HomeMy WebLinkAbout0149 CAMELBACK ROAD - Health 1529 RACE LANE,MARSTONS MILLS
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TOWN OF BARNSTABLE
LOCATION Lm SEWAGE# c�611
'VILLAGE )` Z iLLP ASSESSOR'S MAP&PARCEL e+'t- V,{o
INSTALLER'S NAME&PHO O. � 151 RM4
SEPTIC TANK CAPACITY t& �6(6 1 Cam° 4&L_
/ v
LEACHING FACILITY.(type) 4:-t c"Z (size) ye i
NO.OF BEDROOMS
OWNER ,
PERMIT DATE: - —L6_ COMPLIANCE DATE: > 3
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4-1 Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) N / Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
4 FURNISHED BY �,'
��+focRsG
o -s-
104
i 10 h
t
�-371 No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppliLatlon for MispoSal *pstrm ConstrUttion Permit
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System individual Components
Location Address or Lot No. ,3—<59 Raiii 14 jyio, Owner's Name,Address,and Tel.No.Sos-(01j 1- 7899
Assessor'sMap/Parcel yf)//,/® dq(UAle -SldbD►� 1�q Pa.t°�-Lca,�r�
, , O04
Installer's Name,Addresq,and�el.,No. Q5bg-'off$-'&14 o Designer's Name,Address,and Tel.No. D ~Mel
QbrIv i0trLC�oV 'Kt��-t tTr�C �tP1r7
jva
pe of Building: 14
Dwelling No.of Bedrooms Lot Size O /o sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _3 3 gpd Design flow provided 333 gpd
Plan Date&0 j y�1-16 19 Number of sheets r Revision Date
Title i -1 Sa
Size of Septic Tank 4' 'S . /( 90^,QQ k Type of S.A.S.IS' , r C
Description of Soil 6" L;4 U, f y 10W
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the EnvironmentalCodLand not lace the system in operation until a Certificate of
Compliance has been issued by this Board of Healt
Signed Date
Application Approved by � Date VAOIZO
Application Disapproved by Date
for the following reasons
Permit No. I - 1 Date Issued 1)n
No. C/V t r 7 Fee
ti THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Tippriration for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System FzKndividual Components
Location Address or Lot No. 15 � �( � j1,Q, Owner's Name,Address,and Tel.No.
.Assessor's Ma /Parcel //y p
P �J�/
Installer's Name,Address,and Tel.No. , �/a�, _$ T o�so Designer's Name,
Address,and Tel.No. 5VS• 3e(,
I�..t3r4U(U �.OV,6jfo,_T4G�i IZ\' 4fi\C 4- ,. S
.r-
e of Building:
Dwelling No.of Bedrooms Lot Size 0 yU y sq.ft. Garbage Grinder( )
Other Type of Building _ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 D gpd Design flow provided �3 33 gpd
Plan Date=�n n 4 .n71�rs , Q0 019 Number of sheets nn � Revision Date
s: Title I E r, 7t I S��� t s�P nrn 1.9��n n6j�o 14sz/- 1A A-
Size of Septic Tank C' ; /(yl �(? � Type of S.A.S. �, + ,1 i 1 a-41 i"21C �
Description of Soil no-
Nature of Repairs or Alterations(Answer when applicable)
..:... Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-ite''sewage disposal sy to "
accordance with the provisions of Title 5 of the Environmental Code and not t mace the system in;operation until a Certificate of
�.
Compliance has been issued by this Board of Health.
Signed----) Date O - /
Application Approved by Date T
Application Disapproved by Date
for the following reasons
Permit No. 2 _ 1 Date Issued
------------------------------------------------------------------------------------------------------- -------------------------------
t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(.20 Upgraded( `)
Abandoned( )by rrn
at /5;4 1,.._ /11r�,y,4 1 �'11,7/P, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No�� dated 4 2019
�s� ) f f
Installer � � (s....s�,�, �..{�,,,, `T�.,t Designer ���lft�o �� 6ar���14 7-1-,C
#bedrooms___3 Approved design flow 1 �J�� , ► gpd
The issuance of this perrmmi shall not/be construed as a guarantee that the system will fun"1 sMeD
Date �1 J 9 Inspector j r�
------------- ------------------------------------------------------------ - ---------------------------------------------------------
No. a,"' ( Feed�j��
' (7 ,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
'hisposai 6pstem Construction j3ermit
Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date � ' �� Approved by -
SEP-25-2019 00:22 From: To:15087906304 Pa9e:1/1
Town of Barnstable
'"6 Regulatory Services
Thomas F.Ceiler,Director
� RAt1N6TAtiW t
Public health Division
' Thomas McKean,Director
200 Main Sheet,Hyannis,MA 02601
Officu. 508-862-4644 Fax: 508-790.6304
Installer&Desimer Certification form
;Gate: a Sewage Permit# Assessor's Map\Parcel �T v
Designer. Ow to-, co.,p e h�t�v►r �Jta 1 �n Installer: 0✓ 16 %
d'
Address: Address: 1110- Jdox
4&-m 0 VA all I
On a6lq ��IeGu, �vK�'�uC.�Icmiwbaissuedaper..mittoinstalla
(date) y� (installer)
septic system at /5 a 9 90a LO-.J- based on a design drawn by
/ Q p� D(address)
h&n, i el ll- ,G� A 4 PO4J dated rev. 9 /L
lly
(designer)
I certify that the septic systern .reterenced 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.
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
of the septic system) but in accordance with State&Local Regulations. Pia.revision or
certified ied as- by designer to,follow.
MA OF/ASS/
DANIf_'LA. c�u,
c; OJALA '
(Installer's Siguature) CIVIL H
No.46502
SS/ANAL
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE '(t]E7'UR1V TO .BAR STABLE PUBLIC HEALTH DIVISION'. CERTWICATE,, OF
COMPLIANCE WILL NOT BE ISSUED UNTIL )BOTH �S 11''ORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HI:A,'.Eli))-),VISION. THANK YOU.
