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0215 PRINCE AVENUE - Health
215 Prince Avenue A=076 -044 Marstons Mills 1 No. �,o *0 l b l( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpIication for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade tl Abandon( ) Complete System ❑Individual Components y Location Address or Lot No.Z 17 6z v,G v L� Name,Address,and Tel No. Assessor's Map/Parcel 7V LLj Installer's Name,Address,and Tel.No. O$ Designer's Name,Address,and Tel.No.SO.'V.Sya• $4a� Type of Building:Dwelling No.of Bedrooms Lot Size !� �-, Jc sq.ft. Garbage Grinder( ) Other Type of Building Cj_ �. - No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd ?? Plan Date.Xv'\ > Number of sheets Revision Date 3 —7D l Title (o I A✓rJ h Size of Septic Tank J S'bC� RjL Type of S.A.S. t4 Description of Soil 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 Enviro nta ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of th. Signed Date Application Approved by Date t1 Application Disapproved by Date for the following reasons Permit No. 6 _7 Date Issued << D C) / o e No. I � � �� � Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS. Yes } 01pplic4tt'00,for Disposal 6pBtem Construction VErmi 1 . .. .i`Application foi a Permit to Construct.( )t- Repair( ) Upgrade(� Abandon(+ ) Complete System A 0 Individual Components / ^` Location Address or Lot No. �wG� v O is1 Name,Address,and Tel.No. t rl Assessor's Map/Parcel , f 12,� ����+ Installer's Name,Address,and Tel.No. a Designer's Name,Address,and Tel.No. lc�t'�►�v\�"T� GaNS� y] gcj2Vi �� �P�j►G v I' Type of Building: c Dwelling No.of Bedrooms Lot Size ' / sq.ft. Garbage Grinder( ) Other Type of Buildingj_ �. No? of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) �J�/ gpd Design flow provided gpd "2 Plan Date.Tugs 5 �'O Number of sheets .�-- Revision Date 1 1 J -,2 f- tc Title (", a- tl✓I.?✓� 41 Size of Septic Tank I Sb b 6 L Type of S.A.S. D D L 1 �'��,�7s2y AL 4 /i Description of Soil _ a s Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in t accordance-with the provisions of Title 5 of the Envir0enta�and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ifh. J Signed �� Date �� 4e' Application Approved by Date / D Application Disapproved by Date for the following reasons g Permit No. 2 Q (6 -7((// 2 a•' Date Issued ..--------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS 'I Certificate of Compliance THIS IS TO CERTIFY,that the On }-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by 86 r 16,/6 1.o ' at ' p� ;n—(V � -5 6ryr, !Vi�j S ;has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ) t316 _L00dated /�a/ tt�Installer U1'�vfU \�,r�5�{t�+Nf n Designer 6 SS /J�5 iO /- #bedrooms Approved desigTflow``t/� ��G gpd The issuance of thi permit shall not be construed as a guarantee that the system will functionlI designed. Date ), 7 Ins ectorP --------------------------------------------------------------------------------------------------------------------------------------- No. d ( � �d Fee S )p i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal *pstem Construction jermit ..� Permission is hereby granted to Construct( ) Repair( ) Upgrade("� Abandon( ' ) System located at O( 5 � In"t a r S a I')S ✓", 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. I Provided:Construction must be completed within three years of the date of this permit. Date �U// Approved by v �U v TOWN OF BARNSTABLE LOCATION ,=)--1"�, R'4 o k,�c SEWAGE# 446 VILLAGE �ASSESSOR'S MAP&PARCEL 6-7&-6' * INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 152ro Er AJ R � r LEACHING FACILITY:(type) (size) X t®.7 X. NO.OF BEDROOMS OWNER ° Z� PERMIT DATE: d ( -,3a-(, COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4-5 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 o� 1 . - O 0 • 3 SS ��" I _ a --4 v 2_A P `� w JAN-18-2017 23:57 From: To:15087906304 Pa9e:1-11 Town of Barnstable Regulatory Services $ Richard V. Sc*Interim Director Public Health Division. i9X� , was" Thomas McKean,Director 200 Main Street,Hyannis,lVIA 02601 Office: 508-862-4644 Fax: 508.790-6304 Installer&Desigger Certification Form Date: 1 �'� Sewage Permit#4016_ q 2 a Assessor's MapWareel 6- a- 6f 4 Designer: Installer: D 1 Address: 1 rra Ied. _ Address: ►' C.�k.S i • Cn -3p-le. 60r oll>f�i Cdm7 was issued a permit to install a (date) (installer) septic system at -Si-5 Prinez, A{/al. qy, based on a design drawn by (address) "41+ n 1 ram. dated 7 $ j t(,., P"V, (desig er) {� 1 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. grafter 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. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify tha ystem referenced above was constructed in o liance with the terms of the ap al letters(if applicable) IA OF MAS SoFF1.1EY ei O EMIN pYTa4E9 ; (InsWler i Signature) 4 v NO,C-3489 cn ¢. CIVIL . � �SBIONA�EN st is ignature} (Affix Design 1'T9 amp Isere) PLEASE RETURN T4 BARNS'TAB)LE PUBLIC HEALTH DIVISION. CERTIFICATE . OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT.C,ARD AID RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. _ THANi�XOU. QASepdclDosigner Cenifieation Form Rev 8-14-13.doe Town of Barnstable Pit 'EJET7 o Department of Regulatory Services i BARNSTABLE,i Public Health Division Date y MASS. i639• �m'� 200 Main Street,Hyannis MA 02601 - aTEO h1P't t. Date Scheduled Time_ aM Fee Pd.'' f U C ;�z W Soil Suitability Assessment for Sewa a Dip osal Performed By: re,4�_Yle.4, f-� ;r';r�CY Witnessed By: I LOCATION&GENERAL INFORMATION Location Address p , yu�„ Owner's Name . . Address Assessor's MeplParcel: D✓6,/ 0114 Engineer's Name (//f' `�' r " NEWCONSTtR�UCTION REPAIR I/ Telephone# 'Sbb ?zfJG)5 Land Use ,1�^e't� �C. Slopes(%) Surface Stones r'V p Distances from: Open Water Body ©b ft Possible Wet Area > 11^6_ft Drinking Water Well a/�ft Drainage Way ft Property Line _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) t k{'to(r F- O < 1 q j1 lie x 1 J / Parent material(geologic) Gr r�i�'UiC,=+rZ Depth to Bedrock AA F Depth to Groundwater: Standing Water in Hole: f It Weeping from Pit Face Estimated Seasonal High Groundwater > 31D' 41�-tOr tl )(cif: • DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 4 5 S L`6%- yr"-e&l-:^t Depth Observed standing(n obs.hole: in. Depth to soil mottles: n. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Wall#--- =-{leading Date: Index-Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation - Hole 9 � Time at 9" Depth of Perc 'S, Time at 6" _ Start Pre-soak Time Q �>0? Time(9"-6") End Presoak Rate Min./inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) J 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:\SEPTIC\PERCFORM.DOC f - DEEP OBSERVATION HOLE LOG ' Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) N$ � 'nn� l�Klz��b ttla� aie 51 c.t�'tQrc ,frtt?a i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) MJ q ,:Pry; 16Iik S,,o — '7�a(�� C/ '�.�'"e `�?✓r%� ''�"�''`� `'�� tY G%tf2.f.'s-ra �'.;trl �, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency%Gravel) 1 O C ["wry(�1 r , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) W we Flood Insurance Rate Mau: 0 Above 500 year flood boundary No_ Yes V Within 500 year boundary No Yes_ Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 14 E r If not,what is the depth of naturally occurring per iod us material? Certification 'L I certify that on ry �-1a (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr ' g,expertise and experience described in 310 CNIR 15.017. I � Signature �11 J u,• -e J Irl �2 �r �� j' l ' g �. U � ,. Date�� s Q:\SEPTIC\PERCFORM.DOC I G 1�(.RN-1 l .1 sQlil t VALUA'ro.lt Ir'OIhM l'"'bt z ur 3 Location AM ' s.ar L,vt'.I�o; 15 J '✓� Deo'p Holo Number Location (Id tit :on sfte-plan) Land Use8lopo (%1 Su.la"cg:Stortos. Na Laridtorm �y�, � =pig° iG �G ' x Pos.ftfon on landsca a (sko"tch on tho Uack) - - �y p 2 Distances from; G �`O Open Water Bogy a�', bafeet Dr'o.lnoCo•way .coot Possible Wet Area U .. feot , Proporty l no ` fJ °foot Y Z Drinking Water Well.•, W& foot O,t,hor, DEEP;` OE3SCRVATION f-IC)LC L:OCz' Depth from Soll Horizon" Soil Toxluro Soll Color " 5011 Other,: �E Surlace (Inches! (USDA) (Munsolu Mottling ISlructuio Slonos, Uouldort, Conalstengy, % . ..Gravel!.,;,: . bra WjL MIN IMUIvTi3F�'HZSCt'; ttCZ501tTt t57lTEDEf1Yt�li G ED`G 5—Tfs057t1rAR,EA777711 / Parent Materlal Ieeolcplo) ��li' t.J.