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0029 WARWICK WAY - Health
29 Warwick Way Centerville P A = 148 068 TOWN OF BARNSTABLE LOCATION o q WLDgI yaq SEWAGE#6�qX VILLAGE ASSESSOR'S MAP&PARCEL 14 W-ba INSTALLER'S.NAME&PHONE NO. � �YQCI6I1 11� 3�2D�a� SEPTIC TANK CAPACITY 6610,�. LEACHING FACILITY. (type) m41- �ize) NO.OF BEDROOMS-3 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 leac 'ng ility Feet FURNISHED BY AMC E0 Ab -IZ07 5 ,�, 10 g/co No.-� 0 Fee D� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes t , ftplication for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) ���� omplete System Individual Components Location Address or Lot No. wo rw f"f� wry j/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I q 0 9 l� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4 Type of Building: Dwelling No.of Bedrooms //e� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min. equi ed) b gpd Design flow provided 1`7(a 0 gpd Plan Date 3 1,9 20 Number of sheets Revision Date '— Title VhidikdJtvhlc SwL Size of Septic Tank Type of S.A.S. Vi/ _ �- Description of S 11 Nature of Repairs or Alterations(Answer when applicable) u 1/ gig) L 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 `f th viro ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar bf e th. Signe Date ` Application Approved by Date ZC) Application Disapproved by Date for the following reasons Permit No. Wlzo /® Date Issued No. / '" -OY Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/ PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for M sposaY *pstm Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) Complete System Q Individual Components Location Address or Lot No. ✓ (, CAL(+�' ( tti�t�. ( Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ; ) Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 11(:( i 4Ni i X Jl h,(141 10 :3 l2 6h Py-("iI V,f y )1,I w/j V1_ ! ��. �?; t�i/f t�1 -s s I Type of Building: ` -Dwelling No.of Bedrooms Lot Size 9 Ai jqj» sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) y?2,(`, gpd Design flow provided �,{ (ter gpd Plan Date .Z� ( f �/,�n Number of sheets � Revision Date --- Title � Inl, 'ti� 1, i. (u��{to i ki ys4i., kalid in " J, t ol'1,41i! 1( 11/1 Size of Septic Tank (,! I?i (,S: U Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) f1 ;( 141 �): d �; -1�l) !14_(. ( j, ,I )1A 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 BP oardd f{!ea lth. ! 1� Si ed / ". �' -�' ! ` _ - Date i bra",' T j Application Approved by [� , ,,G-^•"""" `1 Date t Application Disapproved by V Date for the following reasons Permit No. 0 Date Issued 01 - - - - - V I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded O Abandoned( )by ! l at ,1(d�` n I 1 { /`i! has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.;7(V�' —/Od dated !p 7'A7_,,, Installer ;di i i t'l L, y' r I tIl111lain Designer V1(I i YI f t��1'i`(I #bedrooms , - Approve,deslgri flb�w y v "�� k gpd, The issuance of this permit shall not be construed as a guarantee that the system will fun�rc'"tion as signed. �, } Date l � / 2 Inspector I . _ . _. - 7. . . . . ._ No. A Z a "' 0� _ Fee i� G THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS -Disposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( V) Abandon( ) System located at �1 1/100 VIA)i #Q 0U 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 1 �� � Approved br .r,... Town of Barnstable �E1NE T °o Regulatory Services Richard V. Scali,Interim Director R BARNSTABLE, 9oaA 16 9. `0� PubIie Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: -4 q Installer&Designer Certification Form 1 Z� � Sewage Permit# Assessor's Map\Parcel ? " o �Pl eG- �Ce✓1')ee Designer: c ;n�e�—:n� xtg1r c �►�C Installer: �Ul a V1 t� 1�,X Cc,_yc -''� u J Address: iZ W, Crtss-P- /c/ 9d Address: 39 &JO\ f2_-C— On e.ay (LKf�as issued a peimit to install a (date) (installer) septic system at_Z� u�� ��G �y ��n�= based on a design drawn by (address) i r)Qerr� bya r Les J I k C dated i t (designer) AO W-d t4�ti \C \ _LC I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component t of 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. I certify that the system referenced above was constructed in with the tenns of the RA approval letters (if applicable)OJA �N ►+�ssey PETER T. 1 Mc_taee ( aller's Signature) C13% NO 09 (Designer's Signature) (Affix Designe ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:'.septic"Designer Certification Form Rev 8-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting risers/covers as shown on the design plan. , , i , .... .......... i _ I xii`l �u CIO 'V V L .. , _ I ,1 i 2-3 ' • I CA 0 2S i I x _ i C6s , VIA. (SAO- vi - a Z-� i SOP N �a AS e ; Y EX 2 t i : — { 2 w _ z Lz SE a 1— , a , j r IS { t �j,� - i : F , _ _ : I . f { I ; f —...ice_•. jj\ fr , K4 1 10050 1 ► � a loo,ee c 4 • 0la9 w '��..�}r��e'rlf 10914 100,03 ,01 tE L 1' 39 Hogs 29 ,��i�-�R!,, ' AP C '' 48-�068 � 4 ' 3 142,,B:F,� 6-04 DECK r,, q8' ,37 'ip LAM � DEC �e�e�;,D ���� , aD x se,oe,.''',' 4ORO PDOG I ,, 1+' J` p , VENT % 9galls , P ✓0 / r7 S O O t`J. ,�'�d�I re/�. 97,11 K, ........ .„ :. 2711 ' /�90a7 �,' -- IP-2 3 ICJ C G K \ x R7" / Y 0•► r 97,54 ,,�9ae --�� g ENCHMA K SEi' S � sgg ,10 97,98 OUMDE' O R./bOTT STEP t,R+ x s+'+ ' �� EL,• 90.70 Aaaumed Datum 23 a Z S, •t 3 o4�tex sea EX/SriNG SEPTIC TANK a 3` /vow S 1 (TO REMAIN) TOP OF' ANK, EL,-95,66 INV.(OUT)-94,3Jf �R r '.�Led LYc eJt�»hn ev :L� � d h LI- So `L ' 4 e d r lot' ep 1.1- vL) vim. o� Lo/e, AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION ;�5 X?d SEWAGE# P-013 - VILLAGE 76 ASSESSOR'S MAP&PARCEL -aC,B INSTALLER'S NAME&PHONE NO.::�:X,,1,,k SEPTIC TANK CAPACITY 4&15&r-.5 LEACHING FACILITY:(type) 1 20 br=c),s4 (size) 6:2,5 NO.OF BEDROOMS 3 OWNER PERMIT DATE: i s s- 3 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__4Q,,� ,.f A CwT -3 S atop.a A _ is 'ro�a�-FioN �A-C IN 1V�-.22_ ENJ - 83 T3 l7 — I S AOOx �GSC ► ww5-2p Ae6�H�"`5 ?.0's G 2- 00 'E n1D t• 'u 4 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=148068&seq=2 4/2/2018 TOWN OF BARNSTABLE LOCATION e 2c/ SEWAGE# �2_0 13 a- / R 8 `JILLAGE L ASSESSOR'S MAP&PARCEL /ti8 -Q&e5 INSTALLER'S NAME&PHONE NO. �,�� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /G"'Xi!ao r/20 h,6dAtvo (size) 6Ws22-,,,.eA 6d2; NO.OF BEDROOMS 3 OWNER PERMIT DATE: -i 3 COMPLIANCE DATE: , — 2y—�� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Pe 4c 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 � �fi,,.J (?ov -31- lornp L p s is Fooado.k ioA 13 hC SG ENS - 63 14d\NS i.20 cam- 62 S���e 0 � r Aj T No. /� j �CJ� r "y c Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(✓,-,*U'pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2ki,q( r w i cV Owner's Name,Address,and Tel.No. LctergAk c. /It� Assessor's Map/Parcel j Ll 6 O C9 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. D��SIc�� c��a Lrsc Sog qoo�-vs-5 /=v���r�r�•..S (/�U<��5 Type of Building: Dwelling No.of Bedrooms �'� Lot Size �)y 2_ sq.ft. Garbage Grinder( ) Other Type of Building Li�, e� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3"30 gpd Design flow providedj(,4, S' gpd Plan Date 11� Number of sheets 2 Revision Date Title Size of Septic Tank P'I��,F.r, Type of S.A.S. 116%oc7.��\7sr�a' Description of Soil Nature of Repairs or Alterations(Answer when applicable) t n5}-c 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. S' ed ire Date 5 2 2 Application Approved by Date Application Disapproved Date for the following reasons Permit No.2©l3 l Bu Date Issued 51Z2kn3 .41 No.4 '(�(� Fee OC�UJ THE COMMONWEALTH Oil IMASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for -Misposal *pstpm Construction Permit Application for a Permit to Construct( ) •Repair(11,110upgrade( ) Abandon( ) ❑Complete System ❑Individual Components G 1 Location Address or Lot No. 2 VJc,r w c1� IZ Owner's Name,Address,and Tel.No. V Assessor's Map/Parcel 1,-(g - O O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J�)45�1v�OrJ 1.rY $O� `GI00-�/S5 v5 r �r ter,vs 61k)U()C$ Type of Building: Dwelling No.of Bedrooms Lot Size 2 3Lf �/Z sq.ft. Garbage Grinder( ) Other Type of Building rv5 �• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _.a-710 gpd Design flow provided 36 4-/. S- i gpd Plan Date S 12 1 1 Number of sheets I- Revision Date y,_ t Title Size of Septic Tank F yt 16{ fv Type of S.A.S. _1�techA v5 r,r f Pam!'1n Description of Soil Nature of Repairs or Alterations(Answer when applicable) w s�c�\` ty ta.0 C, 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. S' ed Date 5 2 2 Application Approved by Date Zvi Application Disapproved UL Date for the following reasons Permit No.e_70 1 W Date Issued 51zZ/a�'3 - =------------------------------------------------------------------------------------------------------------------------------------ TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance ° THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓) Upgraded( ) Abandoned( )by C at ct tic r w,c 1Z 3 ('Favt(Ow� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.70 1-5— (0 3 dated S Installer`l .bu��rS tG.,,,.t Designer [„r�,,�, �r t i)O V Ic 5 �r #bedrooms 'a Approved desgr�flow G4/, / gpd The'issuance off er/mii s all not be construed as a guarantee that the system�J'.1/fu`c ionnn,aaside/siiigned o ! f /J Date ' ,2 :'/ Inspector 1 !