Q:Health/Scptic/Dcsigncr Ceniftcation'Form 3-26-04.6c
� 1
TOWN OF BARNSTABLE
LOCATION14 S—e &CO Z,&�Le SEWAGE
VILLAGE �254415 2" ASSESSOR'S MAP & LOTP9'1�
ti INSTALLER'S NAME &-P_HONE NO. Pao �/1PU�B1j� tf�$�/D
SEPTIC TANK CAPACITY - �Q d
LEACHING FACILITY:(type) 211 (size) /iQ
NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER
BUILDER OR OWNER 7/ eO 6,441. C� So. /d�✓»Oy
DATE PERMIT ISSUED:. G
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/�"
b�
Lot
J
1 %
No.. ::11( _. Fms..�A. .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............OF......1:: 1- ....__._..._......__.-.-..._
AvOirFation for Btsvniital Works Tonstrurttnn ramit
QAi is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Sy
Loca ion- ress -•• ••••••. Q.@- ._.. �.... ® ,°`te_Owner .. --
W Address
a ......................................•......._.. ...........................
Installer Address
}_
UType of Building Size Loth-a�,e.____.7__-...Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
P4 Other—T e of Buildin
ayp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow........... .....................gallons per person per day. Total,daily flow........... .Z 7..............._....gallons.
WSeptic Tank—Liquid capacitA M0..gallons LengtheYn.(�i'. Width Diameter................ Depth _�.
x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area._... .______.___..sq. ft.
Seepage Pit No 7 p� .�.............. Diameter.._.....__....__._. Depth below inlet_�_..:'�_... Total leaching area... .6P0
Z Other Distribution box ( Dosin��jj�' ( )
'-' Percolation Test Results Performed by..y`1 Ls! �i�!✓ l I )--1�--?)S
,-7 ate - - --------------------
a Test Pit No. 1....2:.......minutes per inch Depth of Test Pit_..�-Z..._..... Depth to ground water..0.0.h..C---.
�Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a
ODescription of Soil (` ..._.(..........................................� t --- ---•--- ---------------------
-----------------
-----------------------------------
x .
(� - .... .
ti ----•-•--..
U Nature of Repairs or Alterations—Answer when applicable.............................................................................. -- .... ....
---------------------------••---•---•------•-------•----------------•----------•-••••......__.......--•--------•-----------•------•••-----•-•-••--•---•-••---•----•-•-•-•-..........--•---•.........--•-
Agreement:
The undersigned agrees to install the aforedes !bed Individual Sewage Disposal System in accordance with
the provisions of TITL U 5 of the State Sanitary de— The uAersignej4further agrees not to place the system in
operation until a Certificate of Compliance has issue e o d o iealth.
Signe . ........--•• ...
Date
Application Approved By. • . ............. ................. . . .....
Application Disapproved for the following reasons----------------•------- ---•-------•----------....----------••-------------•-----•••••--••-Da• a e _....
...--•--•-------•----•-•-•----•-------•-•-----•••-•--------------- --••----------
Date
Permit No..... ..2�_,� J../:6. ..���....._.. Issued------------------------
Date--•------•-----^-------------- �
No... ,1 Fes$..: { .�'`........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. !. ......._OF...... 1���-r�-,�`i .,[ jl..�... ....................
App iration for Biiposal Works C9omitrur#ion Prrmit
Application is hereby made for a Permit to Construct ( Vror Repair ( ) an Individual Sewage Disposal
System at: -.. � � ............................
� L
..... ......� �:. =... _.._ ..... --•---•-•---. ----...---- I --•-----
L " � .�.
' ••
..............
............UA 0......r� dl ��. =�. ...................................... ..`......... .....W Owner Address
a ..................... ......•. .........._....L.. ....
Installer Address
Type of Building
-� Size Lot.�.x...'e__._q7__Z�:...Sq. feet
Dwelling—No. of Bedrooms........................._...._._...__......Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building
yp g ............................ No, of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures --------------------------------
W Design Flow........... -_`' .....................gallons per person per day. Total aily flow............ ............................gallons.
04 W Septic Tank—Liquid capacitA?XXX .gallons Length. -_ 3`. Width. ±.' }. °' Diameter................ Depth..( ��
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....•_..--._........sq. ft.
> Seepage Pit No......I---.•--___--_ Diameter.1... _ ?:;.... Depth below inlet..'.__ 2._.. Total leaching area.. zi....sq-ft- C?�''�
Z Other Distribution box ( Dosing tank
( )
'-' Percolation Test Results Performed �'
a .......-- . ---.....--• ate ............................
Test Pit No. l..... ---___•minutes per inch Depth of Test Pit.... Z_{........ Depth to ground water.. -
t14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-••--•--.-----
---------------
Description of Soil._ ___._ ...-..................................
-- "
U --------------------------------- .......... •• --"- --- --- _
W ....................................E ��- ..` '• v 5P-----Z.{� "�`'?�. IJ F �q'I�,�.`�(r,-� C.' �
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
•-----...-•--------------------•--••--------------•----------------••-••--------•-•---•--........--------....-•-•-----------••--••••--•-------------•-•-•--•----••••••----------•--•-•-----.......----
Agreement:
The undersigned agrees to install the aforedes ed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary d_ — The un ersigne urther agrees not to place the system in
operation until a Certificate of Compliance has b issue e o do ealth.
Signe
................................................. ................................
/ pate
Application Approved By... - . . -- • .. ............ ...... .` t"'r, ._--•-- --
Date
Application Disapproved for the following reasons-----------------------------•---------------------------•--•--•-------------•-------------------------•---•--
..............••-----•-•--••---••----•••...--•--•--••--•-----...------•---•------•....-------•------...--•-•--•--------------••--•----------•-•------•------•-----•------•------•--•---................
Date
Permit No.-----)--�/-- C' --------- Issued------•---•-------- .................................
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. -:.............oF. T` .........................
Trrtifiratr of Mintplitanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by....................................................................................................................................................................................................
