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HomeMy WebLinkAbout0244 BUCKSKIN PATH - Health 2.44 BUCKSKIN PATH Centerville A = 171 — 033 1 fo rd NO. 152 1/3 ORA 1 2 Commonwealth of Massachusetts �w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t t ,.• 244 Buckskin Path V� Property Address Kristen and Matthew Koch Owner Owner's Name / information is required for every Centerville ✓ MA 02632 09/17/2020 page. Cityrrown 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 filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails _ 09 1/8=20—- Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 9 Commonwealth of Massachusetts 1. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This 4 bedroom home has an H-10 1000 gallon septic tank with an H-10 D-Box feeding 16 infiltrators. At the time of the inspection no visible failure criteria was found. System is scheduled to be purred after the inspection for maint. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <, 244 Buckskin Path v Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3 Further Evaluation is Y Required b the Board of Health: q ❑ 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. a. 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: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,1�3 Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 244 Buckskin Path V� Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth _ .. monwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 244 Buckskin Path V� Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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 Were the Were as built plans of the system obtained and examined? were not ( Y 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632, 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gpd))� Detail: In 2019-117,000 gallons were used and in 2018-123 000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts r ►�-p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: New leaching 11/22/2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): I Depth below grade: 26"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts :. Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u� 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) I 6. Septic Tank(locate on site plan): i 18„ Depth below grade: 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: H-10 1000 gallon I Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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 the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >r u- 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: * Ye P 9 ❑ s ❑ 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 16 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is required for every Centerville MA 02632 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information equir for is every Centerville required for eve MA 02632 09/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 s I **As-Built from the installer attached on next page** t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Assessing As-Built Cards https:Htownofbamstable.us/Departments/Assessing/Property_Valu... i TOWN OF BARNSTABLE LOCATION 2 t�' QU4 k s l j4 Pwlr4 SEWAGE II VILLAGE LFNtGVVj/�a ASSESSOR'S MAP&PARCEL/7/-33 INSTALLER'S NAME&PHONE NO.,-OS-5 20-9738 �pS�foLj �jgy,oS j SEPTIC TANK CAPACITY 20o LEACHING FACILITY:(type)y-/locu3 ✓iGk yubiTfsi�e) 2YX//,32 NO.OF BEDROOMS 3 OWNER I,/saN STf?l9UG�jv� PERMrFDATE:.//-/5r!/ COMPLIANCE DATE: (/^22-// Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet ofteachhiingfacility) Feet FDRNISHFDBY QoekSk,ir Path _ (4 .unu 'eck 0" 166 C so. ,) porn I I 1 of 1 9/14/2020,6:45 PM Commonwealth of Massachusetts I�P Title 5 Official Inspection Form +_ 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 244 Buckskin Path Property Address Kristen and Matthew Koch Owner Owner's Name information is Centerville MA 02632 09/17/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feetfeet 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: I You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 244 Buckskin Path V Property Address Kristen and Matthew Koch Owner Owner's Name information is Centerville MA 02632 09/17/2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ry)l 33 /� P t 2l.--o • No. /� ��� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitation for Disposal 6pstem Construction 3permit Application for a Permit to Construct(Z,)- Repair(.'- Jpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. yy QU6(c'Sl<l4! /2j4 rG, Owner's Name,Address,and Tel.No. sr�qugh Assessor's Map/Parcel 171-33 �Et�r-gev 1 h Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.S OE-f61-2 922 Il�rr�,n �yI-e c,-ei^ E. hWe-,611, Type of Building: Dwelling No.of Bedrooms Lot Size �� �,� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 7 gpd Design flow provided cJcJ gpd Plan Date /�� l/ Number of sheets 641 Revision Date Title Size of Septic Tank X f OD Type of S.A.S. Description of Soil Nature of Repairs or Alter ons(Answer when applicable) N,�r"kJ/, y- /20G!/S O F �nF/lfiNif Ta/"S Qui��e 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. I t •.+ c.