� Gf'n ��, Dapllrlot3adrook; 1V" r'v Aeplh to 6rouh&stei: Standing Water In the Holo;,;; Waopinp lrom f It Face, x Estimated Seasonal%High Ground"Water " UEP"APPROVED FOAM• 12IU7195 "t t 1101 n't U>- is �a€COLA.'rIO Location Address or Lot No,t ry , CO MN1ONI/V -MASSACf_IIJS�TT U. usu 1 1 C1 C U��l11,0 Obseraotlon Hole �r , Depth -o Pero Start pre-soak t end pre-soak Time at;:12" k ime at 9 t. Tlrne at 6 t i Time (91r. 1 1 Bate Min;/Inch 2 * Mintmum of 1'percc>iatlon test`ITIUSL U0 arforiliod ii7 both the ptirmar` stag" reserve area, Y• ANp' I Site passed 51t �ailcd } 1 3 1 r „Iffll III Ir/.wlll Performed By; 1. Witnessed By: ' - Gornm�ntsl UEP APPROVED FOitArY 11/ON43. 3 :" , 1. Town of Barnstable P# �p1FtE �y Department of Regulatory Services umsrABM Public Health Division Date KAM. 1679. � 200 Main Street,Hyannis MA 02601 O�AAr A Date Scheduled Time 1AM '`Fee Pd. r 1_.a 4 Soil Suitability Assessment for Sewn: a Disposal Performed By: �Y Witnessed By: T` r v� LOCATION & GENERAL INFORMATION F Address /1/15 Pri�� �m&, Owner's Name P>1r-a/LI MArla s M Address Ph et-t_� Assessor's Map/Parcel: 07b S U 0 Engineer's Name Poe, NEW CONSTRUCTION REPAIR ✓ Telephone# '56B so f w5* Land Use b-P- y. 1 e4 Slopes(%) 115 Surface Stones /V Distances from: Open Water Body o ft Possible Wet Arean> W6 ft Drinking Water Well IA- ft Drainage Way ft Property Line vV It Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 5 Ati16C, ® p 0 Lb I • .pis-� � `� ago►-�-S I Parent material(geologic) 6 14e, bkfWA. 4 Depth to Bedrock LA Depth to Groundwater: Standing Water in Hole: _I V oh►L Weeping from Pit Face /V Estimated Seasonal High Groundwater > CMG trill/ Cj"46- DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 6Q�t�f 4 Depth Observed standingfn obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PE RCO.LATi�.rN TEST Date Time Observation Hole# Time at 9" r Depth of Perc µ'S Time at 6" Start Pre-soak Time @ /►0 7 Time ff'6") End Pre-soak ' ?! Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(YIN) 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:\SEPTIC\PERCFORM.DOC f U DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 16,fAbs�as 0 DEEP OBSERVATION HOLE LOG Hole# 'L Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders. Consistency,%Gravel) No hn rw4 } �2 '& � l *Z -/2b C 5Mk its,y 714 Gleam- 4.0d, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 12 l�Gq S'4 g s e Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No 1/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 1446 If not,what is the depth of naturally occurring pe ioial? Certification I certify that on 4-/4S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr XAT' g,expertise and experience described in 310 CMR 15.017. Signature Date V Q:\SEPTIC\PERCFORM.DOC I ' TOWN OF BARNSTABLE bCATION o�-�� ��1 A/C Z �}U SEWAGE# VILLAGE In L L S ASSESSOR'S MAP&PARCEL tW& BR Ii� S NAME&PHONE NO. A) � / g C IiU C O SEPTIC TANK CAPACITY I A-SWFC7/_a ti LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER V iNT PERMIT DATE: C@M9 T� ^. T-DATE: I 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 an wetlands exist g g tY( Y within 300 feet of leaching facility) Feet FURNISHED BY Q rT a2 S/6 A Box P/7, L o 'DWIN OF BARNSTABLE O OOO7-v"l - LOCATION ��/�C£ u£ SEWAGE# f VILLAGE M- M f Lt- S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. A -,6 0hFNc O SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER P O/�ls r_ PERMIT DATE: COMPLIANCE DATE: Cl1Vt/ -7 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 !i £Ale W� 43 D A Qox ir?-t� a �, d i r No. . _a/ Orr')`. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rphration for Migo al *pgtetn Construction Permit Application for a Permit to Construct( ) Repair(/1""Upgrade( ) Abandon( ) ❑ Complete System Individual Components Locatio d us or Lot No. 7 6' Owner's Name,Address,and Tel.No. ow 491 Assessor's ap. arcel *41 - 14 /LL S ��S/�'ao('F f fT' �L FS�f/ A14 Installer's Name,Address,and Tel.No. OY-9 �—��� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms f �Lotize sq. Garbage�Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd, Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /'P G �/� �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�BpoardoffSign d _- - Date Application Approved by Dated Application Disapproved by: Date for the following reasons Permit No.J.�'�� / Date Issued CID— "No. / —� / Fee `D - - '" THE COMMMONWEALTH OF MASSACHUSETTS Entered in'computec PUBLIC HEALTH DIVISION-- TOWN OF BARNSTABLE, MASSACHUSETTS Yes % 1. IFa application' for Mi�ponf �&p!gtemkon5iruction Permit Application for Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System U Individual Components T Locatio d s or Lot No. 7 6" - Owner's Name,Address,and Tel.No. /� 'r� `o�` Assessor's Map. arcel �+I /jl 1 Installer's N41 ame Addres ,and Tel.No:Say' /s���� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size' sq. ft. Garbage Grinder (; ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title w Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /P G 14 4 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 oard of Health. Signed- Date r� Application Approved by Date 5 O Application Disapproved by: Date for the following reasons k Permit No. argo '-' CPC/2�, Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance l THIS IS TOFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 4 �Upgraded CER/T�I ( ) Abandoned( )by A �(U Od—p—r o it o owl x.' 1 r GU ' ;xx at A P/1 /If/C al -Ay/Le- S has been constructed in accordance with the pr�sions Title 5 and the for Di osal System Construction Permit No. 7—D-19, datedInstaller -R.4-- Designer #bedrooms Approved de 'gn ow r' gpd The issuance of this permitlTia1 pub co strued }gu antee that the system i fu dI d. Date ' L/ Inspector ----------) --=— --------------- -----/—, —� ———— No. - �-%� / / Fee/0( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1igpo!6ar ,p.5tem Cow5truction Permit Permission is hereby grantedto Construct ( ) Repair ( Cor-Upgrade ( ) Abandon ( ) System located at 0-l-r P�P// r F y E In 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 conditio Provided: Construction must be com leted within three years of the date o this perm . Date �/ 7 Approved by t TOWN OF BA.RNSTABLE 7:;1:naf;4�1Cd�J- L Or-A'i 10 4 a/S Zi� SEWAGE # 2?- � VILLAGE ASSESSOR'S MAP & LOT INS*AttER=S-NAME&PHONE NO. SEPTIC TANK CAPACITY /4A'i� aff- LEACHING FACILITY: (type) f�T (size) �C NO.OF BEDROOMS .3 BUffiBER OR OWNER PERMIT DATE: 3-3—7V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility aS l't 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 91 61-7c A- `q _ f � u au vr Ld:-C A N S E W A G PERMIT NO. ©lc1,��sJ` , ,N VILLA E N S T A L L E.1QHA A. AM. kCK*E SI*IRF-R E S S 150 Walnut Street est Barnstable, ass. 8 UILDE R OR OWN ER UOh % /fi% J/fv� H �c�k/4 l r� DATE PERMIT ISSUED ® -3 DATE COMPLIANCE ISSUED ' �- �1 �'' �- �, 0� 9 � �� � � �, �.� � ��. /� �1� � �� �� ti�� � � �`' ��f i` No......................... Fxs...., ......-....... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0- HEALT r� .......... OF....... ..1 .. Apphration for Diijinial Workii Tonotrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................ .•-•-.------f rt.ar 12/6------------------------------------IA ----------------------------......--•-•------- Location-Address or Lot No. /ill/ Address a ........ ...: ... .. . . . ----••------....-•-•--.........-----•----...•--------.........................._..... nstaller Address Q Type of wilding Size Lot----N�sM._.____.Sq. feet U Dwelling—No. of Bedrooms---........ .Expansion Attic (4_1 Garbage Grinder ) Other—T e of Building a yp g ----CA.P! .............. No. of persons_;-.-•---__-_•---_--__.____. Showers (.2) — Cafeteria (A®) QOtheL fixtures ------------------------------------------------------•----•--•----•---------••-•-•----.._...._...-••-•-••-----••--••--•••--•---------••.............. w Design Flow.....•-7-_;!.................. .......gallons per person per day. Total daily flow-------;5$0........................gallons. W Septic Tank—Liquid capacity.d-vv...gallons Length-----X....... Width.... _ Diameter................ Depth................ ---- x Disposal Trench—No..................... Width.._._.. _ ...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./'.____-__-. Diameter.._��. .... Depth below inlet........4........ Total 1 Ching ar sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1 " 7 ' �� �` 77 � ~' Percolation Test Results Performed by _ e. ............::......1112 t ry'?�....... Date...."'............................. Test Pit No. 1._ -------minutes per inch Dc/pth of Test Pit...._.......•._._... Depth to ground water________________•--_-__. r3� Test Pit No. 2................minutes per inch Depth of Test Pit.............