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1 PETER ROADr PETER N Commonwealth of Massachusetts Title 5 Official Inspection Form ��6� Subsurface Sewage Disposal System Form - Not for VoluntaryAs Assessments rl QY. � ug 1 Peter Road eO 04)og SA_EA, C Property Address A(rN Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. CityfTown 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. Immo out forms A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael J. Wood use the return Name-of Inspector key. Service Pumping and Drain Co. Inc. Q Company Name 5 Hallberg Park Company Address North Reading MA 01864 City/Town State Zip Code 1-978-276-0217 5021 Telephone Number License Number B. Certification I certify that 1 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 5-10-2012 Inspects s Signat v 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•11/10 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts IVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owners Name information is required for every Salem MA 01970 5-1-2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N. ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. Cityrrown 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•11/10 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 w„ 1 Peter Road Property Address Lauren and Brian Grace Owner Owners Name information is required for every Salem MA 01970 5-1-2012 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® 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 E] ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•11110 Title 5Offioal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No E] ® 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. An portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ® Y ' � N Y �N Y 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•11/10 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 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? 1:1 ® Have large volumes of water been introduced to the system recently or as part of this inspection? 1:1 ® 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? ® El information the facility owner(and occupants if different from owner) provided with 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. El ® 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 (Sins•11/10 Title 5 Oficial Inspection Fonn:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 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 ears usage d N/A 9 ( Y 9 (9P )) Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currently occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Title 5 ORual Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other ri (describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500gallons How was quantity pumped determined? gauge on truck Reason for pumping: maintenance/ inspection 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): t5ins•11110 Title 5 Oficial Inspection Form.Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: This system is approximately 7 years old according to plans dated 3-2005. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 11" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): There are no visible signs of failure or leakage. Septic Tank(locate on site plan): Depth below grade: 5 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: 11'x5'x5'5" Sludge depth: 4 t5ins•11110 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 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 '2 Scum thickness 3-4" Distance from top of scum to top of outlet tee or baffle $ Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determined? tape measure/sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): There are no visible signs of leakage or failure. 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 sins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owners Name information is required for every Salem MA 01970 5-1-2012 page. Cityrrown State Zip Code Dale of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t51ns•11/10 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): The d-box appears level and watertight with equal distribution. The d-box is equipped with a riser that brings the cover to within 6" of grade. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2, 48' ❑ 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.): There are no visible signs of failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 50Rmial 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 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is required for every Salem MA 01970 5-1-2012 page. City(rown 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.): Sine•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is Salem MA 01970 5-1-2012 requiredge4or every _._...._......_._ —___._ _—.._.__._ page. Ctlyl1'own 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 y l l t I r t ! s f j, _ L_ t A. _ l l_ L r _ I I t5ins•11110 Tle 5,0ffinal inspection Farr¢Subsurface Sewage oas sal system•Pago is of II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name informequine for is Salem MA 01970 5-1-2012 required for every page. Citylrown 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: feet 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 005 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: According to the proposed plans, there was no ground water observed at 121" in a test pit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Sins•11110 Title 5 Oficial 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 ww 1 Peter Road Property Address Lauren and Brian Grace Owner Owner's Name information is Salem MA 01970 5-1-2012 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .......... _ -f —JF I - 1-7 Pri ntF reeG raph Pa pe r,co a i Commonwealth of Massachusetts Salem, Massachusetts System Pumpine Record C qY o aog9ooFs 4201? OF System Owner & Address: yFq<y Lauren Grace 1 Peter Road Salem, MA 01970 Location of system: Rear Date of Pumping: May 1, 2012 Type of system: Septic Tank Gallons Pumped: 1500 gallons System pumped by: Service Pumping& Drain Co., Inc. 5 Hallberg Park North Reading,MA 01864 License#: BHP-2010-0358 License#: BHP-2010-0357 Contents transferred to: South Essex Sewerage District Date: May 1; 2012*• * m-, n. ; Pumping Technician:*MW- This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes Commonwealth of Massachusetts Salem, Massachusetts System Pumping Record _Y p !i System Owner & address: Lauren Grace 1 Peter Road Salem, Ma 01970 Location of system: Rear Date of Pumping: June 23, 2009 �VED Type of system: Septic JUN 3 0 2009 ALEM Gallons Pumped: 1500 gallons ;,.nu Or HEALTH System pumped by: Service Pumping &Drain Co., Inc. 5 Hallberg Park North Reading, MA 01864 License#: BHP 2009-0388 and BHP-2009-0387 Contents transferred to: Fitchburg Treatment Plant ;Date:a"June 23 2008 "" i�„ „ Pumping Technician SPD{m _s3 This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes Commonwealth of Massachusetts Salem, Massachusetts System Pumping Record System Owner& address: 7Rd 1 PeteS Location of system: Rear Date of Pumping: July 16, 2007 Type of system: Septic tank RECEIVED® Gallons Pumped: 1500 gallons IJUL 30 2007 CITY OF SALEM System pumped by: BOARD OF HEALTH Service Pumping & Drain Co., Inc. 5 Hallberg Park North Reading, MA 01864 License#: BHP 2007-0255, BHP 2007-0254 Contents transferred to: Fitchburg Treatment Plant Date: July 16, 2007 *`_n Pdmping Tecnnician: AM "T r This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes No. I- 0 S THE COMMONWEALTH OF MASSACHUSETTS FEE 9 -5-a Lrl BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed V,Repaired( ),Upgraded( ),Abandoned( ) by: f-/one"e A5:z>e1/,? Ivc at I Pe�,-, k,tal—Ij , SA(-i r"I /ZA has been installed in accordance with the Provisions of 340 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. R1- 0 S dated �)• LZ 3- b 5 Approved Design Flow -�"Sr) (gpd) Installer 7 Cfil L� Designer: Spector Date .S Q - e,-5- The issuance of this certificate shall not be co rued as a guarantee that the system will Function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ,. �" ' INFINI7'I L"LC ' IPSWIgi(X1.OPERATIVEBANK � � , � ,��-f+•�+x�t,Cd,.n -r f t, #s •r�' ,„�+ �-"` :3 �"d`,°'_I.P$WK.Y'I MA'-01938 ?,4" 2 x i '` 3 'ka3 x.= xi}" .�.e ,+ .ayry.• t�53-7008,'2113�, ar rna s + u''h r wd. r� t� f �y 4,sSp. .5S src2i 1 .1 3 -AY TO THE Ci of Salem - - s **90.00 ORDER OF City Ninety and 00/100r*****+*+****************+***************+*********+*+***w** +*«****«***r*r**+*+****w*****«********r**DOLLARS a ' City of Salem MEMO DF&mfia9CTs1-tense 1 4 �•Y�- B"�'Ti✓ .--- ----- i1'001694,1' 1: 2 1 1 3 7008 21: 415652 8ii' L No. A /-0 THE COMMONWEALTH OF MASSACHUSETTS FEE $90.00 BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby grayed to Construcht ( ) Repair (v<Upgrade ( ) Abandon ( ) an individual sewage disposal system at I /L 2 as described in the application for Disposal System Construction Permit No. e/-05, ,dated 03 - 2 3 -OS Provided: Construction shall be completed within three years of the date of this permit.)lkll local conditions i e met. Date A4+e=c 4 3 0.0 Z-00:5- Board of Health llee� FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBB58 WARREN" PUBLISHERS- BOSTON No. RI -65, THE COMMONWEALTH OF MASSACHUSETTS FEE $90.00 BOARD cO^F HEALTH OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (/Upgrade ( ) Abandon ( ) - V Complete System ❑Individual Components &t9 n nuyo Location // y� � MaplVarccl k / R/ Lot M —MA)'Oft Installer's Name l/7� � �� igne Address 66yy��(( 777 Telephone Is Telephone 9 Type of Building: / n uS Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ' Other—Type of Building No. of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) glad Calculated design flow gpd Design flow providedpd Plan: Date .V l%-OS Number of sheets �PEI' ?