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0204 ANSEL HOWLAND ROAD- Health
204 Ansel Howland Dr. Centerville A = 171 267 IN ' UPC 12534 2-153L err I - - . Town of Barnstable Regulatory Services Thomas F. Geiler,Director aaxrtsrABLF, 039. ,e� Public Health Division pTFD'"A�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Installer: Address: �:� 1. 'ln Address: ✓.j�Y i�td c d /��s�� Z, On ,(� Zwas issued a permit to install a (date) (installer)d septic system at all n 5e l ffdf/ l A/t,p 0%' based on a design drawn by (address) oC -7 �i�; U.i, i'I wt . dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-bull by designer to follow. DAVID D. (Installer's ignature) COUWNOWR Na. 1093 0 Jsre�� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form PA THE COMMONWEALTH OF MASSACHU.SETTS Enlaced in computer:` �. Yes PUBLIC HEALTH DI'VISION .TOWN'OF BARNSTABLE, MASSACHUSETTS 2pplitation for 30i5posW 6votem ton0ruction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components . Location Address or Lot No. Owner's Name,Address and Tel.'No. 4 2 8-8 8 3 7 204 Ansel Howland Dr, Centerville Marie Donal Assessor'sMap/Parcel 204 Ansel Howland .Dr, Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 108.9, Centerville . 43 Triangle Cir, Sandwich Type of Building: Dwelling- No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder eo) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable.) Install a new Title 5 leach system to plans of -co—Tec , #ETE-2168. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ed by t ' oar f Health. Signe . Date Application Approved by -Date Application Disapproved for the following reasons Permit No. :�JQC 5 Date Issued Fee;1 0 0.CP F THE COMMONWEALTH-.OF MASSACHUSETTS Entered in computer: ` ¢, u •.r. i Yes •- PUBLIC HEALTH DIVISION"-TOWN dl` BAANSTABLE, MASSACHUSETTS i Zlpprication for-Mi!gpoml 6kaem Construction Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. — 3 ,- _204 Ansel Howland Dr, Centerville Marie Donat Assessor's Map/Parcel � / \a 4 ,7 204 Ansel Howland Dr, Centerville r _ ..:_�` 3 4-0894 Installer's Name,Address,and Tel.No. ! Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Ed Tech w--PO Box 1089, Centerville 43Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n? Other Type of Building No. of Persons Showers( ) Cafeteria'(, ) _®they Fixtures Design Flow gallons per day. Calculated daily flow --gallons. "—Plian Date Number of sheets Revision Date Title t Size of Septic Tank Type of S.A.S. D cription of Soil Nature of Repairs or Al eratio s(An wer when pp cable) Install a new Title 5 leach u, system orpslans o Eco-Tech, . Date last inspected: l a Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system r in,accordance with the provisions of Title 5 of the En fronmental Code and not to place the system in operation until a Certifi_ Cate of Compliance has been iss d by th' and Health, Signed ./ _ Date V' Application Approved by Date p Application Disapproved for the following reasons' =% Permit No. C50 �7 (_ "a-7 °^ Date Issued THE COMMONWEALTH OF MASSACHUSETTS Donat BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ( X)Upgraded( ) Abandoned( )by Wm E Robinenn Sr Septic Service 204 Anse Howland rive Centerville at � has been constructed i�naccordance� � with the provisions of Title and the for Disposal System Construction Permit No. 6U 5`►'-a-7 dated � Installer ti Designer v J 9— The issuance of this permi hall not be construed as a guarantee that the syste f nction as designed. Date 15 Inspector Donat THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pont *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 204 Ansel Howland Drive, Centerville and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditio Provided: Construc on ust be c*pleted within three years of the ate of this e mi Date: l, �� Approved Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only ` PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, UI d Cd vgka hG W✓ hereby certify that the engineered plan signed by me dated $ OS ,concerning the property located at 204 Pmel Kowl c4�q Dr Ce► en,,Ile meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) lv� -►S B) G.W. Elevation 3S 0 +adjustment for high G.W )- _ 'D 0 DIFFERENCE BETWEEN A and B ��,,�� ( SIGNED : � CM'�'~-- P) DATE: 4 U 2� , 20 oS NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc J TOWN F BARNSTABLE -.00ATION N � OW /_ �''r'� _ SEWAGE # 05 VILLAGEC L� j ASSESSOR'S MAPn& LOT INSTALLER'S NAME&PHONE NO.0 R6®"1 )vJ 6 ?