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HomeMy WebLinkAbout0086 BUCKSKIN PATH - Health 86 Buckskin Path Centerville A - 170 047 No. 4210 1/3 ORA Pendafle' x' 10% 0 - - - - ............. i 1�i �T� Commonwealth of Massachusetts aI Title 5 Official Inspection Form �' rl Subsurface Sewage Disposal System Form Not for Voluntary Assessments 86 Buckskin Path .Property Address Julie Alpersen Owner Owner's Name information is X required for every Centerville MA 02632 6-26-17 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-26-17 or'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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Dispb�age 1 of 17 T Commonwealth of Massachusetts - lal Title 5 Official Inspection Form �ji;I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 15.3031or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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 , Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��_;;!✓ 86 Buckskin Path Property Address Julie Alpersen _ Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town 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 vto 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 Commonwealth of Massachusetts f Title 5 official Inspection Form . I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_s�!✓ 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 1/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Buckskin Path �� Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 1a=1 Title 5 Official Inspection Form J II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Buckskin Path is Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage 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 o to ed b : n ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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: Sump pump? ❑ Yes ® No 6-2017 Last date of occupancy: Date 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 , Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form f ' 'f,.l Subsurface Sewage Disposal System Form Not for Voluntary Assessments 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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) ion and Innovative/Alternative technology. Attach a co of the currentoperation❑ 9Y copyP 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 Commonwealth of Massachusetts fZ Title 5 Official Inspection Form :. I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:, .. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Al 1;!»� 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 20" Scum thickness 1" 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? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and 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 :a=1 Title 5 Official Inspection Form G� Subsurface Sewage Disposal System Form Not for Voluntary Assessments t s; 4a_s_i! 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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.): Good condition with water at working level and no sign of back-up from field. 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 Title 5 Official Inspection Form �;.I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I` 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-Infiltrators ❑ 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.): Infiltrator leach field in good working order with no sign of back-up into d-box or surrounding stone. 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 :a=1 Title 5 Official Inspection Form i+ -I Subsurface Sewage Disposal System Form Not for Voluntary Assessments l �F� 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts ,a=1 Title 5 Official Inspection Form G' ' .��I Subsurface Sewage Disposal System Form Not for Voluntary Assessments a� 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 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 r 1 r [:Z:= F 's -1 - "7 1 0�V cy 6 -d- 02c)"(0 ,- `3 - 33 6 3 - v?s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �F. �.1#! 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is Centerville MA 02632 6-26-17 required for every 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: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form -;I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `� ,.,p!