_ Revision Date — Title'RACvC DISFt�✓l1Z w4_(Sr wl VP421L /k A ' 43 Sl31--1b1 M4 Description of Soil(s) .�A:n] jCLj Fj> FZ/171 ) Soil Evaluator Form No. Name of Soil Evaluator C- CtxLE J Date of Evaluation 3-?-Di- DESCRIPTION OF REPAIRS ORALTERATIONS je� & l!16 1 Ll l The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITU 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 65 - 23 -OSInspections FORM i - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 .4.�rsw ve.s-. . ,,.rv-1- -._ ..a . .rT,[_:.... �e.ytp r� •Wsw—.r. . '.- ...n..-.%v .:'" �f ... - .- .n..... .:.. q e' THE COMMONWEALTH OF MASSACHUSETTS FEE $90.00 , BOARD OF HEALTH eFTy OF 541 ieNI APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (/Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components &8n 0,41YRIA6 Location Owner's ame P / PFn 72 ,fin 5�/ Map/Parwl# /�..�/) —rt/�n .y4 ress Lot# jlnstaller's Nameign ' None b _ f J�-S.-w�f Address /� 777-39_1Z Telephone# p,�Teelehone# Type of Building: t.t C C/ �/J Lot Size PJB)RSq.fee[ Dwelling No.of Bedrooms Garbage Grinder (✓) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) .3.-2JO gpd Calculated design flow gpd Design flow provided ;�Mgpd Plan: Date .-i-114-0'; Number of sheets �_ Revision Date — Title_ yAGr. 17)6119iytl SL/Sf }2t UPCtITA/Y l krr7 -72 0') 51-ki-7l/1 1144 e Description of Soils) �7F d4 fTl%K l h 7� h/I ( Soil Evaluator Form No. Name of Soil Evaluator (✓ CCX(1=7J Date of Evaluation 3-7- <X DESCRIPTION OF REPAIRS OR ALTERATIONS SET= A7T'H6t&7:> tall-I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date h i 2- 3 6 t Inspections !' / d R l � t FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 w of Bob Town of Boxford DaP'0 \Q 200 Washington St. Boxford,Massachusetts 01921 h Board of Health 3yssgNS [9781352-2413 CF October 6, 2003 Director of Public Health Town of Gloucester 22 Poplar Street Gloucester, MA 01930 To Whom It May Concern: I am writing a letter of recommendation for Mr. Ken Hamilton of Infiniti Construction Company. Mr. Hamilton has successfully completed the installers exam for the Town of Boxford and has installed several sanitary disposal systems over the past couple of years. Mr. Hamilton has been knowledgeable and professional with the work he has completed and comes highly recommended. If,you have any further questions please feel free to contact my office. Kendell Longo Director of Public Health MAR - 3 2005 CITY OF SALEM BOARD OF HEALTH n I Towo of WenhaM TOWN HALL 138 MAIN STREET WENHAM, MASSACHUSETTS 01984 TEL 978-468-5522 Board of Health FAX 978-468-6164 March 5, 2004 To Whom It May Concern: This letter is to notify you that Kenneth Hamilton, Infiniti, LLC, P.O. Box 7, Wenham, MA has a current Installers License issued by the Town of Wenham. Infiniti, LLC has successfully installed septic systems in the Town of Wenham. acobi B rd of Health Agent ACO RD CERTIFICATE OF LIABILITY INSURANCE 03/03/" z"°2005 PSR (978)927-2600. FAX (978)927-8938 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leslie S. Ray Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 129 Dodge Street - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR . . Beverly, MA 01915 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# NBURED Infiniti, LLC BISURERA Nautilus Insurance 80 Larch Row INsuRFRB: A.I.N. Nenham, .MA 01984 RJBuRERc' Safety Insurance Co. . INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWTTHSTANDINI ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D� TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITSGENERAL LIABILITY NC352416 08/09/2004 08/09/2005 EACH OCCURRENCE S 1,000,000 X COMMERCW.GENERALUASILTTY - DAMAGE TO RE FLED s - SO 000 CWMS MADE nX OCCUR MED EXP(Arty are paeon) $ 1,00 A PERSONAL&ADV INJURY P 1.000 GENERALAGGREGATE S 2,000,0 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-GOMPIOP AGG S 1,0001 POLICY JCO,T LOC - AUTOM INLE WL9IUTV COMBINED SINGLE LIMIT S ANY AUTO (Ee eciE ) 1.000, ALL OPINED AUTOS - SODBYUIS . C X SCHEDULED AUTOS (Pg ) . X HIRED AUroS 4170332 06/06/2004 06/06/200S BODILY INJURY $ X NONOWNEDAUTOS (Per eaode ) PROPERTY DAMAGE S . (Pere4JOerX) - GARAOEllAB4J1Y AUTO ONLY-EA ACCIDENT S ' �ANYAUTO - OTHER THAN EAACC S . AUTO ONLY AGG $ EMIMSAMMUN.LA LIABILITY EACH OCCURRENCE $ OCCUR Q CLAW MADE AGGREGATE ; DEDUCTIBLE . $ RETENTION S S _ IVORIVRBDDMPENBATMAND AWC7013406012004 09/06/2004 09/06/2005 "CST^n X GTM EMPLOYERS'LIABILITY E.L EACH ACCIDENT i 500 00 B ANY PROPRIETORIPARTNEwimcUTNE OFFFICERWEMSER EXCLUDED? E DISEASE-FA EMPLO S 500,00 SPECIAL PROVISIONS below EL.DISEASE POLICY LIMIT S S00, OTHER DESCRmDON OF OPERATIONS LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEINWI SPECIAL PROVISIONS CERTIFIrAn HOLDER C ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I W BEFORE THE EXPIRATION DATE TXEREOP,THE MANG INSURER WILL ENDEAVORTO MALL 10 DAYS WRITTEN NOTICE TO THE C67WA-M HOLDER MANED TO THE LEFT, . . BUT FAR11RE TO NAS.SUCCH�rN�O�TICEpSHRA�rM��PIPOSE NOO QR WMBILITY City of Salem OF ANY IIID UPON THEweU�R,STexeB1T991t ��T'I'14- Sal e0,, NA 01979 AUTNOMM REPRESENTATIVE ACORD 25(2001108) .. ._ _ CORDVORPORKTION 1888 V ''d 9Z99 `0N SNI Aad ' S 311s31 ' Wdll 6 9004 'E ` aeW City/Town Contact Name Contact Number City of Beverly Joe Reali 978-921-6000 Town of Essex Kim 978-768-7614 Town of Wenham John Jacobi 978-468-5522 City of Gloucester 978-281-9771 Town of Boxford Kendell longo 978-352-2413 Town of Hamilton John Jacobi 978-468-5579 CITY OF GLOUCESTER GLOUCESTER • MASSACHUSETTS 01930 HEALTH DEPARTMENT 22 POPLAR STREET yc�9paxe,£°�0^ PHONE: 978-281-9771•FAX: 978-281-9729 EMAIL: healthdept&i.gloucester.ma.us www.gioucester-ma.gov KENNETH HAMILTON P.O. Box 7 Wenham, MA 01984 THE COMMONWEALTH OF MASSACHUSETTS City of Gloucester, Board of Health DISPOSAL SYSTEMS INSTALLERS PERMIT Permit No. 4 Fee: $50 Issue Date: 1/13/05 This permit is granted in conformity with the State Sanitary Code Title 5, Regulation 2.2 and expires December 31 , unless sooner suspended or revoked to: KENNETH HAMILTON Whose place of business is: F.O. Box 7 Wenham, MA 01984 Type of business and any restrictions: DISPOSAL WORKS To construct, alter, install, or repair Individual Sewage Disposal Systems in Gloucester, Massachusetts Permit Expires: December 31 , 2005 �N o r Fsa � BOARD OFWEAL. H[ 5 9sSgCHX3 TOWN HALL, 30 MARTIN STREET, ESSEX, MASSACHUSETTS 01929-1219 TELEPHONE (976)766-7614 Infinity, LLC P.O. Box 7 Wenham, MA 01984 THE COMMONWEALTH OF MASSACHUSETTS Town of Essex, Board of Health Permit No. 200528 Fee: $50 This is to certify that Kenneth Hamilton P.O. Box 7, Wenham, MA is hereby granted a DISPOSAL WORKS INSTALLER'S PERMIT to Construct, Alter, Install, or Repair Individual Sewage Disposal Systems This permit is granted in conformity with the State Sanitary Code, Title 5, Regulation 2.2, and expires December 31, 2005, unless sooner suspended or revoked. Permit Issued: Clerk I certify that I am responsible to install and repair septic systems in the Town of Essex in full accordance with Title 5, local regulations, and approved septic system design plans. Further, I certify that I am responsible to fully coordinate my efforts with septic system designers and the Board of Health as necessary. Installer's Signature _ NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2005-0314 City of Beverly FEE Board Of Health $75.00 DATE ISSUED ''Tov aINFINITI, L.L.C. January 01, 2005 .......... ... - .._. ...-- NAME P. 0. Box 7 WENHAM, MA 01984 ADDRESS IS HEREBY GRANTED A DISPOSAL WORKS INSTALLER LICENSE This permit is granted in conformity with the Statutes and ordinances relating thereto,and December 31, 2005 expires -___-_._-_.._...._................... ......unless sooner suspended or revoked. Board Of .............._ .. ...- Health ...._... Director of Public Health - - ......_ ................ \ Massachusetts Department of Environmental Protection 1 Peter Road, Salem MA_ Bureau of Resource Protection — Wastewater Permitting Program Site Address orMap/LotNumber Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information 1. Facility Information Debra Caulkins Owner Name 1 Peter Road Map/Lot 30/13 Street Address Salem MA 01970 City State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. Published Soil Survey available? Yes ® No ❑ If yes: 1981 1:15840 Year Published Publication Scale Soil Map Unit Urban land Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS) February 2005 Range: Above Normal ❑ Normal ® Below Normal ❑ Month/Year 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 5 Massachusetts Department of Environmental Protection 1 Peter Road, Salem MA Bureau of Resource Protection — Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole A: 3/2/05 10 am 20 deg sunny Date Time Weather 1. Deep Observation Hole Logs Deep Hole Number T-1 Ground Elevation at Surface of Hole Location (Identify on Plan ) see sketch 2. Land Use: lawn none 0-3 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) grass Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 100+ Drainage Way 10+ Possible Wet Area 100+ feet feet feet Property Line 10+ Drinking Water Well n/a Other feet feet 4. Parent Material: Unsuitable Materials Present: Yes ® No❑ If Yes: Disturbed Soil❑ Fill Material® Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 5 \ Massachusetts Department of Environmental Protection 1 Peter Road, Salem MA Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole A: Deep Hole Number: T-1 Soil Soil Matrix: Redoximorphic Features Soil