HomeMy WebLinkAbout0585 BAY LANE - Health 585 Bay Lane
187-050 Centerville
f
k
s
i
I
UPC
fin
i
'' S4Nt
OCAT ION MAP(N T.S)
lu
L 5444) ,v exA7' W��Iv
eU �ct C SA'
2�-
i 2y
l
1
I
EXrsT:
P i r
vio
42.
3
2�
1
gJ
ti
a
i
r ,T )
c.
�i
0 /
6�
d �
e
al
o -
y�,
6; O
G'Lo�
� b
b
a
t��
i
T1�^^jl\
V
CA LA
IN
d �
o
L9 ,
P
OC1
a
t
e
tiff
Hui
b t
t
bla
�T�j �A
a �
D
Q
o _
I
R3 �
M
S� O
czor
� C o
� n
J.
Town of Barnstable Health Inspector
THE 1p� Office Hours
do Regulatory Services 8:30—9:30
Thomas F.Geiler,Director 1:00—2:00
9�`AR 639. Public Health Division P
rFn � Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE
1. General Information: Size of Property:
Address: DO Map r c Parcel( Sz)
Name: lam' C�'�'f Phone#: -71 S0 v
a �a � 7
2a. How many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms?6_t4o If yes, how many?
2c. How man bedrooms total are proposed at this roe (including the amnesty unit)?
Y p P property rtY C g tY )�
2d. Please include a copy of the floor plans for the entire property- showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition. Please label
each room clearly on the plans.
\
3. Is the dwelling connected to public sewer? YES or In l
If the dwelling is connected to public wer,skip questions#4 through#9 below. \�
4. Location of dwelling is INSIDE or O TSID a Zone tribution to public supply wells?
5. Is the dwelling connected to an ONSITE WELL or to IP' LIC W R?
6. Is a disposal works construction permit on file? YES or NO
6a. If yes,how many bedrooms were approved according to this permit? _Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO
----------------------------------------------------------------------------------------------------`----------------
FOR OFFICE USE ONLY
3
The Public Health Division has no objection to E3 bedrooms at this property.
Special Conditions: fl
(AJ1 u '^ �� s'^ �' t�i72+�'! 4".f` ✓ /�t�/et
Signed: Date: y oe- � °�°`'(R
Q;/health/wpfiles/amnestyapp e �
SEP, 13. 2006 2: 50PM N0, 649 P. 1
oFZHEr Town Of Barnstable
v� o ,
h T Growth Management Department,
BAMSTAH[E- % _
9 +� g •367 Main Street, Hyannis, NIA 02601
• ♦0
IF x639659,t> Tel: 862-4678 Fax: 862-4782
FAX COVER SHEET
Date: 3
-qfi
Time:
Attn:
Number of Pages (incl: cover sheet):
From: w
Comments:
Y'ek U4i
1
osSEP. 11 2006.2 2; 5OPM15087906230 BUILDING N0. 649 P. 2,E 01
10
.V+ r
to
3 �
3
r
vo ,
SEP, 13. 2006 2; 51 PM N0, 649 P. 3
IN o
t11�^^
V ,
V
rE
� a
o �
'CA 3Jt1d 9Nicnin8 OU906L805T EZ;tt 906L/cT/6A
09/13/2006 13:23 15081906230 BUILDING PAGE 02
oAv
� cLo�r
b �
ti 'd 6t9 'ON Wd l5 :Z 90H 'E l 'd3Q
- ----
TOWN OF BAR.NSTABLE O P
LAN SASS �s1�1 �F SEWAGE
VILLAGE_ � s�T��'�/j/��^ ASSESSOR'S MAP & LO i — D
NSTALLER'S NAME&PHONE N0.
SEPTIC TANK CAPACITY /S40
LEACHING FACILITY: (type) (size) /3 K y2
NO. OF BEDROOMS
BUILDER OR OWNERidnrl,`
PERMITDATE: 10 —20—US' COMPLIANCE DATE: /D —,22-0.5—
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 O ���
Y
-3 L/ i?
t�tt
S3/ Fee
,NO. i
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0(pplication for Zi9;po9;at *pgtem Cow5truction Permit
Application for a Permit to Construct( )Repair( grade( )Abandon O omplete System ❑Individual Components
Location Address or Lot No. f 8s— 134 Owner's Name,Address Ind Tel.,No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Addwss and I No.