Installer
at.
has been installed in accordance with the provisions of TIT f The State 5,,a itary Code as desc ibed in the
application for Disposal Works Construction Permit No.-�1
THE ISSUANCE OF THIS CERTIFICATE SHALL OT CONSTRUE® AS A GUARANTEE TIiAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......... _. ...��.. .. ................................ Inspector.. -----------------------
THE COMMONWEALTH OF MASSACHUSETTS
OF HEALTH
S .......................OF...........:-.r.�r ..... F:....................................
No.... 1 FEE................••......
�i��o��1 ork� �on��ron anti#
Permission is hereby granted...........................................
- ------------------------------------•------•••-•............
_.................
....
to Construct ( or Repair ( ) an Individual Sewage Disposal System��l
at No..-----'1_&.- -----�-c-----•-----Q ` �`' -0'07�`-.`' ....---•---�...'f
Street //�_ � %/' /
as shown on the application for Disposal Works Construction Permit No.jd- .`%/� Da ed......-___.;/....._,./_..�� _..._..
�- _ ````---------------
Board to-il
Health
FORM 1255 "HOBBS & WARREN. INC.. PUBLISHERS
1
•►CATION CAMELOT LOT 56 •� _ NO•
I LLAGE Mars tons Mil 1 s _ DATE ' �$5;
"PLICANT Theo Construction �, FEE y` `
DDRESS 25 Great, Pond Dr_ So_ Yarmnuth , Ma TELEPHONE NO. (Non-refundable)
)G INEER TEL
!TE SCHEDULED I 3 c7 7--
-- nature
• • • • • • O O O O O O • O • O O O • O n ., 4 O • • • O • O • O O O • • • • • • O • • • • • • • • • • • • O • . . . . . . . . . . . . . . . .. . . . . . . . .
SOIL LOG
JB-DIVISION NAME CAMELOT DATE_����-� TIME
:PANS ION AREA: YES X NO _ _422 0U) E�J Co I►•) CZ Iti1 ENGINEER
)WN WATER X PRIVATE WELL C C)>til10tj_ BOARD OF HEALTH
6nI3S7�z EXCAVATOR
!:ETCH;: (Street name, etc• ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES :
40
� O - fig;� •
3G0• '' tv0
6 �•
. �1M •„ 1
ry
''RCOLATION RATE:
.."ST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION:
1 �- - 7Zf' // 1 —
2 •- --- /v=7 2 -
3 3 —
4 �y&iJ!"� 5A�P 4 - ----
5 �� S 5 -
10 - '� 10 - ----
11 --
12 I-- - 12 __.._....---
�Z -
13 /V0 13 -- --
14 14 _
15 -- 15 ----
16 _ --- 16 /
IITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD_ LEACHING PITS
LEACHING TRENCHES_
)SUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
)TE: ENGI14EERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
"•IGINAL: COIIPLETF.D IN FNTTRETY BY P . F. AND RETURNED TO BOARD OF HEALTH
1PY: RETAINF•D BY APPLICANT
Town of Barnstable Barnstable
Inspectional Services Department
BARNSTABL.E.
6 ,� Public Health Division
ArfiO A 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKcan,CHO
CERTIFIED MAIL#7015 1520 0000 1967 7542
August 13, 2019
SLATTERY, SUSAN
1529 RACE LANE
MARSTONS MILLS, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 1529 Race Lane, Marstons Mills, MA was inspected on
07/16/2019 by Frank Nunes III, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
Of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360-20 h).
You are ordered to repair or replace the septic system within two (2) years 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 0 THE BOARD OF HEALTH
Thomas McKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1529 Race Lane Marstons Mills.doc
BAR Town of Barnstable
MASS
- • NSfABLE,
,A 039. ,��. Inspectional Services Department
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An "x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
ofa driveway due to H-10 components, etc)
/eaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:`,SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc
of 1q0
f Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address f
Slattery
Owner Owners Name
information is
required for every Marstons Mills , MA 02648 7/16/19
page. Cityrrown 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.
A. Inspector Information 0#l ypa�
Frank Nunes III
Name of Inspector
saa
Company Name
Box 841
Company Address
East Falmouth MA 02536
Cityrrown State Zip Code
508.272.6433 13010
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ® Fails
9WAd
7/16/19
1 nspectoWSfinature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note:This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
z
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
i? Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
0
v% 1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
f
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to 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):
3) 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.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil 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.
c. Other:
4) 'System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments
I�Yyo
1529 Race Ln.
Property Address
Slattery
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 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.
5) 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 CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner owner's Name
information is
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed.The
owner or operalor of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
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?
El ® Have'large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
t, 1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents:
2 III
Does residence have a garbage grinder? Yes No
9 9 9 ❑
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Occupied
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per Y(gPd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Pumped June 2019 per owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
k t vw.I
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
5. Building Sewer(locate on site plan):
Depth below grade: 12"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10'feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�a L, 1529 Race Ln.
Property Address
Slattery
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 6"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
H-10 tank appears to be structurally sound, inlet is under the deck with no access
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000g
Sludge depth: trace
Distance from top of sludge to bottom of outlet tee or baffle >12
11
Scum thickness trace
Distance from top of scum to top of outlet tee or baffle
>2"
Distance from bottom of scum to bottom of outlet tee or baffle
>2"
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping suggested every 3yrs to prolong the life of the system.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
�. Title 5 Official Inspection Form
b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owners Name
required for every Marstons Mills MA 02648 7/16/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box was video inspected and appears to be crushed.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�e 1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit is in a state of hydraulic failure, effluent is pushing out of the cover at this time
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
I
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
— I
Lj
J,is6z� -t-0 s cf�U`
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
L
I
Commonwealth of Massachusetts
ro Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner information is Owner's Name
required for every Marstons Mills MA 02648 7/16/19
page. C4rrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: >12'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: 1985
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
See above
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
L
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1529 Race Ln.