✓ 86 Buckskin Path Property Address Julie Alpersen Owner Owner's Name information is required for every Centerville MA 02632 6-26-17 page. City/Town 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 VILI;Ar �� r X-SSt;55Ows Hit kLOT iN5TiLF '.5 NANtE 8c p1HQntE,IO. 7CA 1 I t;AlPAcrry OF xl �JIL:01 4R Off .�3 SaprAcation i�9iste Bstv�e��tie ,; ,, tviax mum l�cl)ustad Gzau►adwater'l'sble to th6 k3OMM.0k)<�;aGE+tng C�uiihty -- � Piiv +�4►{�t r 5uO1yEy VILAA Witt treOA16g t'ac�lita► tiny s f tls exist oti sate oc Mthia;200 feet c►f�te�acluag fae#ity') EdLu c��V►Jet9anc�ad i 3LoacOtin Pac li�y au�Y wetf nd5 exi t �Fad t+ittlitl�Q(}fc e�p lettChittg im a /e r � 1 ' Ard- dn. - 020°6 ti. Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name information is 4 �t lAA required for every -- Mtn r l!e page, Cityrrown State Zip Code Date of Inspe io 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: Ian/ key to move your / cursor-do not use the return Name of Inspector key. Z/Y�y/-0 Ll 7 t�l Company Name Company Address. Cityrrown State Zip Code Telephone Number License Number .. r� B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspectors 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. I , l� t5ins-11/10 Idle 5 Official Inspection Form:SubsuA Se%;age Di System Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -�16 /��►�ti-sit �� f�, Property Address Owner Owner's Name / information is required for every Levl4emr page. Citylrown State Zip Code Dat�ection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ahvays complete all of Section D A) System Passes: 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-11110 Tide 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 2 or 17 I t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form //-Not for Voluntary //Assessments �� �y G�S h/l✓1 �G�rl Property Address A Owner Owner's Name information is / e N required for every l� AN �'�` �� page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system-is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetfand or a salt marsh t5ins•11/10 Title 5 Ofliciat Inspedion Form:Subsurface Sewage Disposal System•Page 3 or 17 �C\ Commonwealth of Massachusetts . Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �� ����s�► �� 46 Property Address Owner Owner's Name information is /evi. e `/ required for every C o� page. City/Town State Zip Code Date of 16spe6tion B. Certification (cunt.) 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 ❑ Ell," Static liquid level in the distribution box above outlet invert due to an overloaded / or clogged SAS or cesspool ❑ ,1��/ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins•11110 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sew—age Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is Ceo 4 yyt required for every -' 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: ❑ E 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. ❑ [2"'- 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 coilform 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- 0,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described'in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking'water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �� ��G�s�f� ✓��, �� Property Address Owner Owner's Name�eN I ✓(/l�� ��/ o o�( `�. *d // information is required for every page. City/Town State Zip Code Date of Inspe ion C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No [� ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? El available 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. ❑ 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): Number of bedrooms(actual): 330 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•11/10 I Title 5 official Inspection Form:Subsurface Sewage oisposel System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -66 act,C�4,� Property Address Owner Owner's Name information is required for every page. CitylTowri State Zip Code Date of Ins ecti D. System Information Description: / C' S4,01 JrnTtovl /YOx, /o X 3,6 X o'7 e r� �,!