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Home My WebLink About0091 BERNARD CIRCLE - Health 91 Bernard Circle Centerville A= 349-043 5 M EAR No.2.153LOR UPC 12534 amead.com • Made In USA � i�IS€DNTF4;PAODUCTtNE SFI OFTHE SUROGRAM SWED FlRCM WWWSFlPWGRARO tG W., U v No. O 13^ + ' S Fee THE 'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION;- TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for DIs'pDBal 6pstem Construction Vermlt Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locati n d s or Lot No. ' � � Ow er's Name,Address,and Tel.No. Assessor arcel 1`i g PU��cl 51 q�`u" � Installer's Name,Address,and Tel.No. Designer's Name,Addre ,and Tel.No. 73fia f�cccjvafj vn 5os- ��-0653 Sot n� rlq►'neer,nS Type of Building: Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow(min.required) 330 gpd Design flow provided 347 gpd Plan Date 2"q 13 Number of sheets Revision Date Title Size of Septic Tank f—'Al6b(_1Q 10M QajjQn Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and 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 Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 0 3 o Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for -Disposal *pstem Construction Permit d Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locati n dress or Lot No. Owner's Name,Address,and Tel.No. Assessor's LVla�p�arcel /� C�_ " C F c �j� Cl I -Pj e - 1 J C7 L r C. � Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow(min.required) 330 gpd Design flow provided --I y i gpd Plan Date 3 Number of sheets Revision Date Title Size of Septic Tank C X s t)l I t I ( Type of S.A.S. Description of Soil Nature of Repairs or Alterations when applicable) Date last inspected: Agreement: t 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 Certificate of Compliance has been issued by this Board of Health. Signed _ Date I t Application Approved by Date /^ ?j Application Disapproved by Date for the following reasons Permit No. o 3 LI Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned(-�)by ) i w /�_ X{ /i y C�t � I �:( 1 at �1 I {"}Q (' i )��.( ("� C t_ f r C has been constructed in accordance with the proviions of Title 5 and the for Disposal System Construction Permit No.,;?Ol 3 dated '2 3 Installer Designer L\/\,I 0 �-1 1 Ca f, n `r #bedrooms f g p Approved design flow �C gp'd The issuance of this permit shall not be construed as a guarantee that the system-w ll'fun do signed. Date �� / /� j Inspector ---'-- No. Y Fee THE COMMONWEALTH OF MASSACHUSETTS .. PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to-Construct( ) Repair(! ) Upgrade( ) Abandon( ) System located at W t" ,(' d t! t 1 ` _1 r / _�_ { (� t 1 f r \! 1 C and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi Date 1 a — Gl— r 3 Approved by ` FROM :down cape engineering inc FAX NO. :15083629880 Dec. 12 2013 08:51AM P1 �own ah BaL'us.t 't �` ti -,.•, '1'I4e�Gua�r� �'. >f,�aiRer,�ui•�c�®�- 4 �. KARR 'i hma1a.R McKean,Director :pcy'ib ib12Ban 8-12"cct,Hylnuh s,MA 026RO n:McP: 509-862.4644 r'ax: ,nR-ego-6:30�� SiLovame Pe rm®iit# 42 %'3rkia ai;olt•'q Maysltf'sara el 1fDn;uiTr• `t��ul ' a s YE%�d! �t1.4; 14 G-J,.; .• wF s issued a perm.A to in5t21 �i (date) (_I l fi'talier) sEptic s;Ystel baked ot�.a design c cawz by (�dtlrrss) . _ T u-,i ify tbat the :3trptic syqum refPre,�,3 above Wits jusiulh,,d, suh,�utia.Ly action of to the rJcssi.,11, �.Nliickl 11:i` inc.hade: m or a pruvc:d changers such'a4 Weral 10-10cati of the: di.-trib77.tion box Fjnd/or sel-6c talk 'I certify dint the ;r.;ptic riy:Lcm .iefc:cenced above was iistallccl, with major rhariges (i..r;. — :eater tl�pn,l.0' lflte�_�l I.-loration of t1�- ?AIS n2'arly veTUC.a L of MY CUo7.l7{.7UC-Tlt of the :;eptir, sy,4lrT11) but 111?..cC471CF111.