-...... Depth to ground water........................ �.y .................... .................._ r._/... .._ 711) O Description of Soil--•-- CJ - Z�1: _..._ !�!fl ;? . � ..s'._�.� � - ........ U -------------- �......l-.2...... � - ' ------------------------.....------------------------------------------------. w U Nature of Repairs or Alterations—Answer when applicable........................................:....................................................... --------------------•-------•--•----------------------••--••---•--•-----------------...........------------------------------------------------------------------------------------------...........•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign ......-• • ... ........................ . .•- Application Approved BY.... _ �. 1�P �� '3 . �.. = Dat �' ---•-----Date .... Application Disapproved for the following reasons:------•----------------------•--------------•----------------------------------•---------------•-------......... ...................•...--.---•--------•-•----•--•--...---•----............------•--.......................--•--•-••-•---•--------•---•-•------•-•--•------•-•---••^�-\0�•------_______... a -••--••------- Permit No......................................................... Issued-.....4:� ---- ---)...Date te....... Date 0..N FEB... .!. ............... r. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF............ ......................................I........... Appliration for Dispriiial Warks Tonstrurtion ramit ,,,-/A7pplicatibn is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................... .................................. ...... ................................................ Locatio -- -------------IC.........-Add ess MI Address .......Z I-M .. .. ............... ... ... Fit/�yi}dPr�........ ......0 Installe Address Size, Type of Ilifilding Lot...... feet Dwelling=No. of Bedro Oms...... ...... -----------------—Expansion.2 �Lttic Garbage Grinder *�V) aQiher—-' Type of Building No. of persons...._.._'2 ----------- Showers Cafeteria G34 iI,Othq)�eures .................................................................................. ........................ .................. .......................VJ,4�'. ..�r..$...... .Design Flow...._.......................................gallons per person per,-,,,,,'d`dy. Total daiY/flow---- e.....................s .....gallons. 1:4 Septic Tank—Liquid capacity./56V_.gallons Length------91...... Width.......7..... Diameter_____........... Depth................ Disposal Trench—No. .................... Width.................... Total Length ....... Total leaching area....................sq. f t. a e N Diameter Depth below inlet ing ---------.sq. ft. - - -- ------- Pit 0 A- w p g her Distribution P co t T eiulA Performed by........la ion Test R ...... Date...._._... �4 14 Test Pit NO. I../---,-..._minutes per inch Depth of Test Pit..................... Depth to ground water.._.....__..._......._.. Test Pit No. 2................minutes pere inch Depth,,6f Vest Pit.................... Depth to ground water........................ ...V.b6� ----------------------- 0 Descrip of So'l_.i..... ................. - ---------------------- ........................................... .................................................................................................. .............. .......**.................---------------00- ----------------------------**.. ......... ------------------------1.�......... .............................................................. ................ ---------------------;--------------------------- U Nature of Repairs or Alterations—Answer when applicable_"-..."_______________........................................................................... ...........................w................ ............................7----------------F........... ------------------:_ ......................................... Agreement "The undersigned agrees to install the; a oreIs cribed,Individu4l,.,-Sewate-pisposaI System in accordance with the provisions of TITLE 5 of the State Sanii ry Code— The undersigned furitlieragrees not to place the system in operation until a Certificate of Compliance has been issutd by the board of health. Si. .. ... •........._7. Si e . . .. .. .. .... ..................... .. . .......... ................................. ................... .................. ----------------:---- Date --- ------- Application Approved By...1.�e- D Application Disapproved for the.following reasons:.................................................................................................................. "Ilk ...................................................................................................................................7..............................................................*------- Date x .....................Permit No......................................................... issued................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH ..........l.. OF................. ............................................................. 4 TH 15 CEf]VFY_ at th Individ4lj§eyage Dispersal S tem constructed e") or Rfired b .......... y :......4....e ......... ------------- 6:' a. ...................... at..- ............................... .................... .......Of......... .. ............. has been installed in accor ance with the provisions of TI 5-of The State Sanitary Code as d sr,-ribe&in the application for Disposal Works Construction Permit No..`................................... dated-- ------------------_ ............. THE 15; 'UANCE OF TkIS CERTIFICATE_SHALL NOT BE CONSTRUED AS A`!GUARANTEg.J.HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector ................................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD H.EALTH ............ ..............................................................................OF...... No ...... FEE........................ Mop r 'T n an Permission is hereby granted. ... .................... ................................... to Co o�r�epaii I i a Di4pos em ...No� ... ......... ........ at ... . ...6.2v... ..... ..... ................ ........ ......... Street as showil'on.the application for Disposal Works Construction P r it N Z Dated........................................... ................................ pe... Board of Heal DATE................ ................. .................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 53 ' i N i f MWI A►D lwI L 0 pIr 0 t I i a A a Na 24048 CEQTIF lEt7 p LbT PL.A V-1 . iY ,.• 4� t su LOGATio" M425Tot ,s Mlt-(.5 -Tl� f 1�2oPra �` PLAt.! R�F'c2cNGE k 1 GGiZTtr--.f T14A7 TNT WIT" TWG Lpr ' AWr� SET$ACIG ;;C-4UtQEA��.W-rS �t TNt" � �o w U of C3L2� t ST L,&Q`C 1 w f., RI�TC 1 _�.�tler � +.�d•j B�4XTCt2 4- RCGIS t"C-1Zc� LA.t, O SUZvcY42S 't'l-115 VLAW 1'5 WOT BASeV OW 1464 aSTEC�VtI.I.C. o l�r{ASS� It.d;('QtJ�t~tJT -WZvCY TtaC Ot=t=,t*TS 5tdawtn A}�Pt_1GA,t,..1T tr'�t' L31 : U 9Cu To t�tr.1'C�M fit—. Lj::) LlWe r ti � 2 OF 2 Si.JG� A,4A�I 04 7 f�oST �4,e/0r,vG Alo G,�2a,44 6 62 vD� T�iS�.4G f�rT _ DODO �-¢L ,BoT rD�r•� /4�A � 5D sue' Tore tJA�G F'&me 7-e<7' /''/Iv 044.'N oe L1ss Tom" EG' 99 1 VS 1HVI /NV. L j 6/61'y' .S,4AJD 97a 96,8 s�vr� /kW lcoo t-t•9G 4,C44M Pir PWL w// GrG•9¢ "1�5T .S7'on/E 4607r = 94 3 GSA✓mot.. rG, � Commonwealth of Massachusetts -% Title 5 Official Inspection Form R( Subsurface Sewage Disposal System Form Not for Voluntary Assessments .� 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every CitylTown State Zip Code Date of Inspection page. 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. l Important:When A. General Information filling out forms I on the computer, use only the tab 1. Inspector: key to move your cursor do not JAMES D SEARS use the return key. Name of Inspector BLUEWATER HLD CORP Company Name 350 MAIN ST-ROUTE 28 Company Address W YARMOUTH MA 02673 City/Town State Zip Code 800-593-6449 S-1623 Telephone Number License Number B. Certification 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: O Passes ❑ Conditionally Passes` ❑ ����`� V0.1FtMgsS+'2,, ❑ Needs Further Evaluation by the Local Approving Authority JAMES fi= 0; SE Co *: o . 