/ 4+�.s Sa Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes B No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per y(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: 15ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is8ZY required for every page. Cityrrown State Zip Code Date of Insp ctio D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: / ��' 0 � 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 S stem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page a of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-/Not for Voluntary Assessments Property Address Owner Owner's Name ceo information is 4efvl4required for every /1 page. Citylrown State Zip Code Date of Ins ection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): �l Depth below grade: � , feet Material of construction: ❑cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet �en�alf 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: 6 x / d Sludge depth: t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts MR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1�H Gh�f�l✓1 / 4��l Property Address (O /hoc, e T S Owner Owner's Name information is CeH �✓f Ile- �/�A Oa 6 3a required for every page. City/Town State Zip Code Date of I n6pection D. System Information (cont.) Septic Tank(cont.) // Distance from top of sludge to bottom of outlet tee or baffle 7 X/o— 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 How were dimensions determined? O le �g C�g v/C Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): (A v"1 ► 1/1 Y'90 J � o 4- 4 r r T►H'I� / G✓1 {y A S l"t S t9[9 0 Z-e, 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•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 or 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address klls e4� Owner Owner's Name information is 6?0-4VVI Ile— page. required for every Citylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address / Gf�Se� Owner Owner's Name information is Ga"r► (Nf `,� L� (h�f7 required for every page. Citylrown State Zip Code Date of Inspedi D. System Information (cont.) Distribution Box(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.): Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 0� Property Address Owner Owner's Name information is required for every /Town State Zip Code Date of Insp ction Ci page. tY D. System Information (cont.) Type T —T'j-�J-/ - o"S 1-5-�'0 /0 ❑ leaching pits number. s ❑ 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.): Sl Nr 4,7--- /c —7'�', Itf ,,e . 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•11/10 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments &(a g ��s�.► ��, f� Property Address Owner Owners Name information is 11 �/` ` A' C) czl a �� required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address GI J'P�ct Owner Owner's Name CPS�V l Ile— required i information is 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 =in er supply enters the building. Check one of the boxes below: the area below ❑ drawing attached separately � R 01V -� Q 23 -29 %f—,, -a 9 15Ins•11/10 Ttle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r <a\ Commonwealth of Massachusetts Title 5 .0fficial Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments J � /J u � G/"!, Property Address l�l q SP T� Owner Owner's Name ?l information is Ce,o�1vI /_ /`//� d� . :l /� e required for everylllllli��� rC / �� a e. City/Town State Zip Code Date of Inspect n P9 D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ^ f ?— Estimated depth to high round water. �1 p g g 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 ❑ bserved site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must scribe how/you established the high ground water elevation: / � l�l q Ct N �o /0) — �a /o h -1 �✓G-w4�'-- 4�70 kE- 4 cA1 141. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 151ns-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposai System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Syysstem/ Form-Not for Voluntary(Assessments _ Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Insp cti n E. Report Completeness Checklist Inspection Summary:A, 8, C, D, or E checked inspection Summary D(System Failure Criteria Applicable to All Systems)completed tSy m Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file !Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. V t®� FEE Board of Healt ,CY �'C� __ , MA. APPLICATION F®P, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) !)Complete System ❑Individual Components Location \ VNr-, \ Owner's Name Map/Parcel# �V P)y Address ac�i1 Lot# Telephone# Installer's Namec ,r.