/r�(/ No.00 l—j °� �� -`� � Fee /0oo0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS q,TNsposa,bopstem (LonetrUction Permit Permission is hereby granted to Construct( ) Repair(11� Upgrade( ) Abandon( ) System located at 2 7 t.Jc-r w c�C C) 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 perm' . Date �'2 2 1�1 Approved by i Town 4f Barest-able ftaWery Servkes Thomas F. Geiler,Director PuiC Hem Dl�visaan `I'homas.McKm,Director 200 Main Street, Hyannis,MA 026.01 Office: 50&%2-4644 Fax: 508-790-6304 Date: 1 Sewage Permit#,ZO) 3 ) i`� Assessor'a Map/Parec! I� `� �O Inter der Certification Form Designer; , ? W o r nc , Installer: 0,pi , ( ,�. r.�,•t C _ Address: 1z�W, C� Address: 4 Cz 3� On -22 ` --'"-- -c was issued a permit to install a (date) (installer) septic system at based on a design drawn by ,t dress f v vu v�a�{,�., dated �-� ► (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank, Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any comgoncnt of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) wa led and the soils were found satisfactory. XH Of PETER T. ier's ignature) iV►cENlTEE CIVIL (Designer's Si gnature) (Affix Design ) PLFASERETURN TO RARNSTMUS. piruir.irrIMALTH D SION. )E ATE L CE WILL O BE IS IL B TH MIS jRUILILAM ARE MCErVED By THE BARNSTABIX P L HEAL O , T Y�►.ui g1o£6oe forroa♦deaigrlWce�i'Ifioetfon form.dpC Y y 1 1 1 A- signature ern ■ Complete items 1,2,and 3.Aiso OOmPIO r ❑Addressee item 4 ff Restricted Delivery is desired- X A INery ■ Print your name and address o�thou verse (Printedd Vr` � so that we can return the card Y ■ Attach this card to the back of the mailplece, �� Yes or on the front ff space permits, D.1 deliv rem differerR'_ . if YES, e elNery address Belo 0 1. Article Addressed to: 0 Mohamed H Elithy I 29 Warwick WaY 3• AceTYPe 02832 ' sM Centerville, MA E, nall rr+ Certiffed M for Merchandise o Registered 3 Retum Receipt CI Ir UMI Mail 13 C-O•�) ❑Yes4. Restricted Delivery?(F" 1010 D000 2850 7657 2. Article Number 70],2 1o2�ss-02 M 1640 transfer from service,abeQ Domestic Return Receipt Ps Form 3811,February 2UO4 i 9 UNITED STATEOROS 5;_ nog • Sender: Please print your name, address,^and ZIP+ 'Thih'is'boxl� Town of Barnstable I� ��o��.� Health Division . . MA• 2001v1ain Street Hyannis, MA.02601 i ��'�ruiL� �r�la. ��u.ii. ��i�ra'l��+ty��un � ���u �� rt,i�►� i i 4� c 1 Town of Barnstable Barnstable °F SHE 1p�y Regulatory Services Department ;edcaC; nARNSTAnLE.01 • Public Health Division �m T MASS. �A 1639. �m TF°MAC' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 7657 April 9, 2013 Mohamed.H Elithy and Hadeel Salman 29 Warwick Way Centerville, MA 02832 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 29 Warwick Way, Centerville, MA was last inspected on 3/28/2013 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • The system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\29 Warwick Way Cent Apr 2013.doc i j Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9793 traE T � o 4STAPI, PWl fl 1t y Logged In As: Parcel Detail »Tuesday,April 9 2013 Parcel Lookup Parcel Info Parcel ID 148-068 �I Develope LOT 39 �) Location r29 WARWICK WAY I Pri Frontage 1112 Sec Road Sec Frontage F--- Village IICENTERVILLE Fire District C-O-MM I Town sewer exists at this address j NO I Road Index 1784 � ' Asbuilt Septic Scan: Interactive 'If14 148068_1 Map ra 1 �— Owner Info OwnerFEELITHY, MOHAMED &SALMAN,�HADEELA� Co-Owner! Streetl 129 WARWICK WAY Street2 j I city FCENTERVILLE I State'MA zip 02632 country Land Info Acres j0.52 UseiSingle Fam MDL-01 � zoning RC — Nghbd0105 � Topography Level ( Road Paved Utilities Pu r,Gas,Septic - I Location Construction Info Building 1 of 1 Year 1984 Roof Gable/Hip ( Ext Wood Shingle Built Struct Wall Living 1520 _� Roof FAsph/F GIs/Cmp T AC None Area Cover Type - Bed WOK style Ranch Wal� Drywall J Rooms 13 BedroomsBath '�WDP I day 1. Model Residential I Floor Carpet Rooms 2 Full I P Grade Ave ge TYPe IHOt W to er I Rooms 15 ROomS TotalT) stories 1 Sto Neat(GaS Found Poured Conc. �I —ry Fuel ation Gross Area13756 Permit History http://issg12/intranet/propdata/ParcelDetail.aspx?ID=9793 4/9/2013 Department of Regulatory Se rvlces „ Public Health D><vison late. •h>}a' 200Mam Street,Hyanuis MA 02601JA ' U` i7ate,Scheduled 1 „�"� 1 _Time .. ,, Ae.Pd. Soil Suitability Assessment far Sewage Dsosal Performed.8r. SA I"Z Witnessed By. LOCATION GENERAL;INFORA!IATIIY1 Loeatiott Address. V°t kewl Address 2A w Gik.- do f.c Assessors Map/Parcel: 4 S _ ®(o , Engineer's Name i NEWGONSTRUCnON REPAIR Telephone# 5'0-T — 7 3-7 Land Use !ZC5,d2nw, J Slopes(96) Z"(- Surface Stones Dlstances:from: Open Water Body /J/^ ft Possible Wet Area —ft Drinking Water Well j �ft YJ10- Drainage Way ft Property Line U ft Other SKETCH:(Street name,dimensions of lot,exact locations of test-holes&pert tests,locate wetlands?n proximity to.holes) (9d( 2 i t tr.t Parent material(geologic) U�� s Depth t0 Bedrock, Depth to Groundwater. Standing Water in Hole:/J �.2 Weeping flom Pirpace Estimated Seasonal.High Groundwater r DETERMINATION FOR:SEASC1NAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___- in, Depth to soil mottles: ittr Depth-tn weeping from side of obs.hole: in, GtoundwaterAdJustment 1<. Index.Well.# Reading Date: Index Well level, Adj.Motor,.,q,,._ ,gc({`.Ot�ungwaier:.evxl,,,,� PERCOLATION TEST bate, .TIM- Observation Hole# l� o�``*' Time at 9" Depth of>Penc. @ L Time at 6" / �S Start Pre-soak.Time @ S d�is. Cs lime wi-&') End Pre-soak Lq ,¢erg U Rate Mindinah Site Suitability Assessment: Site Passed�l Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning.' Q:\S8PTIWERCFORM.DOC DEEP:OBSERVATYON HOLE I OG Depth from Soil Horizon Soil Texture. Soil Color_ Soil Other Surface(in.) (USDA) (Mansell) MottlIig (Structure,Stones;Boulders.' 0. A C6 (L DEEP OBSERVATION HOLE TOG Hole# v Deptli'from: Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Molding (Structure,Stones;Boulders SL 10 Z DEEP OBSERVATION HOLE LOG Hole* Depthtfrom Soil Horizon► Soil Texture Soil.-Color Soil Other Surface{in.) (USDA) (Munsell) Mottling (Structure,Stonea;Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth-.from Soil Horizon. Soil Texture Soil.Color Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stokes,Boulders. Conii tan I CI Flood Iristtcance"Rate'M ; Above S00 year flood'boundary" No Yes ., > V✓ithTn Soo 6kr boundary Na Within LOO year flood boundary No '` Yes Death of hFaturally Occurring Pervious<Materi�al DoesYaf least four feet of naturaliyoccurring pervious aterial:exist in all areas obsetwed througk out the area proposed for the soil absorption system? If note what:i the deptlr:of naturally occurring per tous.matarial? Cenhffi *tion date,'I have assed the°soil ev,"aluator examination a proved b)#the I certify that on _[ —(date�' P P, Depafinent of Environmental Protection and that the above analysis Was performed by me consistent with. the ieyutred'training expeitise-arid experience d"esenbed.in lO CMR 15:017: Signature Date 13 Q:�S$pTIG1EBRCPORM.DOC t , l TOWN car'�WSTABLE t,kGE— ON V�1 G�l����- DUI SEWAGE # aQ,�V��I�L� ASSESSOR'S MAP & LOT Iy )7 Y'06Y ER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) n� NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 . .� Ig ����- AI c � AA 2�� �� p o 1 �3�� � y'_ H b Bc �1'� I - Commonwealth of Massachusetts -U7Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 29 Warwick Way - Property Address Mohamed Elithy Owner Owner's Name information is required for every Centerville MA 02632 3-2i3-13 page. Cltyrrown State Zip Code Date of Inspection. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form- Important When A. General Information fi fing out forms ����� ZH OF M.q on the computer, � -.......-•, qc��, use only the tab 1. Inspector: 1 y� key to move your m cursor-do not I DAMES use the return James D.Sears SEA :y key. Name of Inspector Capewide Enterprises_,LLC %��_.�' o•'� Company Name ii��i,�F'�.. ...•�G `\``. 153 Commercial St. ri�unuNrSlp11�"``\ — Company Address Mashpee - - MA _ 02649 Cityfrown State Zip Code 608-477-8877 S1623 Telephone Number License Number B. Certification Q 1 certify that I have personally inspected the sewage disposal system at this add e s and thaw he information reported below is true, accurate and complete as of the time of the,inspection.Tpe inspection was performed based on my training and experience in the proper functi on and m Intenance-of ola' ite sewage disposal systems. 1 am a DEP approved system inspector pursuant to)Section-13.34A f �W Title 5 (310 CMR 15.000).The system: PIJ ❑ Passes ❑ Conditionally Passes ® Falls a; ❑ Needs Further Evaluation by the Local Approving Authority 9-1-azl� z 3-29-13 spector'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. d ii� I b 1U13 15irs•3J13 Title 5 frfaal Insp Fcrn:subsurface S" ge Disposal system•Page 1 of 17 , Mar 31 13 08:26p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is Centerville MA 02632 3-28-13 required for every page. Chyrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments. 