Type of Building:
Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 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 pplicab e)SEW ill /S"d D �.�7• �i�
D l f" o f'�Jt/Yi
t� A
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signe Date
Application Approved by Date
Application Disapproved for the following reas
Permit No. Date Issued
L — ---------- -----_----------------------------
r No. a 5 Fee/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION--:TOWN OF BARNSTABLE,, MASSACHUSETTS
' a �
w 0[pprication for ;Bigogar *pgtem Com5truction Vermtt -
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. -�_ /4 O ner's Name,Addge
Tel
- C y Ti r✓i�/� ��ti�r� e r
Assessor's Map/Parcel isiJ'7 — os-o sus /3oy L*.-?N cn.n n `'✓d/,�
Installer's Name,Address,and Tel.No. De i ne 's 5' ,4TI)eNo. a o
� y31/ihf: .St. l�c/>< l3vr IYI�o233Z
Type of Building:
Dwelling No,of Bedrooms S Lot Size sq.ft. Garbage Grinder( )
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
N re of Repairs or Alterations(Ans er when ppl'coa le)
'-o x y-S'oo &/0 C ��� u..7 rose ��y}
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been 'ss d by thi B0 of R
Signe Date I f
t*, Application Approved by k4� Date I
Application Disapproved for the foilowing�reas v f! s ! C
.-� ey
Permit No. Date Issued
'i
--------------------'-------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certif irate of QComphitttce
THIS IS TO CERTIF'3at the O Lsite ewag Disposal System Constructed( 4c Repaired ( : )— .pgraded( )
Abandoned( )by v 05X�, 'e �yy��� _ i
at a y '� has been constructed in accordance
with the proyi��ns o 1 le 5 d the for Disposal System Construction Pe t No. t �3 dated �0
Installer ✓� PZ�"G���,0rdS Design. I et`
The issuance of this permit shall not be o strued as a guarantee that the system will fu c 'o as d�signed.
Date �'r�� 05 Inspector
_ - —
No.D( '� ��J v � Fee /� -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
litpont *p5tem Cori.5truction 3permit
Permission is hereby granted to air �p
pe Construct , ndon
" U
gr
System located at '41 ,��%
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 conditions. ,
Provided: Cons i sbefoannpleted within three years of the date of this e 2S�
Date:_ Approved by
F
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
+ 9e1R WABhUS&EE, -
`0$'
Public Health Division
ArEa °' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
vto
Date: � �1 ,�
1�0
Designer: (_(I V ✓ V 1 v- l • Installer:
Address: T,vim �� 1 Address:
- 5GI ri ev l(,V /�'lA7 OZ!�3
On-M --,20-OS, ✓off e�Oe zykWS was issued a permit to install a
(date) (installer)
septic system at S 6A T L6/0 C/ rV rile• based on a design drawn by
(address)
�.• dated j0-1l 45'
(designer)
YI certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved-changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any-vertical relocation of any component
of the septic system)but in accordance with State& Local Regulations. Plan rev' 'ion or
certified as-built by designer to follow.
OF MqS��
DARR
o� - Cn
Cn
(Installer's Signature) o. 1140
` \ GI TEa�O J
sgNITAR\Pa �l
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARN TABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
I
Town of Barnstable.
Department of Regulatory Services
" Date ,t r
" • 30
Public Health Division _
*AM a 20o Main Street,Hyannis MA 02601
�. Fee Pd.
Date Scheduled Time
Soil Suitability Assessment for Sewage Disposal
t�Q.) Witnessed By. '
Performed By:
L CATION & GENERAL INFORMATION
Location Address ialei� Owner's Name wa
11 ` �^►9 f� �'�ie Address ��``Q>�f 0 63?—
Assessor's Map/P$tcel: / ��J I Engineer's Name
NEW CONSTRU(,.nON REPAIR
j Telephone#�V - Z L
Land Use
jZe5rp�l�lT1A'c� Slopes(%') surface Stones
7 2 S ft Drinking Water Well ��ft
Distances from: Open Water Body 7 r S� ft Possible Wet Area — t/
Drainage Way
7!Od ft Property Line 7 l 0 ft Other ft
SKETCH:($bwt name,dimensions'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
i
i.