� C Designer's Name Address S S�. Addre i Telephone# Telephone# Type of Building —S�oC�'►sul 1 Lot Size j,`Sj sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building Kk" No.of persons CP Showers (�afeteria Other Fixtures c 1(\6, <rK,,eAf\,, Design Flow (min.required) gpd Calculated design flow er Design flow provided 3,31.B,o gpd Plan: Date \ Number of sheets \� Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation 1 3 ENGW`e? Musr suPtpv,—` " STALLF:-, -;TI DESCRIPTION OF REPAIRS OR ALTERATIONS J C� � F'Y Il'J LD IN 1♦ The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees t7 not to plac �system* operation until a Certificate ofcompliance has been issued by the Board of Health. Signed 1, Date AJ4r� e �tiorr� �� +-✓Y'..''ti" "'.'•.,"'r�.._��•/`�-.aL^ �-"+�'^".r rn.��..'v�y... .-•1.+ ^•'++i_r,,IY'"•R,r....}y��tr71.+ ,,.`.«.. v�wey..,%t ys.4�.r.""�,i.�IT4� ' #-,r�', '..1a.A.tY"' •"^"i't"k.^�.,,'"ti�.j'...'�--v.. � s No_ FEE 4: Board of Health, Z ��tt �`G MA. J APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) Xcomplete System ❑Individual Components / Location Owner's Name t � Map/Parcel# Address �_ u � Rr Lot# �"} Telephone# Installer's Name � �5 C Designer's Name no r Address �, �� {. � Address X M Telephone# ��e�' Telephone# I _ Type of Building L. �GS�CISL� � Lot Size ' ��sq.ft. ,-_Dwelling-No.of Bedrooms ��'�C�S2 Garbage grinder (V< Other-Type of Building No.of persons cQ k Showers ( %,Cafeteria (VK "^ •Other Fixtures Design Flow (min.required) gpd Calculated design flow �� Design flow provided ,` Q gpd Plan: Date W 1­1, Number of sheets N Revision Date Title SJ1 _ co` < �' ). Description of Soil(s) Soil Evaluator Form No. '"""" Name of Soil Evaluatoy�_e2,-N-oe, Date of Evaluation11k 1 DESCRIPTION OF REPAIRS OR ALTERATIONS Cl' �Or7 �Cr� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrre�eys�to/not to place-the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed �lll/{ Y/� Date �1� d r ` .hasp@atoms- /f1 / / Q / r v v / ..-. Nol ml_s'O✓ COMMONWEALTH FEE "~ Board of Health, Ra/n/a 1b Ale—, MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ',Complete System The uu/o6e(r�signed herb certify that the Sewage Disposal System; Constructed ( ),Repaired (�/�Upgraded ( ),Abandoned ( ) by: at 9to gu 1­a4j!� 4 VI has been installed in accordance with the provisi jns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application N o. //,Z CO?-i5�C3, dated 11 1-11 t_ Approved De i n Flow (gpd) Installer l.� /G(1/i�(✓1 _ + f '� �G� Designer: Inspector: // _ Date: II/7-d'63, The issuance of this permit shall not be construed as a guarantee that the system will function as derCsigned. No.i� ���%�` FEE ° ,Board of Health - UI � ��C/ , MA. DISPOSAL/SYSTEM CONSTRUCTION PERMIT t 1 i Permission is hereby granted to; Construct( )� Repair(,i Upgrade( ) Abandon( ) an individual sewage disposal system t')19C,�L�II'� i� � � t (!Yl C PS l/1 E r described at / s �~ as described in the application for ,, Disposal System Construction Permit NO. dated �b/� /98 Provided: Construction shall be completed within-three years of the date 6 his p III?' All local conditions must be met. J / � �� Form 1255 Rev.5/96 A.M.Sulkin Co.'Booton,MA �' l .Date �� Board of Health c /: r. ./ /ix• (X � x ;r TOWN OF BARNSTABLE LOCATION ���� � SEWAGE # VILLAGE � —y`��`� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NOqu SEPTIC TANK CAPACITY 04- LEACHING FACILITY: (type) ! X`� (size) ��"K 34 X/ f i NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: D .3 COMPLIA.NCE DATE: Zv 03 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet 200 feet of leaching facility) on site or within . t Fac ility If an wetlands exist Wetland and Leaching ty ( Y et i Edge of Fe I within 300 feet of leaching facility) IFurnished by hirvr i i P 51 C) j Q .p 0 I i [o T>- - 20-01 13 : 62 BARNSTABLE HEALTH OEPT 5087906304 N . UL t I C)TICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PF,R0.)L,1 TIO-N TEST AND SOIL EVALUATION EXEMPTION FORM , herebycertify that the engineered ian sigmed by me Y !