05/10/2010 spector's Signature Date �4ii�p 'NIIt`�pp���`` 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. I l� t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewag isposal S/em geDtg 17 f _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owners Name information is MARSTON MILLS ` MA 02648 5/10/2010 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: X ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ^I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is required for every MARSTON MILLS MA 02648 5/10/2010 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Properly Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. Citylrown 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 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 ❑ ❑x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ FX1 Static liquid level in the distribution box above outlet invert due to an overloaded _ or clogged SAS or cesspool ❑ x❑ Liquid depth in pit is less than 6" below invert or available volume is less than'/z day flow l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts i r; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments k" 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. Cityrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or , obstructed pipe(s). Number of times pumped: ❑ x❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ElAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑x Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑x Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ti 0 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.] ❑ x❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑x 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. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. Cityfrown 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 ❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x Were any of the system components pumped out in the previous two weeks? ❑ E Has the system received normal flows in the previous two week period? El this 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) ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, including the SAS, located on site? ❑x ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Z ❑ 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: ❑x ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 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 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts _....._...._._.........._. '� it �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t; != 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ElYes M No Is laundry on a separate sewage system?[if yes separate inspection required] ❑Yes x❑ No Laundry system inspected? ❑Yes N No es ❑ No Seasonal use? NY es Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑Yes x❑ No NA Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑Yes ❑ No Industrial waste holding tank present? ❑Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ya 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: 2007 . Source of information: Was system pumped as part of the inspection? ❑Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: x❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �~ ��,,,•'' 215 PRINCE AVE i Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: SYSTEM 1978 PERMIT#78-80/ NEW DISTRIBUTION BOX'07/PERMIT2007-212 Were sewage odors detected when arriving at the site? ❑Yes N No Building Sewer(locate on site plan): 10 Depth below grade: feet Material of construction: O 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.): CAMERA LINES AND TEY ARE GOOD AND CLEAN. Septic Tank(locate on site plan): 14" Depth below grade: feet Material of construction: 0 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 1000 GAL PRE CAST Dimensions: 1" Sludge depth: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form .::: .a ..... Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owners Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Oil Scum thickness 12" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" ASBUILT TAPE-SLUDGE JUDGE How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK IS AT WORKING LEVEL. TANK&COVERS ARE AT 14". INLET TEE, OUTLET BAFFLE. NO SIGN OF OVERLOADING OR LEAKAGE. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form I> Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is required for every MARSTON MILLS MA 02648 5/10/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts r-� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WI LLIAM LEPO I NTE Owner Owner's Name information is required for every MARSTON MILLS MA 02648 5/10/2010 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.): DISTRIBUTION BOX IS 16"X16"32" BELOW GRADE WITH COVER AT 14"/ONE LINE IN, ONE LINE OUT. BOX IS CLEAN &SOLID WITH NO SIGN OF OVERLOADING OR SOLID CARRY OVER. 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.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��� - ' 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is required for every MARSTON MILLS MA 02648 5/10/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: x❑ leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACHING IS ONE 1000 GAL PRE CAST PIT. PIT&COVER ARE 2' BELOW GRADE. STAIN LINE AT 20". PIT WET, BUT NO SIGN OF OVERLOADING OR SOLID CARRY OVER. 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•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts F� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a„ 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. CitylTown 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•09/08 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 J 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every State Zip Code Date of Inspection page. Cityrrown 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 ' o . • 0. r A `3 - dl4 13 ` 27 - o/ 13�3'- 3� . Title 5 Official Inspection Form Subsurface Sewage Disposal System Page 15 of 17 t5ins-09108 Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments mar 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required fired for every ry . Date of Inspection page. City/Town State Zip Code p D. System Information (cont.) Site Exam: 0 Check Slope YES IN FRONT 0 Surface water NONE O Check cellar YES-DRY Shallow wells NONE 20+' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑x 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: NOTE: LOT HIGH FROM _S7RfF7 20'-30' Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 t5ins•09108 I Commonwealth of Massachusetts r Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 PRINCE AVE Property Address WILLIAM LEPOINTE Owner Owner's Name information is MARSTON MILLS MA 02648 5/10/2010 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked x❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed N System Information—Estimated depth to high groundwater x❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I -\ COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Property Information: MAP 76—PARC 44 215 PRINCE AVENUE — MARSTONS MILLS, MA 02648 Property Address LAPOINT, KATHLEEN Owner's Name 155 FORREST STEET Owner's Address WELLESLEY MA 02481 Cityrrown State Zip Cr MAY 18, 2007 Date 2. Inspector: JAMES D. SEARS Name of Inspector A & B CANCO Company Name 350 MAIN STREET Company Address WEST YARMOUTH MA 02673 Cityrrown State Zip Code 508-775-2800 Telephone 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 CMR 15.000). The System: I Passes Conditionally Passes ❑ Fails •lll///�/ 0 d i Ne s Further Evaluation by th Local Approving Authority fH6 Ins or's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of H t�60 L within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10, 0 .iia�U.Irr greater,the inspector and the system owner shall submit the report to the appropriate regionat engffiir—fo 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 ofkksgtat thLA time �GCIc This inspection does not address how the system will perform in the future under the,, ifferent ` conditions of use. Title 5 Official Inspection Form:SubsuAYe swage Disposal System Page 1 of 2 r COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. Certification (cont.) 215 PRINCE AVENUE Owner's Address MARSTONS MILLS MA 02481 City/Town State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Inspection Summary: Check A, B, C, D or E/always complete all of Section D A)Sstem Passes: .