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HomeMy WebLinkAbout0317 LAKE SHORE DRIVE - Health 317 Lakeshore Drive ------------- Marstons Mills - - __ -- A= 030- 107 I y i TOWN OF BARNSTABLE ?L"-OCATION 3(� LC�� �hdre �� �#�►^SP VILLAGE ASSESSOR'S M�AP&PARCELO3 O —/07 1149P94;BW S NAME&PHONE NO. ct SEPTIC TANK CAPACITY /000 LEACHING FACILITY. (type) �� (size) /000 NO.OF BEDROOMS OWNER PERMIT DATE: C( I EDATE:d�'%r P '4 a1 Ito 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 • \ \ \ • \ \ \ \ • \ \ • \ • • \ \ \ \ \ Y \ \ \ \ \ • \ • \ \ • \ Y l f f ! J f / f r ! J f f f F ! f ! J r F . . \J•J•f\l\F•J•fYF\f4�4/ F r f'�JYr fYIYJYJYIYJYJkJ• YJ �ry fYQiLG\!•JY i ! J J f l f J J f f f 777 13 M 7 ! ! r l J r r f ! l r r F f r r r J F J l F J r r J l J J l J f J r f f f l f l ! f J LL ^^ Y Y • • Y Y \ Y , ! / / fffff 4 • • Y • • \ • • \ \ \ \ \ \ \ \ 66 103 y TOWN OF BARNSTABLE LOCATION 3 V-4' Log <e 32 SEWAGE# VILLAGE ? 7"{ ASSE OR'S MAP&PARCEL O. c Q INSTALLER'S NAME&PHONE N �� C51 SEPTIC TANK CAPACITY , np0 Q(21 a LEACHING FACILITY:(type) 1 W-A-)C"N=Q!S (size) r CUl �►.pi� . NO.OF BEDROOMS �- OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within , I 300 feet of leaching facility) 99 N Feet FURNISHED BY 2Qcr ar AA,,-, :A co �nSQ yt s 3a , L�� OQJX t�s� Pam, No. i �'� Fee oov THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 3pplitation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(✓'Upgrade Abandon( ) ❑Complete System�ndividual Components Location Address or Lot No. 3 '-4- L,R KE S�02E Owner's Name Address,an_d Tel.No. Assessor's Map/Parcel 03 t� � is� �i�� Installer's Name,Mdress,and Tel.No. �-a�, any Designer's Name,,AAddrrees,and Tel.No. Li`i Type of Building: Dwelling No.of Bedrooms Lot Size O_�sq.ft. Garbage Grinder Other Type of Building CW-0— No.of Persons Showers( ),<afeteria( �) Other Fixtures Sk Design Flow(min.required) �� gpd Design flow provided �f!q j_ an gpd Plan Date 0� Number of sheets �z Revision Date Title < c� C� J-:C S S � Size-of Septic Tank_(F ,5`T 10,00 =ZQ O Type of S.A.S. e:9 - t-C C�oS Description of Soil erg Nature of Repairs or Alterations(Answer when applicable) 'c_�22C � ,p\Cr Date last inspected: Agreement:. The undersigned agrees to ensure the construction an t ance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' rune 1 C de n t to place the system in operation until a Certificate of Compliance has been issued by this Board of H th. Signed Date 10 3 L.�\ U Application Approved by \ Date 1 1 Application Disapproved by Date for the following reasons Permit No. Date Issued ��� No. � — ` 1 Fee l on THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Z[Oplication for DispoSal•6pstem Construction i3Prlttit Application for a Permit to Construct( ) Repair(r/'�Upgade' Abandon( ) ❑Complete System,,'J;�ndividual Components Location Address or Lot No. 3 1 -4- L"kF_ 5 � Q Owner's Name,Address,and Tel.No. i4 Assessor's Map/Parcel U On Installer's Name Address and Tel. C h No. i Designer's Name Address,and Tel.No. 9 e�c .r, S L, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(NY/1 Other Type of Building No.of Persons Showers( );,Cafeteria( A Other Fixtures Ps Design Flow(min.required) l gpd Design flow provided 4 g4 G- , '� gpd Plan Date Number of sheets 2;2 Revision Date --^- Title ���ln�\ �,< 5�.�.< ���``� J i� Size of Septic Tank !is::! 1 <;;� Type of S.A.S. Description of Soil �� � \ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and i tenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env al C,de `d nbt to place the system in operation until a Certificate of t Compliance has been issued by this Board of Herdt/h. Signed Date 10 ` 3 Application Approved by Date I D Application Disapproved by Date for the following reasons Permit No. 0 � Date Issued lo /3) � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded ,.) Abandoned( )by at 1. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated Installer r r� Designer #bedrooms Approved design flow v gpd The issuance of this permit shall not a construed as a guarantee that the system wi nctioWS-41 geed. Date Inspector No. C( Fee I THE COMMONWEALTH OF MASSACHUSETTS j PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem ConstrUrtion 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at ` kcC _!g+_AXj(?F Zj",'O and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date i � Approved by L' Town of Barnstable r .� Regulatory Services Richard V. Scali, Interim Director MAW. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: —�Z Q5Sewage Permit# a ) 2A Assessor's Map\Parcel �T - Designer: sv-� Installer: Address: Address: On Cwas issued a permit to install a (date) (installer) septic system at L-P kE 5 ycc)�2 c based on a design drawn by ` (address) dated l o oZ (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if applicable) yk .71 a r- Signat ) / Y igner's Signa ) (Affix gi5t� ) t were) �ti;v PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc I Town of Barnstable P#_ � 5*44S O THE Department of Regulatory Services I .1RH.TAni, d Public Health Division Date MABS r61a 200 Main Street,Hyannis MA 02601 L„/ l V l Date Scheduled f—s 00 -' Time Fee Pd._ A°( &---44 M `r Soil Suitahility Assessment for e Disposa• Performed By: Witnessed By. LOCATION&.GENERAL INFORMATION Location Address 3 l Z ) e 's Name - ? Owner n\�-P 17A t 1 1 t �; -�r� Address Assessor's Map/Parcel `Q Engineer's Name C � , NEW CONSTRU(C''T��ION