8) 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 exflltration 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•3113 Title 5 otticHl inspection Farm:Subsurface Sewage Disposal System.Page 2 of 17 Mar 31 13 08:27p p.3 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - . r 29 Warwick Way _ Property Address Mohamed Elithy Owner Owner's Name information is MA 02632 3-28-13 required for every Centerville page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumpslalarms 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh n5in5•3113 Title 5 olncial inspeaton Form:SuLlwilaCe Sewage Disposal System•Page 3 of 17 Mar 31 13 08:27p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is required for every Centerville MA 02632 3-28-13 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: 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 ® El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 is less than 6"below invert or available volume is less than'/z day flow 6P17— (Sins-3113 Title 5 official Inspection Form_Subsurface Sewage Disposal System-Page 4 of 17 Mar 31 13 08:27p p•5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is required Centerville MA 02632 3-28-13 page_ Cityfrown State Zip Code Date of Inspection B. Certification (cont) Yes No El ® 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 20009pd- 10,000gpd. ® ❑ The system fails. 1 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 El ❑ 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•3113 Title 5 Orricial Inspection Form.SubsurUce Sewage Disposal System-Page 5 of 17 i Mar 31 13 08:28p p.6 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owners Name information is Centerville MA 02632 3-28-13 required for every page. CityrTown 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 NIA) ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15203 (for example, 110 gpd x#of bedrooms): 330 t°ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Mar 31 13 08:28p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form {� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owners Name information is required for every Centerville MA 02632 3-28-13 page. CityrTown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal tank D Box and two pits 5 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2011-69,000Gals 2012-92,000Gal's Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date CommercialtIndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203), Gallons per day(gpd) Basis of design flow(seatstpersonslsq.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: — Wins•3113 - Title 5 Official Inspection Fomx Subsurface Sewage Disposa"System-Page 7 of 17 Mar 31 13 08:28p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form -I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is required for every Centerville MA 02632 3-28-13 page. City[Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 11-2-11 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/Altemative 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 11A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Mar 31 13 08:29p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form 19� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is MA 02632 3-28-13 required for every Centerville page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known)and source of information: New pit added 1996 Permit # 96 - 106 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 16' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ®other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): 4" PVC SCH 40 from house, SCH 20 Tank to Box Box to Pit 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 Gal precast NA Sludge depth: t5ins-X13 Idle 5 Official Vispectlon Form:Subsurface Sewage Disposal System Page 9 0111 Mar 31 13 08:29p p.10 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is required for every Centerville MA 02632 3-28-13 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Asbuilt-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 and cover's at 6' below grade outlet baffle. Baffle show's sign's of being over full. Tank is under 3' high deck. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•W13 Title 5 Official Inspection Pone:subsurface Sewage Disposal System•Page 10 ci 17 Mar 31 13 08:29p p.11 Commonwealth of Massachusetts Title 5 official Inspection Form �I SubsurFace Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy. Owner Owner's Name information is requi red for every Centerville MA 02632 3-28-13 page. Cityrrown State Zip Code Dale 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 (flank 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: galions per day Alarm present: ❑ Yes r] No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins.3P3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Mar31 13 08:30p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy - Owner Owners Name information is MA 02632 3-28-13 required for every Centerville page. Cityrrown 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 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.): D Box is 16"x16"-2' below grade w/two line's out. Line to newer pit higer then other line. Wall's are gone need to replace D Box D Box under 3' high deck 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•3113 TNe 5 Official Inspection Forth:SUbsurlaw Sewage Disposal System•Page 12 of 17 L Mar 31 13 08:30p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Warwick Way - Property Address Mohamed Elithy Owner Owner's Name ion is requirequilredd for every Centerville MA 02632 3-28-13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 2 ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of sail, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is two pits. . Older pit under 4'high deck. Pit was failed in 1996. Newer pit w/2'stone installeded in 1996 permit # 96-107. Pit and cover at 22" below grade full to cover. Leaching need's to bereplaced 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 tslns-3113 Us 5 01;BcW Inspection Forth:subsurtaos Sewage Disposal system-Page 13 of 17 Mar 31 13 08:30p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is MA 02632 3-28-13 required for every Centerville page, Citylrown 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.): 15ins•W3 Tille 5 offidal Inspealon Form:Subsurface Sewage disposal System•Page 14 of 17 Mar 31 13 08:31 p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is Centerville MA 02632 3-28-13 required for every page. CityrTown 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 l'i FAQ? 4 -3= 31 6 -3 . 3�� I 1 -y = 317 ` (3 -y _ �/O p�r t5in9•3M3 Tile 5 of-Mal Inspecion Form:Subsurface Sewage Disposal System•Page 15 of 17 Mar 31 1308:31p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way Property Address Mohamed Elithy Owner Owner's Name information is MA 02632 3-28-13 required for every Centerville page. Cityfrown State Zip Cade Date of Inspedian D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 17' 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: pate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: I ❑ Checked with local excavators, installers-(attachdocumentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. Per past report 17' Bottom of pit at 8'. Bottom of pit at 9'above T.H. depth. Before filing this inspection Report,please see Report Completeness Checklist on next page. 15ins-W3 The5 Official Inso2aan Form:Subsurface Sewage ois;>osal System-Page 16 of 17 Mar31 1308:31p p.17 Commonwealth of Massachusetts Title 5 official Inspection Form W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Warwick Way - Property Address Mohamed Elithy Owner Owner's Name information is Centerville MA 02632 3-28-13 required for every page. CitytTown 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•3113 Title 5 Official hspacbon Form Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS D$PARTM$NT OF ENVIROI'f>idEZfTAL PROTECTION 1)1%ldll)l / f © � MAP G o �,q PARCEL. �0 TITLE LOT ; OFFICIAL INSPECTION FORM— ST78SI7RFACE SEW NOT FOR AGE DISPOSAL VOLUNTARY ASSESSME�S PART A STEM FORM CERTMCATION Property Address: Owner's Name; a �,� .-v 6v RECEIVED Owner's Addresar ce.� erg, oa_ . Z APR'0 2 2004 Date of Iuspedion: � 6 � Name of / TOWN OF BARNSTABLE Inspector: print) HEALTH DEPT. Company Name; Ma7mg Addrem: i '� Telephone Number. o © 6 .! CERTIFICATION STATEMENT I certify that I have persona$y W�ted the sewage duposaj system at the �8 experience in the p he=W conq*ft as Of the� on.The inspis ection was information info�on reported approved stem and of on site sewn laarn�d based on ary Inspector pursuant to Section 15-1 0 of Title S(310 CM$13�000 g3tu s.I am a DEP Conditionally Passes Needs Farther Evaluation by theLocal Approving Ahority Fails Inspector's Signature: Date: -4" within 3�� t �°"I�won report to the for sad the won ff the system is a shared system Oroving has a��°f of 10, or authority.The original should be seat to the system o des sent tportto to the�°pr We re '�°w of 10the buyer,if licab office of the aPP le,and the approvng Notes and Comments "'"This report only describes conditions at the time of time.T inspection does not address how the 1°son and ender the conditions of use at that conditions of use. system w�71 perform in the fuhtre ender the same or different 5 • b • Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP ASSESSMENTS ECnON FORM PART A CERTIFICATION(continued) Property Address J G✓a!•^[✓. �y G✓�� 8 v► rv� Owner. A h . J�---. Date of Inspection: 6 f Inspection 3ummarY t Check AAC�D or E/ALWA -.