Texture Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) (USDA) %by Volume Consistence Other P Layer (Munsell) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-34 Fill 34-44 C1 2.5y7/4 MEDIUM SINGLE LOOSE SAND GRAIN 44-56 C2 2.5Y5/4 COARSE 15 SINGLE LOOSE GRAVELLY GRAIN SAND 56-121 C3 2.5Y4/4 COARSE SINGLE LOOSE SAND GRAIN Additional Notes NO E.S.H.G.W. NO REFUSAL DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 5 Massachusetts Department of Environmental Protection 1 Peter Road, Salem MA Bureau of Resource Protection — Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ® Depth observed standing water in observation hole A. none B. inches inches ® Depth weeping from side of observation hole A. none B. inches inches ® Depth to soil redoximorphic features (mottles) A. none B. inches inches ❑ Groundwater adjustment (USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ® No❑ b. If yes, at what depth was it observed? Upper boundary: 34 Lower boundary: 121 inches inches F. Certification I certify that I have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 3/8/05 nature of SoilEvaluator Date Edward Cullen November 2002 Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Martin Fair Salem Name of Board of Health Witness Board of Health DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 4 of 5 ` Massachusetts Department of Environmental Protection 1 Peter Road, Salem MA Bureau of Resource Protection — Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Note: This form must be submitted to the approving authority with Percolation Test Form 12 Use this sheet for field diagrams: A �a l— E `t4 67 3 � i � DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 5 r r, Commonwealth of Massachusetts City/Town of Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer,use Debra Caulkins. only the tab key Owner Name to move your 1 Peter Road cursor-do not Street Address or Lot# use the return key. Salem MA 01970 dVQ Cityrrown State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 3/2/05 10am Date Time Date Time Observation Hole# P-1 Depth of Perc 36" +18" Start Pre-Soak 9:59 End Pre-Soak could not hold presoak Time at 12" Time at 9" Time at 6" Time(9"-6") Rate(MinArich) <2 Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Edward Cullen Test Performed By: Martin Fair Witnessed By: Comments: t5form12.doc•16111 Perc Test•Page,1 of 1 , No. R I - 0 5 THE COMMONWEALTH OF MASSACHUSETTS FEE $90.00 S4tswf BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (Upgrade ( ) Abandon ( ) an individual sewage disposal system at f�(rfLe-17_ X4p as described in the application for Disposal System Construction Permit No. / 0 dated`0'3 - 2 3 -o. e Provided: Construction shall be completed within three years of the date of this perm'itlyAl�1/local conditionsiust'bemet. �A Date 4e/1 � D 7 n i p S� Board of Health / / �1 �.' Ctic� FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM' PUBLISHERS- BOSTON ELEVATION BENCH MARKS CONSTRUCTION KEY NOTES• A DATUM: N.G.V.D. OF 1929 </ <NDr A GONSTRUGnoNOUEN , SEWAGE NO. DESCRIPTION ELEV. O1 coNSU[T WITH OWNER REGARD/NG PRESERVA77ON OF TEES P DISPOSAL 1. HYDRANT - BOLT OVER MAIN OUTLET 46.97 ��'oy REMOVE AND REPLACE A AND B SOIL HORIZONS WITH 2. WOOD THRESHOLD TOP CENTERLINE 48.38' osaEcr SOIL F/[L 3. _ SYSTEM 3 INSTALL SEP77C TANK AND COIVNEC77NG PIPE. - 5\X. rLAIV I NTWARe�H ` UP GRADE THESE DRAWINGS ARE INTENDED TO SHOW CONS7RUC77ON REOUIREMEN75 AMpSCOA 4 INSTALL DmRIBUnoN BOX AND CONNEC77NG PIPE.O O h FORA SUBSURFACE SEWAGE DISPOSAL SYSTEM. 1 PETER ROAD 1A SALEM MA`01970 5 INSTALL SOIL ABSORP77ON AREA AND CONNEC77NG PIPE. �, 'l,� 90�Q '` - O �6a 0 L SCALE.• 1=2000' OINSTALL 40 M/L HDPE BARRIER. TOP OF BARRIER AT EL-41.8, BOTTOM "� G OF BARRIER 70 EXTEND 4 FEET BELOW 8077nV OF S70N£ ELENA77ON AND AT LEAST 2 FEET INTO EXISTING GRADE, WHICHEVER IS LOWER? o Q Q MAP BLOCK LOT O7 KEM07F DELETED ^ LEGEND 30 13 EX/STING PROPOSED OALL D157ZIRBED AREAS SHALL BE BACKnLLM, f7NI-SH GRADED, 2 AND HYDROS£EDED WI7H ANNUAL RYEGRASS WS WATER SERNCf WS C�5 PROPER7Y UNE PREPARED FOR ' O KEYNOIr DELETED �P �� N1204623E BERING & DISTANCE ALONG BOUND41RY NW4623 E Of0 EX/Snw SEP 77c mw(S) / CEs'SPOOL(S) /LEACH PITS) SHALL - 9 BE PROPERLY ABANDONED.- PUMPED EMPTY, CRUSH&D AND FILLED �'� O COQ © �`2 EZEYA770N BENCH MARK DEBRA WITH CLEAN SAND, IN ACCORDANCE WITH 310 CMR 15.354 ,� \;�'60 5 1k 42.2 EDGE OF PAVEMENT EAIS77NG LEACH AREA SHALL BE REMOVED, INCLUD/NG ALL suRROUNDING Q�Q�F 3 4" f T TT IT P�\ 5 FG l�C CURB (see abbmwobons) WC CA V LK11V S 11 CONTAM/NA TED SOILS, AND REPLACED WITH IXEAN FILL WITHIN 5 FEET OF LPIP� (FD) PROPOSED LEACH TRENCHES: 1.1' B.G. PAIN OR TRAWL 1 PETER ROAD 43.23 \ ` \\ 6 BUILD/NG, L7cHr, sT�Ps ovEnH�wc SALEM MA 01970 - --- -50 - - - ---- 00 00 N PETER M. & NICOLE D. x 92.6 SPOT aEVAnOIV 933 TOP OF FOUNDA nON 9 F.G. 47.2f BICKELL - - s2- - - EZEVA77oN Co/vR7uR n D/S7RIBU7701V BOX 10 PLAN #79 OF 1983 T-1 TEST PWT BREAKOUT EL. 42.0 FLA NCOCK 45 456 - --- -"- ----------------------------- MH -------- � � P-f PERTCOLA710N 1E5T MH MH -- 9 :�j -__, 4 z a ASSOCIATES , ti \ . \_EX7SnNc 42.93 BASEMENT � Q GRADE \ 4 9i 11'�v. \x 44.32 \ . ,43 Civil Engineers W fZOGV7_ ' - _- V 40 43s2 5 It .1j eo7T0M of Land Surveyors Z vi APPROXIMATE T-f STONE EL 39.0 REPLACT E M SOOp ,0 Q. a WITH sELEcr 2 �\<J - Landscape Architects W 1+ "� O/L�7LL_ 35 35 -- - -- -__. . -- r _ - ✓ 44.54 Environmental 00 E.S.H.G W. AT x43.96 -� t 1 LOT 41 4 Consultants EL 34. o 8,580± S.F. 30 .- --- --- -- -- - - 30 - -- \ x 44. s \ 185 CENTRE STREET, DANVERS, MA' 01923 -� h m p 45.19 xa5.ta ` `� 3 ; VOICE (978) 777-3050, FAX (978)774-7816 x 45.38 t' 45.22 10 \ WWW.HAN000KASSOCIATES.COM .... ERIC DAVID LEO T. & PHILIP D. °' ::` , . : . .:, : . PEARLMAN FLOW PRORLE HAYES a :° ° . \ , LOT 43 SCALE HOIR/ZONTAL 1'=20' LOT 40 1 --CONCRETE PLAN X260 OF 1963 PLAN #260 OF 1963 • . °PATIO . WOOD of WP77rei• f -dDECK \ Pete acus ¢ 45. 5 .. . STEPS . \ Z \\ - �O RICHARD G. r . 45.55 ;' •.a \ `0OHM °' IL SOIL TEST DATA v / / i / 45:]5 ,pn •31 3 45.58 #2 '\. FIRST FLOOR / \\ oaFc Ea TOP OF WOOD THRESHOLD DEP 7H BELOW / OUNDATION EL.=48.38 PERC GRADE ® 12" FIELD RATE EL. .19 7EST LEVEL (/N.) (M/N,4N.) DA 7E \ P-1 42' C1 3/2/05 3 1 STORY \ a- j - WOOD FRAME o DWELLING \I EVALUATOR EDWARD CULLEN p I WITNESS• MAR77N FAIR FOR THE SALEM BOARD OF HEALTH � FIRST FLOOR � DEEP SOIL DBS HD!£ T-f m WO Ep.THRESHOLD 1 l x44.es DA IE 341W 45.14 \ 6 RADE EL 44.1 \\ MOWEL 3140 cas CW EL N/A 45.7 45.70 ~\\ 80MM EL 3K0 APP ATE ISSUE EVISI ON DESCRIPTION N 0. BY P D /R .TZ �, BRICK STEPS �\ AND STOOP x45.23 \4S DATE: 3/18/05 DESIGN BY: JBS 0-340 FILL t SCALE: AS SHOWN DRAWN BY: JBS 34-44' C1 MED/UM SAND 25Y7 4 SINGLE GRAIN ,LOOSE APPROXIMATE LOCE' Y CHECK BY: RFD / 1, OF WATER SERNCE 100.00 44-56' C2 COARSE GRAVELLY SAND 2.5Y5/4 SINGLE GRAIN LOOSLr 15X GRAVEL 56-121" C3 COARSE SAND 2.5Y4/4 SINGLE GRAIN LOOSE NO REFUSAL NO U077LES OBS NO GW OBSERVED 45.40 45.1s 2 45.64 45.03 45.10 .18 SII PLANI PRORLE & LEGEND / CERnFY THAT ON NOVEMBER 2002. / PASSED mr EXAmw POW P E T E R (PUBLIC - 40' WIDE) R O A D - y 4�� APPROVED BY 7HE DEPARTMENT OF ENVIRONMENTAL PR07EC7701V AND THAT THE SOV[ EVALUA7701V WAS t1� ''� PERFORMED BY ME CGWS/S7rNr W17H THE REQUIRED p Q� y1�^ PAP DAM nd M, U R ,asx TRAINING, EXPER77SE, AND EXPER/EWCE DESCRIBED /N 3P0 1� Pim F:\Land no►�• rm+,> e•a� CMR 15.018 (2). SITE PLAN DWG: 11796S.dwg SEE SOIL SUITABILITY ASSESSMEWT REPORT 0 5 10 20 40 LAYOUT: SE01 A ON FILE W17H THE BOARD OF HEALTH EDWARD CULLEN, CER77mv SOIL EVALUATOR DATE GRAPHIC SCALE: 1 INCH - 10 FEET SHEET: 1 OF 2 SE PROJECT NO.: ` 11796 ,. GENERAL NOTES 1. ' Locations tons of existing underground ut!/Itles/obstructions/systems shown hereon ore SEWAGE /OYIILET(1YP) [11 12'MIN. COI£R/36"MAX C04£R approximate only. A# utilltles/obstrnctlons/systems may not be shown. Contractor DISPOSAL ! shall be responsible for locating and protecting all underground utdlties/obstructions/ [41 [3J systems, whether or not shown hereon. INLET [6J , 2. Unless otherwise shown, all new utditles shall be underground. SYSTEM TET /f INLET .moi OUTLET wj 3. Contractor shall fumish constrvctlon layout of building, septic system, and site IJ 1 ►J 1 lVl �� [6j [J improvements. This work shall be performed by o Professional Land Surveyor. UPGRADE 1. BUILDING USE : SINGLE FAMIL Y DWELLING 8 Property lines shown hereon oro opprox/mote. 2. NO. OF BEDROOMS 3 4. Safety measures, construction methods and control of work shall be responsibdlty J. DESIGN FLOW : 110 GPD/BEDROOM 1=8' of Contractor. 1 PETER ROAD 4'x4' >ff 4. TOTAL DAILY FLOW : 330 GALLONS BAMS (IF REO V) 1-6 6 �'� 5. Contractor shall be responsible for repair and/or replacement of any existing SALEM MA 01970 3/4 -1 1/2 improvements damaged during construction that are not designated for demolition [5J� 51TWE and/or,remora/ hereon. Damaged improvements shall be repoired to the satisfactlon SOIL ABSORP770N SYSTEM REOL/IREMENTS PLAN SECAON 1. DESIGN PERCOLATION RATE : Q MINUTES PER /NCH of their respective owners A89E390RS 2. SOIL CLASS CLASS [I]NUMBER OF OUTLET57 6 6. This plan Is not Intended to show an engineered budding foundation design, which MAP BLOCK LOT. / [21 LOAD RA 77N&% H10 ' would Include details and tiro/ elevations of footings, walls and subsurface J. LCVVG TERM ACCEPT. RA 7E., 0.74 GAL./SF [3J MANHOLE RISER R£QU/RED.• YESi APPROXIMATE DEP7H OF COO? drolnoge to prevent 7nterlor flooding. See architectural and or structural drowln s 9 ' • / 9 30 OPER --- 13 4. GARBAGE GRINDER: YES, INCREASE SAS AREA BY 50X [41 WHERE U�ER OR ADJACENT AREA 70 BE PAVED, COMPACT BAaWLL 7. Any Intended revision of the horizontal and/or ►rertico/ %cation of improvements to 5. Ir7TAL AREA REO'D -LOCAL CODE. 669 SF 70 95X PER ASIA/ D-1557 be constructed as shown hereon shall be reviewed and approved by Engineer prior 6. 