- SEPTIC TANK CAPACITY LEACHING FACII.PTY: (type)y� ' y� Q "� -t!i (size) NO.OF BEDROOMS BUILDER OR OWNER ��rS N A 1 PERMTTDATE: g-6 S` COMPLIANCE DATE: ��J�`a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ' within 300 feet of leaching facility) Feet Furnished by 43 13� .3 r r� r !.L0CAT.IO ND SEWAGE PERMIT NO. Lot R2 Anseld Rd. Cent 82-617 VILLAGE i � 11 Ceneterville, Mara. I N S T A LLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich. Maas, 6 U I L 0 E R OR OWNER Alan Small t DATE- PERMIT ISSVED 11/9/82 DAT E COMPLIANCE ISSUED �/ 7Ir �____�., IO 4 py • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. sk A. Certification s' Jj� Important: When filling out 1. Property Information: forms on the computer,use 204 Ansel Howland Drive - Centerville only the tab key Property Address N to move your Walter and Marie Donat cursor-do not ". use the return Owner's Name key. 204 Ansel Howland Drive �•� —w Owner's Address r�r Centerville MA 02632-- City/Town State Zip Code CU August 18, 2005 ' r-q Date of Inspection: Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number 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 ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ® z t S August 18, 2005 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System- Page 1 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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: t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ 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 I t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3of16 Commonwealth of Massachusetts w Title 5 Official Inspection Form - Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 Y p feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: t5-2163.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection 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 '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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.] 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. t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection 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. t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection 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? ❑ N/A 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, including the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Outlet only ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 0 Does residence have a garbage grinder? Removal of grinder is recommended ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 252 gpd 2003-4 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: July, 2005 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other (describe): t5-2163.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 22+ years. Design plan dated 9/27/82 (Board of Health files) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft (1000 gallon) Sludge depth: Not determined Distance from top of sludge to bottom of outlet tee or baffle Not determined Scum thickness Not determined Distance from top of scum to top of outlet tee or baffle Not determined Distance from bottom of scum to bottom of outlet tee or baffle Not determined How were dimensions determined? Design plan t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville Ma 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be pumped dry at time of repair and examined for structural integrity and water tightness. A new PVC tee with a gas baffle should be installed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Not determined Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box was not opened because conclusive evidence of system failure was observed at leaching gallery. A new D-box should be installed at time of repair PumpChamber locate on site I( pan). Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): A hole was dug down to the top of the leaching pit and the overlying soils were observed to become increasingly discolored. A layer of stone above the pit was removed This stone was covered with a slimy gray residue and had a distinct odor of laundry detergent. The concrete surface of the pit was stained black indicating prolonged effluent contact staining above the leaching pit due to hydraulic overload. t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5-2163.