REPAIR r�T�ell-e�phone# Land Use• '1`u1 4 _ i w Slopes(96) tJt—!a Surface Stones Distances from: Open Water Body ) ft Possible Wet•Area Tft Drinking Water Well 4�ft t < Dtalhage Way �i Pr ft Property Line �ft Other fa- ft SKETCH:(Street name,dimensions of for,exact locations of test holes&pere tests,locate wetlands-in proximity to holes) • & O J ; . Parent material(geologic) C)-rL,TAb' V, Depth to Bedrock Depth to Oroundwater. Standing Water in Hole: M 6 V- ( nSC`& Weeping from Pit Face 2 d:s 'z_s Estimated Seasonal High Groundwater r�LD it H SS 3MeC� DETER14INATION FOR SEASONAL UGH WATER TABLE Method Used: IJ Depth Observed standing in obs.hole: In, Depth to soll mottles: IY,' Depth to weeping from side of obs.hole: In, Groundwater Adjustment Index Well-4 Reading Date: Index Wall laval Adj,-factor, ,e„_ Adj.Clroundwater•Laval PERCOLATION TEST — Daiu i ate Time ..Oa Observation n Hole# Tlmo at Y" Depth of Pare �T 111 l Time at 6" Ly Start Pre-soak Time @ 5, Timo(V-6") \� End Pro-soak Rate Mih./Inch . SOS N1P1 ' Site Suitability Assessment: Slid Passed Sitp Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EPTl0PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# �i Depth from Soli Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. o tsIstcncy.96•aravel) L- D. DEEP OBSERVATION HOLE LOG Hole# Depth from Soll Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell)' Mottling (Structure,Stones,Boulders. consistency, raq COPS 3 t� C. ot,02-Sl La. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency. t . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. Flood Insurance Rate Map: Above 50o year Mood boundary No— Yes ,,, 'within 500 year boundary NoA Yes - Within 100 year flood boundary NO Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring Pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? � If not,what is the depth of naturally occurring pervious material? Certification I certify that on4 (date)I have passed the soil evaluator examination approved by the Department of Enviro e t r ct d that the above analysis was performed by me consistent with . the required trainin expe x rie a described in;10 CMR 15.017. Signature Datb Q:WEPT1C%PERCPORM.DOC Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills MA 02648 April 21, 2010 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the computer,use 1. 1 Inspector: " f" +. a.., only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return 1 key. Septic Inspection Services Co. Qi Company Name r� 189 Cammett Road _ - p a.. Company Address f Marstons Mills MA 02648 renm Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority April 21, 2010 Inspector's Signa or Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 10-97 Dillon I PitaAoc•03/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 15 �A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Recommend pumping tank, leaching pit was found empty. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 10-97 Dillon/Pita.doc-08406 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Imo—- - - - - I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broker, pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The sys`.em 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. 10-97 Dillon/Pila.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 A rll 21, 2010 p every page. Cityrrown State Zip Code Date of Inspection B. Certifications (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 10-97 Dillon/Pila.doc•06106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 10-97 Dillon I Pita.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 10-97 Dillon/Pita.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 16,000 gal. _ 22 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 10-97 Dillon I Pita.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive _ Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 _— every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None available. 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: Compliance issued Feb. 1977 Were sewage odors detected when arriving at the site? ❑ Yes ® No 10-97 Dillon/Pita.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills _ MA 02648 April 21, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 4 Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured 10-97 Dillon/Pra.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 1 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills MA 02648 April 21, 2010 required for P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, baffles were intact and clear. Recommend pumping tank. Tank appears to be structurally sound and watertight. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 10-97 Dillon/Pita.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w, •'- 317 Lake Shore Drive _ Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills MA 02648 April 21, 2010 required for _ P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 10.97 Dillon/Pita.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills MA 02648 April 21, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ inncvative/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 pit was found empty with a faint stain line 10-12" from bottom of structure. Pit had 5'of clean sidewall. 10-97 Dillon/Pita.doc-03/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w ,.