70TAL AREA REOD -777ZE 5.• 669 SF [5]UNDISTURBED SOL OR SUBGRADE COMPACTED >O 95X PER AS7M D-1557 to implementation. PFMARED FOR [6]ALL OPEN/NGS SEALED WATER7761ir 7. 707AL AREA PROVIDED. 672 SF [7]ALL OUTLET PIPE INVERTS AT SAME E7.EVAAON, LAID LEVEL FOR 2 a Rim elevations shown for new structures are approximate and ore provfded to assist �rr Cw f=DOWS7R£AM FROM D/S7R/BUTIOV BOX. Contractor with moterio/ takeoff. Finish rim elevations should match povement, /� /-LO� AND AREA COMPUTA 770NS [8j ALL OUnE7S rO BE Rr7ED WIH fZOW REGULAANG DE74LLrS UNLESS grading, or landscaping, unless speclfica//y indicated otherwise. DEB1\I"1 INLET/S A FARCE MAIN. (310 OUR 15.242) 9. Where existing utility Anes/structures are to be cut/broken down/obondoned, Anes/ �� structures shall be plugged/co ed filled In accordance with owner requirements.6-0UTLEl D/STR/BU/70N BOX PP / q ULKINS 10. A// work on sewage disposal system shall be completed b o licensed "d!s osa/ works (3f0 CMR 15.232) 9 P 1's P }' P Installer' 1 PETER ROAD NOT TO SCALE 11. The Issuance pf a permit to construct, or a certiAcote of comp/!once, shall not be SALEM MA 01970 construed as o guarantee that the disposal system wJ// function sotlsfoctori7y. 12. The contractor shall verify the locatlon and relative elevation of bench marksrior to 1. nRST COMPAR7MENT : 200X DAILY FLOW = 660 GAL. commencement of construction. Any discrepancy shall be reported to the engineer. 2. SECOND COMPAR7MENT: 100X DAILY FLOW = 330 GAL 13. Structure details from Independent vendors ore constantly chancing. Prior to J. REOU/RED.• 1500 CAL, 2 COMPARTMENT TANK construction, the contractor shall verJfy that details shown match current details and HANCOCK specifications brain asndors T A SEPTIC TANK COMPy/A nONS 14 Proposed budding foundation configuration and location on the lot as shown are ASSOC !.TESconceptual and shat/ be verified as to conformance with final architectural plans and zoning ordinances prior to construction. (310 CMR (5.223) - ALL ANDIIN15. Backwash from o water softener shall not be discharged into the subsurface sewage PAMWENr (Non/ o disposal system, but Into o separate dry well or onto ground per 310 CMR 15.004(9). C1V11 Engineers N /1� 70 1/2"'- � -o' 16. Property lines shown hereon are approximate only. 3/s- , '�- No boundary survey has been performed Land Surveyors S70VE [21 ° ° ° e e. ° ° ° ° f�7 ° ° e 17. Project source benchmork Is o spike in u. Pale ,/2890 up L4' A.0 on Linden 12' MIN. OR f74AME�COVF/7 /F ACCESS k e e o °,e ° s E ° , e °e a 4,� A� Avenue Extension (E7.=43.05) as shown on o plan entIlled, ' Proposed Subsurface 36 MAX. Nl MANHOLE R/SER REOU/RED [21[51 P V PIPE Sewage D!s osa/ S tem, Lot 5, Linden Avenue Extension, For 7 ,- °N, 3. ° ° ° [3J Bouchard, prepared by Hancock Survey Associates, dated Ju June 1993. Robert /. Landscape Architects [4J NATURAL SUL OR REQUIRED 96 � suscr AwPoRr sox Na CF 7 PENQYEsEnvironmental REWIRE 1N0 (2) WE NOTES - Consultants 4D/A INLET[3] j [1] ENTIRE BOTTOM OF SOIL ABSORP770V AREA SHALL BE SCARIRED TO L A// sewage disposal system components ore L 4" D/A OUTLET �A MINIMUM DEPTH OF 3 INCHES JUST PRIOR TO PLACEMENT Or S70NE. 9 sP ys P greater than 400 feet away from surface MAX. LIOU/D water reservoirs and greater than 400 feet from tributaries to surface water reservoirs i - 2 ALL STOVE SIRALL BE DOUBLE WASHED LEVEL OU7ZET [ j INVERT � 2. )hero are no we//s within 150 feet of the sod absorption area. 185 CENTRE STREET, DANGERS, MA 01923 [3J (ENDS OF DIS7R/BU770V PIPE SHALL B£ CAPPED UNLESS SYSTEM IS VENTED. VOICE (978) 777-3050, FAX (978) 774-7816 3. !hero aro no freshwater wet/ands w/thln 100 feet of sod obsorpt/on area WWW.HAN000KASSOCIATES.COM °M' SOIL AB,SORP ON AREA TRENCHES 3 Mere ore no coastal wet/ands within 200 feet of sod obsorptlon area a PAR777701V WALL (310 CMR 15.240-15253) 4. Site does not lie within o nitrogen sensitive area. TYPICAL CROSS SECTION OF NOT TO SCALE �� .REGULATORY NOTES RICH D F. R j - - - .CIVIL 6" DEPIH OF 3/4" rO 1. Contractor shall contact Dig-Safe for underground uNity marking at 1-888-344-7233 No.31433�a W-2" 1-1/2" S70VE at /east 72 hours prior to commencement of any work �'o GIs a ' /ON sN. TANK OUTS/D£ WIDTH - 4'-4" 2. Contractor shall make himself aware of all construction requirements, conditlons, and limitations Imposed by permits and approvals issued by regulatory authorities [1JPOLYE7HYIEN£ S£P77C TANK, LOAD RA1/7NC. H10 prior to commencement of any waft. Contractor shall coord/note and obtain o/I 1 FULLY DAM PROOFED EXTERIOR, ALL OVEN/NGS SEALED WA1ER11GHT. construction permits required by regu/atony authorities � AS MANUFACTURED BY WEDCO MOULDED PROOUCIS; C14 £IXIAL J. A# work outside of budding that is less than 10 feet from the inside face of budding [21 MANHOLE RISER REOUIRED.- YES foundations shall conform with the Uniform State Plumbing Code of Massachusetts, /F YES; APPROX DEPTH Cr COVER OVEJR RISER RIM. 6 INC REs 248 CMR 2.00 [31 INSTALL TANK PER MANUFACRIRERS ONRE077O4S 4. ' A// work shall comply'with Title V and loco/ Board of Health regulations except as provided by approved wohers. [41 TANK -WALL NOT BE PLACED /N AN AREA WHERE 7RAFRIC MAY BE PRESENT. i [5]PLAS77C RISER AND COVER CAN BE USED SELECT SOIL 8U. SPEC/RCA 77ON (310 CMR 15255) [61 OUTLET TEES -WALL BE EOUIPPED WIN' A CLWR057OV-RESISTANT CAS DETZEC77a4 L Select sod N1 materia/ for system construction !n n1l may consist of select on-site ys y [7J INSTALL EFFLUENT F7LTER.• Z48R A18010 OR EQUAL sod, or Imparted so/l. BRING MANHOLE ABOVE FILTER TO GRADE AND LABEL IT ZABEZ &IE7Z 2. Select soli fill materia/ shall be comprised of dean, granular sand, free from organic matter and deleterfous substances. Maximum particle size shall be 2 inches /+w rJ 77� AIT Tl NO. BY APP DATE ISSUE/REVISION DESCRIPTION MO CALLOW-COMPAR/ME/Y/ SOWC TANK 3 A sieve analysis shall be performed on a representative sample of the h7l. Up to 45X by welght of the fd/ sample may be retahn on a 14 sleve. A sieve analysis DATE: 3/18/05 IDESIGN BY: JBS (310 CMR 15.223 - 15.227) shall also be performed on the fraction of the fill sample posslno the 14 sieves SCALE: AS SHOWN DRAWN BY: JBS TYPICAL (CROSS SECTION Such onolysis shall demonstrate that the materlo/ passing the 14 sieve meets the ICHECK BY: RFD fol%wing gradation: NOT TO SCALE Effective Percent Sieve Panicle Slze Passing Sle14 vin 475 mm 100 DETAILS 0.30 mm 10 To f00 /000 0.15 mm 0 To 20 AND 1200 0.075 mm 0 To 5 AND NOTES L� �a D.LV L 6)", PLOT DATE Mar 21. 2005 10x2 en 11` PATH: r.Vmd Projects n2\117N\fta\ ' DWG: 11796S.dwg LAYOUT: DT01A ��- SHEET: 2 OF 2 PROJECT NO.: 11796 __._ . CONSMUC770N KEY NOTL�S� ELEVATION BENCH MARKS � �.•� "��� e DATUM: N.G.V.D. OF 1929 tP (NOT A CONSTRUC77ON SEOUENCE) SEWAGE N0. DESCRIPTION ELEV. P ocoNsuLr WITH OWNER REGARD/NG PR£SERVA A0N OF TREES1. HYDRANT - DISPOSAL BOLT OVER MAIN OUTLET 46.97 � �y REMOVE AND REPLACE A AND B SOIL HORIZONS WITH 2. WOOD THRESHOLD - TOP CENTERLINE 48.38' <N., SELECT SOIL FILL. $. �' SYSTEM OINSTALL SEP77C TANK AND CONNEC77NG PIPE ALAN�,.��• PLAN INTENT wgMp�eq UPGRADE THESE DRAWINGS ARE INTENDED TO SHOW CONSTRUCAON REOUIREMEN7s INSTALL D/STRIBUnON BOX AND CONN£CANG PIPE �o O\ h FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM. 1 PETER ROAD O5 INSTALL SOIL ABSORP7701V AREA AND CONNECTING PIPE. .1 A��, SALEM MA 01970 tiO���oF L� SCALE 1'-2000' OINSTALL 40 MIL HDPE BARRIER; TOP OF BARRIER AT EL-41.8, Bonom \/JG OpC,Lbp OF BARRIER 77 EXTEND 4 FEET BELOW BOTTC.m OF S70NE £LEVA77ON � \��_����aaa AND A T LEAST 2 FEET INTO EXIS77NG GRADE• WH/CHEIER /S LOWER O Q `�� � O K£YNO1F DELETED o, MAP BLOCK LOT L£-LEND --- 13 ALL DISTURBED AREAS SHALL BEBACKFILLED, FINISH GRADED, iExsnNc PROPOSED O30 AND HYDROSEEDED WI7H ANNUAL RYEGRASS -WS WATER SE7?V7CE WS C\� PROPERLY UNE O KEYN07F DELETED h 55.36' 55.36 PFS'APE�FOR 1 BEAR/NG d 0/STANC£ALONG BOUNLI4RY ,y� Q�96� N720"4623 E N7?0'4623$ �10 EXISTING 5EP77C TANKS) / CESSPOOL(S) /LEACH P/T(S) SHALL `!� O•� O��F ` a 12 ELEVARON BENCH MARK BE PROPERLY ABANDCNED. PUMPED EMPTY CRUSHED AND FILLED DEBRA WITH CLEAN SAND, IN ACCORDANCE WITH 310 CMR 15.354 ,�� �. X60 c�5 C�\ 0 � �. 42.2 EDGE OF PAVEMENT EX/S77NG LEACH AREA SHALL BE REMOVED, INCLUDING ALL SURROUND/NG P RJ4! a 3/4" FO VGC /� T T KIN / CURB (see obbroviotions) �C CL7 JLl'11 V S 11 CONTAMINA7E'D SOILS, AND REPLACED WITH CLEAN FILL WITHIN 5 FEET OF Q LPIPE (FD) O PROPOSED LEACH 7RETVCHES. 1.1' B.G. g�� 1���. - - H--- - - -r- ---4b -- PATH OR 77Z4/L _ 43.23 \ / . 1 PETER ROAD T 1 �\ 6 BUILDING, LIGHT, STEPS & OVERHANG . SALEM MA 01970 50 - .. ----- - .. --- - ------ �.. -------- 50 - - -- -- - 00 00 PETER M. & NICOLE D. x 92.6 SPOT rwvAwN TOP OF FOUNDA 7701V 47.21 BICKELL - -s2- - - E2EVAnoN CONTOUR n FG. BOX 10 PLAN #79 OF 1983 MIN. T-1 TEST PIT BREAKOUT EL. 42 l \0 HACOCK 45. - - ---_ -. _ �_� _ _.� - 45 B P-1 PERCOLATION LEST MH MH . ----------------------------- ASSOCIATES ............. \-EXlS77Nc \ 42.93 BASEMENT ......... •-•. GRADE \ 11 91 �1'Er. �x F7OOR _ _ iuvc�� 44.32 \ 43.sz t1� �4a 5 Civil Engineers I 40 - - __- o - - � ✓ Land Surveyors 2 I BOTTOM OF APPR0.1'IMA)F �i T-1 hV STONE EL 39.0 �TION OF WOOD REPLACE SHED RIM CL 10�t1 rr IM .a WITH SELECT Y 2 Landscape Architects I = 44.54 Environmental E.S.H.G.W. AT X43.96 LOT 41 4 Consultants EL134.o 8,580± S.F. 00 111 0 11 _O 30-- --------._._.--._ � -- 30 � -- _ � x 44. 