Property Address
Slattery
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7/16/19
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection 'Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prope Address —
LLL•_
Owner Owner's Name
information is
required for every � ✓ _�+
page. Atyown State Zip Code Date of l sA pection
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 filling out forms X General Information
on the computer,
use only the tab 1. Inspector: Z�
key to move your I�tt 1111 lJ
cursor-do not
use the return Y Nam of Inspector
Company Name
Company Address d ,,
City/Town
State Zip Code
q � 3 3p�i SN S1 LOoo
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 15.000). The system:
Passes ❑ Conditionally Passes. ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
lnspe ors 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.
t5ins•3/1 3
Title 5 Official Inspection V.bs.,face Sewage Disposal System•Page t of 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
tn
Property A dress
Owner -mod — —
Owner's Name �—
require information is -u S R J r
required for every �`"l _l 1
page. Cityfrown Wald Zip Code Date of Insp ction
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/ always complete all of Section D
A) Syste asses:
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:
�)urccrJ} erfa--
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
" A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t51ns-31113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address ,
Owner UIL
Owners Name
required for every ---
information is Owner's
` (I s V��
page. Cityfrown State Zip Code at of Ins ction
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
,/�.� ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ 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):
rj ❑ 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
t5ms•3/13 Titte 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
u =0 _ Title 5 Official inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
- oc L i1 C7--C.C'_ �n
Property Address
rf C..
Owner Owner's Name
information is
required for every '1 S OUA K a I�)_l .26 1 _=
page. Cityfrown State Zip Code Date of Insp ction
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
❑ 2/11' Backup of sewage into facility or system component due to overloaded or
❑ 6� 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
❑ I Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool .
❑ Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/Z day flow
t5ins•3/13 Title 5 Official insp
ection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
-- Title 5 Official Inspection form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1 S2�i kccce Elm-
Property Address
Owner Owner's N me
information is required for every I I LS � 6j�r k � lad I
J `t�
page. CitylTown State Zip Code Date 6f Inspection
B. Certification (cont.)
Yes No
❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
ElL_2// 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.
❑ L`7,/ Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ Any Portion of a cesspool or privy iswit
hin 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.]
❑ Ei The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ The system falls. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ 0 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
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 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
c Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Ct ce. Lyi
Property Add ss
� L
Owner Owner's Name
information is '
required for,every
page.. Cityrrown State Zip Code Date df 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
❑ ere any of the system components pumped out in the previous two weeks?
❑ H s the system received normal flows in the previous two week period?
❑ Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
❑ Was the site inspected for signs of break out?
�❑ Were all system components, excluding the SAS, located on site?
�❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Lid' ❑ 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): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
f
Commonwealth of Massachusetts
---- Tide 5• Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
c =
ACC
Property Address ,,,pp
✓I C
Owner
Owner's Name
information is
required for every
page. CitylTown State Zip Code Date of Ins ection
D. System Information
r
Description:
Number of current residents:
Does residence have a garbage grinder? El Yes P No
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ❑ Yes U_- o
Laundry system inspected? ❑ Yes No
Seasonal use?
❑ Yes to
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? If ❑ Yes No
Last date of occupancy: ( t•J /)
Date .
Commercial/Industrial Flow Conditions:
Type of Establishment
Design flow(based on 310 CMR 15.203): --- --- —
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.)-.
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
15ins•3/13 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
----_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Addre s
Owner Owner's Name
information is ,n , ,�¢ Vt xi
for every L� r'� (�C_l,�`L)__
page. Cityfrown State Zip Code Date 6f Inspectibn
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records: ��- 04 1-:�nou3 n "
r 1 v
Source of information:
Was system pumped as part of the inspection? ❑ Yes to
If yes, volume pumped: gallons --
How was quantity pumped determined?
Reason for pumping: -
Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
tSins•3113 Title S Official Ins
pection Form:Subsurface Sewage disposal System•Page 8 of 17
I
Commonwealth of Massachusetts
_---- -- Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
say pace Lam.
Property Address
Owner Owner's Name
information is A (� S ^,I 6q k ;
required for every 1 T �1'� 1 -l I � S HA_ DL 2 Q I I 1d
page. Cityrrown State Zip Code D to e of lei pection
D. System Information (co nt.)
Appr xim te age of all components, date installed (if known)and source of information: _
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: fee
Material of construction:
❑cast iron 0 PVC ❑other(explain):
Distance from private water supply well or suction line:
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
GCx-A Cbnd Y-)
r--) Q� I�eo C
Septic Tank(locate on site plan): < 1 l
Depth below grade: feet
Material of construction:
�oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
IQ(pC) .. l l rt -C � CWC re-i-e.
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
�— A ac
JPro e �
perty Address �+
Owner c l -
0
's Name
information is RUS� S p
required for every
page. Cityfrown State Zip Code Da a of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness vim' U m '
Distance from top of scum to top of outlet tee or baffle 5QA Y�
Distance from bottom of scum to bottom of outlet tee or baffle v`'C U Y- 1
�1
How were dimensions determined? Inn aSU re — � 1- r)q
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
-e C m 1 upon of tst)
cc cua,,n C nLA
v"I
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene
y ❑ other(explain):
Dimensions:
Scum thickness — -- -- —
Distance from top of scum to top of outlet tee or baffle —
Distance from bottom of scum to bottom of outlet tee or baffle --- -_
Date of last pumping: date
t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface.Sewage Disposal System Form-,Not for Voluntary Assessments
J.41y
5a6I 'Rccce
Property Address
_ (
Owner Owner's Nainal
information is ne V S S I IS H required for every t,U �
page. Cityrrown State Zip Code 40atof 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.):
1
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy.attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 11'of 17
Commonwealth of Massachusetts
57
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
t ,
c , (-Un
Pr pp f arty Address
UU—
Owner —
Owner's e information isequired or e very " oz>ft-wS Mi1 1S
page. Citylrown 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' T'
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.):
Uid Scj efbeq- 1-e vjt l C�v kc�,N-c
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-3/13 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M Pro erty Address
Owner Owner's Namie
information is �(_,� S i�' C �y c, —�'21 Q r
required for every 6'�.UX Tl Vl l.� jS
page. CityjTown State Zip Code Dat of Ins ection
D. System Information (cont.)
Type:
leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number: .