•'' 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills MA 02648 April 21, 2010 required for ___ p every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan).- Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 10-97 Dillon/Pila.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts IM Ti .Title 5 Official Inspection Form p Subsurface Sewage Disposal System Form Not for Voluntary Assessments Via +' 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills MA 02648 Aril 21, 2010 requiredfor — --......._____._.__... _.._ . ...... ... ... ._ ......... ______- _.-- --.-_.--- p every.page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Lake Shore Drive Water Service \! J / r'\/♦i f♦?•i l. '• ? 22 \ \ 4 66 103 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 317 Lake Shore Drive Property Address Thomas Dillon Owner Owner's Name information is April 21, 2010 Marstons Mills MA 02648 A required for _ p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 20+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 55 and topo map shows property at el. 100. Pond on opposite side of road is considerably ower than SAS. 10-97 Dillon/Pita.doc-08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r �CS1(_9 Commonwealth of Massachusetts= M A Title 5 Official Inspection, Forrr 7)M11 r*C E �i* Subsurface Sewage Disposal System Form-Not for Voluntary Assessssss.5men APR 2 1 2010 317 Lake Shore Dr. -- W. LI (Property Address Thomas Dillon .�b Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information I forms the computer, r,use 1. Inspector: U only the tab key to move your Scott Campbell cursor-do not Name of Inspector use the return key. Cardinal Construction Company Name , 32 Ridgetop Rd. Company Address Ctyrro Ma Zip 35 Co re°0" Cityfrown State Zip Code 508420-1295 S 1388 Telephone Number License Number B. Certification I certify that I have personally inspected the.sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant toSection 15340 08 Title 5(310 CMR 15.000).The system: '` i 'Es �- ® Passes ❑ Conditionally Passes ❑ F a�.,, µ ilS'' -,-r J, r ❑ Needs F rther Evaluation by the Local Approving Authority 1/29/2010 v r n I spe is Signatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection`does not address how the system will perform in the future under the same or different conditions of use. t5ins.-09r08 Title 5 official Inspection Form:Subsurface Sewage Dis sal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti Sv'y 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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): 4 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. lv-I Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. Cityrrown 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 ❑, ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less ,. than '/day flow t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is Marstons Mills Ma 02648 1/29/2010 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] 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 &ns•og/o6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. too 0' Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 gallon tank 1000 gallon pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.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 W I Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: 2010 Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): septic tank leach pit t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Ownees Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: built in 1977 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet a Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form vSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 'b 317 Lake Shore Dr.l " Property Address Thomas Dillon Owner Owners Name information is required for Marstons Mills Ma 02648 1/29/2010 every page.. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 12" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? tape measure 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 should be ppumped inlet and outlet pipes both at proper working height both baffles in place outlet line at proper working height at time of inspection no evidence tank leaking at time of inspection 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: v, Alarm in working order: ❑ Yes ❑ No Date of last pumping:, Date Comments(condition of alarm and float switches, etc.): k "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes [] No t5ins-09108 s rdle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): k Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: h 1000 gallon pit 4"of water at time of inspection t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner owners Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): dry soil no signs of hydraulic failure no ponding or damp soil normal vegetation 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 " ' r Depth of scum layer _ Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5iris-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6v.,y 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. CityrFown 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 N Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w ' 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately G°4e4� Svc � PoP,C ti 0o LI U�I I t5ins•09/08` _ Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owners Name information is required for Marstons Mills Ma 02648 