I
i
s
t r
614e[wl/lj�iva SLj i Depth to Bedrock
IA—
Parent material(geologic)
Depth to GroundwaNr. Standing Water in Hole: Al, /4"' i Weeping from Pit File,
Estimated Seasonal i fth Groundwater
DtTERMIN TION FOR SEASONAL HIGH WATER TA-gLE 41�A
Method Used: standin I ln'
__in. Depth to soil tnottlus:
Depth db�aerved g in obs.hole: _ �
Depth toiweeping from side of obs.hole in, proutuiwater A�Jusement
- Adj.Actor_� Adj.drnundwater L9V01,,.m
Index Well# Reading Date Index Well IcVd) -
PERCOLATIOiN TEST Date -�"
Observation / ?/' I Time at 9" ---- -
Hole# -----+--
9
Time at 6"
Depth of Pere /
_ f Time(9"•6' �-
startPre-soak Time.@ 1-��--- / 1 3
I.
End Pre-soak
Rite MinJlnch •
Site Suitability Asse'6sment: Site Passed
Site Failed Additional Testing Needed(Y/N)
m leted on Back ----
Original:.Public Hed'lth Division
Observation Hole Data To Be Co p
***If percolali0n test is to be conducted within 100' of wetland,you must first notify the
Barnstable C44servation Division at least one(1)wedk prior to beginning-
DEEP OBSERVATION HOLE LOG Hole#_ t
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
lZ"-2Y" 1444 and Ow 411 «„�
491— 7Lu C /� 5wd 2.SY 7/y terse ravtv'e'r
DEEP OBSERVATION HOLE LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Gravel)
Tel D YL¢ /v Ail uSSG�tP l A h
Zv a Du/N AN !D vkr/16 IRSS v ✓llc
/ � Z: . �' t9 R dry ✓ n,V�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Orave
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
C nsi t
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
---
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe iou material?
Certification
I certify that on b 7 (date)I have passed the soil evaluator examination approved by the
Department of Envi nmental Protection and that the above analysis was performed by me consistent with
the requir . tra'ni g,expertise an ex rience described in 3:10 CMR 15.017
Date
Signature
Q:4SEPTICIPERCRORM.DOC
r -
CST Z, j
COMMONWEALTH OF MASSACHUSETTS
W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROT
RECEIVED
F
Aa
� W
��H J0v
FAILED INSPECTION JUN 2 9 2004
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A iVAP
CERTIFICATION
PkRCEI, •
Property Address: 585 Bay Lane LOB`
Centerville MA 02632
Owner's Name: Dianne Waechter
Owner's Address: Same
Date of inspection: June 9,2004
Name of inspector: PATRICK M. O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailing Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Nu ber: 508-428-1779
W Ln
FnCEffIFIC TION STATEMENT
�1 cei that I ave personally inspected the sewage disposal system at this address and that the information reported
belocs true,aerate and complete as of the time of the inspection. The inspection was performed based on my
training¢and exgUrience in.the proper function and maintenance of on site sewage disposal systems. I am a DEP
mappr system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: `` Nt�Ft1fil."n i
_ 44,
Passes '�.•
c� Conditionally Passes RAC N
an Needs Further Evaluation by the Local Approving Authority t •rn
XX_ Fails / 'CO � 1
Inspector's Signature: ✓L1��---c-�'I Date: 6/9/2004
J N$PEG;
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health o�
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: Leaching pit full to top. Liquid level in tank full over 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 i
Page 2 of i I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
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 3 t0 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:
f
Page 3 of l l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: .tune 9,2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects.the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria 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 fora.
3. Other:
Page 4 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_X_ Liquid depth in cesspool is less than 6" below invert or available volume is less than '.A.day flow
_X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
_X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_X_ 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__(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 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.
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
_X_ — Pumping information was provided by the owner,occupant,or Board of Health
_X_ Were any of the system components pumped out in the previous two weeks ?
_X_ _ Has the system received normal flows in the previous two week period?
_ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection
_X_ Were as built plans of the system obtained and examined? (If they were not available note as NIA)
_X Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out'?
_X_ Were all system components, excluding the SAS; located on site'?