(' vaitll�yL�a'_r &:1.ocal Re—lilataoilS. PI rovisi.nn. ur certiiied as jili-lt by to ib.ltnw. N 4IHOFjf4s�o (lrist3ller'S ,�t :•} �� DANIfiLA, tiG pf OJALA CIVIL No.46502 : — (Affix.� A! zI�:zc} '�t:�7•i;ilZ4�5 ST.�II.�.il,llc} 1�1C.Aj,:k,H' VJSi4_?1'L CEZIJ TC,,'Q 0k i,17 3.IAPla ydiii,i _idto'1' �E L33OKT) T-Nd')i'L BKOTH 'I'Lg.RI9 j.?Ol Z9'd A.ND.AS-BT7&LT CART) A10, _ ��fi;�T�9Ai_�>11�[dSl'fABLL I'TT87 TC'H fe�+iC,[-. DkV!b:CIO+l. T'gL. ZT6C 7t�a f, n_ s,,,,-ri,iq—iiojno,%i or Pr C r..Tt'Fcatiou F'oTm.1-26 U4.dor. j h TOWN OF BARNSTABLE LOCATION 9/ Scrnarot 0 rc)c SEWAGE# 7-613 - 4135 VILLAGE c- ASSESSOR'S MAP.&PARCEL /y A ' S`I INSTALLER'S NAME&PHONE NO. S3�,S3 EXCA✓ q 7 - OG53 SEPTIC TANK CAPACITY f000 �i LEACHING FACILITY:(type) 2Trcnvkc5 (1 ac S9&*ze) Zx 3 x 3--!N NO.OF BEDROOMS 3 OWNER F_orc:cc' PERMIT DATE: /2 -9- J3 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 ow: +. 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 A Az- i3Z-6 a 3 A3-,50 , 83- �� Q Ay- �6 0 f3q- A /3 --"a & k -� • `own of Barnsiable P Departinent of Regulatory.Services TM sTAnLA Public Health Division DatMAB& e /DA� � Tin jq. 200 Main Street,Hyannis MA 02601 Date Scheduled i` r /00 . _ W " .. Time �! Fee Pd. l Soil Suitability .Assessment for Sew .Dls ' 0 l f Performed-By: Witnessed By; LOCATION& 9ENFRAL INFORMATION Location Address f e", r //(n Owuer's Name C Ill` I -Q -C (�(� Address '\Assessor's Map/Parcel: / / (J Engineer's Name / 1 VVVrrr///0 W NEW CONSTAUnGT[ON \< (� REPAIR Telephone# Land Use: RCVS[C2��to Q Slopes(%) b— Z U Surface Stoaes N� Distance's from: Open Water Body-- F —R possible Wet Area Drinking Water Well �ft Drainage Way ft Property Llne —ft Other ft SIMTCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) AS 10 V� CY Parent material(geologic). jQ Co, Depth to Bedrock ✓�U Depth to Groundwater. Standing Water in Hole: Weeping from PI Fncc N0/ Estimated Seasonal High Groundwater... ,Method Used: — DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: , / la, Depth to soil mottles: ln. Dcpth to weeping from side of obs.hole: in, Groundwater Adjustment f. Index Well# Rcading Date: Index Well Adj.thetor— Adj.Groundwater level , PERCOLATION r. EST mate , Tnam4-- Observation Hole# Time at 9" Depth of Perc y Time at G" Start Pre-soak Time® i d�j�, Time(9"-6") End Pro-soak1 Rate Mln./lach $OO 4241- • Site Suitability Assessment: Site passed SICK Fallcd: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back- — ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(I) week prior to beginning. Q:\SEPTIC\PERCFORM.D O C DEEP.OBSER'VATION HOLE]LOG Hole# � Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, onsistcuCy.%'Gravel) iz—3G y/2,4/T : I9EEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistmoV,%G a e A- . L LS 1�y2,,;� DEEP OBSERVATION HOLE LOG Hole#. Depth-from' Soil Horizon Soil Texture Soil Color Soil. Other- Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c O c DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoney',Boulders, Cons! to 6 y Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No._ Yes �r Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obstrved thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious matoriall Certification �U I certify that one (date)r have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in�10 CMR 15.017. Signature Datb Q:�s.�rrlc�r�eRcnoRM.�oc . Postal CERTIFIED MAIL. RECEIPT -� (Domestic Mail Only, Ir For delivery information visit O I A L �_ Ln � co Postage $ f�S ►v H c?60 Certified Fee Q F C' 0 Return Receipt Fee Po � O (Endorsement Required) ere O Restricted Delivery Fee (Endorsement Required). 5 rq / �-� O Total Postage.