6 4514 y _ _ 1 ` 185 C1RE STREET, DANVE(S, jA 01923 W h N o N N ab z9 45.38 x r 'T VOICE (978) 777-3050, FAX 978 774-7816 a Nv a a 45.22 10 , 1 ERIC & DAVID WWW.HAN000KASSOCIATES.COM LEO T. & PHILIP D. = _---- _ PEARLMAN HAYES o a : LOT 43 ,FLOW PROFILE �+ LOT 40 s � � CONCRETE,�,. PLAN #260 OF 1963 J,CALE.' HORIZONTAL: 1=20' vFanrar • ��� PLAN #260 OF 1963 , >.:raPAT10,_, ,. W000 DECK \\ Ea��+ oF,yr 45.55 45. 5 •: < STEP - Z \ �O RI0HARp G SOIL 75ST DA TA 45: 5 l .e ,p . 45.58 ' #2 � FIRST FLOOR i \ •n�FFs` J; TOP OF WOOD THRESHOLD \ DEPTH BELOW EL N�7 19 N EL.=48.38 \ O PERC GRADE ® 12" naD RA 7E \ TEST LEVEL (/N.) (M/NM) DA 7E a11. P-1 42" <2 3/2/05 3 1 STORY \ m > WOOD FRAME \ DWELLING . o I N I - EVALUATOR.• EDWARD CULLEN z W17NESS.• MAR77N FAIR FOR 7HE SALEM BOARD OF HEALTH FIRST FLOOR DEEP SAL ADS HaE T-1 N F WOOD THRESHOLD ^ EL. m =48.41 / 1 DA 7E* 3/1/O5 xa4s9 GRADE EL 44.1 i 45.14 \\ ESHGW EL 340 45.7 45.70 � 04S CW EL N/A \ ROTTEN/ EL 34.0 � NO. BY APP DATE ISSUE EMSION DESCRIPTION j� N BRICK STEPS �� � ' 0-34` FILL I AND STOOP x45.23 �4S DATE: 3/18/05 DESIGN BY: JBS 34-44" C1 MED/UM SAND 2.5Y714 SINGLE GRAIN LOOSE <APPROX/MA 7F LOCA 77ON SCALE: AS SHOWN DRAWN BY: JBS 1, OF WRIER SERVICE 100.00' +- CHECK BY: RFD 44-56' C2 COARSE GRAVELLY SAND 2.5Y5/41 SINGLE GRAIN LOOSE 15X GRAVEL 56-121- C3 COARSE SAND 2.5Y4/4 SINGLE GRAIN LOOSE # NO REFUSAL NO MOTILES OBS NO GW 085MVED 45.40 45.1A 45.64 4:5.03 45.10 .18 SRE PLAN, PROFILE � Q / CERnFY THAT ON NOVEMBER 2002, / PASSED AHE EXAmwAnoN P E T E; R (PUBLIC 40' W & IDE) R O A D p ��1�L LEGEND APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PROTFCnaN, AND THAT THE SOIL EVALUA77ON WAS PLAT DATE Yv�. zoos 10:42 TRAININPATH: PVL d PmjwU R2\1179E\dn\ PERFORMED BY M£ CONSISIFNT WITH THE R£QUlIRED c/� Q /� Z v' CMR 15GOf8XPERnSE, AND £XPER/E7VCEDESCR/BE70 /N 310 V/ / � / �/"IN ,� ���A �d' DWG: 11796S.dwg r SEE SOIL SU/TAB/LITY ASSES'SMEw REPORT 0 5 10 20 40 \ ,A LAYOUT: SE01 A SE ON FILE OfTH THE BOARD OF HEALTH EDWARD CULLEN, CERTIFIED SOIL £VALUA77R DATE GRAPHIC SCALE: 1 INCH - 10 FEET SHEET: 1 OF 2 1 PROJECT NO.: 117961 GENERAL NOTES I. Locations of existing underground utNties/obstructlons/systems shown hereon are SEWAGE /OU7U7(7)P.) [11 12"MIN. COMER/36'MAX. COWR approxlmate only. A// utilities/obstructions/systems may not be shown. Contractor / shall be responsible for locating and protectJng o// underground utffitfes/obstructions/ DISPOSAL 141 131 systems, whether or not shown hereon. DISPOSAL r2' [6J 2. Unless otherwise shown, all new ut!/itles shall be underground. SYSTEM FLOW INLET m INLET OUTLET 00 3. Contractor shall fumish construction /ayvuf of building, septic system, and,site 161 � [71 Improvements 7hls work shall be performed by a Professional Land Surveyor. 1 BU/LD/NG USE : SINGLE FAM/L Y OWEZL/NG [8J Property lines shown hereon are approxlmate. UPGRADE Gl�ADE w 2. N0. OF BEDROOMS : 3 4. Safety measures, construction methods and control of work shall be responsibility J. DESIGN FLOW : 110 GPD1186DROOM 1=11" 1 of Contractor. 1 PETER ROAD 4. TOTAL DA/LY FLOW : 330 GALLONS SAFnE (/F REO17) 1'-B" 6'DEP771 5. Contractor shall be responsible for repair and/or replacement of any existing SALEM MA 01970 1 J148:4 1/2' improvements damaged during construction that are not designated for demolition S7DVE and or remora/ hereon. Damaged Improvements shall be snu ABSORPnON SYSTEM REQUIREMENTS PLAN [5] SEC7)ON / g p repaired to the sotJsfoctlon of their respective owners ASSESSORS 1. D£S/OYV PERCOLA770N RA 7E: Q AflNU7ES PER IlVal [11 NUMBER OF OCIIL£TS 6 6. 7h1s /an Is not Intended to show an engineered bui7din foundation des! n, which MAP BL 2. ;SOIL CLASS CLAS ! [2]LOAD RA77NG: H10 would fndude details and final elevations of footings, walls and subsurface OCK LOT 3. LONG TERM ACCEPT. RA 7D 0.74 GAL./SF (J]MANMOYE RISER REWIRED.• YES APPROXIMA7E DEP 771 OF COVER drainage to prevent interior flooding. See architectural and/or structural drawings OVER' RI&W RIM- 6 /NQYES 30 --- 13 4. GARBAGE GRINDER YES; INCREASE SAS AREA BY 50X [41 WHERE UNDER OR ADJACENT AREA 727 BE PAVED, C10MPACT BAAYI7LL X Any intended revisJon of the horizontal and/or vertical location of improvements to S. 707-AL AREA REOV -LOCAL CODE- 669 SF 70 95X PER AS7M D-1557 be constructed as shown hereon sho// be reviewed and approved by Engineer prior 6. 707AL AREA RE100 -177LE 5. 669 SF [51 UNDISTURBED SOIL A? SUBGRADE COMPAVED 70 95X PER AS1M D-1557 to implementation. PREPAR®FOR [6]ALL GP£N/NGS SEALED WAlER77C,Hr 7. 707AL AREA PRONDED.• 672 Sr [71 ALL OYnET PIP£ /NVPR7S AT SAME ELEm77OW, LAID LEVEL FOR 2 8. Rim elevations shown for new structures are approxlmate and are provided to assist FEET'DOWNSTREAM FROM D/S7R/8U710V BOX. Contractor with materia/ takeoffs Finish rim elevations should match povement, D FLOW AND AREA COMPUTA77ONS [81 ALL 01lam ro BE Fn7TED W17H ROW RE2LYluwo L7 as UNLESS groding, or Iandscoping, unless specJficolly indicated otherWse. DEBRA RA INLETS A FORCE MA/N. (310 CMR 15.242) 9. Where existing utility /Anes/structures are to be cut broken down/abandoned, /fines/ �AT TT �TT�TS `+-O�DIS IBUM , BOX structures shall be plugged/cappedl(Wed In accordance with owner requirements. lJ L 1jV V (310 CUR f5.232) V/1/ V/1 is A// work on sewage disposal system shall be completed by a licensed 'disposal works NOT TO SCALE Installer ' 1 PETER ROAD 11. The Issuance of o permit to construct, or a certlflcote of compliana sho// not be SALEM MA 01970 construed as a guarantee that the disposal system wiz/ function satisfactorily. 12. The contractor shall verify the /ocotfon and relative elevation of bench marks prJor to 1. 'RRST COMPARTMENT : ZOOX DA/L Y FLOW = 660 GAL. commencement of construction. Any discrepancy shot/ be reported to the engineer. 2. SECOND C'OMPAR7MENT : 1100X DAILY FLOW = 330 GAL. 13. Structure defalls from Independent vendors are constantly dranying. , Prior to J. REOU/RED.• 1500 GAL, 2 COMPARIMENr TANK construction, the contractor sho// ►roNfy that details shown match current details and HANCO CK speclflcations from vendors SEPTIC TANK COMPUTATIONSdPAo£ 14. Proposed budding foundation configurotion and location on the lot as shown are ASSOCIATES / conceptual and shall be verfffed as to conformance with final architectural plans and (310 CMR 15.:223) zoning ordinances prior to construction. wo>tr 3.-a 15. Backwash from a water softener shall not be discharged into the subsurface sewage disposal system, but into a separate dry well or onto ground per 310 CMR (5.004(9). Civil Engineers 1�. 1 tENC1H 48=00a 16. Property lines shown hereon are approxlmate only. is !21 e e a No boundary survey has been performed. Land Surveyors e o e n eo 314• Iar1 1/7• o e . a ,- Y o !2J a 17. Project source benchmark Is a spike In u. Pole ,/2890 up 1.4 A.G. on Linden 12 M/N. OR FRAMS&000 ER IF ACL^ESS Ll eooee eSILW£ e e e o "36" MAXfjN/5 MANHOLE' R/SER REOW/RED [2J[5J e o - e e e 4y p�rcwAlm Avenue Extension (E/=43 05) as -shown on o plan entlt/ed, Proposed Subsurface RA l e e e e e P.vG p� [37 Sewage Disposal System, Lot 5, LJnden Avenue Extension, prepared For Robert Z Landscape Architects I [ J w. 3. -1Bouchard, prepared by Hancock Survey Associates, dated .kine 1, 1993.' 4 [1I !1J NA?MAL SAL OR EO M� FT /A/PaRr son Environmental No, OF 7MMES REMMED 700 (2) Consultants WE N0758 4" D/A INLET[3] [1J EN77R£ BOTTOM OF SOIL ASSORP7701V AREA SHALL BE SC4R1nED 7t7 4' D/A OUTLET 1 A// sewage disposal system components are greater than 400 feet away from surface I MAX. LIQU/D A m1mmuM DEPTH OF 3 lwws JUST PR/OVt 7n PLACEMENT OF ST27WE. water raserwirs and greater than 400 feet from tnbufories to surface wafer reservoirs. - LEVEL=OUTLET [2;J ALL STAVE SHALL BE DOUBLE WASHED. INVERT 2. there are no wells within 150 feet of the soil absorption area. 185 CENTRE STREET, DANVERS, MA 01923 [3j7 ENDS of D/S7R/BU710N PIPE SHALL BE CAPPED UNLESS SY57E71I /S VENTED VOICE (978) 777-3050, FAX (978) 774-7816 '0 0"M/ . Tp�w�CHES 3. There oris no feshwater wet/ands within 100 feet of so# absorption area. WWW.HAN000KASSOCIATES.COM SOIL ABSORPTION AREA TRENJ. 7here are no coastal wet/ands within 200 feet of so17 absorption area PARTITION WALL ( 310 OUR 15.240-15.253) 4. Site does not /fie within a nitrogen sensltive area. `r TYPICAL CROSS SEC77ON OFMq 4 NOT TO SCALE Q Qy � 4 tD / /� TO/ !/ NOS DOHERTY oy RICHARD F. G CIVIL " $ No. Q 6 DEPTH OF 3/4 >n 1 Contractor shall contact Dig-Safe for underground u67ty marking at 1-888-344-7233 °99FG 14=2" 1-1/2" S7OW£ at /east 72 hours prior to commencement of any work o� ON TANK OUTSIDE WIDTH = 4'--4 2. Contractor shall make himself aware of al/ construction requirements condltlons, and /lmitotfons Imposed by permits and opprow/s issued by regulatory authorities [11 POLYE77/nENE SEP77C TANK, LOAD RATING. HIO prior to commencement of any work. Contractor shall coordinate and obtafn aff FULLY DAM PROOFED EX1ER/0R, ALL OPEN/NGS SEALED WA7ER77GHr construction permits required by regulatory outhoritles AS MANUFACTURED BY KVCO MOULDED PRODUCTS, OR EOUAL J. A// work outside of building that is less than 10 feet from the Inside fore of buAding [2]MANHOLE RISER REOUIRED.• YES foundations shall conform with the Uniform State Plumbing Code of Massachusetts, /F YES, APPROX. DEPTH CF L10VE'R OVER RI-%R RIM.- __EJNlx/ES 248 CUR 200. [31 INSTALL TANK PER AIANUFACTURERS DIREC7IANS 4. Al/ won* shall comply with Tit/e V and loco/ Board of Health regulations except as provided by approved walmrs ;A NK T [4 J NK LL NOT BE PLACED /N AN AREA WHERE 1RAFAC MAYBE PRESENT. I [51 PLASTIC R/SER AND-COVER CAN BE IUSTD. SELECT SO/L RU SPEC/f-7CA770N (310 CMR 15.255) [61 OUTLET 7U-S• S IYALL BE LWIPPED W1;7H A CARR0570N RESISTANT GAS DEPLECTta4 1. Select so# R/ materia/ for system construction In fl/ may consist of select on-site [71 INSTALL EFFLUENT FILTER.