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
(0
1 X lli� 07e-- 73� I-egch �i'k H,om--e- W tree,-) ya low+
i eo I n a ffd 4 ba��
lq �rn �0�'om -1 ow -o\-- r -1-'r,re r t i's C 5�wn 1 ire
0 ' S ��n 1�v-c 1 had b e n h i h�e Nf� 51'
pa 3 r Prc 5-e►� al w r( .
Cesspools (cesspool must be pumped as.part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer ---
Dimensions of cesspool
Materials of construction — —. —
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
C1 Out
P party Address rP�;d( LL
Owner Owner's Narrd
information is N�S� � Hill I J _H H L U 1 � .� � la I y
required for every �=a+
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts.
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Pro erty Address
Ire CL -f— L1L�
Owner Owner's N m
information is � � dad
�/
required for every � ! ` I. S t=Ln �` --E-h I I
page. Cityrrown 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:.
and-sketch in the area below
❑ drawing attached separately
(�4r o hOV�
I� 5�c fS g
1 0
Tunes
2 0
L3
�f1 D-g Ox
1- 1q " Z
A-3
C) 215�
t5ins•3/13
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Peps 16 of 17
Commonwealth of Massachusetts
w - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
PFo erty Address
Owner - 1 L LLL
Owner's N a
information is
required for every S
page. CityfTown State Zip Code Date Of Insp ction
D. System Information (cont.)
Site Exam:
M,11�'heck Slope
2-1surface water
Check cellar
hallow wells
, I
Estimated depth to high ground water:
feet
Please indicate all methods used to determine the high ground water elevation:
LvJ Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
►� 1 o n enqineerek )an,) can I)-f-
vn e b YY -en (n e-rr-,*0 )n L c'0
C rm(YUA 0 H wu rG)MaAPh I rn Gs,9 53
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 16 of 17
0
Commonwealth of Massachusetts
-- - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
R cc r e. �n
Pro erty Address
-e, LC -
Owner Owner's Narde
information is
required for every
page. Cityfrown State Zip Code Date of Ins ection
E. Report Completeness Checklist
Inspection Summary: A, B, C, D, or E checked
Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
2 System Information—Estimated depth to high groundwater
Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Insp
ection Form:Subsurface Sewage Disposal System•Page 17 of 17
Q
srK.65r
ytK;SET
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PRp�O�E� A�DDI'(Il1 tJ
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ZHOFMASo `
J g° ALAN `Prn
M. -+
� GRADY N
No.37732
16
9�FES
0 lqH�SURgo
le!''-
KAZ,e KI r::�
PLo'r r�i4J �Ir- LAWe ''�J G.A.F. ENGINEERING, INC.
REV. DATE BY JAPP'Dj DESCRIPTION
0 131�RfJ,51A6L , MASS, PROFESSIONAL ENGINEERS & LAND SURVEYORS
DATE: JOB NO.: 3 Io
F PREPARED FOR: 454 WAREHAM STREET, PO BOX 953, MARION, MA 02738 DRAWN BY: K K M
nl N �G N U L.M hJ SCALE: =
TEL: (508) 748-0252 FAX: (508) 748-0542 CHECKED BY:
A
I'_
4
" I HEREBY CERTIFY TO THE. TQWN QF BARNSTABLE BUILDING pEPARTMENT,
THAT THIS SURVEY WAS CONDUCTED IN`ACCORDANCE WITH 250 CMR 6.01 ,
THIS PLAN IS THE RESULT OF:THF SURVEY CONDUCTED BY. G.A.F .
ENGINE,ERING, INC. ON .MARCM 26, 2004.
THE DWELLING AND OFFSETS.SHOWN ARE BASED ON THE SURVEY
CONDUCTED AND '"CONFORM THE .HQR[ZONTAL DIMENSIONAL SETBACK
REQUI:REMENTS`.OF THE TOWN OF BARNSTABLE ZONING .BY-LAWS FOR
THE ZONING DISTRICT "RF" .
THE DWELLING. SHOWN IS NOT SITUATED WITHIN A SPECIAL FLOOD
HAZARD ZONE AS S NON PU6LISHED FIRM MAPS OF THE TOWN OF
BARNST . 11
ENN D. AMARAL, P.L.S. #41406 DATE:
A�
AX S4 y
GLENN ��4
L a Y
V AN.4144L p
rS No. 1
A
J ESQ
h
CORNER
BOARD
r63,. \ (TYPICAL)
LOT # 57 ;:"' ' \ ,.,\\.l o
STEPS \,\\ \ \\ �..\ w
Ck
U IvOl \ LOT # 5
�o
P
SHED TO BE
RELOCATED ON
PROPERTY AT
PROPER SETBACK.
LOT # 54
LOT # 56
LAND COURT PLAN 37712B
AREA = 30,400+/-SQ.FT.
�P
OG
LOT # 49 LOT # 53
.1
LOT # 52
PLOT PLAN
1529 RACE LANE BARNSTABLE, MA.
PREPARED FOR
DON SCHULMAN
DATE: MARCH 26, 2004 PROJECT# 98-436
ZONING: RF G.A.F. ENGINEERING, INC.
SETBACKS
FRONT: 30' PROFESSIONAL ENGINEERS ' & I.ANp SURVEYORS
SIDE: 15'
REAR: 15' 266 MAIN STREFT WAREHAM, MA.