-&Fees Is ra _ f1J ;-r o Kyle & Catherine Forcier ` 91 Bernard Circle Centerville, MA 02632 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt maybe requested to provi roof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee-waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on.the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i COMPLETE •N COMPLETE THIS SECT16NON I ■ Complete items 1,2,and 3.Also complete A. Siyrtature item 4 if Restricted Delivery is desired. X j/�1 Agent ■ Print your name and address on the reverse ❑Nddressee so that we can return the card to you. Re eived by(Printed N me) C Date f D ivery ■ Attach this card to the back of the mailpiece. or on the front,if space permits. D Is delivery address different from item 1? 0 Yes' 1. Article Addressed to: If YES,enter delivery address below: ❑ No �'<Kyle & Catherine Forcier I :91 Bernard Circle 3. Service Type { Centerville, MA 02632 p ❑Certified Mail ❑Express Mail O Registered ❑Return Receipt,for Merchandise `—• ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes j 2. Article Number701'2' 10'�1Q 0000 `2'85�1 0916c) s- (Transfer from service labeQ PS Form 3811.February 2004 Domestic Return Receipt 102595-02-M-1540r I UNITED STATE�s;PQ-!�TW� ICQ, :t XirSt7. us •,Sender:Please print your name,_address, and ZIP+4 in this box• I I I Town of Barnstable Public Health Division 200 Main Street Hyannis,-MA 02601 1 .t *Town of Barnstable Barnstable ,THE Regulatory Services Department ;I AwMca 1. I t �'� Public Health Division i639 ,� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 0916 November 7, 2013 Kyle & Catherine Forcier 91 Bernard Circle Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE. TITLE 5 The septic system located at 91 Bernard Circle, MA was last inspected on 10/10/2013 by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. You are ordered to repair/replace the septic system within sixty (60) days from the date you receive this notification.. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\91 Bernard Circle Cent Noe 2013.docQ:\SEPTIC\Letters Septic Inspection Failures or Future Eval\91 Bernard Circle Cent Noe 2013.doc i Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9782 lee IN a¢PA6l l SS. E�+ p J T+ `en Logged In As: Parcel Detail Tuesday, November 5 2013 Parcel Lookup Parcel Info Parcel y DeveloperLOT 28 ID(�148-057 ( Lot Location!91 BERNARD CIRCLE n F100 Frontage Sec _ _._ ____ _ ____. Sec Road ( Frontage Village Fire CENTERVILLE I Dist ict C-O-MM Town sewer exists at this Road �� — address INo Index F0118 Interactive , Map Owner Info — __.__ _ __-__ .-- ) Co- 0 I wner jFORCIER, KYLE E&CATHERINE M Owner Streetl[91 BERN, RD CIRCLE Street2 City CENTERVILLE ) State MA] Zip 102632 1 Country{�_J Land Info Acres 0.34 Use¢Single Fam MDL-01 Zoning RC Nghbd 0105_ Topography Level , Road Paved Utilities I Public Water,Gas,Septic __ ' Location} � Construction Info Building 1 of 1 Year�-��"^-- _ Roof Ext Built-f 1081 I Struct Gable/Hip Wall Wood Shingle Living 1438 ��I Roof AspGIs/Cmp AC FNone— Area Cover Type Style lRanch Wall Drywall i Rooms r3 Bedrooms Ia ter_ Int Bath Model Residential Floor�arpet I Rooms 12 Full b I(3AF . Heat r _ Total Grade Average Type(Hot Water Rooms6 Rooms _ Heat ___- —___._..__ Found- 2a icy ' Stories 1 Story Fuel Gas ation(Poured Conc. Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9782 11/5/2013 Y5 Commonwealth of Massachusetts _ Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments N 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State 'Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfo . I use the return key. Name of Inspector B&B Excavation, Inc. - � Company Name 14 Teaberry Lane Company Address Forestdale MA :. 02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification 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 • 10/10/13 Inspector's ature 7V Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,.if.applicable, and the.approving.authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/1& Title 5 OffidaI Inspec on Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City(Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 91 Bernard Circle Property Address Kyle&Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bernard.Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check.if.the following have been done: You must indicate"yes" or"no".as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ N 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 El Were-as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® 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. ® 0 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design):: 3 Number.of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 t5ins•3/13:: Title 5 Offclal Inspection Form:Subsurface Sewage Disposal System-.Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011 = 287 gpd 2012 = 241 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: > 10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in working condition. No sign of leakage Septic Tank(locate on site plan): Depth below grade: 29"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gal Sludge depth: 5" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): At time of inspection d-box shows no signs of solid carryover or leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching is in hydraulic failure. Water level above invert. No effective leaching remaining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts + x i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M s 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Titl-e 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Bernard Circle Property Address Kyle;&Catherine Forcier Owner Owner's Name information a Centerville MA 02632 10/10/13 required for every - page. City/Town State Zip Code Date of Inspection D. System:Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below hand-sketch in the area below ❑ drawing attached separately �ACk , g Po�.tk o g16 j t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: > 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: previous inspection report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: previous inspection report took groundwater from plan - plan no longer available at BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 91 Bernard Circle Property Address Kyle &Catherine Forcier Owner Owner's Name information is required for every Centerville MA 02632 10/10/13 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -/N'ot for Voluntary Assessments 9/ �✓N a i� C. t �^ Property Address / !.✓o✓f�.r.7 Owner Owner's Name information is rµ -k✓V/ Ile J required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately s0►1,_ Ppt��` Lill / b Vif a 3 — /0 � 14"s QleC,4✓ Riser 63 3 0 9y - 3/ 'Sins.09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NOTES �Shi COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) G P a. ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 1. DATUM IS APPROX. NGVD 2" PEASTONE OR GEOTEXTILE �° r \ TOP FOUND, EL 56.6 FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING F° �c o o � � MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 55.8 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Gr o PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL.G DE PRECAST H-10 r 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Lo u o RISERS (�.) 