_X_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
_X _ 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
_X_ _ Existing information. For example, a plan at the Board of Health.
X_ _ 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)]
Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
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)): Records not accurate, new meter installed.
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,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: Tank had never been pumped
Source of information: Owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons-- How was quantity pumped determined?
Reason for purnping:
TYPE OF SYSTEM
_X_Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes, attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from systern owner)
—Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Compliance date: 12/23/85
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
BUILDING SEWER: X (locate on site plan)
Depth below grade: I'
Materials of construction:_cast iron X_40 PVC__other(explain):
Distance from private water supply well or suction line: 30'
Comments(on condition of joints, venting,evidence of leakage,etc,):
SEPTIC TANK: X (locate on site plan)
Depth below grade: I'
Material of construction:—X—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: 8.5' long x 5.2' wide— 1000 gal.
Sludge depth: 12"
Distance fi•om top of sludge to bottom of outlet tee or baffle:-
Scum thickness: 6"
Distance from top of scum to top of outlet tee or baffle:
Distance fi•om bottom of scum to bottom of outlet tee or baffle: -
How were dimensions determined: STICK WITH HINGE FLAP.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Liquid level in tank 2"over bottom of outlet pipe,had previously been full to top. Tees intact.
GREASE TRAP: No (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.):
f
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
TIGHT or HOLDING TANK: No (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: X (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: -
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box,etc.):
Full to top.
PUMP CHAMBER: No (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 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date offnspection: June 9,2004
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_X_leaching pits, number: One 6x6 pit.
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.): Pit full to ton.
CESSPOOLS: No (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: No (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: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,2004
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.
Bay Lane
1000 gal tank
1000 gal pit
n
Page 1 I of I 1
OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 585 Bay Lane,Centerville
Owner: Dianne Waechter
Date of Inspection: June 9,1004
SITE EXAM
Slope None
Surface water bone
Check cellar Dry
Shallow wells None
Estimated depth to ground water : More than 20 feet
Please indicate(check)all methods used to detennine 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 ISO feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
__X_Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water below el. 5 and topo map shows property above el. 40
qL
No.--- -.�� .. 9/ Fin$......�..?.�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH 0S U
If.�/1�_OF................ �4i!! .._.
Appliratinn for RoposFal Works Tonstrnr#ion Frrutit
Application is hereby made for a Permit t Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
... -c.i---* dress/ ! / [ �O...... o.
G?6o
Owner d ess
Installer Address
d Type of Building Size Lot..__ _ .......1Sq. feet,
Dwelling—No. of Bedrooms....................J__.._-_•--__-_---Expansion Attic ((Vh- Garbage Grinder
Other—Type of Building A......... No. of persons........ Showers (Y W-J= Cafeteria ( )
Q' Other fixtures ............................. '.
W Design Flow.............. '..1'D....................gallons per person rtday. Total daily flow.... = : Q__._...___.__.gallons.
G; Septic Tank—Liquid capacity.J#00..gallons L ngth_ �.... Width AQ__'�. Diameter_ _ `-
Disposal Trench—No. ___NI_�...... Widths___...N !�. Total Length.�J.� �:_:_.. Total leaching rea___&.1. {}-:sq. ft.
Seepage Pit No.�/------------- Diameter.,._.._._..._. Depth below inlet.-....I'......... Total leaching area ......sq. ft.
Z Other Distribution box ( ) Dosing tank L )
'-' Percolation Test Results Performed by............ /u �- Date---- . 2....---------
Test Pit No. 1 ___minutes per inch Depth of Test Pit.....I ....... Depth to ground water_.N A)0'_
(X4 Test Pit No. 2_... ........minutes per inch Depth of Test Pit..../ .......... Depth to ground water-___ .
pG ........................•.-............. •--•- -----•------ r......r.:
O Description of Soil.........0.. 3•.........(.OAkv�.-•••--•��----�•'�!t� ��(r✓lZ(
U +Z --C!E vi i'YZ ell r�✓v+ .........(`'`Q .............................................
V Nature of Repairs or Alterations—Answer when applicable---------- ________________________________________________________________________
Agreement: t".S ' 11 '
The undersigned agrees to install the aforedescribed IndfUal Sewage Disposal System in accordance with
the provisions of iI'L U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until er ficate of Compliance has been issued by the board of ealth
ned -•-- '-_2S
-::::.