—��9 complete aD of Sardon D A. S __._. I have not found any infonlodou which indlpt�d 13.303 in 310 CI1�IIt 13.304 exist qny f ubm criteria not evabinged are h4cated��'bed in 310 CM w. Commew ---------------- B. Sy C oudidonaIIy pyum One orWre system components as deacribod in dm« CDMOW retWee .The systan'tq=co>np"an 0f the replacement oP"r Woved by the � or AnswcrOtHealt4 will pass. eqgai,Lyea.no o not determined(Y,1N,ND)in the— fo the fall .. ° 8 its`If not deWwh,,Please ---_�septic lank is metal and over 20 years old'or » 9 tank is teP1substau '�atw inSltration o�t�or�c r(wheft l or not)isWactmally metal septic tank will passmspcction if it is �aPP�ved��Board a�'Hure is inuvinMS�will� 0a if the g the tank is less than 20 yearn oldM'W S0 not leaking and if a Gate of Compliance ND explain; o�of Wwap or break ont or high staff Ievel in the ppe(s)Or due to broken,setded o uneven d stribution box due to broken or approval of Board of Health)): lion box System will pass inspoction if(with broken pipe(s)are replaced obstruction is removed dismUtion box is leveled or rqgaced ND explain: --, The system requrred pig more than 4 win Pass�ecaion if(with approval of the Board of H th)a year to brdue a or°bs f �pip,(,). The system broken pipes)are replaced 0bsMWfi0u is removed ND explain: I i • Pap 3of11 OFFICIAL INSPECTION FORM_NOT FOR VOL SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ION F MESS PART A FORM CERTIFICATION(continued) Property Addrem: a w, Owne !e�� �� ✓ r• Date of uspedton: C. Further Evaluation is Required by the Board of Health: A/Conditions exist wbicb requke further bythe S P public health,safety or the m m� Board Hed11h in order amine if sy m 1. System WE pass unteas Board of Heaht6 d in acco rdance system is not In a manner which With p pubdee be with 1 3(1 )that the attb,Safe ty and the evMroament: — C=P00l or Privy is within 50 fleet of a surface water — or P ivy is within 50 feet a- B vegetated wetland or a soh marsh Z System will fail unless the Board of Health(and Public Water 3aPPiler,if an system is functto�in a manner that protects the pablk he saf y)determines that the �and�xironment: smrl&w water su]P*or septic tank and soil absorption"M(SAS)and the SAS is within 100 feet of tributary to a surface water yv*- a — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water. The system has a septic tank and SAS and the SAS is within 50 feet of a private water . weM MIC system Pdv'aft water has weU**.Method used to and the SAS is less thu 100 fleet but 50 feet or mew determine�bnae m from a *This system passes if the well water bacteria OrP*compoundsPerformed at a DEp the p�sena of�a W��the well is�Po labof'f failure criteria are trigs that 6mkand �offwalysis mut be gmis�� f 5 °' other form, 3. Other; ' Paso 4 of 11 pMCIAL INSPECTION Fps NOT FOR VOL SUBSURFACE SEWAGE]I SPO NARY ASSESSMENTS SYSTEM'NSPECTION FORM PART A CERTMCATION(continued) Property Address: d Owner: /'eDate of of Inspection: A System Failure Criteria aPPlkable to all systems: You mug indicate°ye8"or of the following for a�,�, ons: Yes �� of into .L MChioaoe ar pon�rng Ofent to 00 t due to overloads clo /clogged SAS or space of the end 88od SAS or oessp� — v won ba,abo,,'per aoe waters due in an overloaded or I/ Cesspoolu �m � due to an overloaded or c1og�SAS air iou.is less � less than 6"below MM or a�,adahle val of times Pun4ledmore than 4 times in the last year l�pT due to clogged or Obstructed 8s w P� of the A, or�is below hi laps()•fiber _ �waterPppljOf Ces 1 or prnry is within 100 feet of a surf.,water supwaterjply ar to to a of a cesspool woe Portion of a o or�is within SO 1 of a public well, Any portion of a Cesspool of privy is less feed of a pr*,,ft wales. pptJr well with no than 100 fed but �PNy well. P�bde water qualitj,analyda �t>�SO feet from a private performed as a DEp certified laboratory,for Ibis aY�Passes d the water indkatea that the welt L feerom coiifurm bacteria and vo well w�'analysis, nitrogen and nitrate nitrogpr ht P�ollatloa from that facr7ity and the lame organic compounds am �A COPY of the analyyds mast be �to�f ceded that �other fa%reacdeeria � 1•� (Yes/No)The system r&I have d mlined descri6od in 310 CPAR 15.303,therefore t�one or n above failure criteria exist as Health to determine what will be necessary ��fth= owner should eon the Board of X Large Sy,imc To be considered a large system the gpd. system must serve a facihity with a dedgo flow 10 You must indicate either"Yee or"no" ,000 gpd to 15,000 /- - g criteria any a of the following to)arse systems in addition to the cutena above) ystem is within 400 feet of a surfa;e drinking water mPP�' ystem is within 200 feet of a�� YtoastuFamdigwateralyII of a located in a nitroggn=Wt,.,am(l�ern W haftoon 'c water supply well ellhead Area—I"A)or a mapped HyOUI Dave answered"yes"to any question in Yee in Section D above the la any question won E the system is cons;dmW a significant got In S threat under Section E or Tls;oar or operator of �or answered system 15.304.The system owner failed uncles Section D shall any hem Considered a should contact the appropriate regional o � rdanCe with 310 C)4R p9p S of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A SUBSURFACE SEWAGE DISPOSAL SYSTEM SSESSMENTg INSPECTION FORM PART B CHECKLIST Property Address. 7 / Owner: A r. Daft of Tnspeedton: Chad if the owm have been dma You mast nai es"ar"no "as to each of the foHoWin i y ------- mg won was Z,,- pro�►ided by the owner, or ofx� gene any of tha system=Vmvnftodd is tim pmm— hehetwo�r-slot�Wskm=dyed mutual&W is thePrevioustwowestPeriode of water been Wmduced to the system Andy or as part of th s won 1L. Were as burl*as of the Was �ob1°ed and ex (If they were not Wadable note as VA) the face*or dwelling wVocted foe signs of sewa$e bast UP 1� was the site iIIspocted for signs of h=k olg went all system fnK mbdmg the&AS,located on site ere the sqgk'm*=mhoks of ffi` ea and`bc mteew of ft mid far om�Ot�tt depth f d` condition Was the o �d depth ol'scam Mak*nance of se s( from owner)P mxbd with Womwd=on the la'oPer The size aed bcatloe of the Sal Absorption system(SASS on the site hasen be Yes � determined based on: Eustmg informatioa For exampk a pin at the Board of Era" Deed is the field .3o2()(b)I of a��to Pfrt C is at issue aPPm3dmat ou of di nr�ocePtable)[310 E'dbIIt I5.302 3 stance Fags 6 of 11 OFFICIAL INSPECTION FORM_ SUBSIIRFACE SEWAGE DISPOSALSYSTEM ASSESS PART C INSPECTION FORM SYSTEM INFORMATION Property Addresm C.�� rw�� I.✓ Lem ,•✓, Owner. 2 c✓� ��,� Date at Insp ; RFSIDENTIAL _ W ONDITION3 D1?SI( >Io based o(n310 i 1�h�mber of b�M Nmnbe r of cumeat jed&WAL. d 203(for 110� ): Does sa3deace hive a � be�voms}:= Is�y an & oft of no):," �y syst®icy(y ��r no �or no):"Cifyes boa Seasont use:ON or no): /!�C/ water meter r=caw if S� ).v(last 2 (84)= � Last date otoccapancy; TYPO Of f; Design flow(based(m 3—ITC—MR-1 5—203—):_) Basis t'mase of design Bow(� . 9„i DPP (yes orno): waste hang taut t wmla to the Ttte�nosy (yes or no): Last date of oavpny ss OTHER(describe): PbmP&t Record. GENERAL VOUBMATION Sande Ofinfamafn: �. was If ye4 o as pact of the• (yes or no): Reason for pump—____�-�'"—How was:gmn&y p TV B SysTF.M _._Septic tads dignbution bM soil absor c, —Ovedlow ccsspd —fth7 —�wative/ mAh nes 0jr e-00tech o og p ion records,if any) obtained frm system� gy a copy of the�Venation and woe �W of the DEP appr _Other(descnbe): APIximate age of an components daat instail�(¢mown h(- o^r )pd source of inf, amation: X Wen;sewage ohs detected when amivin 94 O', g at the site(yes or ao):�f� pup 7 of 11 OFFICIAL INSPECTION FORM SUBSURFACE SEWAGE DISPOSAL SYSTEM�ARY ASSESSMENTS INSPEC°I'ION FORM PART C SYSTEM FORMATION(contiod) PrepertyAddress rwj a fy �v Owner: 09re/66 ��-£��— Date of�sPectioo: 3 ,[ 0 BUII.DING SEWER iTocate on site per) Depth below grade: Materials otcmutma2= 4, cast inmDistance o PVC from private water supply wen or h;Otha( )' Com�(an consti m of loiam venthrg,evidence of Ieakagg etc.): SEp'1'IC TAN><G._(locate on site plea) Depth below gradsMatOW / Ofconstnxtion: ;metal dam ) --P*C&Y ens If tank is metal list ap•_ Is age cow b9 a Of ons: � (Ves or n°)•—(attach a copy of DistOOC fim top of to bottom of outlet tee seam,tbi orbafe• �l How wm connmenrs( aos o/e outlet tee baba an g seoommendati R � C leas to outlet im►ec� tee or balk condition,s liquid levels GREASE MAP.-�(L(lecate on site plan) Material of gm*. �' c°ncr+ete metal_glass_polyethyl�_otha scum thick. Distance fmm top scum to top of outlet tee or baffle.- Distance from of scum to bottom of outlet tee ors Date of last pnnpWX� bai}lecommus : as (� g�o�inlet a�owlet tee or baffle ooadition, loge,etc): gnty,bgnid Ivels } A PaDo it of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSEMUNTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM MSPECTI NO FORM PART C RM SYSTEM INFORMATION( o.rh4c �- L,." Owner. .'-g! Ela ,� a� TIGHT or HOLDING TANK-�taak must be pumped at time of )O..W Depth below grade: Material of o —°m=ew metal Deslga Flow:Alarmpracp — oalti 'y"ar no). Date othd Alarm 8° no): (oon'"oa of ah m and goa s kjk%eta): DISTRIBUTION B4)X. (jfPueW myA be on site plan) Depth of ligmd kvd above outW inverts Commeuft(note if box is Wd and to leakage i00 or box,ft): MiCts e4�,M9 evidence of solids camyma.WY evideaoe of Ao PuW CIIAIimf&.