1/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12+feetfeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 317 Lake Shore Dr. Property Address Thomas Dillon Owner Owner's Name requir required Marstons Mills Ma 0264E 1/29/2010 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 FORM 30 C&w HOBBSSWARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A t2 N STA$LC CITY/TOWN -1 N 'a DEPARTMENT 2 ©a Nis ` -AA a 2rao A DRESS / 5d 9 I GSM 50 y`e� l 7 3 f ri LA KC— S N U 2c- DIEN C TELEPHONE Address "AdLSza)!4S M%L.L-s . occupant GA►A K t►�• f-Vf-LA1l C, Floor -A- Apartment No. - No. of Occupants No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming unit No.Stories A Name and address of owner S A TZa b ® . o f LA i t LA vir—Sv4o,12.E Q„ _ 'v 4 4$'I.O (_ C3 24.4,q Remarks Reg. Vio. YARD Out Bld s.: Fen es: Garbage and Rubbish g- SA A N v g Containers: &L. Z o Drainage i?W;jj P CUAD 20 Infestation Rats or other: A ti% L STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ' e4S K iA e ❑ B ❑ F ❑ M Doors,Windows: `s r $LIt- / ftj Roof f4a h^ 4ir,,7 Gutters, Drains: iL4( f4L,IS )S Walls: NIA 6ALS Oti Loots Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows.- HEATING Chimneys: Central ❑ Y ❑ N E uip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ' ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSIDE TION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJURY." INSPECTOR TITLE A.M DATE 6 TIME— M. A.M. THE NEXT SCHEDULED REINSPECTION 7�� P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within_this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. i (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. '(C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and.410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. . (4) Failure to maintain a safe handrail or protective railing for every-stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said,condition within the time so ordered by the Board of Health. ti TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C&w HOsas 6 WARREN _ BOARD OF HEALTH CITY/TOWN ' I o DEPARTMENT _2 00 MAMA �-► A +4 t,AA ( 3 z-Go A DRESS \�•0 A 4'M Sve y`�z C V V ) 3 1 r7 C A W iC_ SNORE. De C. TELEPHONE Address "A O_STO uS T1 �'L t-S , MA Occupant_SA►2A H �� ��� t�t t 1] Floor A- Apartment No. No.of Occupants'' No. of Habitable Rooms — No.Sleeping Rooms No.dwelling or rooming units � No.Stories �- Name and address of owner S A,t24 3 �'Z LA t-kL s,"o 4f DQ.• . O ti1S '►�I 1�L . r�� 02(e44a Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish CA A. SACt!<,, A ti,5 Q v 6131 C Containers: Q V-0 o Rio Drainage i?AC;If S pOrAD A 1160 vj /120 Infestation Rats or other: A N-i V^ti s-S Q16 607-(A STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: 7 eA S N ❑ B ❑ F ❑ M Doors,Windows: "1 9 Gv Roof f2d P,'r F_4vh,7 t2U oA- E G„ .A Gutters, Drains: L9/464 klis` f C O A 6s;iSy Walls: A-0 6it/ lJ^� Loo2� Foundation: 10 (?az( Chimney: BASEMENT Gen.Sanitation: Dampness: z t Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: ' Hall Lighting: r ; Hall Windows' �1., 'J 1 HEATING Chimneys: _ �• • -,Central.._❑,Y `Q N - E:-ui :�Re-air !�= = .:;-, lam; TYPE: Stacks,flues,Vents: PLUMBING: Supply 1_6`e:� - , ❑ MS ❑ ST ❑ P Waste Line: AW H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grhd.: AMP: Gen.'.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. Lgtn . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom PantryI Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES ,'F PERJURY." '^ INSPECTOR TITLE '�^' S i fCT,41r- A.M. DATE 9 Q TIME `x, M. A.M. �"` THE NEXT SCHEDULED REINSPECTION 794 P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health,or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s)pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) .Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required.by 105 CMR 410.250(B), 410.251(A),410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410:300. (G) Failure to provide adequate exits, or the obstruction of any exit,passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105.CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or.harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public - Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c.-111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock,,accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3).or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) .Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through(0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said conditioh within the time so ordered by the Board of Health. r��°�"`'4�+y.t'*`.,�r/�+.'�"�r^'►+t�"'S+m5v R,t,.�,;,.;:.�nS;j�:v+w*�'�&.,;,r, FORM30 C&w HOBBSBWARRENrM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN 10 0 DEPARTMENT G �� aatha 5� ��, N ►�'�S VAA 0 ZGO 1 ADDRESS.311 LA V,C.. �IA O C C c TELEPHONE « Address "A as to a1<, Pit r�.� c, . M/�_ OccupanL_—i�4 f2f1 R Lam• z L/1 LA q D Floor Apartment No. No.of Occupants No.of Habitable Rooms """" No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner ��N>Z N 1d 17 . V£ LA Q.E) bx ��- �1.4(� E �. ��'�"ST �1�, 1 c.L - �� C3��41f� Remarks Reg. Vio. 1� YARD Out Bld s.: Fences: Garbage and Rubbish Q A. 13AC,f',•, Sal ;q Containers: W t t_Ca P4 ak-_,1 (r�:T VAgo Drainage -T 06A I( S P17,flU A �6j 4 Infestation Rats or other: i7A NJ�1 p�t � a ! ,.