( j have not found any information'which indicates that any of the failure criteria described in 310 CMR 15:303 or•in 310 CMR-15:304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: N/A ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or Repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the M for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of compliance indicating that the tank is less than 20 years old is available. ND Explain: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 2 , 1 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 215 PRINCE AVENUE Owner's Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection B) System Conditionally Passes (cont.): N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: N/A 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 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 3 r , COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 215 PRINCE AVENUE Owner's Address MARSTONS MILLS MA 02481 Cityfrown State Zip Code LAPOINT KATHLEEN Owner's Name MAY 18, 2007 Date of inspection C) Further evaluation is required by the Board of Health (cont.): NIA 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.Other: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 4 COMMONWEALTH OF MASSACHUSETTS o Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 215 PRINCE AVENUE Owner's Address MARSTONS MILLS MA 02481 City/Town State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection D) System Failure Criteria Applicable to All Systems: N/A You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 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 0 Liquid depth in pit is less than 6"below invert or available volume is less than Y day flow ✓� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Q0 Any portion of the SAS,cesspool or privy is below high ground surface water elevation. FN-/-A-1 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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.] YES No The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. Yes No ® ✓� The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 5 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityfrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection E) N/A-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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 6 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No 0 Pumping information was provided by the owner,occupant,or Board of Health Q �✓ Were an of the system components pumped out in the previous two weeks? Y Y P P P ✓� Has the system received normal flows in the previous two week period? ✓� Have large volumes of water been introduced to the system recently or as part of this inspection? ✓� Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓� Was the facility or dwelling inspected for signs of sewage back up? 0 0 Was the site inspected for signs of break out? 0 Were all system components, including 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? 0 ® 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. ✓7 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)]. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 7 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection is required] ❑ Yes 0 No Laundry system inspected? © Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 2005—35,000 GAL. 2006—7,000 GAL. Sump pump? ❑ Yes ❑� No Last date of occupancy: UNKNOWN Commercial/Industrial Flow Conditions: NIA 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 F1 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 8 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection General Information Pumping Records: ✓ Source of Information: N/A Was system pumped as part of the inspection? ❑ Yes No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: © Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank.Attach a copy of the DEP approval. Other(describe): Approximate age of all components,date installed(if known)and source of information: 1978 PERMIT 78-80 NEW D-BOX PERMIT#2007-212. Were sewage odors detected when arriving at the site? Yes ❑✓ No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 9 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments 0. rey`ey Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Building Sewer(locate on site plan): ✓ Depth below grade: 10" feet Material of construction: cast iron 0 40 PVC ❑ other(explain) Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage,etc.): Septic Tank(locate on site plan): ✓ Depth below grade: 14" feet Material of construction: 7 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-GALLON PRE CAST Sludge depth: 16" Distance from top of sludge to bottom of outlet tee or baffle 14" Scum Thickness 0" 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 18" How were dimensions determined? ASBUILT—TAPE—SLUDGE JUDGE. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 10 COMMONWEALTH OF MASSACHUSETTS r Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection 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 & COVERS AT 14" INLET TEE — OUTLET BAFFLE. NO SIGN OF LEAKAGE OR OVER LOADING. NOTE: MAINTENANCE PUMP AFTER INSPECTION. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass polyethylene other(explain) Dimensions: Scum Thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): N/A Depth below grade: Material of construction: 11 concrete Elmetal fiberglass polyethylene ❑ other(explain) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 11 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Tight or Holding Tank (cont.) N/A 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 a copy of current pumping contract(required). Is copy attached? Yes No Distribution Box (if present must be opened) (locate on site plan): ✓ Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): D-BOX IS NEW 5/07. D-BOX IS 16" X 16" — 14" BELOW GRADE WITH COVER AT 6". ONE LINE IN — ONE LINE OUT. Pump Chamber(locate on site plan): N/A Pumps in working order: Yes ❑ No Alarms in working order: Yes No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 12 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form d Not for Voluntary Assessments Qt e� Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 City/Town State Zip Code LAPOINT, KATHLEEN Owners Name MAY 18, 2007 Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): ✓ I If SAS not located,explain why: Type: © leaching pits number: 1 leaching chambers number: leaching galleries number: leaching trenches number, length: leaching fields number,dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): LEACHING IS ONE (1) 1000-GALLON PRE CAST PIT, PIT & COVER AT 2' BELOW GRADE. PIT DRY, 18" STAIN LINE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 13 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form y� Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 City/Town State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A 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,damp soil,condition of vegetation, etc.): Privy (locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 14 1 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Sketch of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. R 14 C 1y�v O /O I� - aX °7 - pIT- :2y- � ,pox - � 4/T 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments „ems Subsurface Sewage Disposal System Form D. System Information (cont.) 215 PRINCE AVENUE Property Address MARSTONS MILLS MA 02481 Cityrrown State Zip Code LAPOINT, KATHLEEN Owner's Name MAY 18, 2007 Date of inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 20+ Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: Date Observed site(abutt.ng 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: NOTE: LOT HIGH, OVER 20' TO WATER. Town of Barnstable OF 7HE TaY Regulatory Services snxrrsrna[E Thomas F. Geiler,Director �$ �9 Public Health Division ATED�.�A Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. CERTIFIED SEPTIC SYSTEM REPORT LOCATIU. �® 215 PRINCE AVE � �►'oF MARSTONS MILLS, MA y �'of" A9 A O MAP 076 PARCEL 044 LOT B 1 4 . PREPARED FOR SELLER MR. JOHN BRYAN 215 PRINCE AVE MARSTONS MILLS, MA 02648 BUYER ?'R. AND MRS . WILLIAM L . LAPOINT 23 NORTHGATE RD. WELLESLEY, MA 02181 PREPARED BY HILLIARD HILLER P .O. BOX 250 CENTERVILLE, MA 02632 508-778-1472 CommonweaM of Mossachusetts Executive Office of Environmental Affairs Department of • Environmental Protection Trudy Coxe MNWm F.Weld secr.ury AM"Paul Collucel pavidc8m Stru�hssr tL Gomm SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: a?