�( on site . plea) �1°�g cedar 0=or no): (note �or no), I *m1ber,ooadmon orf pumps and VpftwxM eta): • Paw 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contim ed) Property Address: r I -/, ,, ✓o Owner. G � Date of Inspection; SOII.ABSORPTION SYSTEM(SAS); (locate on site Plan,ezcavatlon not required) If SAS not located exp=why; Ty" w / y l/eachin8 PIK number: ��'P n c� G+, leaching chambers,m mbw. l 8 sanales,auinber Sf leaching bwdes„number,length; leachim8 fields,munber.dons• overflow cesspool,member: Co �n�iveW s9� TYpel�e of technology: etc.): Q uents ` '�Of SO1l'signs of lt�' level of ponding,damp ,wiaon of vegetation, f /v si r�1 CZWOOISa�cesvooi must be pQ°'Ped as part Of mspocbionxIocaGe an site plea) Number and congigniation. h—top of liquid to inla invert: Depth of solids layer: Depth of scam I: Dons of cesspool; Materials of constroglon Indication of groundwater iotiaw(yes or no): Comments(note coadit on of soil,signs ofhydr=nc failure,level of ponding condition of vegetation,etc.): pRIVY4-4 pocate on site per) mataials of D1t�ons:coaStrUCt10II: Depth of solid's: Comments(note coition of soil,signs of hy&=Uc fjW re,level of P condition of veget.,etc.): Pale 10 of 11 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(comamm ) ProPertyAddr+em bv?:Zrm c L, Dan of Inspection SKETCH OF SEWAGE DEPOSAL SYSTEM Provide a sb1ch cdthe sewage ftffid system mduft9 ties to at least two permanent reference land o; benches Locate all welts within lo0 fast.Locate where public water mpplp enters the hnlftg 43 3� r�/ .�0 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(condor 4 Property Address: )9 c Owner. r"I Date of%vecdlo': STTZ EXAM Slope Sudsm water Check cellar Shallow wells r ft maiOod depth to vomw water /2 feet Please bye(cU&)all methods used to determine the high gmmd water elevation; Qtabwd frm system&dsm plans on m d-if chedmd date of desigp On mviewe& Qmrnd site( S propertyfobsecvation holele 150 feet of&" Ceedood-with local aid of Health-explain; or jof Chedmil with local auavatom installers-(attach docomeotation) Accessed USGS database-axpiaa: Yon must 'be bpw y u estabfthed the Td ground water dev �o H n v ✓ (S i� ,' r� A � ®r 0 o C o ` ' 7t 0 v 7 / (D \ V RRUB E0lip ,� MAY 3 2000 - T�ICA �r COMMONWEALTH OF MASACHUSETTS % > EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 0LA r Name of Owner DIANE AZULAY Address of Owner: 29 WARWICK WAY CENTERVILLE,MA 02632 Date of Inspection: 4/14/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: X Passes _ Conditionally Passes _ Needs Further Evalu ti n By the Local Approving Authority _ Fails Inspector's Signature: Date:4/14/00 The System Inspector shall suilmit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate 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,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is 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 complying septic tank as approved by the Board of Health. n& Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)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 n& The system required pumping more than four 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: s 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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS 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,Method used to determine distance n/a(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: s I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below Invert or available volume Is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped tl. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The 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 health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner: DIANE AZULAY Date of Inspection: 4/14100 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X _ None 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. X As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - The 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.The size and location of the Soil Absorption System on the site has been determined based on: X - Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM M ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS PUMPED SPRING 99 BY ACE System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 16 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 8" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: 0" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 2" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" 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: n/a How dimensions were determined: MEASURED 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.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. I GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (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.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a I revised 912198 Page 8 of i l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(2)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE.THE SOIL PROBED DRY IN LEACH AREAS CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 912/98 Page 9 of 11 � r , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4/14100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) � 6 v U �A��Y k 3a6 011 96 3 b � 3,N revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continu;�d) Property Address: 29 WARWICK WAY CENTERVILLE, MA 02632 Name of Owner DIANE AZULAY Date of Inspection: 4114100 NRCSReportname: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) UGSS MAPS AND CHARTS-12+ FEET revised 9/2198 Page 11 of 11 TOWN OF BARNSTABLE LOCATION c;?f Wft U/l�/t C.Jz A✓'(f_ SEWAGE # Zf ,o VILJ.A ASSESSOR'S MAP&LOT�� -4�� INSTALLER'S NAME&PHONE NO. alb LRQ e- Se-V hCe 6Q4 d. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Ako—W 1 boa 6?k( P f (size) NO.OF BEDROOMS 3 P BUMDFR OR OWNER. PERMITDATE: �' lam"' COMPLIANCE DATE:O!��f 0 l "2-25C Separation Distance Between the: . Maximum Adjusted Groundwater Table and 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 a- 100 On i l�vtk �e.L log o &T , P, t No. / (� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACH SETTS lU � 01ppYication for Migogai *pgtem Cow6truction 30ermit Application is hereby made for a Permit to Construct( )or Repair )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 757 gallons per day. Calculated daily flow 3 3 p gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0400 0111n., 6 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 Certifi- cate of Compliance has been issued b this B o Signed Date Application Approved by Application Disapproved for the ollowmg reasons Permit No. I//, ® C/, Date Issued i' No. /G 0 Fee�1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS .5 01pprication fo,r Migogat *pgtem Congtruction Perron Application is hereby made for a Permit to Construct or Repair(✓)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. t ,act W a Y W(G IL. to -'s ON-,r l POyt Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow "S -75— gallons per day. Calculated daily flow .3© gallons. Plan Date Number of sheets Revision Date Title Description of Soil ) 7" Nature of Repairs or Alterations(Answer when applicable) �� D/«-- � � 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 Certifi- cate of Compliance has been issued by this B o Signed Date Application Approved by Application Disapproved for the ollowmg reasons Permit No. ri• ,� (� �v Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of"Compliance ,'HIS IS TO C Y, t the e ewage Disposal System installed( )or repaired/replaced�n 77S i�d- . ,mv'7F S for ,-- as Lvat u-u� 0 �wT'i has been constr cted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set f below:f No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigogal *pgtem Co (ng_truction Permit Permission is hereby granted to � to construct( )repair(,�,>4,rOn-site Sewage Wystem located at C 0K-/ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed/within two years of the date below. Date: 3 Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL AVORKS CONSTRUCTION I'EltMl*l'(1V1'I'IIOU'I' DESIGNED PLANS) 1, hereby certify that the application for disposal works construction permit signed by me dated a-O\`C�o , concerning the property located at a-� (�,�av���-�-G 7 C e��rl meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED- : DATE: - _ LICENSED SEPTIYSSnM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submitted]. ,., a � �� P' i 7 a Tyl ma's ay4.' _ #.S• �sQ^ Ste, ; �.. �,�• _ JJ og :lii' .g�' 'Xro' :•, :.r, t. » t. ` Fg i . '= ,- �•� �g� b° ',!SS' - r - f• _ y •tk�� .y 5 fJ1i'. .ate-te.� K'��.�JJ� .•�w 'T ,.�>�1� .� Y� ','�✓� .'r� .� •i�.• „"` - < - .. f..•1'J�., '...1,,.•,nn... V. p- . &<,Y'u s. •te.3.�-,r'"'S1` :�•y 5f��� - , . .l � �►. � : �� ate. c �1� � � • x CE . H O AC- _ - •• .. - _ - Toles! �. • .