• ZABEL A1800 OR EQUAL sal, or Imported soil BR/NG MANHOLE ABOIE f1L 1ER 7U GRADE AhD LABLZ /T LABEL f!L lE]Z 2. Select so# fi7/ materfo/ shall be comprised of dean, granular sand, fee from organic matter and deleterfous substances. Maximum particle size shall be 2 Inches N0. JOYLDAISSUE/REVISION DESCRIPTION 16W G4LL0N2-C0MPARTA/1ENTSEPTIC TANK J. A sieve anolys/s shall be performed on a representative sample of the MI. Up to 45X by weight of the Ell sample may be retp10on o 14 sieve. A sieve ano/ysls DATE: 3/18/05 IDESIGN BY: JBS (310 CMR 15.223 - 15.227) shall also be performed on the fraction of the All sample passinQ the /14 sieve SCALE: AS SHOWN DRAWN BY: JBS TYPICAL. CROSS SEC77ON Such ono/ysfs sho/I demonstrate that the materia/ passing the t4 sieve meets the ICHECK BY: RFD NOT TO SCALE fallowfng gradation: Effective Percent Sieve Partlde Size Posslna Steve 14 4.75 mm 100 ,{50 0.30 mm 10 To 100 DETAILS I j100 a15 mm 0 To 20 w, ,{200 0.075 mm 0 To 5 ANIS NOTES _ PLOT DAIS Ma Pro" 2005 M.42 ! 5 Wor PATH: Pno}ets R2�fl796\ep\ DWG: 11796S.dwg LAYOUT: DT01 A SE�2 SHEET: 2 OF 2 - PROJECT NO.: 11796 IMPORTANT MESSAGE FOR �"'�tiA a 6 DATE 9—e(s TIME 26�' � 9 P. M In - OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOBILE AREA CODE 1,111 UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN' WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE JV1 o-7� ice SI NEO V�psFORM 4009 MAGE IN LLS. z 0 conn LETTER OF TRANSMITTAL H NCOCK 25 Years of Excellence t A Providing Land Surveying, Civil SSOCIAT ES 1 _ 7 Engineering, Landscape Architecture and1;85 Centre.Street, Danvers, MA 01923 -i Environmental Services Since 1978 Phone (978) 777 305,0.,'Fax (978)-:7,74-78167 „ i ww .hancockassociates.c'om TO: John Maestranzi DATE: 5/5/05 1 JOB #: 11796 FROM: B. Derek Anderson RE: Debra Caulkins (pickup) 1 Peter Road As-built Plan&Letter • We are sending you: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order COPIES DATE JOB# DESCRIPTION 3 5/3/05 11796 As-built Plan 2 5/3/05 11796 As-built Certificate of Compliance Letter • These are transmitted as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ® For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: John, 1 am attaching 2 copies of the as-built plan and an original as-built letter to be submitted to the Salem Board of Health. The third copy of the plan, as well as the copy of the letter, is for your records. If you have any questions or comments, please do not hesitate to call me at(978) 777.3050, extension 202. COPY T0: SIGNED: If enclosures are not as noted,kindly notify us at once. ' 6viron ental Co Civil Engineering Land Surveying E M HANCOCK ASSOCIATES #11796 May 3, 2005 Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970 Attn: Joanne Scott Re: As-built Certificate of Compliance 1 Peter Road Dear Ms. Sawyer: I hereby certify that the sewage disposal system installed by John Maestranzi, at 1 Peter Road (Tax Map 30, Lot 13) was installed as shown on the enclosed as- built plan. The approved design flow is 330 gallons per day. Enclosed are two copies of the as-built plan for your use. This letter is submitted as a substitute to fulfill the requirements of Certificate of Compliance signature on DEP approved form 1255, Rev 5/96. Please note that the issuance of a Certificate of Compliance shall not be construed as a guarantee that the system will function as designed. Should you have any questions, please call me. Very truly yours, HANCOCK ENGINEERING ASSOCIATES Richard F. Doherty, P.E. Senior Project Manager - Engineering Enclosure RFD/bda cc: Debra Caulkins John Maestranzi File # 11796 DANVERS OFFICE: BOLTON OFFICE: 185 Centre Street, Danvers, MA 01923 626 Main Street, Bolton, MA 01740 Phone: (978) 777-3050 Fax: (978) 774-7816 Phone: (978) 779-6767 Fax: (978) 779-2228 HSA@hancockassociates.com bolton@hancockassociates.com www.hancockassociates.com n — IF H ANC0CIrv% #11796 ASSOCIATES May 3, 2005 Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970 Attn: Joanne Scott Re: As-built Certificate of Compliance 1 Peter Road Dear Ms. Sawyer: I hereby certify that the sewage disposal system installed by John Maestranzi, at 1 Peter Road (Tax Map 30, Lot 13) was installed as shown on the enclosed as- built plan. The approved design flow is 330 gallons per day. Enclosed are two copies of the as-built plan for your use. This letter is submitted as a substitute to fulfill the requirements of Certificate of Compliance signature on DEP approved form 1255, Rev 5/96. Please note that the issuance of a Certificate of Compliance shall not be construed as a guarantee that the system will function as designed. Should you have any questions, please call me. Very truly yours, HANCOCK ENGINEERING ASSO IATES Richard F. Doherty, P.E. Senior Project Manager- Engineering Enclosure RFD/bda cc: Debra Caulkins John Maestranzi File # 11796 DANVERS OFFICE: BOLTON OFFICE: 185 Centre Street, Danvers, MA 01923 626 Main Street, Bolton, MA 01740 Phone: (978) 777-3050 Fax: (978) 774-7816 Phone: (978) 779-6767 Fax: 1978) 779-2228 HSA@hancockassociates.com bolton@hancockassociates.com www.hancocl(associates.com i ELEVATION BENCH MARKS A DATUM: N.G.V.D. OF 1929 P SEWAGE OMER/APPLICANT°° NO. DESCRIPTION ELEV. P DEBRA CAULK/NS 1. HYDRANT - BOLT OVER MAIN OUTLET 46.97' � �y DISPOSAL 1 PETER ROAD SALEM, MA 01970 2. WOOD THRESHOLD - TOP CENTERLINE 48.38' � 3. � SYSTEM MgRe UPGRADE OMPONENTRADES ELENA 110NS p���\� � swgMAq BU/LO/NG AS-BUIL r PROPOSED \��5 � �P6y 1A 1 Peter Road OUTLET 43.61 42.5E ��� 'l.p��eo �a LCh( SCALE.• 1'=2000' Salem, MA 01970 SEPTIC TANK � 0 ti SSESSOM INLET 3. 413 42 � � 25 p� A OUTLET 43.01 42.00 o Q Q DisTRiBunoN Box ^ LEGEND 30 BLOCK LOT INLET 41.45 41.45 Q EXIS77NG PROPOSED f OUTLET 41.29 41.28 O� WS WATER SERVICE wS LEACH F7EZD GjG PROPERTY UNE PFIEPARED FOR: BEG/NN/NG OF UNE 1 41.20 41.24 55.36' - 5536' BEMNN/NG OF UNE 2 41.22 41.24 p� y DISTANCE ALONG BOUND4RY END OF UNE 1 40.94 41.00 END OF UNE 2 40.99 41.00 �� o� g�OF Al2 ELEVATION BENCH MARK D EB R A �• o`�' o �0� �0 EDGE OF PAVEMENT �T i. STRUCTURES D/A. (IN.) MATFR/AL QQQ1_P 3l(FD �C CURB (see abbreviations) LPIP �C CAULKIIV S BUILDING TO SEPTIC TANK 4 PVC SCH 40 1.1' B.G. -tom'- --�� - PATH OR TRAIL 2-COMPARTMENT 1500-GALLON H-f0 SEPTIC TANK - - 10 WITH TEES ON INLET AND OUTLET PIPES (ROCHESTER ROTA77ONAL MOLDING INC. TANK) BUILD/NG, LIGHT, STEPS h OVERHANG _ _ __ ____ 1 Peter Road SEPAL TANK S EV LE 4 PVC SCH 40 x 92.6 SPOT ELEVATION ;� Salem MA 01970 D-Box (WITH SPEED LEVELS) - - PETER M. & NICOLE D. 933 SOIL ABSORPTION AREA LATERAL 4 PVC SCH 40 C BICKELL - -92- - - ELEVATION CONTOUR n FG 11't PLAN #79 OF 1983 AS-BUIL T 77ES ® r_1 TEST P/T C O CK S7RUC7URE N (2) (3) P-1 PERCOLATION TEST SEPAL TANK INLET COVER 26.9 39..0 - ASSOCIATES qo SEPTIC TANK OUTLET COVER 30.2 39.2 D-BOX 35.0 - 43.3 oo• SOIL ABSORPTION AREA HDPE LINER CORNER (A) 35.3 - 45.2 a HDPE UNER CORNER (B) 86.8 - 26.8 HDPE LINER CORNER (C) 87.5 65.2 - © 1�' 1 '� Civil Engineers HDPE UNER CORNER (D) 38.8 - J8.3 T-1 Land Surveyors INSPEC77ON WOOD S BDA .APRIL 22, 2005 SHED P-1 �1� Landscape Architects 10 INSTALLER Environmental ,1 HN MAES7RANZI - INRN/A LLC LOT 41Consultants 8,580± S.F. 90* BEND D/S7RIBU770N BOX O SEPTIC TANK 45' BEND 23 VO8 E (97 8)CENTRE 7777-3 50, FAX A (978) 774-7816 816 220BENDERIC HC DAVID WWW.HAN000KASSOCIATES.COM LEO T. & PHILIP D. •- •-- -`•-- PEARLMAN HAYES : . N LOT 43 LOT 40 ' CONCRETE; .. PLAN #260 OF 1963 PLAN #260 OF 1963 r . r;PATTO ; - WOOD •►uta° DECK ...: ..WOOD.- CONNECTION TO OF /P�Tn MASS © STEPS EXISTING SEPTIC LINE F RICHARD F. �ZG •. FROM DW£LUNG OO DOHFRTY M #2 ` U CIVIL N 13 .o 'PNa. � . SNA - J5 a D 3 1 STORY rn� WOOD FRAME 0 DWELLING �. 0 z En BRICK STEPS ]WO. BEYAPP DATE ISSUE/REMSION DESCRIPTION AND STOOP DATE: 5 3 05 NTBK: E-68 SCALE: AS SHOWN DRAWN BY: BDA � 100.00' CHECK BY: RFD AS-BUILT PLAN P E T E R (PUBLIC - 40' WIDE) R 0 A D PLOT DATE May OS• 2005 6.23 am PATH: F:Mond D.akah Yt\11798\dq\ E PLAN DWG: 11796AB.dwg 0 5 10 2040 LAYOUT: AS-BUILT - GRAPHIC SCALE. 1 INCH - 10 FEET SHEET: 1 OF 1 AB PROJECT NO.: 11796 I ELEVATION BENCH MARKS A DATUM: N.G.V.D. OF 1929 " v SEWAGE OWNER/APPLICANT.' NO. DESCRIPTION ELEV., G DEBRA CAULKINS 1. HYDRANT - BOLT OVER MAIN OUTLET 46.97 �y DISPOSAL 1 PETER ROAD 2. WOOD THRESHOLD - TOP CENTERLINE 48.38' SYSTEM SALEM, MA 01970 3 ti 1 wAMAoq AS-BUILT GRADES �� UPGRADE COMPONENT ELEVA 77ONS AS-BU/LT PROPOSED �6� 1A 1 Peter Road A �, Salem' MA 01970 W T 43.61 42.51 SCALE. 1'=2000' G��� �Q OF L • SEP77C TANK X006 ASSESSORS INLET 43.13 42.25 Q\pQ�,P� OUTLET 4.3.01 4200 LEGEND MAP BLOCK LOT D127RIBU71oNBox Q EXlS71NG PROPOSED 30 13 INLET 41.45 41.45 OUTLET 41.29 41.28 O� WS WATER SERVICE WS LEACHFIELD ��G PROPER7Y UNE PREPARED FOR: BEGINNING OF LINE 1 41.20 41.24 �P �h 55.36' - 55.36' BEG/NN/NG OF L/NE 2 41.22 41.24 Q 9 y \ DISTANCE ALONG BOUNLl4RY END OF UNE 1 40.94 41.00 �` � '�6 © #2 ELEI/AT10N BENCH MARK END OF UNE 2 40.99 41.00 �� Q 9 pF iv EDGE OF PAVEMENT DEBRA VGC VGC '.1 STRUCTURES D/A. (/N.) MATER/AL Q�Q�P I. 3 4'FD) CURB (see abbrmviations) CAULKINS BUILD/NG TO -SEP77C-SEP77C TANK 4 PVI; SCH 40 1 1.1' B(G. > -W�---W-� - PATH OR 7R4/L 2-COMPAR7MENT 1500-GALLON H-10 SEP77C TANK - 01 W17H TEES DN INLET AND OU7LET PIPS (ROCHESTER ROTA7701VAL MOLD/NG, INC. TANK) - - -- BU/LD/NG, LIGHT, STEPS & OVERffA/VG ---- 1 Peter Road SEP77C TANK 70 D-BOX 4 PIA;' SCH 40 D-BOX (WITH SPEED LEVELS) - - PETER M. & NICOLE D. x 92.6 SPOT ELEVA77ON 93.3 Salem, MA 1 7 SOIL ABSOIRP77ON AREA LA7FRAL 4 PVC SCH 40 C BICKELL - - 92- - - ELEVAnoN CONTOUR n F.G. 11't' PLAN #79 OF 1983 /� AS-BUILT RES ® T 1 7EST PTT HA �I�� COCK STRUCTURE (1) 0 (i3) 8 P-I PERCOL477ON 7EST ASSOCIATES SEPTIC TANK INLET COVER 26.9 37.0 - � SEP71C TANK OUTLET COVFR 30.2 39.2 Z moo. SOIL ABSORPTION AREA D-BOX 35.0 - 43.3 HDPE LINER CORNER (A) 35.3 - 45.2 $' HDPE UNER CORNER (B) 86.8 - 28.8 h HDPE LINER CORNER (C) 87.5 65.2 - � �� � �'' Civil Engineers HDPE LINER CORNER (0) 38.8 - 38.3 T-1 Land Surveyors INSPECTION SHED SHED BDA APRIL 22, 2005 Landscape Architects 10 11 Environmental INSTALLER LOT 41 Consultants JOHN MAES7RANZI - INRN/77 LLC 8,5801 S.F. so• BEND D/S7R/BU7701V BOX O SEP77C TANK 185 CENTRE STREET, DANVERS, MA 01923 450 BEND VOICE (978) 777-3050, FAX (978) 774-7816 t -_j ° 22' BEND ERIC & DAVID WWW.HAN000KASSOCIATES.COM LEO T. & PHILIP D. • `• PEARLMAN HAYES < : . N LOT 43 LOT 40 -CONCRETE- PLAN #260 OF 1963 PLAN #260 OF 1963 • . •;PATIO .