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. LOCATIONS A B 1 23.5 Ft 53.5 ft LEACH 2 2 8.5 f t 48 f t O PIT 3 93 f t 21.5 Ft SEPTIC I 0a 2 3 TANK B A EXISTING DWELLING # 204 W - Z J W 3 i I ANSEL HOWLAND DRIVE NOT TO SCALE t5-2163.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 204 Ansel Howland Drive Property Address Centerville MA 02632 City/Town State Zip Code Walter and Marie Donat August 18, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 25 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: Not determined Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: USGS topography maps You must describe how you established the high ground water elevation: Design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a witnessed test pit in which no water was encountered. Town of Barnstable GIS Department records indicate that the property is 25 feet above groundwater table. t5-2163.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 TOWN OF BARNSTABLE LOCATION �����5�� �oWGan d —D ~ — SEWAGE# 1LLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO �U uQh a now r. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS B 91F R OR OWNER (, O-i-{.c ` ar•¢.1o1)Qf PERMITDATE: �_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 1 LOCATIONS _A B 1 23.5 ft 53.5 ft LEACH 2 28.5 ft 48 ft O E 11T 3 93 ft 21.5 ft TAN S az 1 TANK B A EXISTING DWELLING # 204 w � Z W�3 ANSEL HOWLAND DRIVE NOT TO SCALE i No THE COMMONWEALTH OF MASSACHUSETTS BOARD.9F HEAL I-" /.G�� ' ..............OF.... 1.�L .......... .................................. ApplirFatilan for Dispniial Workfi Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal QSystem at: ocation:Ad es r � r Lot No. ............ ••-----•-------•............................. ......•... _.................... .. -••-----------......_..................._...... Owner Address a -••.. . '�' ................................................ •---••--•- -�.........•--_.. ...-•---------•--....... Installer v Address UType of Building Size Lot.. /._.l47_'P----Sq. feet Dwelling—No. of Bedrooms._.___ .......•....................Expansion Attic (/�� Garbage Grinder (/1,)!9 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .. .� W Design Flow...................��.....__._____..gallons per person per day. Total daily flow .._........_.___.......__.._.._._______.gallons. WSeptic Tank—Liquid capacity -gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No...../.............. Width.................... Total Length.................... Total leaching area..............-.....sq. ft. Seepage Pit No....._�......... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r1 Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ x .��-----•.......-•----------------------------------------------------------------------•-------------------'•-•------•--------•---••-'........--•------•_--•-- O Description of Soil..1.•- W ----------------------------------------------------------------------------------------------------------------------•-----------------------------------•-•------•-----------••-••-•••-•---•-••---••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------- Agreement: The undersigned agrees to install-the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iimLL 5 of the State Sanitary Code— The undersig'�ed further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board/of health. a � igned - D Application Approved By.....:. .... .. Z ° _..l° �l� .----- Date Application Disapproved f th f ollowing reasons---------------••------•-------------------------------------------------------...---••-•-•••--•-•---•........._ Date PermitNo...................................................... Issued....................................................... Date l_ FRic I1r.............. t THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................... ...............OF........................-----.........------............---.........................-•---- App iration- for Dispati al Workii Tnnitrnr#iun fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... _ ....................................... ......... - -----'- .......................................... Location-Address or Lot No. ......................—...............6.......................................................... ...................................__...---....--'-•------------•-'----......................_.... Owner Address W ..............................."........ -••...•-•---------...................................... ---•---•-•--•-•--....'--•--•--•-----'--. Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q+ Other fixtures ---------------------------•-•• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ P+ •-•-------------------------------------•-------------....................................--•---•---......................................................... 0 Description of Soil........................................................................................................................................................................ U ---••--•----•-•••--•...•-•-------------•-••----........----•-...-------•---------•---......---------•-------•-------------------••--------•----•----•--•-------•---------...._..---.........------•---- -------------------------------------------------------------------------------------------------------------------------------------------------------------'----------------------•--•-----•'•-----.--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •-------•'•-----------------------------------•-'-----......-•--------...--••-------•--••-•--.------•.........-•----------•.......------•--•---------•-••-•-------••-••••-•-•-----••---•-••..__.......-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITT LEE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. . ..............................•----•-•-------------......•--•--------•-•------- XDnaa.,t'� Application Approved BY .1�✓ - ---......•---------------•---.....---------.......-------'- -Application Disapproved fo the/�ollowinq yeasons:.......................................................................................... ----•-••---•-• ----------------------------------------------------------------------------------------•--------------'-------•--•-•--•------•---•----------•----•-•-•---•---------------------•----------•--•......... Date PermitNo........................................................ Issued....................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA '7- : `yE: ....................OF..... a�.. ...............�` _. ._ .............. �rr�ifirtt#r iaf (t�lam��t�a�t�� �--- THIL ; T CE TIFY, That the Individual Sewage Disposal System constructed or Repaired _ g P �' ( P ( ) by — lrf+CA/U-•--•-•ice=a {p+�.�.. u �: r Inst. -,� " at-----Y�"`~fJ �` t �' ` t y f .fG . has been installed in accordance with the provisions of TIT IZ -of The State Sanitary Code d cribed in the application for Disposal Works Construction Permit No...Y�_ ...f�................. da.ted__44 ../¢-.tL .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRII ® AS A GUARANTEE THAT THE SYSTEM WILY F NCTION SATISFACTORY. l v ,� DATE. ��.�:Z...(�.......-•......................................•--'---- Inspector....--------- ............................................................. THE COMMONWEALTH OF MASSACHUSETTS ` BOAR F H H �.......................O F...... No... "E �. , ........ FEE.3............ �i��.� � rk� �nn�irtinn rrmit Permission is hereby granted.... C ... -- �htJ�..... to Constru h Repair ( -lndiv' Q.S rage spos , System �r /�/f ------•-•••-....... at No... Y ........ ....... .. :.t? - Street ' as shown on the application for Disposal Works Construction Permit No.________.__ %'�Dated.�E_.. ._..�................ --"f'� -------------- .------------------•----•------•- O L /y Board of Health DATE..............................-�-----G- -------------•-------•------------ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,i rj►�.JGLG- FPM1L.�{ - � BEORoOM• - •� �� ►J� GARBAGE• C�211JDEL2. I DAILY F1.ow : I10 x 3 = a3vG.Pp 'S�Pa1G TP�K = 330x15o'/• =�495G.P. � �:;-;_. '� +I Q w o15Po5AL P►T u4E IvoO GAL.. � � 5 DSWALL. AQCls 1 gc-SA - 150 5.F x �•5 F 379; 6.Ro N BOTTOM AQE.A'S.F• x 1• o =.. Yoi . F«�Am -AW 'To L TA . o1c.51GN * 4z5 G.P. D � -ToTAL pA 11.Y FLOW = 330 G.Po32+ _PE2COL.ATION RATE , VAIN ZMIN o�LE ' 20, 1 rR i OF NES �5 TESTt3I To P FND•.Col' S 0, Ei...Gv. �� �,��yfi ��9�°r Imo• 5 9.0 LvAM loots INV. Soli.. P►ST. INJ. OAL.' Sc 5 Z./lt. (Ot70 INS 0oX 5s- vT�c .TANK I SAND` l.P Tu INV. INV. • 6Q1.VEL bJ17W �P''2- f 8'4 WASMGD 7 6'Ta N6 CER.TIFIGC P1.wr PLAN I ' '. I PRvFIL� Lo�4'TIoN It•,t.t �Z!