//0 60 Z W STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: 767,4 z:4,; 1-t r 441 6 4 616f� ❑ B ❑ F ❑ M Doors,Windows: \/ i S i 9G L-_ Roof vA- G.,/uOBrv.s Gutters, Drains: L4/Z6r t C (j F Z is F,is�/ Walls: Nr� /J� g/Z1S lJ'v �Goo2�. Foundation: z//U c©02(`8) Chimney: BASEMENT Gen.Sanitation: Dampness: - t 1 Stairs: ,f' Li htin STRUCTURE INT. Hall,Stairway Obst'n.: R Nall, Floor,Wall,Ceiling: Hall Lighting: Hall Vlfind,ows _ HEATING Chimne s:r ~Central : 0•Y-' N ` - E u. Re air ="_ � .=-. t TYPEf ,s Stacks.`Ftues,Vents: PLUMBING: SuppVy Liner' :• R t ` ❑ MS ❑ ST ❑ P Waste Line: '! H.W.Tanks Safety and Vents ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: " AMP: Gen.:Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L6tn . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 _ Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove " Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE f OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OjF PERJURY .% INSPECTOR— TITLE "TA' S rc Ta�'" A.M. DATE Q� TIME P.M. ((✓✓ '�` A.M. THE NEXT SCHEDULED REINSPECTION �' P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns,shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke.detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Certified Mail:7005 1160 0000 0191 0836 oFTHE T Town of Barnstable ?y O Department of Health, Safety and Environmental Services • BARNSTABLE, MASS. s639. Public Health Division �0 AlFD MAC s 200 Main St.Hyannis,MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health May 8, 2006 Ms. Millicent Eveland 317 Lake Shore Drive Marston Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION You are scheduled to appear before the Board of Health for a public hearing on Tuesday, May 16,2006 at 3:00 p.m. The hearing room is located in Barnstable Town Hall, Selectmen's Conference Room,2°d floor, at 367 Main Street,Hyannis,MA 02601 The property owned by you located at 317 Lake Shore Drive, Marstons Mills was inspected on May 4, 2006 by Donna Z. Miorandi, RS, Health Inspector for the Town of Barnstable and FPO Frank Pulsifer, Fire Prevention Officer for the Centerville-Osterville- Marstons Mills Fire Department. This inspection was performed as a wellness follow-up and your daughter, Sarah Eveland was present. Based on the results of that inspection, the Town of Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L c. 127B and 105 CMR 410.831 (D), the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. The following violations of 105 CMR 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation were observed: 105 CMR 410.750: Conditions Deemed to Endanger or Impair Health or Safety(I) "Failure to comply with any provisions of 105 CMR 410.6009 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease." The occupants have a condition known as "hoarding". The rooms are full of unused debris and clutter to the extent that there is no visible open space on any counter, table or Q:\health\order letters\Condemnations\317 Lakeshore Drive,Marstons Mills.doc chairs. There is limited space for one to walk. The kitchen counters and kitchen stove have piles of debris on them thereby rendering that space unusable. 410.351: Owner's Installation and Maintenance Responsibilities: The owner shall maintain free from leaks, obstructions or other defects,the following: (A) all facilities and equipment which the owner is or may be required to provide including but not limited to, all sinks, washbasins, bathtubs, showers, toilets,....owner installed stoves and ovens..... 410.450: Means of Egress: Every dwelling unit shall have as many means of exit as will allow for the safe passage of all people in accordance with the Massachusetts Building Code. 410.451: Egress Obstructions: No person shall obstruct any exit or passageway. The owner is responsible for maintaining free from obstruction every exit used or intended for use by occupants. 410.452: Safe Condition: The owner shall maintain all means of egress at all times in a safe, operable condition. 4.10.602: Maintenance of Areas Free from Garbage and Rubbish: In any dwelling, the owner shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the dwelling which is used in common by the occupants and which is not occupied or controlled by one occupant exclusively. All garbage and rubbish needs to be removed from the dwelling. With the large accumulation of clothing, boxes, books, magazines, papers, cups and other debris in this dwelling, you may want to opt to purchase an offsite storage unit or a shed if there are items you would like to keep, but do not use on a regular basis or need. The large amount of debris present poses hazards for fire, means of egress obstruction, and harborage areas for insects and rodents. 