Date .a
A licatio roved B ...............:.......Y__
PP PP Y
Date
Application Disapproved for the following reasons:--•-------------------------------------------------------------------------------------------------•---.----._
....•...............•--•--.....--•-•-----•---•-----------•--•------------••---•-••-------••-••---------•-------••----•••••••----•-----------•------------•--••---•-•---•-•----•--••------•---•.........
Date
PermitNo......................................................... Issued.......................................................
Date
................-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF Hf ALTH
t---------------------------0 ... ...............................................
Appliration for 13isposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
I � E L4 e & �'V'
............................... -- -------------------------------- -------------------------------------i ------------------------------- ---p /----
: ess / or Lot No. 60S {em �& / o
... ........ ........................... ........................................... .......................................
0 dressi?1 4/
W U" (f V-4ee�111
�4 Installer Address
PQ
Type of Building Size Lot... S fe t
-----
Dwelling—No. of Bedrooms............................................Expansion Attic (Af, Garbage Grinderq
N-� (+-
PL4 Other—Type of Building .......!?�IA........... No. of persons Showers (,4//�--_ Cafeter*
PL4 Other fixtures .............. ---1.1._Z4...................................................................................
Design Flow............../1.6
.........................gallons per person per day. Total daily flow---------3.3 ........De th........_....gallons.
*6t 4 p
9 Septic Tank—Liquid capacity-J."U..gallons Length-?Za...... Width..�4.'_10_". Diameter_ ----
Disposal Trench—No. Width....... /A7..... Total Length. 6� Total leaching area.._.... ------sq. f t.
------ 41 9
Seepage Pit No.......... .......... Diameter......L---....... Depth below inlet.........I........ Total leaching area..gRk'�....sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by............................... ........................ Date.....!!!��.2.........................
�--4 . I ...... ...
Test Pit No. 12��.��....minutes per inch Depth of Test Pit../,;' ............ Depth to ground water....A-,*/U-,e
-------------------
0�4 Test Pit No. 2... _...minutes per inch Depth of Test Pit-----I............... Depth to ground water.__- .....
................... -
0 Description of Soil -------- ------ ........................................................
A
_ - ----------e...46" ------------ ........:P�i. ......... ...... ............................
V
U ................................... ..........................................................................................................................................................
............................. ..................................ev5?-------- ......... T(z--...........................................................................
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 T IT L14: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee . s11f1d by th 1��
............agned---:7....................................................................... ................................
Date
"Al) roved By__..__`
)T ' ..................... .... ........I Ap�iication/ � roved .......... ....................................... ----- .......J=
Date -_
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo....................................................... IssuedL.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
I
BOARD OF HEALTH
..................... ...................OF........................................................................................
....
"Trrfifiratr of Tautpliattrie
THIS-IS TO CERTIFY, That thejndividual Sewage Disposal System. constructed or Repaired
-1 S.V'S I&AX / - ' le-r-- - %;,WOE (
by----------------------_-La .1-41S. ......... _1q.A............................................................).......................
In tall
at............................................................... I LIC r
-----*...ions.....*............. ............................................................................................
has been installed in accordance with the provisions of TI-qp&5 qyqhF State Sanitary rgFabed in the
application for Disposal Works Construction Permit No......................................... dated-........._.....................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUICTION SATISFACTORY.
DATE................ ...).T5................................. Inspector..........4... .................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
qua ..........
.......0 F.............................................................................
No.........................
FEE..... ........
Permission is hereby granted..............Kcj.uq........ ..............................................................................
to Construct ( ?Q or Repair an Individual Sewage Disposal.System
atNo......... . .........I.S.115 .Z....a ....................Street_................................................................................
Z
Date&__��. -------- --
as shown on the application for Disposal Works Construction Permit Np_',. 7
..........................
Board of Health
DATE..................M... ...............................
Ll FOR.%1 1255 A. M. SU N, 1N BOSTON
e> : J DESIGN DATA
In STRUCTURE 3 e4 RM - s,F.LaT LC 70-7 I DESIGN FLOW uo ��aQl t= GQ�H�MR-
-- -- �(� Q Ilo CPD n 3 Po0Q•M = .35o GPD
II -� 1 Ol •Lg k 33o GPD 4iS lohl-
SEPTIC TANK use AAiw loon GAL.