• Wo� SCALE 5CALa \" o 'D Al F= E I�T101.1 SNowN PLAN R�FEQENGE 1 GE ct'f►1~•Y THAT 110 H6.P-Saw GoMPL'(5 WkTH-THE LvT 1+2- 1,1 A W P SET5AC-K R.6.qO%9-eMEN'fl�' 0F 'TNE 10H/N of 802-144TAf3Ua'"' AND 14.1 9tJT" LENTEIZ.VII-L. 1�1GNt_AN�S 1� L.DGp►TED WITN IJ N6 0o PLA1N DID r5 N 5AXTSV- IJ`(E INS• I REGIS�E.Q6�'LAN0SuwrcYoL r -ru15 PL QN 1�i NoT gx\5t;o old AN 05Te2NILL& • MASS• IN,5TRUtAaW-' SUPVr--Y 'THE oFVSE-r5 6W'cUO r.r 0 Cg!1_ 0 C--'T V'-S'-tA I V 4 L- L.nT 1, 111G'� lAPPL,le-'Pt-Jr m ia. 5�l�l,L 4 1t FLOW PROFILE ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS VENT PIPE TOP OF FOUNDATION RAISE COVERS TO WITHIN EL - 62-34 +- 6 in OF FINAL GRADE ONE INSPECTION RISER FOR LEACHING GALLERY 61.00 2- LAYER OF 1/8' /D BOX H tr X 1/2- STONE �3- DROP r FLOW LINE rr lo-u 14_ 'Ile48- GAS�e r�r Y PRECAST INA 3/TONE4' BAFFLE "�� '' ' DRYWELL 6 in BOTTOM OF 58.68+- STONE SOIL ABSORPTION exisnNo oasnNa BASE 57.43 LEACHING SYSTEM EXISTING 57.60 GALLERY pc�sTNG 57.30 5.00 ft IOOO GALLON (END VIEW) 55.30 EXISTNO SEPTIC TANK lz 70 ft Iz .3) s ft 12-5 ft b) 14 ft ADJUSTED 37.00 SEASONAL HIGH GROUNDWATER Cn 96 34 jr `rTl t rn m � o II � C 1 111 y N m o 1 N4. Z I Q) 1 � rn O 0 ° o c w� y ° , w do ' Z C) m° 1 ZX 1 v Z ry GAS LINE > - , a r mZ 3NI VM x co 0 Z ; SLAB R rN 7�o m m PA VED FOUNpA T/ON m m vo m-�. pp A DRIVEWAY o y N -h D 1 c°oi°0 mDSO O v °1 m z mz° 0* > I 1 m m rnw 3 \ D• >o G) CAD m2 . 3 m cCOMM��/i z � o c� v s ry � a C� _ r m a> o O 00, r� � N - w o 0 SNE .60\ G) z ©O ti F� �11�5��`'a� 1 000� -71 OZ p Q, ln� , / i 7 (of) m2nv m � � D � � � . O � r i At Z>o : r m m m az3 m mx m rh x mZ�m C> m n 0 < � xmA fll �y y O yOy � OZ6 n = r- m c1l 3"A nZ X n ZFTI ,ww 2 z m p m rn =0 y z SZ o 55 mm �r rn F z c. � p cn C m Z r -m y �Z ' I I p O^ ��'� 'y<y m Y U, 0 Z 70 ;C7 n' �� m t l yC off`' 3 �-' c0 n Z Z ti o p = 3 -+ mm O ® cEy D z 3 (T1 v r 3 m n vmmz Z O r ° _ 0 2 o z m \ O --� m z f m Z pC72 m NO Ln Z aa� oa m . D DATE OF TEST: AUGUST 20. 2005 _ SOIL TEST LOG SOIL EVALUATOR: DAVID D. COUGHANOWR, RS DESIGN CALCULA 710 N S WITNESS REQUIREMENT WAIVED NO VARIANCES SOUGHT NO GROUNDWATER ENCOUNTERED TEST PIT I PERENT MA ERIA: M N/CINCH I AL C SOILS H DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD ELEVATION - 60.95 -- SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) 60.95 0-14 AP LOAMY SAND 10 YR 4/3 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 14-34 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE 58.12 SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 fi x 2 ft LEACHING GALLERY CAN LEACH 34-150 C MEDIUM SAND 10 YR 6/3 NONE LOOSE Abot - ( 24 x 12.5 ) - 300 sf 48.45 Asdw - ( 24 - 24 12.5 - 12.5 ) x 2 - 146 sf Atot - 446 sf NO TEST PIT 2 PARENTOUNDWATER MATERIAL: P OGLACIALD Vi 0.74 x 446 - 330.04 GPD OUTWASH PERC AT 64 in 2 MIN/INCH IN C SOILS USE A 24 ft x 12.5 ft x 2 f 1 GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED ELEVATION - 61.35 +- - _ - . . DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 61.35 0-16 FILL 16-44 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE 57.68 44-120 C MEDIUM SAND 10 YR 6/3 NONE LOOSE LEACHING GALLERY 500 GALLON DRYWELL DIMENSIONS AND DETAIL. 51.35 CONSTRUCTION DETAIL "SE H-!0 Leer DRYWELL UNIT INSTALL ONE INSPECTION IX 8'-S'x 4'-10"x 2'_9 STONE INCHES OF FINALRISER TO WITHINS 2 ft EFF. DEPTH AND INDICATE LOCATION 24.0 f t ON AS-BUILT PLAN O n NOTES 0 33 in p 0 0 in I) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN N �-" p�pop o 000� N o o0ppc—jc p o�pp �0�0 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. poppoQy�p 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS Oo OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 3.5' 8.5' 8.5' 3.5' 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 24,0 ft NOT To ��2 in SCALE BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN SEWAGE DISPOSAL SYSTEM PLAN<< GROUNDWATER ADJUSTMENT 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE -INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF;, THE SEPTIC TANK EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARBSTABLE 9) SYSTEM IS NOT DESIGNED TO;WITHSTAND; VEHICULAR LOADING. DO NOT GIS DEPARTMENT RECORDS. WALTER & MARIE DONAT PARK OR DRIVE VEHICLES OVER SEPTIC `SYSTE-.M. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. INDICATED GW 35.00 204 ANSEL HOWLAND DRIVE CENTERVILLE, MA II) SEPTIC TANKS SHALL BE INSTALLED LEVEL-'-AND TRUE TO GRADE ON A LEVEL INDEX WELL SDW-252 STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH READING DATE DEC. 2004 ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN' PLACED TO MINIMIZE UNEVEN SETTLING READING 46.7 1 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED ADJUSTMENT 2.0 43 TRIANGLE CIRCLE SANDWICH MA-02563 FOR STRUCTURAL INTEGRITY. INSTALL .PVC OUTLET TEE FITTED WITH GAS BAFFLE. ADJUSTED GW 37.00 ETE-2168 . AUG::21. 2005