� P o , u ;ec UA - concerning the property located at I s �n y \f meets all of the t, Powmg , tteri�a. I This failed system is connected to a residential dwelling only. There are no .orrimercia! br business uses associated with the dwelling, f Tie soil is ciasstced as CLASS l and the percolation rase is less than or equal to rt:notes per jinch. The applicant may use historical data to conclude this f3c: or may :onduc( pre'IrrWary tests at the site without a health agent present I There :s no Increase in flow and/or change in use proposed L here are (Io vanances requested or needed. The bottom of the proposed leaching, facility will not be located less than fourteen l,) fee: aon've the maximum adjusted groundwater table elevation. (Adjust the nunc:wa;ed table usin, the Frimptor method when applicablel Please complete the following: I i �.I fop of Crouno Surface Elevation (using GIS information) 3, C. E!rvat:or, s- ad;uscmen( for high G.W. F�ENu.F.. BETWEEN .\ and B A La i S 6. ED _ _ DATE: ...- ---------- - -- NOTICE Basec jpori t^z atove information, a reoair permit wil! be issued for '-)eddooms I ddiwl)nat bedrooms are authorized to t`ce future without engtncerec is pt�c plans. I I i i i I Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION I Site Location: C2Lot No. Lt' Owner: I Address: C�t1� Contractor: i Address: _ Notes: r I i STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date G C� month/day/year STEP 2 Using Water•Llevel Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... �o5ot OWater-level range zone ..................................................... STEP 3 Using month) report "Current Water Resources Conditions" determine current depth to water level for index well ......................... 10 4 moot /year STEP 4 Using Table oflWater-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and waterdevel zone (STEP 28) determine water-level adjustment ,. ........... ............ I STEP 5 Estimate depth)to high water by subtracting jthe water• level adjustment (STEP 4) from measuredidepth to water levelat site (STEP 1) ..................................................:.......................................................... Z3 1; Figure 13.--Reproducible computation form. I I i I 02/18/2014 19:51 FAX (AO01/002 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O.Box 627,East Falmouth,MA 02536 November 20,2003 RE: Certification of Title V Septic System Installation: Residential Property 86 Buckskin Path,Centerville,TNIA Dear Sir or Madam: On November 18,2003,Roger Roberts,Inc.was issued a permit to install a Title V Septic System at 86 Buckskin Path, Centerville, MA, based on a design drawl by Shay Environmental Services on November 18,2003. 7`S7,n, I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations,Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. if you have any questions,please do not hesitate to call the undersigned at(508)-548-0796. Sincerely, CAKVENE.SHAY ENVIRONNIF,NTAL SERVICES,INC. 1\OF :' `t TJo.1181 Carmen E.Shay,R.S.;C.S.E.A o F. President r NOV-21-2003 FRI 07:35AN ID: PAaE:1 TOWN OF BARNSTABLE LOCATION F(a �� SEWAGE # VILLAGE N� -�s���� t ASSESSOR'S MAP & LOT T'?0 INSTALLER'S NAME&PHONE NO. ca> Y(� SEPTIC TANK CAPACITY �� ,-1 LEACHING FACILITY: (type) 3:!"_dG` (size) ZQ")c.34 X/ f NO. OF BEDROOMS BUILDER OR OWNER � U( 6 PERMITDATE: It COMPLIANCE DATE: (/Zo lo3 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 2W feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ph st®c 8 �,;,,',�-, ,`:� : : ,�- �, I I 1, 1� ,, � �,::� " ., , � ',',��,­,, �."-�,�-!�:""�, , �—- I -, � I I,,,, ,,,", I , "-­,�-��!`1,���"­',,t,'�'�,,�-.`,-,�' ,­�', I , I I � I 111.11'I.,,�',',1��­­' �,,�. , , � �­��,I 7'.1�,", " �,�.-,,, ,�,,:J�1-�.","'�� - � , , . �,11 . -��1: �., ,-,, "I,, ­ ­­­.,4 I -� ,,., � . � " . ,�,,­1 ,-, , I . t " " I I , � I , I �-, �. I it�, .�, ; , 4� " ,�� It ,, ",I ,,L, I , , , ,�� ,,I",tl.�,�11 1.�� - ­, , "' 1�­ , t, ` I-—I ,I I�-,�, �,­1 , � - , , �, �111"I'll.11, I -�­"I li�, t, ," 1� : . 11 I,,�- "I ,�,�,�.'�11.,,;,�I—, I -1. 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I I E 40, �-,-� _j� I I I I - ' ­I I 1 4' , , ��i'-��- -, I I I � ,- �: I I - 1� �� i ­ , I- ' , I � � � . � 11 .: , I I , "�� I I : I , ;, . SOIL `ABSORPTION SYSTEM (SAS) I " I I i � , "I'' , 11 I , L", - I ��.� 1: _x 5 C I 1 1 � - I I I � - .."'..''