1+. 1 i J/ Ir'
3So4 S� AL, � i i � 1 � ; iJ ICI 'ZI LEACHING FACILITY :
BOTTOM
LEACHING RATES SIDE AREA 2•� GPD/SF
i � _Q to AREA I.a GPD/SF
t
o- ---------- siDE AREA I/L x rr x 4 =. Is 1 s.F•
FSoTTaM A-�A. Tr = 113 S F
Gi4PAc
`14. + (t5► x 'L.$ ) t lll3 x I.o) = 49c, .vvv
I j I I I > j Q '_�' tiM
I I T o A• PLAN REFERENCE
---------- 1 1 1 9? � � p3 � 1 I I O. \ Fa4Q�J5TA-(3L� Co��'TY Q>r'G�STOs/ of Di=t✓'•DS '
P1u° w ex==4 PA3a 84-
Q. 1
q�
---------� / i // , , l ASSESSORS LOT NO. AAUP I97 PAi-=c_ 'L6
NOTE:
r �•1 `+ `� r,�7 22' I + 8 �� J J I. ALL MATERIALS AND CONSTRUCTION METHODS
I 1 / `+ I�' J % 1► r� Lu
TO CONFORM WITH COMM. OF MASS. TITLE:L
FAD +
L�J � -roP 2_ � 4�1' �, O �.� Q �. ENVIRONMENTAL CODE
I—, ro�__' ` / ✓a ; `. .` I�o.o + — ki pknptm
O — -- Ex15TU.tLz Go�Ttx�Q
ED cci rrov Q
• `J 0 ; `, D.B. ;. \ 3C' ; �, QJ �' d'
r J L e•T IS AD-F-A
J / L CST L g. 1 / / / `, `b r -rov n, w 4i R. AyPn L*pf c- •AT s re-
�
- _ � 0� .. A _ � _ N oL"TEST P�F A- ►-73�-
9) 9_
(T
f=uD EL = I OO.o 212:9Lo a� "i13M @ \11A OF
Q EL- Ioo.00 y>FP �'SJq `tH OF �1 S
N
cvcr-F _ �o� V.IA_ �
o
TH4�JLIrT o alv i �✓
PLAN oc -299Z8 cry' t IS N
EXlsnu� GP DE SCALE I"= � TEST PIT NO. I TEST PIT .NO. 2 F ✓�'v �� 29874
P I�cP�Si=fl GP-ADE x ELEV. 93.-7 ELEV. 9 I,s f SST F fCISTER��J��`
95 95 j ✓✓AL E.A��
SvE65aL_ SOIL OBSERVATION PITS
— '91.6 DATE OF TEST o4. 21 • .53
ENGINEER 5-A-A7f& A-k4-eF- luc.
N Ro B.O.H.AGENT Jf�cct31
to.o ffi.C.
EXCAVATOR P�u_M7�
L5r,-7g aq 4 e j — EL= 88. 5 PERC RATE IN T.P. NO. 1 AT 4 FT.=< 2 MIN./IN.
0.�X> e.AL o ,
a.�.
1 4
gCne-TAuK 98.5 w/ 3 ' s'rc�l I I. cLs41.•I M eD
55 B5 -'ca F i w a --.;,A I D cau-r�2.i M ASS .
ELLIS & THULIN, INC.
S o 11' W<=,WATER EL = 79 S + LAND SURVEYORS AND CIVIL ENGINEERS
EAST SANDWICH, MASS.
• uo we're-2 .
80 V�RT I ' `�� � �; •.. .. , , ,..• .. ... .. . �. P�c�_.ED pLo-r- QLAcr`I
SECTION THRU SEPTIC SYSTEM DaAwtw P-'-( :EL -> MAY 14, I`t5t,
8
03
M
F
!
4
i
.f.
17
I, tk
ut
,. �.! �! ��it 4l�/.• � � 'rl , i i s� � - � �-' -
ryn
13
yi
VN Si
Ci Y QQ 1 I
I \ VN
62
I
l I '
~i
1
0
I I I >3E
u
c
I � � -...(.....