- - WOODa�A f a h' zm . DECK -0 WOOD - CONNEC77ON TO o� RICHARD f. Cry © STEPSI � ooFi�Rr EA7577NG SEP77C LINE �oCIVIL r FROM DWFLUNG OL a ;,,No, 3]433 #2 " p Q o e/ E�'l 3 1 STORY rn� WOOD FRAME DWELLING Q_ a 0 z 5 F- m BRICK STEPS NO. BY APP DATE ISSUE/REVISION DESCRIPTION AND STOOP DATE: 5/3/05 NTBK: E-68 SCALE: AS SHOWN DRAWN BY: BDA I 100.00' CHECK BY: RFD AS-BUILT PLAN P E T E R (PUBLIC - 40' WIDE) R 0 A D PLAT DATE: May 05. 2005 923 am SITE /`�ALAI PATH: F.Vand pm*W 2\11798\dn\ DWG: 11796AB.dwg 0 5 10 20 40 - AB LAYOUT: AS-BUILT GRAPHIC SCALE: 1 INCH = 10 FEET SHEET: 1 OF 1 PROJECT NO.: 11796 ELEVATION BENCH MARKS A DATUM: N.G.V.D. OF 1929 P SEWAGE OWNER/APPUCANT.• NO. DESCRIPTION ELEV. P DISPOSAL DEBRA CAULKINS 1. HYDRANT - BOLT OVER MAIN OUTLET 46.97' � �y 1 PETER ROAD SALEM, MA 01970 1 2. WOOD THRESHOLD - TOP CENTERLINE 48.38 3. SYSTEM MgRB AS-BUIL T GRADES �� 1 Swq NpiQ q UPGRADE COMPONENT ELEVA AONS p� BU/LD/NG AS-BU/LT PROPOSED 1�6 19 4t y 1A 1 Peter Road OUTLET 43.61 42.51Salem, MA 01970 SCALE. 1 2000 SEP77C TANK �,� 6 � ASSESSORS INLET 43.13 42.25 P� OUTLET 43.01 42.00 o Q Q0 D157PIYU7701V Box LEGEND MAP BLOCK LOT INLET 41.45 41.45 Q EXISTING PROPOSED 30 13 OUTLET 41.29 41.28 WS WA7ER SEWCE WS LEACH 5� PROPERTY UNE PREPARED FOR NG 55.36' - - 5536' BEG/NN/NG OF UNE 1 41.20 41.24 g BEGINNING OF L/NE 2 41.22 41.24 �P Q� y \ DISTANCE ALONG BOUN04RY END OF UNE 1 40.94 41.00 �' 4, Q�'CN ro END OF LINE 2 40.99 41.00 ��� �� g�OF © 12 ELEUA770N BENCH MARK D EB lltl vot ��� �0O �0 2�h� EDGE OF PAVEMEM A STRUCTURES DIA. (7N.) MATERIAL P Q�QvP� 3/4" VGC CURB (see abbreviations) V1;C CAULKll r S BU/LD/NG 70 SEP77C TANK 4 PV); SCH 40 I'1.1' FD --its ---�- 1.1' B.G. --w-- - -ab- -- PATH OR 717A/L 2-COMPARTMENT 1500-GALLON H-f0 SEP7iC TANK - - 1p W17H TEES ON INLET AND OU77ET PIPES BU/LD/NG LIGHT, STEPS c@ OVERHANG \������ (ROCHESTER ROTA770NAL MOLD/NG, INC. TANK) .6 SPOT ELEYAIION Peter MA 0 970 TO SEP77C TANK D-BOX 4 P14; SCH 40 ;� D-BOX (W17H SPEED LEVELS) - - C Sale PETER M. & NICOLE D. X 92 933 SOIL ABSORP7701V AREA LATERAL 4 PVC SCH 40F.G. BICKELL - - 92- - - ELEVA77ON CONTOUR rY21 f1'f PLAN #79 OF 1983 AS-BUILT AES ® T 1 TEST PIT HANCO CK ShTUCTURE (1) (2) (3) 8 P-I PERCOLA77ON TEST SEP77C TANK INLET COVER 26.9 370 - ASSOCIATES SEP77C TANK OUTLET COVER 30.2 39.2 - Z o 0 D-BOX 35.0 - 43.3 0. SOIL ABSORP77ON AREA HDPE LINER CORNER (A) 35.3 - 45.2 9 HDPE LINER CORNER (B) 86.8 - 28.8 cj HDPE LINER CORNER (C) 87.5 65.2 - HDPE LINER CORNER (D) 38.8 - 38.3 Civil Engineers T-f Land Surveyors INSPECAON WOOD BDA APRIL 22, 2005 SHED P-1 ,� Landscape Architects Environmental INSTALLER LOT 41 Consultants "NMAES7RANZ/ - /NF7N/11 LLC 8,580± S.F. 90' BEND DlS7R/BU770N BOX O SEP77C TANK \ 185 CENTRE STREET, DANVERS, MA 01923 45• BEND VOICE (978) 777-3050, FAX (978) 774-7816 22' BEND ERIC & DAVID WWW.HAN000KASSOCIATES.COM LEO T. & PHILIP D: PEARLMAN HAYES . :.< N LOT 43 LOT 40 '-CONCRETE; ^ PLAN #260 OF 1963 PLAN #260 OF 1963 • ..•;PATIO'; : WOOD A. DECK e aF,w STEPS • i o RICHARD F. G WOOD. CONNEC710N TO �� QOM © QOM OHELLINC LINE O ADH=RTr v'. T S crop No 33 GAS #2 90 F s } DL Q 1 STORY m > WOOD FRAME o DWELLING Q. o , 0 z Fn BRICK STEPS NO. BY APP DATE ISSUE/REVISION DESCRIPTION AND STOOP DATE: 5/3737_K TB : E-68 SCALE: AS SHOWN DRAWN BY: BDA � 100.00' CHECK BY: RFD # & i AS BUILT PLAN P E T E R (PUBLIC - 40' WIDE) R 0 A D PLAT DATE May 05. 2005 423 am SITPATH: F:\Imd projects 2\fl 798\drq\ E PLAN DWG: 11796AB.dwg 0 5 10 20 40 AB LAYOUT: AS-BUILT GRAPHIC SCALE. 1 INCH - 10 FEET SHEET: 1 OF 1 PROJECT NO.: 11796 IMPORTANT MESSAGE FOR �O DATE ja larY z4z1 TIME -4LQ W M E d �/� 1�145✓1rr OF /l cY� ac,rCY� ti PHONEB- K /'7 9 -JG ARACOCE NUMBER ENSIO �J Q FAX � O MOBILE AREA CCOE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE XD CuLLk'"" C ( o v c r SIGNED MOpsFORM 4009 MADE IN U.S.A. qn"9�''eyRl PN94a91 4... LETTER OF TRANSMITTAL7T 25 Years of Excellence 15, Centre Street, Danvers 8 , MA 01923 Providing Land Surveying, CivilPhone (978) 777 3050 Fax (978) 774 7816 Engineering, Landscape Architecture and i www.hancockassoctai_es com Environmental Services Since 1978 TO: Salem Board of Health DATE: 2/16/05 JOB #: 11780 93 Washington Street FROM: Edward Cullen Salem MA 01970 RE: 1 Peter Road • We are sending you: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order COPIES DATE JOB# DESCRIPTION 1 2/11/05 11780 Title 5 inspection form • These are transmitted as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: COPY TO: SIGNED: If enclosures are not as noted,kindly notify us at once. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1 Peter Road Owner's Name: Debra Caulkins Owner's Address: 1 Peter Road Salem MA 01970 Name of Inspector: (please print)Edward Cullen Company Name: Hancock Associates Mailing Address: 185 Centre Street Danvers,MA 01923 Telephone Number: 978-777-3050 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 ❑ Needs Further Evaluation by the Local Approving Authority ® Fails Inspector's Signature: Date: ;?-111105 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. Notes and Comments The distribution box was full of solids, and the liquid level was 8 inches above the outlet invert. ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 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. 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 ❑ distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑broken pipe(s)are replaced ❑ obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 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 15303(1)(6)that the system is not functioning in a manner which will protect public health,safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone I 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 aseptic 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 **Thus system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 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%2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ❑ n/a 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.l yes (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 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 backup? ® ❑ 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: Yes no ❑ ® 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) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 Peter"Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 1 Does residence have a garbage grinder(yes or no):les Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):no Water meter readings,if available(last 2 years usage(gpd)):n/a Sump pump(yes or no):no Last date of occupancy: rn esent COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sq ft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:owner Was system pumped as part of the inspection(yes or no): yes If yes,volume pumped: 1000 eallons--How was quantity pumped determined?Measured in truck Reason for pumping:to inspect tank 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: 20+years(owner) Were sewage odors detected when arriving at the site(yes or no): no Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulking; Date of Inspection: 2/11/05 BUILDING SEWER(locate on site plan) Depth below grade: 2'± Materials of construction: ®cast iron ❑40 PVC❑other(explain): Distance from private water supply well or suction line:n/a Comments(on condition of joints,venting,evidence of leakage,etc.):no evidence of leakage SEPTIC TANK: ® (locate on site plan) Depth below grade: 6" Material of construction: ®concrete❑metal❑fiberglass❑polyethylene❑other(explain)_ If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 8'x 5'x 5' Sludge depth:24"± Distance from top of sludge to bottom of outlet tee or baffle:n/a Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle:n/a How were dimensions determined:measured in tank Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):There was no inlet or outlet baffle. The liquid level was at the outlet invert. There was no evidence of leakage. GREASE TRAP: ❑(locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulldns Date of Inspection: 2/11/05 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ® (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 8" 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.):The distribution box was filled to the ton of the box with solids. After pumping the D-box both leach lines were also full of solids. PUMP CHAMBER: ❑ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulldns Date of Inspection: 2/11/05 SOIL ABSORPTION SYSTEM(SAS): ® (locate on site plan,excavation not required) If SAS not located explain why: Both leach lines were completely filled with solids,which prevented me from snaking them. Type ❑leaching pits,number: ❑leaching chambers,number: ❑ leaching galleries,number:_ ® leaching trenches,number,length: 2 trenches of unknown 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.):Both lines are completely full of solids,and backing up into