/5 /'i('/l.L �Gi� �l 'S/�f✓5 �l/fiLS Address of Owner. Date of Inspection: a114 j7 (If different) Name of Inspector. Company Name,Address and Telephone Number- /lG,` CERTIFICATION STATEMSN7 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 inapec'aon. The inspect;on was performed based on my training and experience in the proper function and --intenance of on4dte sewage disposal systems. The system: ✓isasses _ Conditionally Passes _ bleeds Further Evaluation By the Local Approving Authority _ Fails Date: The System burpector shall submit a copy,of this mspec-son report to the Approving Authorty within thirty(30) days of completing this iaspeGion if the syste is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the. m ,,.port 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. IN8P8,CTION SUMMARY: Cheec?C,or D: Al SYSTEK PASSES: �I bx-not found any information which indicates that the rmtem violate&any of the failure criteria as defined in 310 CMR 15 303. Any 69um Criteria not evaluated are indicated below. Bl 9YSM CONDITIONALLY PASSES: ow or more system components need to be replaced or repaired. The system.upon completion of the replacement or repair,passes Tatham yea,m or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined", &plain why not) Tba wc tank u metal, cracked ctruc:uraily;u:sound. shows suoataat ai infiltration or e:frltration, or tank failure is imminent. The system will pass :: Decnon i:he existing septic tanx isepiaced Wt mi th a;onformmg septic tank as approved bw the Board of Health. (revised 11/03/95) 1 One VA..m Street • Boston,Massachusetts 02108 • FAX(61.7) 556-1049 • Telephone(617)292-5300 :^1 Pnnrgd on RaKW*d Paper II ACE SEWAGE DISP OSAL POSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (ontinued) arty Address. Owner. 41c' , i�it/ /✓�QY%,�/ Dane of Inspection: a�jG�y 7 B1 SYSTSM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the ribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system pans inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or repia The system required pumping more than four times a year du to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF EALTH: Conditions exist which require further evaluation by the Bo 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 ETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A HANKER WHICH WILL PROTECT THE PUBLIC TH AND SAFETY•AND THE ENVIRONMENT: Casapool or privy is within 50 feet of a surfa water Cesspool or privy is within 50 feet of a bo ring vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUN ONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH.AND SAFETY AND THE ENVIRONMENT. The system has a septic tank and so' absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply The system has a septic tank and it absorption system and is within a Zone I of a public water supply well. The system has a septic tank soil absorption system and is within.50 feet of a private water supply well. The system has a septic tank soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well ware analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. S) OTHER (revised 11/03/95) % 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: c?/3- Owner. ^1/j Date of Ingxwtkon: DI SYSTEH FABB: I have deesrmined that the system violates one or more of the following failure criter as defined in 310 CAR 15.303. The basis for this dets=matioa is identified below. The Board of Health should be contacted to 'etermine what will be necaesa-to correct the faikure. Backup of sewage into facility or system component due to an overload ' or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surf ce waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or availabl volume is less than V2 day flow. Required pumping more than 4 times in the last year NOT a to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System. cesspool or pr . is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supple. Any portion of a cesapml or privy is within a Zone I a.public well. Any portion of a cesspool or privy is within 50 feet f a private water supply well. Any portion of a cesspool or privy is less than 1 feet but greater than 50 feet from a private water supply well with no scoeprab a water quality analysis. If the well been analyzed to be acceptable. attach copy of well water analysis for coliform bacteria,volatile organic compounds, onia nitrogen and nitrate nitrogen. El LARGE SYRTF.hi FAILS: The fdDowing criteria apply to large systems in ad tion to the criteria above: The gstam serves a facility with a design flow of 10.000 gpd or greater(Large System) and the system is a significant threat to public bsahh and safety and the environment because ne or more of the following conditions exist: the sysum is within 400 feet of a drinking water supply tbs system is within 200 feet of a ributary to a surface drinking water supply _ the system is located in a nitro n sensitive area(Interim Wellhead Protect-on Area(IW?A)or a mapped Zone II of a Public Wnter supply well) The or operator of say such system shall r:ng the system and facility into hill mmpuance with the groundwater treatment program ownst raqui:emsats of 314 CMR 5.00 and 6.00. Pi consult the local regional office of the Department for further information. (revieW 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addre.c Owner. /4�'/1 BTU/�G r,Qy/fif/ Date of Ingmcuon: 'Check if the following have been done: ---Pump*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. As 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. The system does not receive non-sanitary or industrial waste flow The she was inspected for signs of breakout. / _All system components,se;c�iuding the Soil?,bsorptior. 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 tses,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 costing information or /approximated by non-intrusive methods. vThe fadlity owner(and o=pants. if different from ownev were provided with information on the proper maintenance of Sub. Surface Disposal System. (revises 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Owner Date of Inspection: FLAW CONDITIONS RESIDENTIAL: Design flow er ll°na Number of bd:ooms:� Number of carnal reeid+ents:�O,. Garbage grinder(yos or no):.A&�' Laaadry ooaaeesad to system(yes or no):y� / Sonmal we"or no): •�� 7/�,y is/s 5� —a��/G G/fL 39 OcYI Cr9G Water meter res&ngs if ale: Last daft of oaapacy: zxfSG.UTGy COMMERCIAL/IND U STRIAL Type of establishment: Design flow: Allczs/day Grease trap present: (yes or no)_ Iadastrial Waste Holding Task present: r no)_ Noa sanitary waste discharged to e 5 system: (yes or,no)_ Water meter.tesdinp, if availab Lost due of caapancr i OTEWL. ) Lost daft oceQpaaey GENERAL INFORMATION' pUMpING RECORDS and source of information: 970M pmeped as part of iaspec'aon: (yes or noi_A:j�' If yes,volume pumped ¢allons Reason for pumping TYPE OF SYSTEM �$e tank4stziuzon batisoil abwrpuon system eked.oaaspool Overflow compool pTivy (if yea, attach previous inspection records, if any) Owed syswm(yea or no) Otbar(s=plaia) APPRrOID[ATE AGE of all oompo aetus. date installed(if known) and source of information: G�-rj. U� GU.ti/>G✓o9riG t S-wage Odom dgtaeted when arriving at the site: tyes or no) 16:�� (revised 11/03/95) 6 i SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: aJ•5 �.C�itiv/ s�U� fzi aT��' `�/GGf Owner. .ei/< Date of Inspection: -'//e197 UP=TANK-le-1, floras on cite plan) Depth below pads:/ Material of Win: Lasaaete_metal_FRP—other(explain) SheLge depth O" Distsm from top of dodge to bottom of outlet tee or baffle: /d Satin thielmees: %/- DW&m iSrom top of so,- to top of outlet tee or baffle: 7,d ; ; Dktaaca 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 Ln relation to outlet invert, st:uclwal integrity, evident*of leakage, etc.) Tf///f" ,quo TL'G3 LLzil-,Eo '� !Z: S�Gr� !>f G�rfi�i�t�G' Tfi:UK J7'//lI S'�y,OGE vP Ti<' 4�iT/�i.�/ >�•• U� Tli,� �x�%LLT 7GE l .