III—
( is II i
ri I
4
I ;
t i
( t
t
t
r
:
}
ASSESSORS MAP : 01
TEST HOLE LOGS NOTES:
_ 05 PARCEL : U50
l) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
�e SO L EVALUATOR : �Vlt{IRS THIS PLAN, 1995 MASSACHUSETTS TITLE„ V & TOWN OF,
A44� rNE Sr FLOOD ZONE : N 0 r 14 q 2k--p-j� � ���,�(� BOARD OF HEALTH REGULATIONS.
�,� WITNESS : D. LI✓A-bp- t5
��' q \ REFERENCE: FAIL I0418 DATE : 27 0S 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
ovq PERCOLAT 1 ON RATE L- 'ZMtnlllatkl SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
M�
2 + INSTALLATION.
TH- 1 CL 25,r:® 0" TH-2 E(• 2, ,-7 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION
ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
R �S A-NP loy�'¢�I ArAq DETERMINATION.
(,o�tM ?-q,Sb z 23.75
R `� (pY�'�V LO� 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
,Z�n SA1�1b i Z.�j.SU � S/N`1� I17YI(ZSl SPECIFIED OTHERWISE)
LOCAT I ON MAP N T-_ , �t 8
( '� L�PrM� j a1T(zS/g � 3q 2.l ;SO 5) , THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A `
J I U Ni GARBAGE DISPOSAL.
4� Wl EDI V - t: 21 S 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
�"1 CoPr,QS E �� G MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
A BASE OF 6"OF CRUSHED STONE.
-21.6,1
J
y bLQ_��w )_f�F►VA Wei,t,5 w ► �f_S' ' ___
Zy I.
9 Oft, rt,�, t�_I Asa_ _
SEPTIC SYSTEM DESIGN
f _10,v r,) _OF
26
_—�}cAvT�fi (ZE uLA-Tt Iry
FLOW ESTIMATESoNs
13�rs��tz: 13p. oG - 4 S IZFI�UtRC--p.
5 BEDAOOMS AT Ito GAL/DAY/BEDROOM - 5SO G
SAL/DAY !Z. 4.g 1'�- NOTI
J bt aqv If,69 6N� CPP7
-
SEPT I C TANK
GAL/DAY x 2 DAYS - /,L 100 GAL
2Wwa USE I �x> GALLON'SEPT i C TANK
AfL r _ d� (-A/o'lF-_ 7� h
q2, 74. 11 SOIL AUSORPT I ON SYSTEM -
2- L k t 3' wv 4_'L�1
o
2 t o y SIDE AREA:j�`f�-� �-*�►3�Z x z 0• 7y 6 2.
3 S BDTTOM AREA: 3 k U 4Z I
P-D
30
-7Ss0 G PP Y�y'
� P E1C15
— — z& SEPT I �: SYSTEM SECTION
Dw�N3
C.
.� K T�F-3t3NI
N 73oc-IN4 ro
I A \ ` , / I0 14, �radc 19'M �/ �"'4iC EG 2Z
�Y ww 6
Iy rt \ExrSTrnt� lhs-t�t l 2'�-3�g" Washed „P
�� AS 6Ar>=t,c 0 1/0
t, = n o L=I Cam ,
3v 6 saaE
I p I c ,Bcr�6r D-BOX Z2.63 Ll �i ►
R GAL
D SEPTIC TANK Fok- LEU Lj*jts ZI ,SU 3/4
Alm
w4sti� s�� S�S
L x
— Ts ems', 13,7s
77a�' of r
SAY '
L A�V Vj,A FPS
cyGN
SITE AND SEWAGE PLAN
DA
r� LOCATION : S85- P�f6L
"Iol.= Top a F P+� cn
ER
Aj No. 1140 CE/�Il ,e V l C(.t /I/!f} C2 633
6aA- t EL: 33.44 �o
(A-
s
AtiGb
SgarTAR\�N r�f( PREPARED FOR : D/f t) E
N " llu,09 cc.�a-7��2
0
Tr1- SaS y
DARRF_N M. MEYER, R.S.
SCALE :
w
0.
sue F� n1C,� 43 VINE STREET DATE:
-plA�
DUXBl JRu, MA 02332
DATE HEALTH AGENT (781) 585-0293
z 0, -p„ 19lio