= Y,��� .. �+ac':�34a7n-e. �^ - "�'�a_�*.a.sw.c'A4PiF" .. -.. .. ... +S? em .. .. . u' ti. . s.:eei• e i •• ch 0 Residential&Commercial Inspections Complete Building Maintenance 7�is low/-'•s��e y/ fix, ,— y x y, P.O. Box 435 West Falmouth, MA 02574-0435 540-6016 4 Commonweafth of Massachusetts Executive Office of Environmental Affairs '�� ° Department of qR 8 Environmental Protection William F.Weld Gammor Trudy Coxe Secretary,ECEA . /L/ David B. Struhs commi»ioner M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION r Property Address: 9 j4),*1ZrllelC U,-4Y eENICQ0'� 1 /ASS Address of Owner: �0 44�(�/� Date of Inspection: 3 14, 9 (If different) 02/ Name of Inspector: �4oM4$ J\• ZO3ER-T-S el `� li S /� Company Name, Address and T lephone N ber: 770 R,s ST pL` A µ 7�+ays c �tN Z— CERTIF CATIONOSTATNENT11 gS s o�536 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: _ Passes Conditionally Passes 1eeds Further Evaluation By the Local Approving Authority 1;alls Inspector's Signature: ` olZe Date: 3 �6�9 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 appro•:ing authority. O$i�IoUS O N INSPECTION SUMMARY: aJdIZS 'WL/ZF }�RFS&.tJ?' ft R.)ZI V 4 L .. .S i SZoiv� -5t P T t C Check A, B, C, or D: A) SYSTEM PASSES: 01tor 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: i _ One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate 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 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 A ii Pnnted on Recycled Paper J 1\ t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) NT�� 1f'lLLG /'����• Property Address: 02 9 Owner: Date of Inspection: .3 6 9 L B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): i 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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ 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. N I 1) SYSTEM WILL PASS UNLESS BOARD HEALTH AND DETERMINES AFETY AND THE ENVIRONMENT:STEMISOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC _ 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 IN A MANNERETHAT PROTECT THE PUBLIC HEALTH AND SAFETY AND TLTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) HEE RMINES THAT THE SYSTEM IS FUNCTIONING ENVIRONMENT: _ 1 he system nas a septic tanK and soii absorption system and lb within i 00 feel iu a sup�a`� water supp > u:ti'uu.ary to 0 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• D] SYSTEM FAILS: �1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the fail 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. 2 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: - Owner. Date of Inspection: 3/ -10 6 D] SYSTEM FAILS (continued): ZStatic 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 112 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 t , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTS CHECKLIST Property Address: a,g *zWtuc •W,+/ e€NTC�-vac �E, Owner: Date of Inspection: 34196 Check if the following have been done: IVIIPIU'M' ping information was requested of the owner, occupant, and Board of Health. ✓None 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. ,1AAs built plans have been obtained and examined. Note if they are not available with N/A. ,✓ The facility or dwelling was inspected for signs of sewage back-up. Y The system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. iN _All system components,-cxcluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or t material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or r im t d b• non-intrusive methods. app a e _ he facihty o--nc7 ;and occ:.-pants, if different from ownPrt were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 1 ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 0/ a`)' Gr✓,*3Z ccl jc K Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:'�30 gallons Number of bedrooms:_ Number of current residents:' Garbage grinder (yes or no):_fi�o Laundry connected to system (yes or no): YFS Seasonal use (yes or no):_" CCv� e Water meter readings, if available: ��0( / U/44`-'A 70 /Q/ Last date of occupancy: tigw7 COMMERCIAL/)N DUSTRIAL: Type of establishment: esign 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: System pumped as part of inspection: (yes or no)ffS If yes, volume pumped. Lq __gallons Reason for pumping: 2 n� 0 1Z7�-2 0 0 3j5c'2v� SYSTC-w C oM POA-115 TYPE O -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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)�t s (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: a 9 Gv 2-6vi e K Lc1.4 y Owner: Date of Inspection: VG/9� SEPTIC TANK:_ YFS (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP other(explain) Dimensions: d0O Gattoa� �CAST Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 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.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: —concrete _metal _FRP—other(explain) �I Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottoms nt grtim in horr' of outlet tee or bane 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.) (revised 8/is/95) 6 I J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address. a 9 � /f t✓t cK i,R�t-/ �Fti i EJL uI l r s"S Owner: Date of Inspection: 3 qG TIGHT OR HOLDING TANK:_ V/wlocate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: Yt S (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is eyuai, evidence of solid, cairyu%er, evidence of leakage into or out of box, etc.) ow 9c ETLy r t_oob ED oN tNtT11�L x�SPFCT)G'I> 'e gig L PUMP CHAMBER:_ (locate on site plan) ' Nl Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) 5 (revised 8/15/9 ) s \ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: .29 R !aJ a CK �i9 y Owner: Date of Inspection: 3/G14 6 SOIL ABSORPTION SYSTEM (SAS): Yr s ' (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type' i odb GALu'N PlLe —CI}5T eoA.e tt � leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length:_,_ leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) v 2 d ZaV aJi7P NCT S V T La1 a TN S�Icl�l 6 I osL !h/ G✓�S �v i��iVT CESSPOOLS: _ y (locate on site plan) I` 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 groundv.ver: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) AlA Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised 8'/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ;L W R R-w o c IK iA.)Pr y C�+(��E 2•V�t tr /I?�S S Owner. Date of Inspection: S r 6/9 L SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' O u SE 3 A 4 DEPTH TO GROUNDWATER Depth to groundwater:_220feet Wo method of determination or approximation: D C�/L rt'�f,C) !r¢C !� (revised 8/15/95) 9 SearchforMap/Pay el 148068 Townof Barnstab e 4 [ ... i �� '-:For Parcel Number 148068 - Rental ProP�erty(Y%Nj "BUM nessName Zo�neof Gan ribut�on(Y N) ! r !' Area a Number Contaminant Rel Y( tN) Phone 000 OOOOOOOIFuei Storage Tannkpermit � Gard Onf. �� Das�posa Works t� Perc tesAw t : w el!Pup G� m 106Fiimo � ,> issuance Date -- 03/29/19961 < , ! Gompiet�nDate 04/01/1996 1 , Size ofSep6c Type, ize of SAS fomments r .. REPAIRT5 mappar `148068 Owner ORELLA3011, NA ALEJANDRO proploc 29 WARWICK WAY gag r r q innovive/Alternative Teh17 no clogy�Septicystems Single or a. .. o3v Clustered: .: .., ` 1/A T e I/AfS mice Type � YR , A s � adds3 dOA elete records? l � o-� .................. THE COMMONWEALTH OF MA$SACHUSETTS BOARD OF HEALTH f .............OF...B19P-AJ,3777.S ................... Appliration for Dispusai Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct (j< or Repair ( ) an Individual Sewage Disposal System at: Y------------------------------ -------------------------�.�-..f ---- � _..A ---- - ------- ocatio -Address �i �/, # w� n//-�.. -•--......-•••••...._..-•-- �7 St°Su. .. t ... . ?�!5.. P`6(/ Ca:------------•-•------...--•........... ... C` / ./•• wt /l ad _!CAM Installer Address Type of Building Size Lot..;Z3,1.4= ..Sq. feet Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -----------•------------ W Design Flow...............�''*0 ...................gallons per person per day. Total daily flow..........3 25 ....................gallons. WSeptic Tank—Liquid capacity/Z.0.gallons Length-__�_'_.._ Width..._._....._ Diameter................ Depth....�...._-- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...........:........sq. ft. � Seepage Pit No_____________________ Diameter... Depth below inlet.... ..i_.______. Total leaching Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by__, ... ._wL - .-!..!SJ ..,-.. Date_,.o_'/_ .'�a ....... Test Pit No. i._4� ..minutes per inch Depth of Test Pit..144... Depth to ground water&o*r'__.��.v_.:— rZo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water�?G A"=!F'� a .........................................•.......................... ................................•-•••••-•--••-------••--••----•-- O Description of Soil-•-------------5$640_.....P� ft)_........-------------•-- ..•...---•...•....----- x w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------••-----------------------------------•--•--------....------.......---•--....------------------------•-------•------------------------------•••-•----......_......._.. Agreement: The ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro•'sio s of TITU 5 of State Sanitary Code T e undersigned further agrees not to place the syste in oper on ntil ti a mpliance has is d t e board of health. Sig . ........................................................ _/X X'1( .------- Date Appliti pproved By...... ............................ ......... .................................... .................. -------•------ Date Appl' ion Disapproved for the o g reasons--------------------------------------------------------------------------------•----------.........-••••-......- ....----••••--•-----••••--•---•--------•----•---------••-.-----•--••--.---•--•-•---.-•--------.-••...-Date PermitNo .... --•-•-------------•----------•--------•--- Issued....................................................... . :/" Date No THE CQMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y' ( V. �. A .W. Appliration for Uiiipao al Works Tnntitrnr#iun ramit Application is hereby made for a Permit to Construct (>Q or Repair ( ) an Individual Sewage Disposal System at: tA Location-Address �� or o. ......................