410.831: Dwellings Unfit for Human Habitation: Hearing Condemnation: Order to Vacate. (A) Finding that a dwelling or portion thereof is unfit for human habitation. If an mspoction pursuant to 105 CMR 400.100 or 105 CMR 410.820 reveals that a dwelling or portion thereof is unfit for human habitation, the board of health may(after complying with 105 CMR 410.831 (B), (C) or(D) if the dwelling is occupied) issue a written finding that the dwelling or portion thereof is unfit for human habitation. (C) Hearing if dwelling or portion thereof is occupied. If the dwelling or portion thereof is occupied, then the board shall, prior to issuing a finding under 105 CMR 410.831 (A), and at least five days after service of the notice required by 105 CMR 410.831 (B), conduct a public hearing to determine whether the dwelling or portion thereof is unfit for human habitation and whether an order to secure and to vacate should be issued. At the hearing the occupant(s), owner, or any other affected party shall be giver an opportunity to be heard, to present witnesses or documentary evidence and to show why the dwelling or portion thereof should or should not be found unfit for human habitation, and why an order to vacate and an order to close-up should or should not be issued. Q:\healrh\order letters\Condemnations\317 Lakeshore Drive,Marstons Mills.doc You are directed to correct the above violations within Five (5) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. You have the right to inspect and obtain copies of all relevant inspection of the board of health; the right to be represented at the hearing; and that any affected party has a right to appear at said hearing. Furhermore, anyone who fails to comply with any order of the Board of Health may be subect to fines of not more than $500. Each day's failure to comply with an order shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH T emas A. McKean,R.S. Director of Public Health Town of Barnstable CC : COMM Fire Department,FPO Frank Pulsifer TOB Building Department, Thomas Perry Sarah Eveland, occupant Q:\health\order letters\Condemnations\317 Lakeshore Drive,Marstons Mills.doc AsBUllt Page 1 of ] LO/CAION �c7 T / 5 S EWA G E PERMIT ' N.O. L Y I L,�L�A G E V2-G I N S T A LER'S " NAIVE & ADDRESS ccl Q BU1l DER OR OWNER QA T E P ERMIT ISS U E 1) DATE COMPLIANCE ISSUED 77 littp:Hissgl2/intranet/propdata/prebuilt.aspx?mappai=030107&seq=1 1/29/2010 ; ;4L, "LO,CAT ION ySEWAGE PERMIT N0. 2 VILLAGE V H4 NLaesvt.e t INS TA LER'S• NAME & ADDRESS eel B U1 DER OR OWNER V - DA T E PERMIT ISSUED E MPLIA DA 0 i T C NCE S S U E D 730y '7 _� ��i �J' I � ,\y �� _�� ,,t �'� ,. /.... THE COMMONWEALTH OF MASSACHUSETTS " BOARD QF F-9 E�� A�T App'liratinn -for Uiip.uiitt1 Worko Tomitrurtion Vrrufit Application is hereby made for a Permit to Construct (��r Repair ( ) an Individual Sewage Disposal Sys at: , ocation-Address Z or No. _ /c O ner Address ---------- - - ------------------------------------------- Install Address dType of Building Size Lot_ A__4zo.�'__--._.Sq. feet V Dwelling—No. of Bedroom _-.- _ ----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _.._ No. of p y Showers (� — Cafeteria ( ) �' Other fixtures ...-r-'�-bedc>e,--- -- --- "y('..�..iG d t --------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity! r''-_gallons Length---------------- Width................ Diameter................ Depth.--_----__.... x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------2------------ Diameter____________________ Depth below Y let-_._..._._..._.._... Total leaching area------ ----.-__--sq. It. Z Other Distribution box ( ) Dosing tank ( ) e 0 _ ^ / '9•"Jl �'�� Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ ,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..........-------------- f� Test Pit No. 2................minutes per inch Depth of Test Pit............. De th to ground water---------------.-_---.-. }... ---------- --- --- --- --------- °� Description of Soil------ *0--- •�-•--•-. ® e�� - ----- x 4 X 2 � - UNature of Repairs or Alterations—Answer when applicable,........................................................................... ................... -----•-•--------------------------•----------------•---------------------------•------•-----------•------------•--------------------•-••----•--•------••--•-----------------------------------------_-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been'*ssued by the.b- of health. Sl e f 1 Date„ y Application Approved By------- A ..-•---•......•--••••. 3 ..... Date Application Disapproved for the following reasons------------- ---- -------..................................................................................... ---••-----•-•--•---••---------•••--•------•-••---•--•---------•-•--.....-•--•----••-.._..•-••-•--•-----•-•••--•-••••--••-•--•---••-••--------------------------•----------•----••---••-•••••---------•-- Date Permit Permit No......................................................... Issued--------- (�....... {---------- Date No. ----•-•------ Fs�............................_ THE COMMONWEALTH OF MASSACHUSETTS �� BOARD F . tll -- Appliratiuu -fur UhipvAttl Workii Cnuuutrurtiuu Vrrmft Application is hereby made for a Permit to Construct (,—r .Repair ( } an Individual Sewage Disposal Sy a ----------------- �u„� ,t;,�._�lnl.:'//l --------------- ------- ................ ocation.Address or No., W .O ner _ Address ...................-•. Le - ---------------•----•--.................. ........... � ................................................ PQ Install Address Q Type of Building Size Lot_ 4.4.0-70_______Sq. feet U Dwelling—No. of Bedroom ______ :..___.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons___________________________ Showe Cafeteria ( ) A' IP Other fixtures ....I ..... W Design Flow............................................gallons per person per day.. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityglrl+__gallons Length................ Width................ Diameter-------......... Depth.--._-____-_-_ x Disposal Trench—No. .................... Width-------------------- Total Len h..............._._.. Total leaching area.-_.-._.