. ­V� I - � I I I I 11 I , - � I . I L I � I ,% S ' � .: � I � ,m � 1 ,­ � r I 11 I ,;,,, � 11 I �, I .:� I'" " _,L : , I I " I C , , .I " � �JZ'.55� �:, , :, :.: , I I I I I I I I I I 1 4 . I r, ,�, I I I I . I I I � " I I I. , 1 2"� I �- I � L � , I �q-. I �,, . ,"I I I � � I I � ., I � I I . I I . I I � 11 e� �-, - 11 I I I I I 1� .1 � I I -11, L �I I I ; I I I I I I . I 11 I I I I 11 I I I I - � �', ., e I t­1 - ....In ''.,- � .T �� TY i � (H-10 LOADING)/ GEORGE O'BRIEN�" 1, I I . . � I I o I I � - :i 1, � ,� I � I � . � ., I % I 11 I � I ' ­ , I - � I 1, INFILTATROR.HIGH CAPACI GENERAL .NOTES I . I 11 I . I 11 "I I I I I 6 i"f 3/4�'-I 1/2 1 :,a I � i 1 4) 1 � I I I �I, . � I , ,1� I � I . I .I ' I I I I I ��I � I I I I CoMpftted atone L , , , ,. EffectNe Vkft I I�. I I I� I I 11 I I I I I I � I I I 11 I I I � - � I I I I I � I I : .1 I I I , ,I 1� I - " I I � � I NOTE, -� ALL COMPONENTS MUST HAVE ,RISERS TO WITHIN 6*,aELOW GRADE 11, . I I � ,i 11 I I � �.� t�I I I � , , � 01 I �n ,. � � (OR tQUIVALENT� Not t,o,,,Scale I . � �- I � I I I 1. Contractor Is responsible for Digsafe 'noirification ,- � . 1, �, ­ � I I I I I I I... ­ I I I 0­ Bottom of'Test Hole I 10ov.-88.50 in 1,� I I I I I �11 I I I � . � , I I r I ''I - I � I .. I I I I I ' I I I � �11. � I NOTE. OVERALL HEIGHT OF iNnLTRATOR IS 18- /EFFECTIVEIHEIMT IS 10, , I I I 1. d. protection of all ,underground ,,utilities and pipe �' 1! � I � � . I I � � I I No Groundwater observed 0 132' 11 � I I I . I I - I � I I I I an � I I L � ­ . � I . I L I I � I � I I " I I � . I � . I - I - I � I- I I 11 I r 11 I- I I I . 11 I .1 � I I � I S.'' � : : I . � I � � � � � 11 , I . � I . I I "I � 1, I I � � I . � , ,� � I ,�, I ,�I I- ,� I I 11�,Vy � I I I I ,� I I I - � 11 I IL .,� �;e . I I I I I ''I I- I I. 11,� ­­ I t -I" ''I L I I I� � � I o I I-, I I �2. The 'septic tank anj distri uti6n'b'6x shall be,set I I I . . I I . I , I I � I � I I I . 1. � I I � I I � �, � - I I 1�111 I . 11 � 'I', I I I I 11 I I . I I I I � I .1 I , . 11 I I �. -, 1� I � I I L 11 L' I I "' ' ,� I I I " , , I .1 I � I � I I I level on '6"�;of 3 2"-stone. ' I—', r � I I I 1, - I I I 1-1 I ,� . I I 1.11 I � I 11 I � � � I I I I I I I 1� 11 I � I . i , I I I I , � � - � I I . �, , ' : I I I I I Z", � 11 I �I I I . �­;­ I I I � I I I I I '' � ­ L ,, 11" �� "I , , 1. 11 11 � . I I I I I I I I I I I . ,� �,'' I, - I I I I I L I I � I .1 I I I � I -,'L I , I I ,�'' �, 11 , I I - I . I I I 11 I 3.,.B()6kfill--should' be clean�sond or, gravel,v' ith no .1 L 11 - I � I I I I I . I . � � I I � I I I I I . - I "I I ­­ I " , I .1�� I � I I I . " r I I I I I ­1 I 1 13. � I, I I I I �': I . I � . I I I I I I I �I I I � I ,!stones over: , ,in :size. I 'll - I I I , -, I "I I 1. I � � I I � I . I I I I 11 . I r I I . � � I I I I I I . . I L�' - I .I I L � �, I � I I ' I ,. I i, �,11 I ­ - I I I I I � I I I I I I ''. I I � I , I I -, . I � I I I I I ­ I I I ,,,<,>V� I , I I 11 ­ 11 � -is subject to inspection,during installation 1; � I I 1� , I IL I �1, I I I ; � - . . I . - I I I I � I I 11 I "� 11, I I �, 1. . : I 11 I I I I � 1 4. This system - I .I I 11 . I I .11, ,. . P I I I I I I 1, ,� . 1;1 I 11, I � 1-1. , . I I I I "I ''I I . I I 11 ��11 � I I I I .1 I� 11 I I . ''I : I - ­ I ' 11 I , �,by tormen E., Shay,,;-- Environmental Services, Inc � , �I" � I I . I I �, ;, I I I. I I I ,,��, I ,�,� I I �I I ,, ,, I I I L� , I I I I I.,. � � L I I _,I ' , � , ' 4 ' I � I , - ,­ �- I 1. "I �, I 11 I .: , I 1 I i � I I I 1, I.I I I � I I I � � I I I I I I � I - ,�­ I I I . � " I , 1 I I , � I I "I � �� . 1 � I � I I . I � - I I I , " ' ' i s sy, In a' once ,,. : � I 1. I � . 11 I I I ,� � I I ­ I � , . I I . I I , I I, "I I - 5. . he contractor ,shall install,thi � I . I 1-�, I I 11 11 I . I % - � � I I I ' . � " � I I � I I I I .. I . � I I �.I I 11 I I I � I ,� � I I � .111�x -�,�'. � I- I <�� I I I 1. I I I I � I , I .rT I I sterii ccord I .1� . I I .. . :?, I I , �� I I I I � I . I I I I I � n, I I ''I ''I � �1�25�.009 , , �: :1 � � I I I 11 �r. I I � I I I �, I with�Title V of'.the Massachusetts state I code. the approved pIan ' I 11 I . � L ,�, � I I I I I I I I I I " , lf�', I I I ­ I I � I I I � ­ �,,� I . I � . . I I . I � . I . � I � � I I ,11� � 1, I � I,Regulations. ,,, �� � I I 11 �. I , . � "I i := I . � I � , . ­ 1, " L - I I I " 11 �I PERCOLIATION , TEST I 11 I 1� .1 , I , 11 I I I � 11 I � � , 1, , �, � � , 1, I ks", - I I ,: and,Loca L' ;I I '­,­ I I I , . I I I I 1 1 � � .R,�' 11 - . . I I I . . � __� " ,,­r I � I ., I . .