53.5' 4"0SCH40 PVC UNITS TO BE AASHO H-10 �o PIPES LEVEL 1 ST 2' 2" DOUBLE-WASHED PE:ASTON e� 14 OR GEOTEXTILE FABRIC' S. PIPE JOINTS TO BE MADE WATERTIGHT. e e T10-EE EXISTING SEPTIC TANK** TEE *, 52.1 1 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE c�e� \52.1 f WITH 310 CMR 15.000 (TITLE 5.) Q° °°°°°°°°0000 , 000000000000000000000000000000000000000 00000 000 00000000000000 ti( GAS BAFFLE..,' Leo°o °0s 51 .61 00000g0g0g000gogogogogogogo$og000gogog" 0 0g000g 1. g0g000g0gog00 z 5e 0°0°0°0°0°0°0°0°0°0°0°0°0°0°0°0°0°0°0 0 0°0°0° °0°0°0°0°0°0°0° 49.45 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND cho 51 .81 ' 51 .64' 4" PVC SET AT'.005'/' SLOPE ' NOT TO BE USED FOR LOT LINE STAKING OR ANY o p 4vi c� ';, r . ,• =• <, a.:...... ON 6" DOUBLE WASHED 3/4" 1 1/2" STONE OTHER PURPOSE. 12" MIN. INT. DIM. 6" MIN. SUMP 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. '*** 6 4.75 ` 9. COMPONENTS NOT TO BE BACKFILLED OR " CRUSHED STONE OR MECHANICAL COMPACTION. (15.221 [21) CONCEALED WITHOUT INSPECTION BY BOARD OF {e 2 HEALTH AND PERMISSION OBTAINED FROM BOARD o� ( 1 % SLOPE) ( 1 % SLOPE) OF HEALTH. BOTTOM TEST HOLE 2 EL 44.7' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP LEACHING CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- xI sT SEPTIC TANK 29' D' BOX 5' FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & G-W EXPECTED AT ELEV. 33't PER TOWN MAP NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WORK. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE ASSESSORS MAP 148 PARCEL 57 CONDITIONS IF NOT SUITABLE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE a J PROPOSED LEACHING FACILITY. - 6.03 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN / SAND. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE / IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR �55 .84 O 6.00 0 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED BY THE BOARD OF HEALTH REVISED DURING A PUBLIC HEARING HELD ON AUG. 4, 2009 / SYSTEM DESIGN: 3) FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEMZO INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW _ GARBAGE DISPOSER IS NOT ALLOWED GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) AND WITH-H-20 LOADING, BUT IN NO CASE SHALL THE SAS / BE LOCATED MORE THAN SIX FEET BELOW GRADE. PLAN 55./ 5.72 DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD / T - x 55.78 Box 5 5.80 USE A 330 GPD DESIGN FLOW 55 :'a- �c 55.70 / / ! 5 55./LP ' 65 �1 SEPTIC TANK: 330 GPD (2) =LL660 - a_ / �_. / ` 6.04 Asa RE-USE EXISTING 1000 GAL. SEPTIC TANK ** EXIST / EXISTING DECK O TEST HOLE LOGS / ENCL.PORC 5 92 LEACHING: ON SONG 7.36 s6 PROP. VENT WITH CHARCOAL FILTER1 TUBES 6.18 SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD ARNE H. OJALA, PE, SE CONT�TOR WITH HOMEOWNERMENT TH 2 ENGINEER: CONSULTATION) 55. 3 6.05 BOTTOM 2[32 x 3 (.74)] = 142 GPD SHWR EXISTING 6.32 6.15 WITNESS: DONNA MIORANDI, IRSDWELLING _ 04 DATE: 12/3/2013 TOP FNDN. 0 \ TOTAL: 472 S.F. 349 GPD 'L .53 x 55. EL.=56.6' BENCHMARK 56 \\ \ USE (2) 32' LONG x 3' WIDE x 2' DEEP < 2 MIN/INCH COR BULKHEAD < \ PERC. RATE = EL.=56.0' x 55.38 \ \ LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE CLASS I SOILS P# 14202 \ \\ \ \ \55.36 55.02 ELEV. ELEV. \ \ ST NE\\ GAS \ PAVED\ IVE 0p° 55.6' Opp55.6' 5.10 METER . gpp \ DRIVE R \ A w V of 55 \Wq 54.78 \ R \ FILL SL 00 s w� c 55.22 55 \\ \ 54.33 4.46 , MA 1OYR 6/6 �, w \ \ APPROVED DATE BOARD OF HEALTH 12" 8» / vN \ 4: \ w� �53.°6 5310 Bw B s TITLE 5 SITE PLAN 4 \ SL LS x 5 . 6 54 OF LOT 28 un 36" 10YR 6/6 52.6' 389' 10YR 6/6 52.4' 15,000 SF 292 91 BERNARD CIRCLE i x 5 x .31 8 CENTERVILLE C C i �O PREPARED FOR PERC B&B EXCAVATION/FORCIER MCS MCS ,_-`563 53 i DECEMBER 9, 2013 2.5Y 6/6 2.5Y 6/6 i °'" ,�' W Q htq off 508-362-4541 'C'52.56 DANIEL DANIEL O[ ��°"�� s��.c fax 508-362-9880 A. �� :�° OJALA A• downcope.com CIVIL A Noo..40980 down cape eagineefing, /nc. No.46502 120„ 45.6' 130" 44.7' °�� sTEFi Fss\o o� Civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' Z(� Ss,oNAL E�G� su vE land Surveyors h� 939 Main Street ( Rte 6A) 0 0 20 30 40 50 FEET / 98 DATE DANIEL A. OJALA, P. P.L.S. YARMOUTHPORT MA 02675 / 3-2 Q�c 2