____---_____sq. ft. Seepage Pit No------a------------ Diameter.................... Depth bels0v#1ct_/./2--- o a�chmg area_-_--______.__:__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of. Test Pit....:_...........___ Depth to ground water_..________._.____-_.--- 4q Test Pit No. 2......... minus er ' c D th0f),' est;Pit........::..... .. Dh to nd water........................ Description of Soil----------a------- �3 lt9t ._ W UNature of Repairs or Alterations—Answer when applicable.._____________............... ------------------------------------------------------------------------------------•--•------••---------------------------------------------------.--------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until'a Certificate o�ffCoolianc has been is ed by th boar health. ge •--•-----------•-•-••-••. -- - ----- -- - r 31 Trat---- Application Approved By---------------------------•-••------•---•---------- = ................................. j �-y ......................................... Date Application Disapproved.f or the following reasons-...................---------------------------------------------------:.......................................... .........................................................:--------------_................. w------------------------ =-=-------------------------------- Date PermitNo......................................................... ;. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS / p BOARD HEALT ....................................'. . ..............---................................. • filer ifiru e of f�umphaurr v C e fndividual Sewage Dispo 1 System construe d ( ) or Repaired ( ) b = -�---------„ ;19 - .-` - . . • ............................................. at-------------------------------------------------------------------------------------------------------------------------------------------------------------•---••-•-----•-•-••-•------•----•------- has been installed in accordance with the provisions of;Art 61 The State Sanitary, ode c]�scLji e in the application for Disposal Works Construction Permit No..............:.......................... dated_-_____.......................l-•i____--. --- THE. ISSUANCE OF THIS CERTIFECATE'SHALL NOT BE CONSTRUEDAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. riz. DATE ----------------------------- -- -- ........................ Inspector --------------------------•--------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD ;HEAL �« Q A.4 ......................:...................OF..............................................<:;------------------..------------. ....,,r..► No......................... FEld... ��t siot}�ts_.,Sreb nt ......... -------•-•-•-----•--•-•------------- .44 / •• -••-• -' to o t uct ( ) or � att4Ii i taj Se >rspos em atNo.........................................................:......................................... -- ------.tZ: :.-----•----......... • Str t � � ♦ � as shown on.the.application-for Disposa r'Works Constru er Da d.......................................... - ........................................................... -------------•-•-------.----• � '"'�..'� ..�. ..............................tBoard of4. • DATE............................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �`' /r. s: a a ps t A - t t q GENERAL NOTES Bed ' Bedroom Livin Room 1. Contractor is responsible for Di safe notification, Verification of Utilities 100 --� ,S" � ��� Room g and protection of all underground utilities and pipes. 2. The septic tank and distribution box shall be set \ (40 FOOT RIGHT OF WAY) level on 6„ of 3/4"-1 1/2" stone. Kitchen 3. Backfill should be clean sand or gravel with no — Bedroom o o EXISTING stones over 3" in size. s Dining GARAGE 4. This system is subject to inspection during installation by Carmen E. Shay — Environmental Services, Inc. S 61D 53' 27" E \ 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan 100.00' \ ,� \ EXISTING and Local Regulations. 3 SEASON 6. If, during installation the contractor encounters any /// ROOM soil conditions or site conditions that are different from those shown on the soil log or in our design �3 installation must halt & immediate notification be LOT #27 'jam, \ 3 BR 1 Story HOUSE—(Provided by Owner) made to Carmen E. Shay — Environmental Services, Inc. / 20,607 Square Feet +/— °� I _- 96 7. No vehicle or heavy machinery shall drive over the LOCUS MAP septic system unless noted as H-20 septic components. / 8. Install Tuf—rite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. .E c\Py� 10. All solid piping, tees & fittings shall be 4" diameterg2P 4 Schedule 40 NSF PVC pipes with water tight joints. 11. Municipal Water is Connected to ALL OF The Residence and Abutting C I aye' Properties Within 150 Feet. THE PROPERTY LINES ARE APPROXIMATE AND / EXISTING 317 Lake COMPILED FROM THE SURVEY PLAN BY BEARSE & KELLOG ENGINEERS Shore Dr 3 BEDROOM ENTITLED: "SUBDIVISION PLAN OF LAND IN M. MILLS, MA"BOOK 249/PAGE 79 lHOUSE I °4 DATED JULY 7, 1971 o 4 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN / EXISTING �'� w IT SHOULD BE USED FOR NO PURPOSE OTHER THAN #317 GARAGE I O ° ID SEPTIC SYSTEM INSTALLATION. �j GRAVEL O i EXISTING SAS TO BE PUMPED OUT AND REMOVED / DRIVEWAY c0�' ` �' NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE M EXISTING .