_...... .............. ",�+i'F.7•C--- "...................... ---------- _•-------- t---•• --••--•----•-•-•-------_-••--_-----•--- W 0; ner Address a ......................... —� --•---........................., ..........................................................._................................. Installer Address U Type of Building Size Lot..2.3i__J..4t_4m..Sq. feet I—I Dwelling—No. of Bedrooms............*5............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ..... W Design Flow................ ...................gallons per person per day. Total daily flow..........3 .....................gallons. WSeptic Tank—Liquid capacity/L24OV..gallons Length...,:........ Width......!.... Diameter________________ Depth..-!....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No......1__............ Diameter.../©, _'_. Depth below inlet---4_.......... Total leaching Z Other Distribution box k ) Dosing tank ( ) Percolation Test Results Performed by__J! . -tom)..._ .. E�-4. T.__��J •. Date./..V.-_l. .'. ........ 4 Test Pit No. 1--<2— -.minutes per inch Depth of Test ."._.. Depth to ground water!lJ©%...0�:-- fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wateic.-P—u ti:TC Ra-;Z� a ................................ ...............•...................................................-••-••......•------•--••-• Descriptionof Soil...............-.E�•-----i j" 4110--•--•--•--•-------------------------------------------------------.............................................. V ---••--•-•-•-•------•--•----••-----------------•----•-------•----•----------•----•...-----....•---••••---••••--••---••------••••-----•--••--•--••---•-...----•.....•-•-•-----•-..__............------•-- W V Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----•-•-----------------•--•--------...-----.......----......---------------............---------••----------•---•-•-------•........................... Agreement: The -n ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro 'si is of TITL%, 5 of he State Sanitary Code Tye undersigned further agrees not to place the system in oper io ntil t• a mpliance has b n is d e board of health. Sign . ............................ ..................... //1�edz_��4"06--...----- r Date Appli ti pproved By ....-•---•••..--•- Date Appl tion Disapproved for the o g reasons-.......................................................-........................................................ ...-----....._.....--•-----•----------------------------------------•------•-•----......................... Date PermitNo..............•.......................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................I.....OF . (9rdifiratr of fwnmplittnrr TH�IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�,,,.�-�o'f"'�2ep fired ( ) by -- --- -- ------------------------•-•------••-•--------------...... ------... ---------------------------- {._. Installer at ------------------•---------..._...---------------•-------- has been installed in accordance with the provisi s f T TIE 5 of The State Sanitary Cod s scribed in the application for Disposal Works Construction Pe it Noe-3--! �1.6 ............. dated__ , .--4 . !„ ------------------------ THE ISS A E OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM W �I CTION SATISFACTORY. DATE.l Inspector.. 7 HE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................. ............ OF................................................................................. �t��r�a � rk� Cn�an�trnr�uan rani# Permissionis by gra ted....... -•--• ---------------•--.----•---•••----•-••---•••-•----•-•---•-••-•-•---••-•--••••--•....••---•.............•••••.••... to Construct. or ( ) an ps S stem atNo.. - ` of -•--- --------•----------•---- -•--••----------------------•--•-•--•--•-•--- f Street as shown on the application for Disposal Works Constr c io ' rmi No --''Dated......................0................... ......................................................... /! ................................ ...........•..•............... Board of Health DATE............. �'..�...... FORM 1255 A. M. SULKIN, INC., BOSTON - L.?.CATION 0zc SEWAGE PERMIT NO. 1./)4,-�9' (JJ,4kU)I (IC► ,(IAA( 8 3- 103 VIELAGE , INSTALLER'S NAME & ADDRESS ,-Roe)f a ?�, LJK Co G]CF-A7- LoFST6K,,rJ -RC� U HftfWIu4 S U I L D E R OR OWNER LiFWl S Gcz Qo n - DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ® ' 0 A. 0 ?_ z7-��y ZAC, o f Hdaus C 1 � 3�� LEGEND N -- 88 -- EXISTING CONTOUR Rd o< �a x 100.98 EXISTING SPOT GRADE ® Ge a a o �� -W EXISTING WATER SERVICE �t Rd V, o �� -G EXISTING GAS SERVICE N' P�ec1n Nod�odo �a Ll UNDERGROUND WIRES one cto6 100.50 TEST PIT S, pfec�nct Rd LOCUS �� 100.88 BENCHMARK W /\ �o A �e�ideh to J �'�/ �A' o RoSemo y �o ecnofd �o �ro 100.80 100,45 x 1.18 +101.12 OV / P 01.3977L�/ J G 0.29 CD �"/ 101,04 100.76x ..99.a J •.`,O�•! - 100.14 100.03 LOCUS MAP 101.32 . X101.3�' �� -_..�2•,2 100.59 W x 101.04 101.41 a(G x 100.64 o F. 101.01 � \ � x 101.17 o GENERAL NOTES: .� ' U �� EXIST/N obo :. pRIVEWAY.j 9B (19 \LT 39) + 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL '�.. �� 99.37 HOUSE(#29) :9r,:la APN /�148-V V 8 BOARD OF HEALTH AND THE DESIGN ENGINEER. x looao' .O.F.=103.4f95,9i;.,"�� % 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SEWER CONNECTION AT D-BOX 97•aa Cellar Floor pg /23,142 .S.F.t OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �� =96.1f 'DRyyG L 5 LOCAL RULES AND REGULATIONS. SET OUTLET TO EXISTING TRENCH i � "97.30 G`� ....5:: HIGHER WITH SPEED LEVELER FOR ��� 96.04 yo�� �. / }p9� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR FUTURE USE. �� ��'� DECK r�F a 97 �F TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 99.30 /�� ,AS'37 EO�� DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LAMP DEC 95.89 �x s .10BM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 9670 x 98.98 ENGINEER BEFORE CONSTRUCTION CONTINUES. ABOVE15 95.68 I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 9680 GPOOL 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 99 iy/�i� x 97.58 x 96.18 I 98 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. TP-1 // I �1 0� 97,11 x.. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. T x 9s.21 . / 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. i P- � � , 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 95. 7 �°�� p0 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. X 97.54 95 CO.81 i ' x / BENCHMARK SET 95.2 x 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY m i �� 3 O i 9792 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SI OUTSIDE CTR./BOTT. STEP CONSTRUCTION. gam% EL.= 96.70 (Assumed Datum) Z 96.11�/ ��;: O 1�,0� 3Ag6 SHED �' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS -P : ,: x O QLA0 / ,, IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND .. QUO yA. / REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). v �Z ��y x SHED 9537 EXISTING SEPTIC TANK 01110 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE vi to x 9a.a7 / (TO REMAIN) �`� �F MAss9 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. TOP OF TANK, EL.=95.66 �kQ yG 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND INV.(OUT)=94.33t o PETER T. �, NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. x,95.11 i� C McENTEE ---•4 14. USAGE OF THE EXISTING SEPTIC TANK IS SUBJECT TO THE APPROVAL OLD LEACH PITS � CIVIL "' OF THE BOARD OF HEALTH. ABANDONED No. 35109 15. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC `���','{ R£G/S1, SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. x'9s.98 PROPOSED S.A.S. � 4-500 GALLON CHAMBERS F SURROUNDED W/4' STONE -- ��� l-Z- PROPOSED SEPTIC SYSTEM UPGRADE PLAN 29 WARWICK WAY, CENTERVILLE, MA Prepared for: Rafael .R;beiro, 29 Warwick Way, Cantercille, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. PLAN REVISION 4/27/20 RIBEIRO, RAFAEL JESUS Engineering Works, Inc. 1"=30' P.T.M. 151-20 MOVE S.A.S. TOWARD BACK YARD BY 10' 29 WARWICK WAY 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 3/13/20 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=91.5 LHOUSE&29) TING. FOR A DISTANCE OF 15' FROM THE EDGE GARAGE OF THE PROPOSED S.A.S. UNDER PROPOSED D-BOX PROPOSED S.A.S. 103.4ESEPTIC TANK INSTALL WATERTIGHT RISER & INSTALL RISER & COVER OVER ONE CHAMBER AND ar FloorCOVER. SET TO 6" OF GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT 6. F.G. EL.=96.1 t F.G. EL.=99.0t F.G. EL.=95.0f F.G. EL.=95.0f MAINTAIN 2% SLOPE OVER S.A.S. , ► � a� � DECK L = 67' L = 23'(MAX.) S=1% (MIN.) p S=1% (MIN.) 4'SCH40 PVC 4'SCH40 PVC 2" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE 6 6 aaeSaaB (OR APPROVED FILTER FABRIC) DECK aaaaBaa INV.=94.01 t E)CISTING aaaaaaa —3/4- TO 1-1/2" DOUBLE 4 8' 4' WASHED STONE PATIO EXISTING(VERIFY) �OX INV.=91.40 PROPOSED INV.=91.23 INV.=94.33t D—BOX EFFECTIVE WIDTH = 12.8' EXISTING INV.=93.84 INV.=91.00 EXISTING_SEPTIC TANK 4-500 GALLON LEACHING CHAMBERS SEWER CONNECTION AT BOX SURROUNDED WITH STONE AS SHOWN SET OUTLET TO EXISTING TRENCH ABOVE HIGHER WITH SPEED LEVELER FOR H-20 RATED GROUND FU TURE USE. TOP CONC. ELEV.=92.1 t POOL NOTES: BREAKOUT ELEV.