�✓t � S Tex 0 Tf/�i T/fLL TIf/T Tff� T/f,�/T; GREASE TRAP:_ (lot*u on Site plan) Depth below lea: Material of oonammetion:_nonce _metal_FRP _othersesplai:. Dimensions: 8c�thirhaess: Distant*from::o= of top of outlet tee or baffle: Dlstana from o satin to bottom of outlet tee or baffle: Comments: (tommmenda for pumping, condit.on of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddram Ovenw As'X Data of Inspeadon: a?AO 7 TIt1RT OR HOLDING TANK_ / (]oat.an site plan). Depth below psde Mat�wW of cmmunoeion: _concrete other(e:plaia) Dimensions: C+Pficitr ¢ailons Deep aallo /day Alum W"I' __ Commaats: ' (condition of inlet condition of alarm and font switches, etc.) DISTRIBUTION BOX:L- (bests on site plan) Depth of lugiad level above outlet invert: G� Cotes: evidence of leakage into or out of box, etc.) (sob if level sad distribution is equaL evidence of solids carryover, �711 J Hr /✓�E'O��,l.v G�scs1! P ��Ci 1Z�io PUMP CRAMBE3L'_ (bate on Sib place) pwp in working arden(yes or no) CammSars: (note eoaditiaa of pump r,eondiuor of pumps and appurtenances. etc.) --------------- (revised 11/133/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 9/5 Owner. Irr:" Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_4,:z-,' (loats on site plan,if poeable:excavation not required, but may be appr=mated by non-intrusive methods) If not determined to be present, arplain: Type- lawbixgg prt+, number: lsaebing chambers,number_. Laebiag galleries, number: ls hiag trenches, number,length: leaching fields,number,dimensions: overflow oasspool, number Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) T/�'' D" 7-17'E 57ST�.y G�'�s .yUT /'fri lG P�i�' lel�r 11s , eel /fs '1�cY" 'e�Xc,eSsi�/� CBBSPOOLS:_ (locate an site plan) Number and conf4uraticn: Depth-tap of liquid to inlet invert: Depth ofsaWs layer- Depth of«com layer Dimes of mwpwL- Materials of consumc don: Indication of groundwater. inflow(osespooI must be ped as part of inspection) Comments:(note--Aitiion of iL signs of hydraulic failure, level of pending, condition of vegetation, etc.) (loota on site plan) Materials of eoaamvctiow Dimensions: Depth of solids: cammaatt(note oondition of signs of hydraulic failure, level of pouding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propedy Address: Owner. /*/"" Date of Inspection: SIZTCH OF SEWAGE DISPOSAL SYSTEM: melude fiat to at least two permanent references laadmarks or benchmarks locate in Wang within 100' AgG � � I i u _ a' DEPTH M OWUNDWATER Depth to Voodwat+r• d, m thod of determiaasion or approrimatwn: li iT (revised 11/03f95) 9 � 6 BE O � V GENERAL PLAN NOTES WALL/DEMO - _____________i W O ' -ALL EXT.WALLS TO BE 2x45 O 16' O.L(L44E_5 NOTED OTHERWI5E) - I ------'- WALLS AND ITEMS TO' I eM+a r mL' -ALL INT.WALLS TO BE 2X45016' ------- BE REMOVED i O.L.MESS NOTED OTHERWISE I `p E1I5TING WALLS TO v @J 1 -WINDOW5/FRENCH DOOR TO BE'AND-ERSEN• REMAIN i - V - f r 2CO SERIES TILT-WA5H WINDOWS W/ATTACHED I c I� MNTINS f59U WITH NON-IMPACT-RESISTANT F••'— NEW MULLS GLAS5 AND PLYWOOD PANELS AND FASTENING '~ SYSTEM AS SPECIFIED IN THE TTH ED.OF MASS.STATE BLOC.LODE N m 6 (.REFER TO ELEVATIONS FOR WNTI45 DEMO NOTE5 I n, r PATTERNS) o TOP OF SUB PLR. i (TO MATCH EXIST). E T DOOR BY SI EXISTING DASHED WINDOWS 4 NALLS N N ❑ -'EATING' NTRM.SON I TO SE REMOVED AND PATCHED AS E /( NEEDED OR REPEALED AS NOTED ---- TOP OF FOND.WALL= / y • -REFER TO ELEVATIONS FOR WIW GARAGE OW t RA.HEIGHTS ABOVE WSPLOOR J _____________ U t0 U TJ-5 REBAe ni s) I I I T-2' MCI rn /n/ CONCRETE WV.L ON ON 14'T 12* EF . KEYETE FOOTING IN rT, W W P.T.6X6 POST I\RAPPED—\fo. 4 nq YUIX PVC TRIM IB V2'% VERIFY INFI LD -------------4 $LAB IEIGIIT TO B U2'FIN.DIM) a MATCH EXIST- - -' ry fV U V _ ENTRY PAVERS AT—�� FBI ) (1)45 REBAR SIDE ENTRY IN, BRILK'(i N-T AT V ON EXI(I2'TREADS) 'ram TOP EAOF SSEMENTT ON EnI5TIN6 PATIO I ON. V V ' 4I .EXISTING)W SIMF KET SERIES, IES, IN5WIk6 r SIDE. _ _ 2-13X-KET SERIES:11512(DOWLAS FIR) II; PATIO V ' RD,3B DOOR Ir ,® ' N. - p PLO.:}EO V2%6-II° w PITON FLOOR APPROX.ANAY —� EATING/ MFH 136 i 2050 EXISTING ' I /� FOUNDATION DETAIL I MRETINS:(b/U PORCH i r r 3-B' lei 4-9 5 C.ALEr 1/2' = I'-O' m -EXISTING GIRDER ' r - '- <v ' BATH 2 - - / N A.T.2X6 SILL W/5/B'X12' ' A ANCHOR BOLTS®2'-0'MAX FM DYE_ FROMMIN.RN PER TILL 4, A3 FROMOORNERS TYPICAL; - KITCHEN --- MIN.(2)BOLTS PER SILL DIN i'J6 - ' (P T.BLOCKING AS NEEDEDI LTR.IN EXIST. 294 DH 2B36 i NEW BASE AN OPENING R.O,:2-5WFE r r MIAITINS:(b/it MATCH EX5TIN6> 1 EXISTING FOUNDATION r ' WALLS Y y y ' _. Y wit rna'�tum�^tcEo ___________________._________, _______ _____ REF. r n TOP OF //// EXISTING GIRDER EXISTING GIRDER I BELOW TOP OF Ex.SUBFLR. Y 6Y LLIENL iy S ac4 ja o_so-0 7 a o e>v 9 DRILL m4 REBAR 4 INTO E.Y.LONE. Ym ` _ NALL 4 FOOTING 112'&0&VERTU _ , �/SECURE W/EPOM GROUT;RE3AR / . 81�. ..SEAT..•- I'-- _--_-- TO PROJECT 12'MIN..IMO NEW CQ ,,; 5'S' 1'-0 b'-1 V2' L WALL/FOOTIkG mP m c ANNING-2-DA-e W.I.G. nLE sHINR. MSTR. �- - - (OR SIMILAR CELLAR SASH) Q /\ ALIGN WALLS o BATH 244 ON 2B96 p MINTINS:NO MUNTINS - " FAMILY 5TORA6E RA,T-B-X 1'�' - N�• \ RO'2dX4-6 - a&sa= sa`m=m" MA5TER M1NTiN5:(6)u a q 244 ON 15SO LTR.IN EXIST. LIVING \�\l` BEDROOM '� TEAT .O.:R 2-5 X-O OPENIN'C- r i r MMVTINS:(b%L LINEN - CUT OPENING IN EXIST. q•CONL.5LA8 HEIGHT�' _ g WALL TO LEVEL OF ; I w i0 MATLH'cXI5TIN6 b/ H k &��- N NEW 4'SLAB AT LRAWi- (IN LOCATION OF EXIST, r , --- --- + GELLAR SA51U I I _ rr _____ _____________________!______ N- h d C Cs 0 ----------JI 0 r___________ _________________ N Q) V _ -----------------------J N .Ln co; Cu N U LL G= C N FOUNDATION GENERAL NO112-. I - T: NA.LL/DEMO 5TRULTUR1L FOUNDATION NOTES DN. -z� ON. V)'„t V) Q -CONCRETE FOUNDAT70N WALL TO BE 10'THICK PATIO O `�•! Q ON 29'XI2'(UNLESS NOTED)CONTINV015 -NO FOOTING TO BE PLACED IN CONE.FOOTING W/KEY NH<IGNT OF WALL - WATER OR FROZEN SOIL TO BE BASED ON GRADE CONDITIONS;4'-0' -D '� "NEE FIN.GRADE TO BOTTOM OF FOOTING) EXISTING HALLS TO w W REMAIN -CONCRETE STRENGTH MIN FL=3.000 PSI 4 V c 0 G AT 2B DAYS Q O SILLS N E N EEL ANCHOR(PRESaREB TREATED)W/SIB'X 12' LL 0 3'FROM STEEL ANCHOR BOLTS 6 NO O.G.MAX.AND -ALL RERGORLING SEAMS TO 02 ASTI A615. B 11'FROM CORNERS.BOLTS SHALL ENGAGE BOTH A NEW WALLS CRAVE 60.DEFORMED BARS PLAT-c5 AND BE FASTENED YV 3'X3'PLATE YY451ER5. THERE SHALL BE A MIN.OF 2 BOLTS PER SILL. -CLEAR COVER FOR TIN65(CAST TO AI 3' TO BOTTOMS OF FOOTIkGS(LAST AGAINST O -POST OONNELTION AT ATTACHED FORLHES EARTIU AND 2'AT 51DE5 OF FOOTIk S Oft '. -1"'- ', job no.:ISIS DEMO NOTE5 NLALL5. -' ''.'" ...'f r TO BE LAST 544 S R PF OF WALL \;I'''• r I „-.,j,;�,, 5 EL P05 PB44 OR PF64(12 6UAGE1 E _ L" p-� _ •m= is<. STEEL POST BASE PNLHORS -SEE TYPICAL V GENERAL NOTES �- � ,Q` � p�� �- ��,.%;\..,r-^--�,yes',_�• date 02 NOVEMBER 2016 EXISTING DASHED NDDOYG(WALLS .AND EMENI DETAILS FOR OTHER m<.o' 'ep`xm m To.rn x;o 'u I.<m x`o q r`o �e.�p " TO OF REMOVED AND PATCHED AS REOULREMENTS n m •NEW INTEFN2R DOORS AND CASED NEEDED OR REPEALED AS NOTED. m < dui / C SodIB AS NOTED OPENINGS TO MATCH HEIGM OF ALL STEEL CONNECTIONS WELDED �I'yF 'J'c z r'rvF �:A'x ��Y z:AF b n_z ��F z mY "';: -J U\;r`� EX15TINC WTiERE NOTED IN FIELD.REFER TO 5TRLGTJ.3AL q O p qF Q q 4 a Q- -'' t��K.,_ DRAWINGS na rva a° $a n� a al a a ... J WILLIANI '- drawn:KmN T-4' 4'-4' -0. l'_6• ^" •'�•..> BISHOP A ', .�.i �;.,rev. STRUCTURAL L EXISTING NO.29488 "rev. 1''' O FROPOSEDI LII NG AE�A= 1 3 O 50.FT. ^ -`. F Is T FOUNDATION PLAN FIRST FLOOD PLAN __ „/�•> A 1 N 1/4" 1 ' I '-O" SG ALE. I/4 = I'-O SCALE, " TOTAL LIVING AREA 1,52350.FT. �•\'.��•�/n\I i,•>L~ ',/.\� o Je TW ISSUED FOR PERMITRNG sbt I of a Eo V ________________ _________ O .V W n V c L2I u'� C r i+ OI l0 DUT ------------------------- tp C1 i to e - rvx � cu H U ---------------IT -----..------...-..-- ----- I. V d 2z L L=j ,0"*g, , I _ t----------------- ----------------- -------------------- ----------I we I i BATH 2 A BEDROONI 3 A3 ROOF FLAN LINEN 5CALE, 1/8' 1'-0` sir is ' HALL --------------------------------------------- - BEDROOM 2 �� - DH 2O46 CTR.IN EXIST. o _ LTR.IN EXIST. _ MINTINS(b%U OffNiNG OPENMG RA 4 l/B X 2-411/B MUNTINS:IS WIDE X 2 HISW o.m 3 ors'.a N oy n` mm I BEDROOM 4 vLU, m_ a;-`t? �a a - I'S wo Asm� • - c s +, N Ln Ln V H Ct O iInN � o� > N � -------------------------------- -------- CIS /N� V EL R llz$ Cz L O Ln -0 U- G - ) WALL/DEMO �_O GENERAL PLAN NOTE5 �+ OL(UNLESS NOTED OTHERWISE)16' ¢ +V y ___----- WALLS AND IT-cMd TO ALL IT. NOTED i HER4tl KA BE &W ____ BE REMOVED L N p N RE-IN WALLS TO _ q+ WINDOW5 TO BE'ANDER5EN'200 SERIES REMAIN TILT-WASH WINDOWS W/ATTACHED KYNTIN5(SDU WITH NON-IMPACT-RE5ISTANT NEW WALLS JOb AO.:I516 CLA55 AND PLYWOOD PANELS AND FASTENING SY5TEM AS SP-cLIFIED N THE _ TTH EPM OF MA55.STATE ELDG.CODE -(�' I:i S'� /. date 02 NOVE!45ER 2016 m v _ (REFER TO ELEVATIONS FOR KWTIN5 DEMO NOTES . :%.�•^, — 'I;^�,.g PATTERNS) G- SCale AS NOTED ^ n� EXISTING DASHED WINDOWS G WALLS �.�JT•'<` V\�•; 2ATING'ENTRY DOOR BY SIKP50N TO BE REMOVED AND PATCHED AS �/\> a'i rvC Q. drawn:KMYI NEEDED OR REPLACED A5 NOTED. 1 T� -REFER TO ELEVATIONS FOR WINDOW RD.H-cI6HT5 ABOVE SUEFLOOR ',' C rev. S E G O N D F L O O R P L A N E%15T;NO LIVING AREA = 698 50.FT. i n B TURA�' �;_ SCALES 1/4 1'-O'. SNO Zg4g4 Fitz. �'? rev. r 9 f'w,_v+'�y 155UED FOR PERMITTING sht 2 of a LEGEND NOTES: oQ E 1. LOCUS IDENTIFICATION: N o MILL � PROPERTY LINE HOUSE No. 215 PRINCE AVENUE POND ,� ROAD ASSESSORS No. MAP 076 BLOCK 044 0 4- FENCE LOT 1 PLAN BOOK 561 PAGE 50 2. LOCUS IS WITHIN: ti EXISTING CONTOUR ZONING DISTRICT: RF FALMOUTM LOC.1f/S -Q/ � D E S I G N [40] PROPOSED CONTOUR FLOOD ZONES: AE (ELEV 12) & X E EXISTING ELECTRIC BUILDING CODE WIND EXPOSURE CATEGORY:B � ENGINEERING RESOURCE PROTECTION OVERLAY DISTRICT ' ESTUARY PROTECTION DISTRICT & SURVEYING CB.