� Q :►/ 59" FROM THE EXISTING SAS TO BE DISPOSED 3 SEASON OF AS PER BOARD OF HEALTH SPECIFICATIONS. ROOM I A O ( a I � O 1 N EXIST. O U_ PLOT PLAN 1000 al. PROJECT BENCH MARK ' O I Septic 4Tank TOP OF FOUNDATION OF PROPOSED SEPTIC SYSTEM UPGRADE ELEV. = 100.00 (ASS MED) om X PREPARED FOR M �+ o DENISE PITA TEST HOLE #1 3 HOLE —H10 I AT 241 ELEv.= 98.00 D BOX VENT PPE 8.5' o 317 LAKE SHORE DRIVE 3' ASSESSORS MAP 30 LOT 107 / FAILED z.5 7.50, 2.5' ( Qa: _ _. MAR STO N S MILLS MA LEACH PIT INSPECTION / I o� / PORT --— :, ' r .•�.���.El. PREPARED BY: O TEST HOLE #2 /� /���T�T �j u �T 3 ELEV.= 98.00/ I o l ' r ,' li4 R l�l li 1 d li . Sll A l ,y ENVIRONMENTAL SERVICES P.O. Box 1576 Y � HP MA 026 s MAS EE, 49 AN1�� TEL/FAX 508-294 7498 S 61D 53' 27" E I SCALE: 1 "=20' DRAWN BY: CES DATE: OCT 24, 2018. °� i PROJECT#317 Lake Shore FILENAME:317 Lakeshore SHEET 1 OF 2 *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 10' min. from Grade over Septic Tank - 98.00 VENT PIPE 6® Least 24 inches tail) Schedule 4 PVC w/Charcoal Odor Filter Existing Foundation [house to septic tank Provide Risers if necessary D-BOX cover must must have riser and be LEACH TRENCHES CROSS-SECTION (2 TOTAL) TOP OF FOUNDATION = ELEV.100.00 to bringg Septic tank covers within 6 in. of finished grade Finish Grade = Elev 98.00 within 6" of finished grade 1[ Grade over D-Box -98.00 + 4" PVC (CAPPED) INSPECTION PORT TO BE 4' PVC (CAPPED) INSPECTION PORT TO BE INSTALLED"AND TO BE WITHIN 3' OF GRADEINSTALLED AND TO BE WITHIN 3' OF GRADE S - 0.02 3 H - Top Of System = ELEV. 94.50 •S=0.01 or Greater DIST. BOX Sm 005 afar S=0.01 or Greater 3'-0'N1de 15� EXIST. 4'Perforated P.V.C. '-1/8"-1/2' Washed Stone Or Approved Filter Fabric EXIST. PIPE LO 1000 GAL. O 4" Invert Elev.=93.78 2'of 1/6'-1/2' _ FROM EXIST. FOUNDATION o^ SEPTIC TANK O 35 M a) 5' O to •- 3/4'-IV washed Stone 4 Washed Pea Starve a, (6 o Bottom of Leach Facility Elev.= 91.78 or Approved Fater Fabric CONCRETE FULL � I'• H-lOGas Baffle °' rn 0) rn 2.5' 2 TRENCHES TOTAL 2 in II II II Note: All leach Imes to be capped of ends w/PVC caps. 5• PROVIDED 2 M 6 In.of 3/4'-1 1/2' m d m > Bottom_of Test Hole 2 Elev.=86.50 W compacted atom LEACH TRENCH 3/4•-11/2'Washed starve ' (2 TOTAL) w pacted atone Z - - - C perforated SCH 40 P.V.C.Pipe 6 In.of 3/4"-1 1/2" NOT TO SCALE compacted atone NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 2 FOOT EFFECTIVE DEPTH FOR LEACHING TRENCH NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE SYSTEM PROFILE Not to Scale 2-18' DIAM. ACCESS MANHOLES PERCOLATIONTEST ALL OUTLET PIPES FROM THE :... DISTRIBUTION Box SHALL BE .. �,":-_'-+'._ram.•;.•..•`:_.'��.n •.:•;• SET LEVEL FOR AT LEAST 2 FT. 12' CIN•1CRETE COVFJt Date of Percolation Test: AUGUST 15, 2018 P#15760 ;..:.• „:5 2' Test Performed By. CARMEN E. SHAY, R.S. C.S.E. /=" KNOCKOUOUTLETTTs "° " 1.." Results Witnessed By: DONALD DESMARAIS �BARNSTABLE BOH) _ _ as EXCAVATOR: Shay Env. Svcs. OUTLET 1 I 1z' INLET / / :,•-OUTIET Percolation Rate: Less Than 2 MPI ® 48" = /:' r:'s• e r.`. THE ACCESS COVERS FOR THE SEPTIC TANK, Test Hole Test Hole ~155' ..• 4" - SCH. 40 Te 1.75' DISTRIBUTION BOX AND LEACHING COMPONENT NO. 1 No. 2., „y.;?: 'wr:.^;;�`_• -'� ,� SET DEEPER THAN 6 INCHES BELOW FINISHED PLAN SECTION CROSS-SECTION GRADE SHALL BE RAISED TO WITHIN 6" OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. DEPTH SOILS ELEV. DEPTH SOILS ELEV. PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS 0 98.00 0 98.00 3 HOLE H-10 DISTRIBUTION B 0 X Sandy Sandy 3-24" REMOVABLE COVERS Loam Loam 11 10 YR 3/2 10 YR 3/2 4. ,•: 0rv- 6" A'v 97.50 0"- 6" '� 97.50 : ..: . .:.::. ::�� ... : r P LOT P LAN 3' min. clearance ` B' minTT 12 Loa �min. inlet to outlet S•min. t� {j}v���.r SandLoamy Sand y Liquid level OUTLET 10 YR 5/6 10 YR 5/6 5' _7" mm. u �j5' 6"-24" 96.oD 6"- 24 96.00 OF PROPOSED SEPTIC SYSTEM UPGRADE Ev 01.Bde 'y a'-O" ep silt silt PREPARED FOR j' c Liquid depth Loam Loam al� 2.5Y8/4 25Y8/4 DENISE PITA v 24' 48" C, 94.00 24" � 94.00 AT B-a" Sand 317 LAKE SHORE DRIVE CROSS SECTION END-SECTION 2.5 Y 7/4 ` 2.5 Y i4 TYPICAL 1000 GALLON SEPTIC TANK 48'-138" C2 86.50 48"- 138 C2 86.50 ASSESSORS MAP 30 LOT 107 NOT TO SCALE MAR STO N S MILLS MA Design Calculations Garbage of Bedrooms: 3 EXIST-4 Permited Equivalent to 440 Gal./Day Garbage Grinder: No t ;!A ¢ :. PREPARED BY: 7� Leaching Capacity Proposed: 440 Gal./Day Minimum I Per Original Permit)t ,r .�, • �/)t(� /�/f�/ /'T E. ,�H�1 Y Septic Tank - 2 x 440 Gal. Da P •.r�°` `� `=LY 1`Y 1�l l.i 1 B' p / y = B80 USE EXIST. 1,000 GAL. Septic Tank. � N l \? SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Perc #1 Depth to Perc: 48 to 66" •O -1FY , ENVIRONMENTAL SERVICES Proposed Leaching Trench Dimensions: 2 TRENCH TOTAL-3' Wide by 42.5' Long by 2' Depth = Perc Rate- 2 MPI � Rl Bottom Area Square Footage: 3' x 42.5 =127.5 sq ft x 2 trenches=255 sq ft Groundwater Not Observed 1 s 1 P•O• BOX 1576 Sidewall Area Square Footage: 2' x 42.5 =85 sq ft x 4 sidewalls(2 per trench)=340 sq ft No Observed ESHWT �^s S c�� e MASH P EE, MA 02649 END Area Square Footage: 3' x 2 =6 sq ft x 2 trenches=12 sq ft ADJUSTED H2O Elev. = None I S p�sr LOADING RATE: Use: 2 TRENCH -42.5'L by SW x 2'D EACH _ _ ,. TEL/FAX 508-294-7498 Bottom Area: 0.74 gal/sqo ft. x 255 sq. ft. = 188.70 gallons + SCALE: N/A- SHEET 2 DRAWN BY: CES DATE: OCT 24, 2018 Sidewall Plus END Area: 0.74 al. s ft. x 352 s ft. = 260.48 / 9 / q• q• gallons Providing: = 449.28 gallons PROJECT#317 Lake Shore FILENAME:317 Lakeshore SHEET 2 OF 2