESIDENTIAL- Design flow:33® gallons Number of bedrooms: 3 Number of current residents-j---'-/ Garbage grinder(,yes or no):!f'0 Laundry connected to system(yes or no). 5 Seasonal use(yes or no):/t— 0 Water meter readings,if available: 1995 - 82 , 000 gals. Last date of occupancy �� '7 COMMERCIALANDUSTRIAI.: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Al//a System pumped as part of inspection: (yes or no)A- 6 If yes,°volume pumped: gallons Reason for pumping: TYPE OIfSTEM i./Septic tank/distrilution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: v S ys ® "Y Sewage odors detected when arriving at the site: (yes or no)14,0 (revised 11/03/95) 6 ,a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) propertyAddrsw 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection: SEPTIC TANK:_ (locate on site plan) t ► Depth below grade: Material of construction:�acrete_metal_FIZP_other(explain) ` Dimensions: Sludge depth: /® 6 Distance from top of sludge to bottom of outlet tee or baffle: ll Scum thickness: K—16 ' L Distance from top of scum to top of outlet tee or baffle: i Distance from bottom of scum to bottom of outlet tee or baffle: G Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) e 6 42/a c ` fit,L`�Q G E TRAP:_ (locate site plan) Depth bel w grade: Material construction:_concrete_metal_FRP—other(explain) Dimensio Scum • 5+om top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comments. (recommen tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence o leakage,etc.) (revised 11/03/95) 6 • f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop.AyAddreae: 271 Skunknet Rd, Centerville, MA Owner. Dorothy & Richard Niemi Date of Inspection: j 7 TI OR HOLDING TANK:_ (locate on site plan) Depth grade: Material construction:_concrete_metal_FRP_other(e:plain) - Dimensio Capacity: ons Design ow: pUona/day Alarm 1 1: Commen (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOM (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUM CHAMBER_ (locate on site plan) Pumps working order(yes or no) Comme (note co tion of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 ` r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 271 Skunknet Rd, Centerville, MA Owner. Dorothry & Richard Niemi Date of Inspection: 1/-//-cs-7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible;excavation not required,but may approximated PProximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number:_ leaching chambers,number: :2-. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (aQte�condition of ,il, eignaf hydraulic failure, level of pendingyondition o6f v t on,etc.) S I d'.- 15 12 POOLS:_ ( to or site plan) N r and configuration: Depth top of liquid to inlet invert: Depth f solids layer. Depth f scum layer: D' no of cesspool: Mate ' of construction: Tactics ' n of groundwater: inflow(cesspool must be pumped as part of inspection) Commen : (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate o site plan) Materiala of nstruction• Dimensions: Depth of so Comments:(n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) propertyAddrese; 271 Skunknet Rd, Centerville.,. MA Owner. Dorothy & Richard Niemi Date of Inspection 41 SICMH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I � Lf N � s gl --� 9-3 DEPTH TO GROUNDWATER Depth to groundwater: /U a feet �� method of determination or approximation: y (revised 11/03/95) 9 TOWN OF B S'TABL.E ,OCA'I<ION kneT >. SMAGE # QLAGE 4 e,4� Pr iJ it e- ASSESSOR's "& LOT NSTALI.ER'S NAibfE&PHONE NO. i6MC TANK CAPACITY I � .EACHNG FACTt..M: (type) F/y S (size) o� 40.OF'BHDROOMs 3 J UI7..P3M OR OWMR 'E IS'DA7E,:...._.....,.....W.