TEL: (508) 295r--6600 FAX: (508) 295-6634
I
SPECIFICATIONS & GENERAL NOTES
GENERAL CARPENTRY(continued)
ALL WORK SHALL COMPLY WITH THE MASSACHUSETTS STATE BUILDING CODE (MSBC),&ALL LOCAL LAWS. EXTERIOR WALL SHEATHING SHALL BE EXTERIOR GRADE PLYWOOD,OR EQUAL
SAFETY PRECAUTIONS SHALL BE OBSERVED PER MSBC,CHAPTER 33. RAFTERS&CEILING JOISTS SHALL BE DOUBLED AT EACH SIDE OF OPENING(S).UNLESS SHOWN DIFFERENTLY IN THE PLANS(S),HEADERS SHALL BE 2-2 x_SIZED TO ACCOMMODATE
ALL WORK SHALL BE PERFOMED WITH PERMITS,LICENCES &OR LICENCED PERSONNEL VERTICAL OPENING(S)
WORK SHALL BE CO-ORDINATED WITH UTILITIES & PUBLIC AGENCIES,INCLUDING'DIG SAFE',IF NECESSARY& OR APPROPRIATE.
ALL FRAMING SHALL COMPLY w/MSBC AND'FRAMING PLANS'&OR'SECTIONS'.EXCEPTIONS ONLY ARE SHOWN IN PLANS. ROOF SHEATHING SHALL BE 5/8"EXTERIOR GRADE PLYWOOD.
"OR EQUAL"AS USED HEREIN&OR IN THE PLANS SHALL MEAN'APPROVED BY THE BUILDING OFFICIAL AS EQUAL TO THE DESIGN INTENT&ALSO WITH SUBSEQUENT SUB FLOORING SHALL BE%"EXTER.IOR GRADE TONGUE&GROOVE PLYWOOD,GLUED & POWER NAILED OR SCREWED.@ 8"O/C"
APPROVAL&ACCEPTANCE BY THE OWNER. HEADERS SHALL BE PER.MSBC.CHAPTER 36,TABLE 3406.2.6,UNLESS SHOWN OTHERWISE IN DRAWINGS.
THE CONTRACTOR SHALL: ALL NAILING SHALL BE PER MSBC,CHAPTER 36,TABLE 3606.2.3
(a) VERIFY ALL DIMENSIONS&CONDITIONS PRIOR TO START OF WORK &REPORT DISCREPANCIES TO THE OWNER PROMPTLY. PREFBRICATED&ENGINEERED PRODUCTS SHALL BE ACCOMPANIED BY MANUFACTURERS STATEMENT REGARDING LOAD BEARING&/or OTHER STRUCTURAL CHARACTERISTICS.
(b) BE RESPONSIBLE FOR ALL DEBRIS TO BE CLEANED,SWEPT&REMOVED ON A DAILY BASIS FROM THE CONSTRUCTION SITE.
DUMPSTERS SHALL BE PROVIDED ON SITE&SHALL BE REMOVED&OR REPLACED WHEN FULL.DEBRIS SHALL NOT ACCUMULATE ON THE SITE TO ELECTRICAL
THE EXTENT OF CREATING A SAFETY OR HEALTH HAZARD. ALL WIRE,INSTALL ATION&MODIFICATION OF WIRE&OR ELCTRICAL SYSTEMS SHALL COMPLY WITH THE REQUIREMENTS OF MASSACHUSETTS ELECTRICAL WIRING STATUTES. ALL ELECTRICAL
(c) MODIFY,RELOCATE OR OTHERWISE RELOCATE&OR DICSONTINUE&REMOVE EXISTING MECHANICAL&OR STRUCTURES WHICH WILL IMPEDE A CLEAN EQUIPMENT,DEVICES,FIXTURES SHALL BE APPROVED BY'UNDERWRITERS LABORATORY'OR EQUIVALENT INDEPENDENT TESTING AGENCY&SHALL BE APPROVED BY THE LOCAL ELECTRICAL
&THOROUGH FINISH PROJECT.WHERE MECHANICAL SERVICES EXIST BUT WILL BE IMPEDED BY NEW WORK,CONTRACTOR SHALL MODIFY&OTHERWISE INSPECTIONAL OFFICIAL.
EXTEND PLUMBING DRAINS&OR VENTS&OR REQUIRED BATHROOM VENTING CONFORMING TO ALL STATE&LOCAL CODES.
(d) MAKE ALL REPAIR,REMODEL,& OR RESTORATION WORK TO MATCH ADJOINING EXISTING WORK.WHERE APPLICABLE,ALL SUCH WORK SHALL REPLICATE PLUMBING
EXISTING WORK. ALL PIPE,INSTALL ATION&MODIFICATION OF PIPE&OR PLUMBING SYSTEMS SHALL COMPLY WITH THE REQUIREMENTS OF MASSACHUSETTS PLUMBING STATUTES.ALL PLUMBING
(e) INSURE WEATHER TIGHTNESS DURING CONSTRUCTION& AT THE COMPLETION OF ALL WORK. EQUIPMENT,DEVICES,FIXTURES SHALL BE APPROVED BY THE LOCAL PLUMBING INSPECTIONAL OFFICIAL.
(f) NOT SUBSTITE ANY PRODUCT,PROCEDURE,METHOD OR DESIGN WITHOUT THE EXPRESS APPROVAL OF THE OWNER. HEATING SYSTEM
STRUCTURAL ALL HEATING EQUIPMENT,FIXTURES,APPARATUS&NECESSARY ATTACHMENT TO OTHER MECHANICAL,PIPING&OR ELECTRICAL SYSTEMS SHALL CONFORM WITH ALL MASSACHUSETTS
SOIL BEARING CAPAGTY=2.0(4000 lBS)TONS PER SQUARE FOOT,ASSUMED. REGULATORY AGENCY REQUIREMENTS&OR UNDERWRITERS LABORATORY STANDARDS&SHALL BEAR STAMPS/CERTIFICATES WHERE APPROPRITE.HEAT SYSTEM(S)WHETHER NEW OR
DESIGN LOADS(D.U.=DWELLING UNIT) IN POUNDS PER SQ.FT.(PSF) (L LIVE, 0—DEAD, T=TOTAL); REHABILITATED,OR ADDED SHALL BE DESIGNED&OR APPROVED BY A COMPETENT HEATING SYSTEM SPECIALIST&SHALL MAKE HIS/HER FINDINGS KNOWN TO THE OWNER.