�­ , r I'll �I I I I I I ,�, , � I I I . I- I I � I �1 I I � 11 1 . I 11 11 I., I I I I I I - ,�., tr . �-' i ' , ",','':� "L­ 1�4 11 � � , I I I I " - I � 11 I I I I I . I : 11 I � � I I I . . , I - e I . -, � 11 I I I I ­ � I � I "' ,, , , � ­-, I 11 11 .1 I I Date of Perc-olation,'Test,:. , -N�OVEMBER"14., 2003 :� '' , ''I ": '' " I Lr �I I I I. I 11 ,.I . I I 11 �.. I I , 1. � I I I I . , I L � � �1` -Pk------, I 11 .e� I � I I I . �, I 1. : 6.'If,� during 'installation the, 66n ractor encounters any �' ' I 1, , I . I �. . I I �, . � I I '. I - I I I I . I 11 I C), I I . 11 I ' � � I � I I I., I -i � I , I � I I .I . I I I I I I I � � I I 11 I I I I 11 I I I , 2 ­ ­ I �that are diffe I � I � 1 I . 1 �39 27 1 1 1 1 r I 1, �� I .10 rent 11 I I ,.,� � , Test Performed By- -CARMEN-E SHAY RS-, C.S.E. , , o�, I I I 11 I I . I I I I I I . .11 , %- I (I I I I I . .sail �conditions or 'site conditions,r' I 11 - L r � . � " I I - � �, -, . " I I !, " ' I I I I I I I I I ­I .�I I I I - I ­ ­ ,�, I I ., I I . I;0;---,�­ 1 �� I , I I I '' , ' . in 7ur design . ,, . � . - ' I I I �i , I I L ,� , . I L-, � Abo;�- � ,�,�v I from Ithose shown on the, Boil log� r' i � . I , - � , 11 � I I I � I I 11 11 � , 1, 6 I I I i � , Results Wtnessed By..�WAIVEk Z1 pei.�,`,�ar�si'oble B.O.H.)�� It�­ I I I I I .� I I ��: I 11 I . I , I I P /, r � I I 11 0 1 1 1 11 I I I �. - I I I c I ,I��, I I I I I I .1 I 11 , I �11 1 -7- 1 ,,�C/Y,� I - I I I I I ' ' I . I . , 'mediate notification be , . I , I I I - � I I I I ,:_� I L, - , . I� I . . , 11 . I I � I I I - I /.�, I � ,,_ L. ,� , 4C,�V, .� Ans a ion must halt & Li . ��'�" � '�­ , I � , � I I L . � ' .. . IL � 'I, , :­ i - " I I m - : I I I . -21 � SHAY,ENVIRONMENTAL SERVICES' W��I:�­, �­ �,� '. I � -V , _ , I t 'Ilot� � I � I � I � - 1- . 1111 , I I ­ � I I ,� I I I L I . � I I I I � .�� I, 1. . L � 1, I I I - � I I I � I ,;:) , , I I � I 1 3' �'­ I �, � � rj'J I � r " , . 1. I /, �' ­ � 1 I -.�,, , 0, .1 11 ....0 100, "I I I �� made to Carmen'E. 'Shay" ,tmtironmental Services, Inc. I I ': I � ,� . I, I I I I I 13 I I . I I I " I I � / �, I I �? 11 , 17, 1 1 - I Percolation' Rate.,, :'Les �Than.,2 MPI 0 40",1�1 ', 11 I � I I I� I I I I I I I � 11 11 .I I 1 ­ I : I I I � 11 I ''I I I I P � I ' ' L I . I � I 5 , I � I . 11 .� I I 11 - I I I ­ ,,, I . I ­ ' ' I I I : ol , I I I I , , 71 �,,,- I I , , , � , � � I - I � �­, ''I �," �. . I I -� � � � , . e I � i .%, , I I ; I �, I I I I . , ,,� -�o. , � I . I I I 11.1 1 4� /� , � � I 11 / � MI. � I I - , I 11 . I r I I I I ­ I I ,, � " I ,� �­' -,� � � � I . I I I , I I I I I 1r,q)-) , - machinery 'shall ,drive over the I I L�, 11; ­: I I I '� -1�.,' ,yc, �, x I 1- I I � � . I I I - ` 1 , * 111!,e L 7. No vehic 1 , I I 1� 1, . 1� 11 " I I 11 1, 'I' - ,� I � ,. ,� I I . '. �." .!4 . ­- I � I I -, I I I I I I / 'I, I i � I -`11 I I � �­­1011!�� , 'I . .le cirl,heaVy " I I I , �, ,� . I I-,�� . I � , I � I I (�,\ , 1 r,4 e I I� I I I 11 I � �,, - � I - � � ; , I I I � � � I ' I i I,,�4� 1 41, , �, 4,, �, I - � I I.- I � - �,� .,-%-; "k I r ,� '11, I � 4 / 1 34' , , 11 ,:", I I I , I I 11 I I fj.,--�, I I , I I I 11 . I I I � 11 I 11 Ir ­I I I I I I � I � , I � I I , I �I I r 1.� I � . I 4t� , I , , I ,f\A' ,­,\�,--. '� - 1�"I I �, ., I I ,� � - -. . � , septic -system' unless noted as H­��20 septic components. -, I I r ; : '� : � �, :", , � I . I I � I I I , I . r " I � ' , '' I I �� - I I I I I :: I/ � I I I : " I .1 * . I I�' �� " I I ,� -I :r' I . 1 , .1k;1 , - , n -. I, ­I , I �"­. - I -41e�: �,8."Install: - I br'eqU outlet tee ends. � �� ­ I I , o � �,�' "�, ­ : .�', , ", � I I I . I! � I I I I I I � I"\,,- v ,.- ­1 .�- ­ 1 � �,� I 1 �­ � / . r � ''. I . I I I 11 ,,'Tuf rite gas baffles als�an ,all " 1, �, I I � �, I � ,e , 1,1; � � , I . .1 11 C%, _ . �� %, ,� r , I I I � I I I - 11 -- , 1, ,,,�� I I '. ­ , I I I I I - I � I I � I 1 '. I I I I I ­I ,� I - I I , I I I I I I I I � - I ,.I � � I I I -- I �.1 I�, . I I � b ­-4o�di" 't, ", " � " I . I I I I I I I z11'' I 1,111 �,�, � I I� I I, ,I, , : ;, I �I ,, 1 I I I .1 � .I 1� I , I " 11 . I I 11 I I 11�vz� C ,J :I �­�1� � . I -1, I I � , 11 I - I % I- I/ I I I I ,� 11 I I 1 I I I 1 9. All ibuitia 'Lines shall ,' e , � ameter Schedule 40 NSF PVC.:pipes. I I I � ,. I . , I- � ,.,I I� r I I � - I I I . - n I, I I I ',L�_ � I 1 I � , / I � I - I I . "I " � V� I � I - � I 11 I���� � I�� I . � I I I ". I I ­ I I I 11 , � IS- I � - "," I I I I I `0J I I I I . Lrl � � 11 I � , � I Distri ­ I I . I 1 I- ,. � '' I �� I�I.. I .4. I 11 : e . I I � - I I I � : � ,\1 -e) � , L 4, 1 1 � I 1. 11 : '.:, ­, � / , I I-, I �-, " . . ." 