—.--.-,-Ct)MPL,IANC'E DATE iepareition Distance Between ft: vlaximum Adjusted Groundwater fable to the Bottom of Leaching Facility Eeket }rivate Water Supply Well and Leaching Facility Of any wills exist on site or within 200 feet of leaching faclUty) te8 ;Age of Wetland and 1Leacigng Facility(if any wet ds exist wltWn 300 feet of leaching fuciliry Feet �urnishcd by /� 1 n J 111 ��' �� ilV•f -�- �' a -C- 3�,Y', o c -O Y'' 1-l'-3� _F 3y6" 4-F- A-F- 3�'6 f 13 SECTION SEWAGE - - F- r.l SEPTIC TANK— .4 1 —'D"BOX i LEACH. rP4E=j TOP OF ON STD- ♦�O (MSLIi ..2..OF 118TO Ph" WASHED STONE #t Go r/a—�, i A,� 1 IN• OUT IN' OUT. , IN �•�,'22 SEIC PT 5 %�J TANK _ fJ.7� c3:90 ELEV. _ _ ELEV. ELEV. ELEV. - r 'ELEV. )ELEV. / 1 $ '/ 9.0 WASHED STONE • / /I G U T I(o ST HOLE LOG "F' � .�089 �c.�V. TE _ a, q Vo r TEST BY 1 /28 8 S WITNESS:.. ;DESIGN BED.ROOM HOUSE TEST DATE �— -7 T.H: ar 1 T.H.-+� 2 ELEV.�Xo 4 ELEV. Gel DIS OSER DISPOSER' ':. a PERC RATE MIN/IN. FLOW RATE 313 d(GAL./PAY) SEPTIC TANK 3 3 0 . (/'S= 07 REQ'D SEPTIC TANK SIZE z Wl :LEACH'FAC(LITY a G. =/ .8 377,n fl E nJ (o SlD WALL l � , BOTTOM l �ZfT=.t�D�3 /,o) .. -'� G/D. TOTAL 4, 3. USE: O LEACHING ` /T ( �p WATER ENCOUNTERED , I`,r (UNLESS OTHERWISE NOTED) NOTES L o 7 1.DATUM(MSL) TAKEN FROM 5,A 11J0 W l— '" QUADRANGLE.MAP 2:MUNICIPAL WATER AVAILABLE ft .:PIPE PITCH:IM"PER FOOT \t� OF 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- 74—/ -44 y_� S.MIN..GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. �� ARNE H. yG I iE-- 4% 20 / 6:PIPE JOINTS SHALL BE MADE WATERTIGHT .r � _ 7:CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. O'"','"' r' S I�� /� _ SITE' AN STATE ENVIRONMENTAL CODE TITLE S 8. TV-i�S �1►Jt.,`� FOL i-"Pp7t7'�c.7 ►.,o�c,� o..��-r a._.a �+•�o���.-� C� CI.. � J��IC= l D� OF Locus: Ln?-1 S SOU lV)CT�FT �'0���• — ti.10T �E USED O.L. "•�CG�•=.Z�`'� 1...•`tG -'ST��•s�1G-. '. F ASS ' RNE NGINEER -- _. . LA - REF: 0 k 4Uz PAC�F .�7 �' �Z" a down cape-ea�ifteer1n� :t, yf ' PREPARED FOR: LL— CIVIL ENGINEERS SO`' - - --- -- _ .._ _. ._... ._..,-- ATE _.. -.-._, ._ __._. _... LAND SURVEYORS , _y'B�OAAA�R`D/OF HEALTH - ._, ._.. .___.__. . REG.. �� _OR• ---. ... _ ,a � v _.. (EXISTING)------------- ��`��� �MA SCALE �� CONTOURS (PROPOSED)—0—�-4�- APPROVED D 42. ADDITION EXISTING .00 a A#fin Ro©m. TL s, DINING PC I TGI- EN 2446 v 1 d QOOR 3 7 8c�e►A peas — S,U D ROOM 2 7�-2 I1411 y 2 c XfO c�a �\.e S�a�a� o DpaR. ELE%. TEX . 2-0 FIRE RATEED D a \� to G ! IV �ce 11 ------ V o0 ��"c5 i�e Ctosek. OL rug„ems 0r -n, J bAsemw// /W110om c^n GU'r (Co,nv,�,, O"e °`' C r� F e R tl i j 1 e M AP3 , � � I PICA P-� I � r RIDGE VENT 2x12. RIDGE BOARD - ASPHALT SHINGLES E/S" CDX 5I-IEATHING 12 G' 1 t2 112 3/4" PLYWOOD CONT. VENTING DRIP EDGE` 16" I-JOIST'9 0 16" O.G. L tx8 FASCIA W SECOND MEMBER L 6/6" FIRE RATED. ALUMINUM GUTTERS AND DOWN SPOUTS � GYP. BOARD 0 FRIEZE BOARD AND MOULDINGS L� BETWEEN GARAGE MATCH EXISTING --i4ND LIVING SPACE 2x6sN EXT. STUDS 16" O.C. L`- U D ROOI"( D f I�l.l NG 1/2 PLYWOOD SHEATHING �, TYVEK WRAP (OR EQUAL) L CEDAR CLAPBOARDS IN FRONT GARAGE W.C. SHINGLES L. SIDE & REAR L-7 Q MATCH EXISTING " GONG. SLAB L-i T FLOOR SYSTEM Fi lsT FLU , PITCH TO DOORS .A -C4MPAGT FILL - CRAWL SPACE 24 ?Roe GcA- d '-tops e p, Y O t e Nee+ A3 I J t. PA 24 4C, s�e�c�DP7 hey . . Ren}N�'e 25i