(a)FLOOR @ LIVING SPACE: 40 L + 15 D = 55 T MISCELLANEOUS METALS
(b)FLOOR @ SLEEPING SPACE: 30 L + 15 D = 45 T ANCHOR BOLTS=1/2"DIA.x 12'LG. STEEL @ 6'-0"0/C,MAX.
(c)ATTIC(STORAGE): 20 L + 10 D = 30 T
(d)STAIR: 100 L+10 D = 110 T JOIST HANGERS&SIMILAR SUPPORT DEVICES =18 GA GALV.STEEL .
(e)DECK(S)&BALCONIES: 60 L +10 D = 70 T INSULATION
(1)WALL, EXTERIOR; 25 L + 20 D = 45 T . THERMAL PROTECTION SHALL BE PER MSBC CHAPTER 13 & APPENDIX 'J'.
(g) PARTITION INTERIOR: 0 L + 10 D = 10 T MINIMUM REQUIREMENTS,FIBRERGLASS(UNLESS NOTED OTHERWISE);
(h)ROOF: 30 L + 15 D = 55 T (a)FOUNDATION WALL= R 13(ALT.=2"RIGID-R 14[MAY BE OMITTED IF FLOOR ABOVE IS INSULATED ]..
MASONRY (b)FLOOR OVER UNHEATED SPACE = 8"-R 30
MASONRY UNITS SHALL BE FULL SIZE WHERE POSSIBLE&SAW CUT WHERE NECESSARY. UNITS SHALL BE LAID IN FULL BED&END MORTAR JOINTS. (c)WALLS,EXTERIOR WOOD FRAME =3/2" R 13
ANCHORS SHALL BE#4 RE-BAR DOWEL @ 8'-0"O/C IN FOOTING,FOUNDATION,ETC. TIES SHALL BE GALV.STEEL @ 24"0/C,EACH WAY IN BACK-UP WALLS. (d)SILL x 6- SILL SEALER
WORK PROTECTION;(a)WORK SHALL BE COVERED UNLESS IN PROGRESS,(b)UNITS @ LESS THAN 35 DEGREES,F.,OR IF COVERED w/ ICE&OR SNOW SHALL NOT BE USED. (e) ROOF/ CEILING= R 30 w/BAFFLE @ EACH RAFTER BAY @ EAVE (See VENTILATION,below).
CONCRETE VENTILATION
CONCRETE STRENGTH,COMPRESSIVE[WALLS &FOOTINGS=3000 P.S.I.] EAVE=CONTINUOUS VENTED SOFFIT TYPE OR OWNER APPROVED EQUAL
SLEEVES& OR INSERTS SHALL BE EMPLACED PRIOR TO PLACING CONCRETE. BAFFLE(ROOF SLOPE)=PREFORMED STYROFOAM VENT CHUTE @ EACH RAFTER.
FOUNDATION:(a) WALLS SHALL HAVE 4'-0" MIN.FROST PROTECTION BACKFILL.& SHALL BE DAMP PROOFED PRIOR TO BACKFILLING..(b)FOOTINGS SHALL BEAR ON RIDGE=CONTINUOUS PREFORMED CELLULAR P.V.C.TYPE
UNDISTURBED SOIL OR STRUCTURAL FILL THAT HAS BEEN COMPACTED IN 8"MAX.LIFTS TO 96% MAXIMUM DENSITY. GABLE=SEE DRAWING(S).
CARPENTRY DECKS(exterior)
ALL WOOD,INCLUDING WOOD SILLS,GIRDERS,STAIRS,ETC.,IN CONTACT w/CONCRETE &/or CLOSER THAN 18"TO GRADE SHALL BE PRESERVATIVE TREATED(P.T.). SHALL CONFORM TO MSBC,CHAPTER 3603.14 & HAVE CONTINUOUS GUARD RAIL 36"(3'-0')ABOVE DECK SURFACE,CAPABLE OF RESISTING
ALL EXTERIOR DECKS,BALCONIES,STAIRS,RAILS,ETC.SHALL BE P_T.,ALL EXTERIOR TRIM SHALL BE PRIMED 4 SIDES,MIN.PROTECTION. 200 LB.THRUST AT THE TOP & HAVE 5' MAX. CLEAR OPENING IN BALUSTRADE. STAIRS SHALL CONFORM TO MSBC,CHAPTER 3603.14.2.2
FRAMING LUMBER SHALL BE; Fb=750 P.S.I.; E=600,000 P.S.I. SMOKE DETECTORS IN DWEWNG UNIT (D.U.)
FLOOR JOISTS SHALL FIRE PROTECTION/WARNING SYSTEMS SHALL CONFORM TO MSBC,CHAPTER 3603.16. EACH D.U.SHALL HAVE A PRIMARY HOUSEHOLD FIRE WARNING SYSTEM PERMANENTLY WIRED TO
(a) BE DOUBLED AT;(1)EACH SIDE OF OPENING(S)& (2)ALL PARTITIONS PARALLEL TO JOISTS, (b) HAVE 1/2"x 1 1/2"(2.25 SQ.IN.)BEARING,MIN.& SHALL BE A.C.ELECTRIC POWER & A SECONDARY-HOUSEHOLD FIRE WARNING SYSTEM POWER SUPPLIED FROM MONITORED BATTERIES.