11,­ L 11 .I , I , , I � � I I I 11 I 1� I'll I I . I I I � .T� S,k�\G - -I I I � I ,,,,, I I I I I I 11 I � I I I - I - ,� � " ' . I I . I. I I I � I I t� I I I I I " 1:66i�& I I . I I . I �,", .1 I ­1 I . :,-, , , I �,N\N�t�-� I - I I I - � � I, . 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NOTE- ANY STRIPPED OUT SOIL CONTAINING LEACHATE I L � I � I I � 1,I I . Soria 1. I� �-4' � � I I ,I, � I �I I 11 �I I 11 I I I�, I I / . . I , � I I I I � .1 I I , I I I I I � � I '' ­ I I �� 1. I ,­ I � '.� ­1 1, I I , I I I I t � I I I k � " I / � I - I I I I // 11 ��, . FROM THE EXISTING CESSP001­2 TO BE DISPOSED I I I I I � � I I I I I � I � I I I I I ,z I I I I I �I �. \ � ", 1, .: , / . I I I I ­ �, / I . I r . I I L I , I - I I 11 1 2,6 Y 8/6 1. . 1. I I - I I I I I , 11 I � , I OF AS PER SOARD ,OF HEALTH SPECnCATIONS. � I I I I I I I I � I 11 � 150*-132"L, q 88.50 1 1 � � 11 � I I I . I � I �, I I I I 11 I �� . I ,� . // I I I I I I I // I .1� I I I I , I I � , 4 ': � I 11 11, I . � I N I I / I , 1Y ' - I - r . � I ­ , - I �I�Ir . , I - - ­­- -- ---�­ ­- I- -- I - I - , , - / - ­-- I �- � - I -,� - �I -� I -- - - -- ,- - - --- I --NO- 1 200' OF THE PROPER - I - I I , I I ' ' , ' L ' e , / I I I� � I I x / I I I WETLANDS ARE,PRESENT WITHIN � I � I . I I I�I I I I I � I .� .. 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I I I I I , ,��. 2,C ROAMABLE COVM I �I � "', � I � I I I � I -1 I I I I , I I ,\ � I I I I . I I I � I I I I I I I �0 � I , ,, I I I I I � LOT #40 1 1 1 HARLEY & , G RAC E THURBER I � " � � 1, I � .�,11 , � I I � I - 11 � I I I I I I I � li I I . I I I I 11 � I I I . I I I I I � .1 . L 11 I I I % I I I �� I . ", I � � I � I I � I — r--" I I ,, I I I — , I 11 I I I , LOT #39 , �, I I I I � . I I �, I I I AT , L � I I ; -I .. - - . -., . - ... e I . .­--� -L-�,T � � � I I I . I I I - I I I I I � ,. I ." I I I I �,� . � . .. .. I ,� I I I - -F-41-- . I I � I I I . I I I I � � I L . I I I I - 3"Min. I - I I ;� " I I I . I I : I I _J - �. I . - I I 1, - I � I � I 1 � I I I . I I I I I I INLET--E!� - , .� 'I', I ., ,.: Ir V&"-r'! I I . I I I . � I , 86 BUCKSKIN, PATH I I I - . I I ­1 I � � I I I I I � I I I I ' ll, I I ," I 11 I I I I 11 I " . % , I ., 8,no'.F 1 2 min. Not t I a outlet or we, - GUM-ET� - - —�:. I I I :1 I I ­ � �� I I I I I I , I I � I I . I , I I I �: I I I I I I I � I " I � L � , 11 I -, , I . INLE r � , I I. I % I I I. .� I I I �L I I I I I I I ) I I � . I'll- \ I I Ile I : I I I' ' ,� -. I I I I . � ;. � I 1-1; I -% I I I i I � I. I I I I I ,� I � I I . � I I � � I I . 11 I I I :� r - I 1. I I I� I � — -� , � ,. � 11 1-4 .. I � f T � I I I � , I . I 11 5, 'r " llr:��11 U;i�l I � I L- W I ,-5--7' 1 1 1 '' I 11 1 - 11 I 11 I . I I I I I - , . I I I � � I ,, ," CENTERVILLE MAK I - � I I 11 ,� 11: 1 ,95 , . I � � �.d � % 1, I I . L I � I I - 11 1 . 7 I I I . I � I I 11 I : , - I I 11 1. I I %I � I I I . . - - , � I I I � 1, I I I I I I I .: 1 I . I I - .1, 'L I � . I I I I I% I 1,I I. ! %Ft I'. , I ;� e � ,V-O" min.. ..'1',� I I % : I �% �I I Desic1h COIC010tio , " I 11 I " I . I � I I 1. I I �.., 1 ,4 :",r, . Q-SSW. '� " � - . . , % I 11 I I I � ,. - 7. .�I­l I � I I I I I - I � I I I � : 6 ,. I 11 I;. � � . Liwid depth � r, ; , 1% I 11 I I � I I r, 1, I I I I I I I 1 �,6 - �!,<�511 1 1 � I , ,� I ,, � I . � . I � . 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I I . �� - I '05 1 1 1 - 10`--W ­, =- ---=--i;;71J , .. I �' ay Minimum (Min.-Per Title V) i ' Y­% ',E.'r ' ' %SHA Y I ' '. . '" . ­ I I '. I" I . I . �7 -, ­::-;i� -_,�i,� -, , Garbage,Grinder.No , I I I I . , I I I 1% I,I I - j, I � I I I I I . � � I � I L N , ,P 24 ­I � I T,­�.- ; " -�I, ----!� --- - .� �V` - 1 4 � �" � . I oposed:- 336�Cal./b � 111­/-�A ff � I ,. I .� . I I ? I I I � . I . �I I I I : , " . I I I -1 . I .I It-, . I 1, "I I I I I � '� " I I I , :Septic Ton . y = 660 USE 1.5oo :GAL Septic, tank. ,� I , �, I . I .� 6 cr) '. �� I - I - � I 1i 1, I- L — � :S ECTIO , ' �­ ' ,� I , ,,, k -' -�­ 3 x Z30' Gat./Do I � � '' I 1 I 11, I ' ,., . � I - I I I I� I I 1 -4 1 1 1 , , , I ' -1 I "O ENV 1, I . I I I , � "I , I I i e' I 11 I I -1 I I - - . 4 � , IRONMENTAL"SERVICES, INC. I , � I I - %� , � I 11% CROSS-. 0 :� � END= ECTIO�', -1, I � I., -� ,Using per661ation` ' te ot,<2 min./in6h ,,'.,. I . I I I 0 , , 201, - 0 50�.." I .1 . 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