■ CONCRETE BOUND 3. LOCUS IS NOT WITHIN: ZONE II OF A PUBLIC 'WATER SUPPLY TEST PIT AQUIFER PROTECTION OVERLAY DISTRICT 4. LOT COVERAGE BY STRUCTURES: Q� �' www.bssdesign.com EXISTING:: 1754 SF 3.42% �� BSS Design, Incorporateid EXISTING STRUCTURES PROPOSED: 1,984 SF 3.87% Q -9� Q 164 Katharine Lee Bates Rd 5. 'ELEVATIONS ARE FROMI ON—THE—GROUND SURVEY BASED ON RD Falmouth Massachusetts 025410 GIS MAP DATUM. 508.540.8805 FAX 508.548.8313 6. EXISTING SEPTIC SYSTEM WAS DRAWN AS OUR PROPOSED STRUCTURES INTERPRETATION OF INSTALLERS SKETCH AND HAS NOT BEEN VERIFIED. LOCUS MAP 7. EXISTING BUILDING OFFSETS ARE MEASURED TO CORNER REMOVE EX/SANG PROPOSED GRA VEL BOARDS, NOT FOUNDATION. ~ BENCHMARK: CONCRETE SEPAC SYSTEM _FILLED TRENCH DRAIN 8. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A Z W BOUND ELEV 41.74 To DRYWELL rY TRENCH PERMIT FROM LOCAL MUNICIPALITY IN WHICH THE w V) WORK IS BEING PERFORMED IF REQUIRED. Q 9. CONTRACTOR SHALL NOTIFY DIG—SAFE AT 1-800-322-4844 _ AT LEAST 72 HOURS PRIOR TO ANY EXCAVATION. — 01Z U CB FND Q : N 63 35 37 W 0 N 'Q 235.00' Q w (n \ \ (n Q w FUTURE \ 1 �- LL1 \ � � � ;..:: .; SWIMMING g \ :,• POOL 4 .2 W z .. �� ,� \ \ c,+ T.W.=43.0 J : o w \ � \ LOT1 Qww FOUR 500 GAL. H2O .`•. : Dc w , \ \ \ > J �,. ::, �. N 51 ,251 SF 0 0 ,�-- LEACHING CHAMBERS 3 :,� N ^ \ \ 1 Q CO O Z c�. T.W.=45.2 t,. APART w/3 OF DBL. r• p \^, `-� \ \ \ \ PROPOSED Q WASHED STONE ALL AROUND. N \ \ \ DRYWELL o LJ J Z 'BOTTOM AREA: f0.83' x 49.0'P DB5 20' MIN. / \ \ \ \ \ TYP O :•: • " \ \ \ TW=4.30 I'1 W U CO Q o \ \ A- •�`\' o Z Z � \ W Ld 6 EACH O PITLLI MIN• / PA n0 • 1,500 GAL. H2O 488 O \: \ \ ti, I \ , \ O Q- SEPAC TANK O ,: 1 \ \ o0 138.5 w Ls7 •. Q RINSING' 6� M `FPRAIN\ rT1PROPOSED 6 STATION / \ \ \ \ \ 1 / / // //j// / //^� Q J �/ ' P/CKET FENCE / 2 � 0 ��� 15.0' � \ � \ \ . \ \ � / /j /j/ / / /// / /p0 ELECTRICAL N � ��. 2 42.2 EMOVE \ \ \ \ \ ) / /// ////// / / // / O CONTINUES TO ' 8�4j , ED ALKWAY \ \ \ \ ,\ / / // /// / �/ / / / / // /// /� PRINCE AVE � �• m I� N P . ' PROp nON \ \\ \ \ \ \ \ 11 // /// ///// / / j////l l . p J� N � l 22 D S 65'08'23" E / / i.s' PATIO I \ \ A) /N 1 1 OROS, 1 1111 11 \ \ \ ( ( ( / ( I ( _ o �, "�- Z' Q Iw LY 1 1 1 11 1111 \1 \ \ \ I 1 I I Q F- 252.93 / pGE I I -1 \1 1 11 \\ \\ \ \ III _ J O / ( GAR 1 1 1 \ \ \ —__ V) LAWN \\ EXISTING O / I I LAWN I \\\ \ \\ \ ___ — CURB STOP < 1 1 \ti _— _--� � � Q ovSE EXIS�NG HOOR i I I I \ 1 \ \\ � �� �•_�� ._--- + L 81.8 W CONC 215 F�- I I 1 \ \\\ �� 135.0 PROPOSED 4 STEP T10N 44.1 I I I \ I ���\ 1 \ 1 P/CKET FENCE _ E1.EVA I I I I 1 I 1 I 1 \ scale 4?� I EI 1 1 l 1 1 I L 1 _— RINSING u=Crnic 11 1 \ I I 1 1 20' A,9 S STATION METER 239.36' ,,h --(�' ,I 1 1 1 1 1 1 1 I 11 1 I I O date „ PAVED I I I I I I I 11 1,' 1 1 1 1 � I I� 11 � 1 of N JU LY 5, 201 (6 N 60 25 20 W CB FND o -- --41- - rn I Z drawn LAWN �/ l I I I I I I 1 1 1 1 I 1 1 1 1 I EJP MRT LAWN � �`_� , I I I I I 1 1 1 I I � m ' PROPOSED / / I I I 1 1 I I I I 1 I I 1 I checked PAVED DRIVEWAY FLAG I POLE * / _ I I I I 1 1 1 I I job number PROPOSE 1 39.7 ,� / / / I I I I \ \ 1 1 11 1 1 I 0.00' N LEACHING 39 0 ... /�� / / / / / I I I I I 11 1 I I I I I I 10 „ W 15118 CATCH 71 53 02 z BASIN g.8� PROPOSED P�S�c� / / I M I I I ) I I I N revisions 3 5 g9 / I w I CHANGES TO SSDS AND SHOW N CC BERM .P� / / / / / I I I 1 I I I I FUTURE SWIMMING POOL �: o / . 1 I I I , I I LOCATION OFMgS / / RODCKIP I I I I I I I I I I I I AUG 25, 2016 MRT ZN U�M� �P sy�y o o / / / FOD I I I I I I I I I o I I 1 CHANGES TO SEPTIC S�9 �c c,� r w I I I I I N I LOCATION S / I _ I I I ? JEF . E /(.+ Bch hrs uak � a rrI EXISTING / 'y / I N ( I I I I 7 NOV 3, 2016 MRT SWIMMING / / y / ,� ( I I ( ADDED RINSING STATIONS, Nt: 32G53 rn r ' POOL I I I I / / / I I UTILITIES AND WATER �, s �� ti° /,. AREA / / SERVICE EDITED NOTES q. CHANGED SEPTIC PROFILE S �01• 6. NOV 23, 2016 MART 5/ON.ALF�� / .�+Z / Bg� title -9�OA G� SITE PLAN 60.00' ���9 LOT 2 0' 20' 40, 60, 1 OF 2 N 65'22'57" W �F drawing number I : B23-58 j ' I PROFILE IS NOT TO SCALE INSTALL CONCRETE RISER AS SEE SITE PLAN FOR ACTUAL ORIENTATION REQUIRED TO BRING COVERS TO WITHIN 6" OF FINISH GRADE D E S I G N FF EL. 44.1 ENGINEERING & SURVEYING 42.1 EXISTING GRADE 42.0 40.8 41.0 40.5 MAX minimum 2% slope EXISTING GRADE PROPOSED 4" 39.50 FIRST 2' SHALL PVC PIPE 1/4- e,,, CLEAN BACKFILL do FITTINGS per ft. slopeJ= BE SET LEVEL www.bssdesign.com + " " 37.17 2 RISERS HSS Design, Incorporated LIQUID /4 per ft. min. 38.15 1/4 per ft. min. 38.00 164 Katharine Lee Bates Rd CONCRETE LEVEL 8' (END CHAMBERS) oe FOUNDATION 1o" 14' OO �, ,,,,., ., , : 2"(1/8"-1/2") PEASTONE Falmouth Massachusetts 02540 39.5 38.25 ,. o 0 0 0 r • .. , 3 37.66 .!•a� ti. o 0 0 "�, "�,a"� ;.�i•y:= OR FILTER FABRIC CONTRACTOR SHALL VERIFY 4 508.540.8805 FAX 508.548.8313 4 :•i►S#:'''%°.� 0 0 0 0 •'•�;'•;;:�a�.�•' - OF PERVIOUS SAND BELOW SAS G.B. 38.00 37.49 o 0 0 0 ..I. x a. • , a I 3' 4-10 3 3517 WASHED_STONE, SET TANK AND D-BOX ON STABLE COMPACTED BASE SEE NOTE 3. , " CONNECT CHAMBERS TOGETHER WITH 4 DIA. 64 11 17 2 OUR 4 PIPE SCHEDULE 40 PVC PIPE. (207' & 2018') Z THE BOTTOM OF THE LEACHING CHAMBERS ARE L!J > 20' ABOVE HIGH GROUNDWATER. 0 w U) PRECAST SEPTIC TANK G G u 1,500 GALLON ONE COMPARTMENT DISTRIBUTION BOX FOUR - 500 GALLON LEACHING CHAMBERS _ Q � 5 HOLE AASHTO H26 SOIL ABSORPTION SYSTEM �- < AASHTO H2O PRECAST SEPTIC TANK (DB5) PRECAST LEACHING CHAMBER - H2O - _ 0 ZD Q SUBSURFACE SEWAGE DISPOSAL SYSTEM Q Q w V) 0 NOT TO SCALE Q L i C) � � � Cr Ld Z m (n < LIJ L�.I O o Qm Q � � CALCULATIONS LIJ � W z GENERAL NOTES L� (.) Q Q SEPTIC TANK: U z z w 1. All system components shall be installed in DESIGN CRITERIA �" Q iy r w' P he State Environmental Code Title 3:: Q o_ accordance with t to DESIGN FOR USE WITHOUT A GARBAGE GRINDER w � V: Minimum Requirements for the `Subsurface NUMBER OF BEDROOMS 5 bedroom design I Ln m o� 550 gpd x 200% 1100 ,gal/day DESIGN FLOW 110 a brm Disposal of Sanitary Sewage, and any local rules USE PRECAST H2O 1,500 GAL. SEPTIC TANK gP / w L which` may be applicable. TOTAL DAILY FLOW 550' gpd U U) 2. The Barnstable Health Department & BSS Design z Q CV J SOIL ABSORPTION SYSTEM: Q � Engineer must be notified when the system is -� installed, and prior'to backfilling, for inspection. � � Q FOUR 500-GALLON LEACHING CHAMBERS 3 3. The stone around the leaching chambers shall APART, CONNECTED WITH 4" PVC PIPE, W/3' OF a- M (D consist of double washed stone ranging from 3/4 WASHED STONE ALONG SIDES AND BETWEEN, AND � to 1-1/2 inches in size and be free of Iron, fines, 3' OF STONE AT ENDS. �- � Z and dust, In place. The stone shall be covered with BOTTOM AREA: 10.83' X 49.0'. 0 0 at least a 2 Inch layer of double washed stone 0 Z �- ranging from 1/8 to 1/2 inch in size, and be free LEACHING AREA PROVIDED: STATE' TITLE V � Q W of .iron fines, and dust, in lace, or filter `fabric. � TEST . HOLE DATA � W P SIDEWALL=(2(10.83 )+2(49.0 ))x2.0 x(0.74) 4. , The grade above and adjacent to the leaching = 177.10 al da PERC. RATE: Q facilityshall slope at least 2� to prevent g / -Y E 2 min./inch assigned in C layer BOTTOM AREA 10.83 x 28.0 x (0.74) EVALUATED BY: Jeffrey E. Ryther, P.E. _ accumulation of surface water. 9 .7 al da„ - 3 2 0 g / y WITNESSED BY: Dave Stanton, Health Department 5. Sewer pipe shall be 4 diameter schedule 40 PVC or TOTAL LEACHING CAPACITY 569.8 al da DATE:Nov. 3, 2015 equal at 1/4" per foot (2%) slope mina g / Y scale 6. Flow equalizers shall be installed on the ends of all q No groundwater was encountered. NOT TO SCALE outlet pipes inside the distribution box. 7. Contractor shall notify the Engineer if he/she - - date encounters soil conditions other than those shown JULY 5 2016 on the soil log. , drawn MRT checked job number SOIL LOGS 15118 TP #1 TP #2 TP #3 TP #4 revisions EL. EL. EL. EL. CHANGED SIZE OF SYSTEM H OF 41.5 0" 41.5 10" 41.0 0" 41.0 0" TO 5 BEDROOMS, ELEVATION A LOAM A LOAM A LOAM A LOAM AND CALCULATION UPDATES .tCFfREY 10YR 3/2 10YR 3/2 10YR 3/2 10YR 3/2 " AUG 25, 2016 MRT 40.75 9" 40.67 10" 40.17 10" 40.0 12 ED+,1N CHANGED PIPE LENGTHS LOAMY LOAMY LOAMY -LOAMY --; R E --� s� B B AND ELEVATIONS BETWEEN r B SAND B SAND SAND SAND COMPONENTS IN PROFILE CIVIL Q 10YR 5/6 " 10YR 5/6 " 10YR 5/6 10YR 5/6 NOV 3, 2016 MRT aw 38.5 36 38.0 42 37.83 38 37.5 42 FF �N� ADDED 'STABLE COMPACTED DNA �a BASE' NOTE IN PROFILE AND MED. SAND MED. SAND MED. SAND MED. SAND UPDATED PROFILE C C C NOV 23, 2016 TJB 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 title SSDS PROFILE AND DETAILS 31.5 120" 31.5 1'20 31.0 120 31.0 120" DRY DRY DRY DRY 2 OF 2 drawing number B23-58