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629 Title 5 11-14-19 HERITAGE SURVEYS, ING. Professional Surveyors and Engineers 241 College Highway & Clark Street Post Office Box 1 Southampton, Massachusetts 01073-0001 Bruce A. Coombs, President Telephone(413)527-3600 Professional Surveyor, *A, CT& VT Facsimile(413)527-8280 E-mail. bruce@heritage.4urveys.com Website: heritagesurveys.com Title V Certificate of Compliance DESIGNER & INSTALLER SIGN-OFF Pursuant to 310.CMR 1,5.00 of the State Environmental code: Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, Section 15.021 (3), the Designer and Installer of a system are required to sign ign this form as a condition for issuance of a Board of Health Certificate of Compliance for the onsite septic system. This is to certify that the onsite sewage disposal system that Heritage Survevs,Inc.,designed as: new construction —T repair/upgrade(existing system) SITE: 629 Florence Road,Florence,MA 01062 FINAL INSPECTION DATE:. November 14 2019 DWCP# OWNER: Anthonv A�Dastoli has been constructed'in compliance with 310 CMR 15.00, and all local requirements. Any changes to the original approv d plans have been reflected on an as-built plan that has been submitted to the Board of Health. DESIGNER INSTALLER Heritage Surveys,Inc. Craig'Malanson 241 College Highway& Clark Street 4 Leadmine Road P*0., Box I Southampton,MA 01073 Southamptp6,MA 01073 (413)297-4572 (413)527-3600 Signature Date Signal re Date NOTE: This certificate represents no warranty, expressed or implied as to the functioning or longevity of the on-site -em subsurface disposal syst. Rather,the plan and installation are in compliance with all applicable rules and regulations as are in effect at the time of plan submittal. :,C"*\ Commonwealth of Massachusetts m Cit.Y /Town:of Certificate of Compliance Form 3 'GSM ...... .... .. ... .. .. .. DEP has providedthis form..for use by.local Boards of Health. Other forms maybe 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. .. This is to Certify that:the followi,n.g work on an On-Site Sewage.Disposal_System Important:When fining out forms ❑ Construction.of a new-.System on the computer, . Repair or replacement of an existing system use only the tab Lj Repair or replacement of.an existing system:component - key to move your cursor-do not use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): key. �I tab DSCP Number DSCP Date Facility Owner :. .: .. ... .. Street Address or'iLot:#- City/Town State Zip.Code Designer Information: I Name - Name of Company Signature l Date .. Installer lnforrnation::. i Name Name of Company Signature' Date Use of this system is conditioned on compliance-with-the provisions set forth below: i The issuance of this certificate shall not be.construed.as a guarantee that the system.will function as designed. VnSfct t a Approving Auth ,,uJ C, i�Kk 011 �51�9 Signa ure 1 Date t5form3.doc+'06/03 Certificate of Compliance•Page 1 of 1 i i i W`v .,, t.: t �.c>. UWNE ./���tr><oi�`:° ,,.A• t.:!.:,.r :t. :'.t, •i�','': ^^„5 v ,5. t s:. C•�:.. {k t ^.tit� i' r -',1•:' .3 s,..lakd ,�?+, wry Kit ,a;:;�{.,: -;:�'•,;�i K: Q ,k: :.5 . :;S'�, .r....4 �tii,•.,'A.... .i:�. '�n..r,: {�..i'. ■,■ G'x4CJ!..,y •C,i 94� tr '1 tt.i .,i�rh'•' •.< ""� ';1•:t. :.zat�'. ,:tic. .J ':4l'. '!'i...t. ': 51.n.`�1,� S.�rw- .i.C,.: � - .v\i::,•i., r,' ,,:i>. '4, t ,•JST LE '. 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'i,{C•.f,:•rv: ..l��.,ro,a.,,5�'1}y 1r,'.;,�:iycc{ii.., �•--- 1.,.G... ,:I;,. M,�:..�_�...u.. .� 3:.1 rti w''V:, ,xt.... ,i�� �:i�;'li:.!xa.,.r.,3 .5:.1':d C u.:ti. oil, a 00�G t,L N EiX1STtNG -BEDROOM-t•iOUSE� - SEf?TI��TAy OU7.Ei 629 FLb sa• QR Pi ,4 V 1 •t �°L SYST? M TIES Tc=138.51 GAOJL:=3 :3' 1= 4 610. 26.1 37t _ - OR =26. C C TER 0'F�T EPITCTANK OVER 0' i P©RT4. + � TiONBOX- gn= PORT=tN�P-ECTION--P_OR.T- e�/� � 5.81'' i2,r 4�-C}0 N SR t OAF tELD wi- z=2 0 S I A E N' T 241 College Highway &Clark Street . T.O.Box SoU�bam�3o'a�1�A©10'1'3 Particle Size. Distdbution Report q a! 4t z" 100 —— Mass Title V I I i t I I I I I I I 11 I i . I 90 -- _ 80 _ IL 4— \ � --I -- -._.....- 70 _11 L1 Z 60 I I - F Lif � I � Z 50 w uJ 40 r-- 1 — CL I 30-- 20 0 20 + 10 - I 0 ` 100 10 1 0.1 0.01 0.001 GRAIN SIZE-mm. °!°+3'0 %Gravel__.. %Sand -- — %Fines .— ��.. _ Coarse ; Fine Coarse r Medium Fine Silt Clay. 0.0 .0.0 ' 1 0.0 19.8 ; 39.0 39.2 2.0 TEST RESULTS(ASTM C 136) Material Description Opening Percent Spec." Pass? Hathaway Pit Sand-Title V(MA). Size Finer ' (Percent) (X=Fail) F11#4 100.0 100.0 ##$ 83.8 Atterbera Limits (ASTM D 4318)#16 6$.1 PL- LL- Pi- 30 50.3 C Classification #40 41.2 USCS (D 2487)= AASHTO(M 145)= #50 ••303 10.0- 100.0 #100 10.1 0.0-20.0 Coefficients #200 2.0 0.0-5.0 D90= 3.0957 DBb= 2.4850 D60= 0.8645 D60= 0.5938 D36= 0.2974 D16= 0.1840 1310= 0.1493 Cu= 5.79 . Cc= 0:69 i Remarks This sample delivered to lab by client.Test results based on the ` fraction of material passing the#4 sieve i i Date Received: 10/9/2019 Date Tested: 10/10/2019 Tested By: ' Checked By: John McGrecq y Title: Dir,4 Testing Services Mass Title V Sample Number:7964 i Date Sampled: 1019!2019 ALLIED•TIEVING Client: Hathaway'Construction Corp LABORATORIES; INC. Project: Quality Contra! Spri I l assachusetts Project No: _ Fi ug re — i Septic System Inspection Checklist: Address: Lod, Date: i Iq Inspector: S A Septic Tank- least 97 of cover Oil III sers in place within 6"or less of finished grade air spade above tees N/2- 'drop 'from inlet to outlet I utlet tee equipped with an approved effluent filter Pump: / N/A [I Alarm pow' ered by a circuit separate from the circuit to pumps 0 Alarm functional 0 Pump functional at time of inspection D-Box: N/A EBox is equipped with tee, baffle,or splash plate if effluent is pumped or slope S4. >.08 feet per foot N/A FBox is I!evel utlet lines are level for first two feet qEuipped with a riser within 6 inches or less of finished grade Leaching Area- D7Length and width correct according to plan 0 Equippe !with vent if more than 3 feet of cover OR more than 50 feet of line - V-1 N/A gAnds capped F] itle V sand certificate N/A spection port to within 3 inches of grade "agnetic tape Notes: V