the D-box 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 or 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 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. D �v « ��✓G A i�Na O D-3 ox TA AIX z 8. is" zoo c wf-41A Ccs V e ice;, - 6t�x 35,0 8. ® ' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Peter Road Salem MA Owner: Debra Caulkins Date of Inspection: 2/11/05 STTEEXAM Slope 0-3% Surface water none Check cellar no sum Shallow wells none Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record-If checked,date of design plan reviewed: ❑ 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: Since the system was in failure due to an overloaded and clogged S.A.S.,the groundwater is to be determined during soil testing for the new system F Eg; 18 2005 Cjn OF SALEM sop"" OF HEALTH Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 , every page. CityFrown 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Jonathan Granz cursor-do not Name of Inspector use the return key. Preventative Septic and Drain LLC Company Name 327 Asbury St. F Company Address Hamilton MA 01982 Mi City(rown State Zip Code 978-468-9001 S113405 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 6/17/11 I p or's Signature Date he 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•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 1 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 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: System is in good working order. 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): 15ins-11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 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•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool E] ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1%day flow t5ins•11/10 Title 5 Official Inspection FormSubsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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. El ® 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 El El Area 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•11110 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. city/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? El ® 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? ® El information the facility owner(and occupants if different from owner) provided with 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. ® El approximation 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): N/A Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11110 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address - John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town State Zip Code Date of Inspection D. System Information Description: System is composed of a 1000 gallon septic tank and distribution box serving four(4) leaching laterals. Number of current residents: 3 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 ears usage d 217.8 GPD 9 ( Y 9 (9P )) Detail: Water meter readings were provided by the City of Salem Water Department, GPD was averaged from usage between 4/13/09-4/19/11(see attached copy). Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Title 5 Oficial Inspection Form'.Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: • Source of information: Tank has been pumped once a year(per homeowner) Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Truck sight glasses Reason for pumping: Inspection 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): t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 8 .<r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age is unknown, estimated 30yrs Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments on condition of joints, venting, evidence of leakage, etc. : Building sewer is in good condition with no signs of backup, leakage or any other problems. Septic Tank (locate on site plan): Depth below grade: 12 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7'Diameter x 4' Depth, effective. Sludge depth: 1 tsins•11110 Title 5 Official Inspection Penn.Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle 511 Distance from bottom of scum to bottom of outlet tee or baffle 15" 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 is in good condition, structually sound, no signs of leakage in or out, liquid level at outlet invert, there is a PVC T in place on the outlet and a concrete inlet baffle. 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 (Sins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 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: 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 t51ns•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is new, there are no signs of solids carryover, no leakage in or out. Outlet inverts are 35' below grade, there is a riser bringing the top of box within 12"of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Sins-11/10 Title 5 Oficial Inspection Form.Subsurface Sewage Disposal System•Page 12 or 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 @ 8' x 40' ❑ 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.): Ground over leach field is dry, grassy and consistant with the surounding yard. There are no signs of any failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Peter Road Property Address John Ra nes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town 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.): t5ma•11110 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 14 of 14 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. City/Town 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 t5ins•11/10 Title 5 Oficial Inspection Form.Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. CitylTown 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: feeetet + Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record Y 9 If checked, date of design plan reviewed: Date 5 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: Soil testing was performed on 3/2/05 at 1 Peter Road by Edward Cullen and witnessed by Martin Fair, there was no ESHGW found at 121" (see attached copies). This information puts the system at 3 Peter Road well above the ESHGW. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 50fiicial Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 I Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 Peter Road Property Address John Raynes Owner Owner's Name information is required for Salem MA 01970 6/17/11 every page. Cityfrown 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 /v-�- �-a I 17��✓c Uv� I �, 13 N A lie 14 203 /S �6 Is IT ie /,3 - 3 - 30 ---- luh N gvNN FLOW PROFILE SCALE. HORIZONTAL: 1'=20' SOIL 7EST DATA DEPTH BELOW PERC GRADE 0 12' FIELD RATE TEST LEVEL 0/0 (MIN/IN.) DATE P-1 42' d 3/2/05 EVALUATOR., EDWARD CULLEN WITNESS• MAR77M FAIR FAR TH£ SALEM BOARD OF HEALTH DEEP SM OBS HALE T=I DA IE 3/2/05 ORAOE EL 441 MGW G- 340 OBS GW EL N/A BOTTAV EL 34.0 L-1 0-34' FILL 34-44' Cl MEDIUM S4ND 2.5Y7/4 SINGLE GRAIN LOOSE 44-56' C2 COARSE GRAVELLY SAND 2.5Y5/4 MNGL.E GRAIN LOOSE 1! 56121' C3 COARSE SAND 2.5Y4/4 SINGLE GRAIN LOOSE NO REFUSAL NO MOTTLES OBS NO GW OBSERVED / CERAFY THAT ON NOVEMBER 2002, / PASSED THE fXAMINA77ON APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PRO7EC710W, AND THAT THE SOIL EVALUATION WAS PERFORMED BY ME CONSISTENT W17H THE R£OLNR£D TRAIN/NG, £XPE]RASE, AND EXPERIENCE DESCRIBED IN 310 CMR 15.018 (2). SL--E SaL SUITABILITY S ON FILE W Ty THE BOARD OF HEALTH REPORT EDWARD CULLEN, CER77RED SOIL EVALUATOR DATE LyIUJ IiLI\IHL JII\LLq u.• ..� ..... _.___ VOICE (978).777-3050, FAX (978)774-7816 r. WWW.HAN000KASSOCIATES.COM - � ^`I 1 OF Mast p RICHARD G' OOHM O IL N -.3 3' >T T lb a� _0 F. LL N0. BY APP DATE I ISSUE/REVISION DESCRIPTION S , ` DATE: 3 18 05 DESIGN BY: Jos TLl SCALE: AS SHOWN DRAWN BY: JBS CHECK BY: RFD 54 f SITE PLAN, �R� PRORL.E ,ul LEGEND .PLOT DATE Mw 21. 2005 1D:42 um p,J �0' /� I VATIk F:Vme"c R2V1798\Ewv\ DWG: 11796S.dwg r LAYOUT: SE01A No SHEET: 1 OF 2 iIC PROJECT NO.: 1 796 a RKs P SEWAGE ELEV. DISPOSAL QUTLET 46.97 SYSTEM fERLINE 48.38` w Rem, UP GRADE. AMpsco rOW CaVS7RUC77a4( REOUIREMENT.S f 1 PETER ROAD srs7EM A SALEM MA 01970. Lt c , SCALE `1=2000' MAP BLOCK LOT [�/VD 30 --- 13 PRS VG ---- ws wS WATER SEWCE FF3EF'AFM F PROPER7Y UNE ' ' ANCE5ALONG WUNWY /NG dDIST56�3E�6 N1Z0'46?3 . DEBTA 2 t7 tVATION EIENCf! ,1(ARKAUL - jf T' —--w-- £OG£ OF PAVEMENT 11[x. ----- CURB (see oybnsvioHons) 1 PETER ROAD _=wit = PATH OR WNtSALEM MA 01970 . .... alio nIAV LIGHT, STEPS OVERHANG ———— ' ,.:i•ii.1,rJj:-j j!._gl, :;:_ .f-r 1,It, f j i H My Pile Edit Tools Help --- m L 9 Tter History I Account 010387 Customer 111879 IL Replace Hist Palcel 300004 RAYNES JOHN H JR ETUX Lucation 3 PETER ROAD Status Active Demand Inq Service 1WO63R 001 O W 518 R Man APB Meter# 2D68940666 1 oil c0 Ld z H W riTt Read Date Re9me Bi11E p R Current Usage ReplUse Use Days Charge Amt BillAmt Adj Bill Aml Avg Cons z 04/19/2011 669292 A 165500 19D0 0 98 44.04 44.84 44.84 19.388 H z 0111112011 . 654563 A 163600 1900 0 90 44.84 44.84 44.64 21.111 w 1011312010 639978 A 161701) 4800 0 92 113.26 113.28 113.28 52-174 07/13/2010 625418 P. 166900 4300 0 98 101.48 10140 101.48 43.870 04/11612010 610848 A 152690 1700 0 82 38.59 38.59 38-59 20.732 Mill 42010 596536 A 1509DO 1600 D 100 36.32 3632 36.32 16.008 1 D10612009 581723 A 149300 2400 0 7B 54.48 54.48 54.48 30.769 07/20/2009 567121 A 146900 2600 0 98 59.02 59.02 59.02 26.531 04/13/2009 552736 A 144300 3100 0 8B 67.58 67.58 67,58 35.227 0111512009 537932 A 141200 1800 0 106 39.24 39.24 39.24 16.981 10101/2008 523440 A 13940D 3200 0 as Bo?c C07 07/1012008 508971 A 136200 2800 0 87 61.04 61.04 61.04 32.184 v r m m N 11� N H ti m N H m