=91.50 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=91.00 eaaaa INVERTS, PRIOR TO INSTALLATION. as®aaaaaaaa aaaaaaaaaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=89.00 GRADE ON A MECHANICALLY COMPACTED SIX 4' 4 x 8.5' =25.0' 4' J INCH CRUSHED STONE BASE, AS SPECIFIED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH=42.' IN 310 CMR 15.221(2). PERVIOUS MATERIAL 5' (MIN ) ABOVE GW 3) INSTALL INLET & OUTLET TEES AS REQUIRED. . . . LEACHING SYSTEM SECTION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL=83.9 r , AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 2� O SHED 20 8, SEPTIC SYSTEM PROFILE N.T.S. N I SHED SOIL LOG I Q I DESIGN CRITERIA N I � DATE: MAY 2, 2012 (REF#13,935) I � I pj SOIL EVALUATOR: PETER McENTEE PE(SE#1542) I p NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DONNA MIORANDI R.S. HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH I a I <0 DESIGN PERCOLATION RATE: <2 MIN./INCH 96.0 q 0 95.4 q 0" DAILY FLOW: 330 GPD SANDY LOAM SANDY LOAM 10YR 4/2 10YR 4/2 DESIGN FLOW: 330 GPD 95 5 B 6 B 94.9 GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 10YR 5/8 10YR 5/8 DEXISTING DISTRIBUTION BOX: 1 INLET, 3 OUTLET (MIN.) 92.5 C 30 92 7 C 32 S.A.S. LAYOUT PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLET (MIN.) LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN .74 GPD/SF MED. SAND MED. SAND USE 4-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 7/3 2.5Y 7/3 29 WARWICK WAY, CENTERVILLE, MA SURROUNDED BY 4' DOUBLE WASHED STONE—ALL SIDES Prepared for: Rafael Ribeira, 29 Warwick Way, Cantercille, MA 02632 SIDEWALL AREA: 2(12.8 + 42.0') x 2' = 219.2 S1 BOTTOM AREA: 12.8' x 42.0' = 537.6 SF Engineering by: SCALE DRAWN JOB. N0. 84.5 138" 83.9 138" Engineering Works Inc. NTS P.T.M. 151-20 TOTAL AREA:........ 756.8 SF PERC RATE <2 MIN IN: N FILE-IN SAND 9 g NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(756.8 SF) = 560.0 GPD I (508) 477-5313 3/13/20 P.T.M. 2 Of 2 (; LEGEND N i - 88 -- EXISTING CONTOUR } x 100.98 EXISTING SPOT GRADE -W EXISTING WATER SERVICE c1 -G EXISTING GAS SERVICE p`ec,n HOacoa° P Ra U UNDERGROUND WIRES 5< of oa-0 100,50 TEST PIT 5 pre°nCt Rd LOCUS "pP° 100.88 BENCHMARK W O( J/ rn ern°ra �` �0 100.80 100.45 x 1.18 t 101.12 �� o 1001"01.39 J G x �(� 2�,�1: .29 100.14 100.03 LOCUS M A P 101.32 101,04 IOOJ6 ^ 99.41:J J 0 i' *2 100,6.9 NOT TO SCALE 03 101.04 101.41 C7 �� ...';... ' .`. Y c 100,64 101. LALn r '•10101 s \ GENERAL NOTES: ...:...,. o x 101,17 '• p 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL PAVED , CL rt 39) ,• 0, BOARD OF HEALTH AND THE DESIGN ENGINEER. c> 5 o EX/STIN 06,0 98.19 \ g`1• 1� :� J DRIVEWAY,` t^ v 9 99.37 HOUSE(#29) �s5,la {• �+Q 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS cn 1 :K 100, 3'� T.O.F.,=103.4t 95,91," APN; 148-068 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �:...'.... : LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 97_87 CAI{or Floor q� 1 ;`L3,142,.S.F.f e 6 99935' -310 CMR 15.405 1 b : y , LL 97,30 96.04 G' ` 1) A 3' variance to the 3' maximum cover reguirement, for up 021" g Zp �� -18E)� to 6' max, cover. S.A.S. shall be H-20 and vented. 3 DECK F�F a`> pF 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 98, % /�37*� ' 97 00� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE .•' , "�g.•' LAMP - 'DEC 95,89 /x ,10•• DESIGN ENGINEER. BM x 9e.9e.•' 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 96J0 68 5. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ABOV� �• O ENGINEER BEFORE CONSTRUCTION CONTINUES. ��• �; 96.d POOL -'`�6- 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. VENT ,C 1 .•>C98 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE R TH F FAILURE F Y x 9618 �•, ES N E 0FOR E A 0 99�a ' x 97,58 ,� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 27' .' x 95.29� x 7. WATER SUPPLY, PROVIDED BY TOWN WATER SERVICE. TP-1 `y t,,�� e `� 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. �95,37 �.°�NpO� 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS k 97.54 961TF 2 x x S�$ BENCHMARK SET DIRECTAGREEDEDUPO BYNTHE APPROVING OWNER DAUTOHORIT NTRACTO ES R OR AS OTHERWISE 97.92 OUTSIDE CTR./BOTT. STEP 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY m, x 94,46 , 000, EL.= 96.70 (Assumed Datum) THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 96,11 :�6 y 94.76 SHED CONSTRUCTION. �n ,/• 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS (D 94.4e I SHED x <o� IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 4 2 X 95,37 EXISTING SEPTIC TANK REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). �p Ci x 94.47 , (TO REMAIN) 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE j TOP OF TANK, EL.=95.66 ��� OF Nss, INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. INV.(OUT)=94.33t �P 9� . y� 9G 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND x 0511 o PETER T. v' NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. EXISTING LEACH PIT- McENTEE ' TO BE PUMPED & FILLED -' 14. USAGE OF THE EXISTING SEPTIC TANK IS SUBJECT TO THE APPROVAL CIVIL " OF THE BOARD OF HEALTH. W/SAND AND ABANDONED No. 35109 15. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC x-§98 A �'FGISIE��� SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. FSS PROPOSED SEPTIC SYSTEM UPGRADE PLAN I zf((3 29 WARWICK WAY, CENTERVILLE, MA OWNER OF RECORD Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 ELITHY, MOHAMED H & Engineering by: SCALE DRAWN JOB. N0. SALMAN, HADEED A 1"=30' P.T.M. 146-13 29 WARWICK WAY Engineering Works, Inc. CENTERVILLE, MA 02632 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. E (508) 477-5313 5/21/13 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.=94.2 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. 99.7' SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S� oc INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER & o T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL 2 INSPECTION PORTS (MINIMUM) --- ------ , 3$'� COVER. SET TO 6" OF GRADE 65' _2. _— CHARCOAL EXISTING F.G. EL.=100.2(MAX.) VENT ___----1'�QeQ$ ------- F.G. EL.=96.1 t F.G. EL.=99.Ot MAINTAIN 2% GRADE (MIN.) OVER S.A.S.W. v'- U O rn ` L = 32' L = 8'(MAX.) INSPECTION PORT S=1% (MIN.) ® S=1% (MIN.) (1-MINIMUM) ABOVE DECK ►o C) 4"SCH40 PVC 4"SCH40 PVC {� GROUND DECK V V y ° 1 4" e" 11.3" TO POOL p EXISTING 48" LIQUID INVERT LEVEL INV.=94.01 PROPOSED INV.=93.84 1 ROW OF 10 UNITS AT 6.25'/UNIT GAS� BAFFLE INV.=94.33t D-BOX INV.=93.80 EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN HE SHED NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT EL.=TOP EL. �,;'' '�-'': ;`';, S•A•S• LAYOUT 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=94.23 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=93.80 75" 2) D—BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=92.86 II�IIIII�II I GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' MIN. ABOVE BOTTOM OF 2.83 IN 310 CMR 15.221(2). T.P. EXCAVATION OR G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL=83.9 — MATERIAL AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. 76„ 1 ROW OF 10 — 16" (H-20) ADS BIODIFUUSER UNITS �— PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION WT.& N.T.S. 16" 11� SOIL LOG �..-�34" 0 fl% /6 DESIGN CRITERIA DATE: MAY 2, 2012 (REF#13,935) SECTION TI N I END CAP NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 16 HIGH CAPACITY (H-20) BIODIFFUSER UNIT DESIGN PERCOLATION RATE: <2 MIN./INCH ELEy. TP-1 DEPTH ELEv. TP-2 DEPTH MODEL 16" HICAP UNITS MUST BE STAMPED H-20 96.0 q SANDY LOAM SANDY LOAM 0" 95.4 q 0" LENGTH 76" DAILY FLOW: 330 GPD NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT DESIGN FLOW: 330 GPD 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 95.5 g" 94.9 GARBAGE GRINDER: NO B B g" SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. . EXISTING SEPTIC TANK: 1000 GALLON CAPACITY VERIFY SANDY LOAM SANDY LOAM OVERALL HEIGHT 16" (VERIFY) 10YR 5/8 10YR 5/8 OVERALL WIDTH 34" 4640 TRUEMAN BLVD (IF 1000 GALLON AND FOUND TO BE UNSOUND, REPLACE WITH NEW 1500 GALLON TANK) g2.5 C 30 92 7 C 32 13.6 CFRomeHILLIARD, OHIO 43026 PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLET (MIN.) CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. LEACHING AREA REQUIRED: 330 GPD = 445.9 SF 74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN MED. SAND MED. SAND 29 WARWICK WAY, CENTERVILLE, MA SOIL ABSORPTION SYSTEM 2.5Y 7/3 2.5Y 7/3 USE ADS 16"HC BIODIFUSSER UNITS IN STONELESS TRENCH CONFIGURATION Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 (GENERAL USE APPROVAL FOR 7.88 SF/LF IN TRENCH CONFIGURATION) Engineering by: SCALE DRAWN JOB. N0. 1 TRENCH WITH 10 UNITS O 6.25' PER UNIT = 62.5' 84.5 138" 83.9 138" En 'ineerin Works, Inc. NTS P.T.M. 146-13 62.5' x 7.88 SF/LF = 492.5 SF PERC RATE <2 MIN/IN. (ON FILE—IN SAND) g 9 SF 492.5 SF NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD / ( ) = 364.5 GPD (508) 477-5313 5/21/13 P.T.M. 2 Of 2 �l - ' I WWI O TE ; EXTE-,IJD .. � . FL L SCF�L � ,E' T SCfaLE : / • _ eO !")AA-/1-101E COV EA,2 5P P7-0L4 � /2" OF F/AJISNEZ7 GeAL:) E . S C HE D. 40 P v C. Ole -- --F L O f..J EOU19L TO S+.PT1G �m,nirnurn �' �r �•oo-{� �? Of /8 - i2 cvashed sfone -- 0 i� ' a D/ST. BOX a o , J ° o e ! ° o � Cam_ °o-/- .� I/ ~ O a t 1000 GHL. SEP_T/C 7/9A A:K fl, 2 e o CeJCi S f+cad S O►-7� ° 0 s ° O o 30 fi 5 -- ,v o � - 1 zt BE--O e oo� HOUSG- L),9T PEA?C. ,2F� T� < Z Nri,v//.v c N z✓ i �i�, ESS : � c�OF3ir � r. .t'31@ f J'f� F L O[.v 2 FATE ,��_ GRLS. 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