BRIDGED @ 8'-O"O/C MIN.,(c) HAVE BRIDGING @ 8'-0"O/C& SAME SIZE AS ADJACENT JOIST 2-2"x_"SOLID BLOCKING-ABOVE GIRDER
. ,PLANS FOR-ADDITION TO &-REMODEL OF EXISTING SINGLE FAMILY DWELLING
<> <> FOR <> <>
REALTY DEVELOPMENT ASSOCIATES
PREPARED BY
DALY DESIGN ASSOCIATES
11 CHILTON STREET, PLYMOUTH, MASSACHUSETTS
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FEBRUARY 19,2001
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SYSTEM PROFILE NOTES
1. DATUM IS NAVD 88 �a'%is ro1%9,
PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) MARK CORNERS OF PROVIDE INSPECTION PORTS TO
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE LEACHING FIELD W/ WITHIN 3" OF FINISH GRADE 2. MUNICIPAL WATER IS EXISTING Swa 0 Rd
REBAR SET 4" BELOW
TOP FOUND. EL. 109.5' fi t5J`e
GRADE 2% SLOPE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �a� Font e
FILTER FABRIC
\ MINIMUM .7_' OF COVER OVER PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST f'oce
107.0 TOP 104.20' FINISHED GRADE- 4" LOAM & SEED OR PAVE AS REQ.
NOTE: 2" MIN. WALL UNITS TO BE AASHO H-]Q ��. Cone
Locus
PRECAST H-10 THICKNESS REQUIRED yIIIIIIIIIIIIII
"6 2
RISERS (TYP.) 4"0SCH40 PVC 5. PIPE JOINTS TO BE MADE WATERTIGHT.
2'0 107.2' CLEAN FILL ea
.. 6" MIN. SUMP PIPES LEVEL 1ST 2'
,., 12" MIN. INT. DIM. !,- 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE
• 4" PERFORATED PVC 3' O.C. �_-0.005-� O G ms
*106.7 10" **EXISTING 14" o WITH 310 CMR 15.000 (TITLE 5.) s'�9
TEE SEPTIC TANK TEE 3/4"-1-1/2" DOUBLE WASHED O
' *10 5. s" STONE LEACHING FIELD ° 6"DEPTH MIN BELOW INV. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND a
000000000000 WATERTEST D'BOX ° 103.68' NOT TO BE USED FOR LOT LINE STAKING OR ANY •��R M stic Lake
GAS BAFFLE °o�°,00,,9 °*o° FOR LEVELNESS �103.85' LEVEL BOTTOM o �'
OTHER PURPOSE. d
4' LIQ. LEVEL (ACME OR EQUAL) 104.12' 103.95'
30.0' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
J�00000000000000000;000000000000000000000000t
00000000000000000000000 103.18' 9. COMPONENTS NOT TO BE BACKFILLED OR
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CONCEALED WITHOUT INSPECTION BY BOARD OF
*THE INSTALLER SHALL VERIFY THE 6" CRUSHED STONE OR MECHANICAL - - 7.18' �- HEALTH AND PERMISSION OBTAINED FROM BOARD
LOCATIONS OF ALL UTILITIES AND ALL COMPACTION. (15.221 [2]) OF HEALTH. Locus
BUILDING SEWER OUTLETS AND 96.0' BOTTOM TH-1 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
ELEVATIONS PRIOR TO INSTALLING ANY (6.6 y, SLOPE) ( 1 % SLOPE) N0 GROUNDWATER FOUND CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP
PORTION OF SEPTIC SYSTEM VERIFYING THE LOCATION OF ALL UNDERGROUND &
OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
FOUNDATION EXIST. SEPTIC TANK 27' D' BOX 12' LEACHING SCALE 1"=2000't
FACILITY RACE LANE WORK.
**INSTALLER SHALL CONFIRM MINIMUM SEPTIC 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 47 PARCEL 140
BE REMOVED BENEATH AND 5' AROUND THE
TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY
FOR RE-USE. REPLACE WITH 1500 GALLON PROPOSED LEACHING FACILITY. SITE IS LOCATED WITHIN A ZONE II
SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF 12. EXISTING LEACHING FACILITY SHALL BE PUMPED
NOT SUITABLE AND REMOVED OR PUMPED AND FILLED WITH CLEAN
/ SAND.
LEGEND '
R=215��3 Uj � SYSTEM DESIGN:
99- EXISTING CONTOUR
`10 of
X 99 EXIST. SPOT ELEV. o / GARBAGE DISPOSER IS NOT ALLOWED
-[99]- PROPOSED CONTOURUj
DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD
05 a_
198•4] PROPOSED SPOT EL. V 0/ USE A 330 GPD DESIGN FLOW
TH1 /
- TEST HOLE SEPTIC TANK: 330 GPD (2) = 660
o�
3!_- SLOPE of GROUND 1 / **RE-USE EXISTING 1000 GAL. SEPTIC TANK
LEACHING:
Q- UTILITY POLEGAS r
330 GPD / (.74) = 446 SF REQUIRED
FIRE HYDRANT METER /
15' X 30' = 450 SF OK
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING
ELEc 450 SF X .74 = 333 GPD OK
> METER
PORC� o USE A 15' X 30' PIPE AND STONE LEACHING FIELD
TEST HOLE LOGS EXISTING
DWELLING 00
SE
CRAIG J. FERRARI, 13871 TOF=109.5
ENGINEER: #
FFLR=109.6
WITNESS: DAVID W. STANTON RS
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DATE: 8/28/2019 "Z
< CH DECK a: APPROVED DATE BOARD OF HEALTH MA
2 MIN IN
PERC. RATE _ / DECK j ->1 0 z
CLASS I SOILS P# 19-124
DECK ❑
ELEV. ELEV. AG
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PERC W J -�BORTOLOTTI CONSTRUCTION
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MS MS ��N OFt4As asr� q°�i DATE: SEPTEMBER 4, 2019
Q �43 �ycy DANIEL c�� REV: SEPTEMBER 12, 2019 (TANK NOTE)
v �o DANIELA. A.
BENCHMARK: �o OJALA �� OJALA U'
2.5Y 7/4 2.5Y 7/4 2 CEMENT BOUND FNO CIVIL No,40980 off 508-362-4541
(� Q�` /� No.46502 _ �P P fax 508-362-9880
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NO GROUNDWATER ENCOUNTERED Scale: 1"- 20' � �L �� �•- � 939 Main Street � Rter 6A�orS
DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
DICE # > 9-276 0 10 20 30 40 50 FEET 19-276 BORTO-SLATTERY.DWG