��� Date /) /� t Application Approved C�T� - Date Application Disapproved by Date for the following reasons Permit No. ' �/ 3 3 Date Issued J �j F o3 -,No. ,, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH pl / SION - TOWN OF BARNSTABL.E MASSACHUSETTS Yes aPP11Latt0 "for Jisposal .pstrm Construction Permit Application for a Permit to Construct(4- Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2'I'Y 9CICkS1,11 I 1-24 r17 Owner's Name,Address,and Tel.No. St�a ugh�r Assessor's Map/Parcel /'7/-'�� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.,S•OG-fG 2- 2'122 Type of Building: Dwelling No.of Bedrooms Lot Size �� �41� ®sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) 3 c�0 gpd Design flow provided 33�► gpd Plan Date �10 1J Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil x, Nature of Repairs orAlteraations(Answer when applicable) 74/5 rr411 `/ - 11 O //)• 'r- �/ J7A9 iQ�cil lit n,/TJ w/T4 /v, STUy/f Date last inspected: Agreement: 3 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ' 3 1 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. ' Date /1 )1 q Application Approved Date l 4 Application Disapproved by Date for the following reasons q ^� Permit No. '"' J� 7 J Date Issued THE COMMONWEALTH OF MASSACHUSETTS : BARNSTABLE, MASSACHUSETTS Certificate of CompYlattre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(4--)- Repaired(�-j Upgraded( ) Abandoned( )by at 2"-/'-1 1561GK SA-ice/ 'T�� �i:t�T=��(//�l/� has been constructed in accordance by) with the pr/ovisions of Title 5 and the for Disposal System Construction Permit Now"J) �39dated Installer%'jf/'/° 6,� L pj"- Designer #bedrooms 3 Approved design flow 3 3 c> and �._.., The issuance of this permit shallnotbe cco sued as a guarantee that the syste w CI o signed. Date ' I 1 , r Ins ector ---------------------------------------------------------- = _ No. C>AY ' � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal 6pstem Construrtion �Prmit Permission is hereby granted to Construct Repair(�) Upgrade Abandon ) Abandon( ) System located at Crr�Tr--�v�1tN 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 a c'oni leted within three years of the date of this ermit. Date � � �I 7) Approved by ��_ NOV/22/2011/TUE 04:46 FM SandwichTownOff ices FAX No. 1 5C8 833 OC18 P. 001/001 Town of Barnstable Regulatory Services » Thomas F, Geiler, Director KAM Public He2lth Division ' Thomas McKean, Director 200 Main Street,Hyannis,yL4 02601 Office: 508-862-4644 Fax: 503-790-6304 Installer& Desigaer Certification Form Dates 4� Sewage Permit ssessor's iV1ap11'arcel jG Designer `rYf'-4& '�T Installer: 99cv_e" Ad ess: P _ � K 1VI Address: On // J'11was issued a permit to install a d installer septic system at ,w L.iC -s1::4 4 Poiw based on a design drawn by (address) dated . (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved chan.ges such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. gxeater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State c Local Regulations. Platt revision or certified as-built by designer to follow, OF Cal DA E NU (Ins ler's Signature) ' (Designer's Signature) (Affix Desiper's Stamp here) PLEASE RETURN TO SARNSTA rEPUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUR LIC HEALTH DIVISION. THANK YOU. Q: Heafth/SepticDe6grer Cartit:cation Fomi 3-26-41doc TOWN/WN OF BARNSTABLE 'LOCATION 2 `,�� 906l�_'4-/4 P4TG, SEWAGE# 2D//—,?93 VILLAGE ASSESSOR'S MAP&PARCEL_171-1,5 INSTALLER'S NAME&PHONE NO. SO$-1720-�F�S 1a_5z 04 l7�y'`O5 SEPTIC TANK CAPACITY /4900 LEACHING FACILITY: (type) Z/-nowj �diGk Yuti/Ts�size) ,?`/X NO.OF BEDROOMS 3 OWNER ,S11S/4`! 5'rRJ4a0# PERMIT DATE: COMPLIANCE DATE: //"22 - Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY duc%Sk.if Poril 6\ w� rj�c�C oF�io�SG 3 io„ ti �o 41 Porr y ��own.of.B -astable. P#— z 7 Department of Regulatory Services , Bate Public j3ealth Division • KAM 1639. tee$ 200 Main Street,Hyannis MA 02601 Date Scheduled /y/ `��� i`Time. Fee Pd. i Soil Suitability Assess kent,for Se e Disposal Performed By: /•1(p ' Witnessed By: y.'.w�1�.h C� LOCATION& GENEPAL INFORMATION 1 Location Address 2t- LI 4V�f�j t+� �' Owner's Name "r Q�l �✓) I I Address � . P 1-71 /®3� I En neees Name Assessor s Ma /P reel: g� NEW CONSIRUt2ON REPAIR �� Telephone �L)�� f1- t 2-Z: Land Use f`+1 -����/ Slopes(%) !©� Surface Stones � Distances from: Open Water Body '>2W Ft Possible wet! _ft Drinking Water well ft Drainage Way } U O ft Pmperty Line l y ft Other ft SKETCH:(Street name,dimcnsiods'of 104 exact locations of test holes&perc tests,locate wetlands in proximity to holes) om 3]N3! --55'9l l -.--y�-9,- M,SO,HO.BZS d O .t O Ii`ems. a .00',Z 1 A. i n a ez < �'-- o c',b u . � os><< 3sz osseN i '�.--- --------------- F Hldd M>is ione i Parent material(geologic) /�" 1 Depth to Bedrock ' Depth to Groundwatdr. Standing Water in Hole:' i Weeping from Pit Face ' Estimated Seasonal Tbgh Groundwater , ! DtTERMNATION FOR SEASONAL HIGH,'WATER T,DLE. Method Used: I. • ' ! ln. Depth C bperved standing in obs.hole: in. Depth td S011 m0ttlr s, Depth toiweeping from side of obs.hole ! in, ©roundwater Adjuettttent A! .factor.,.._—.Adj.firoundwaterl evel.,,�,o, Index Well# Reading Date Index Well levdl -- 'U PERCOLATION TEST . DateTime Observation Hole# Time at 6" Depth of Perc Start Pre-soak Time.9 2 End Pre-soak ltateMinJInch !/ ' ' Site Suitability Asse sment Site Passed _ Site Failed; Additional Testing Needed(YIN)' Observadoti Hole Data To Be Completed on Back— OriginaL•.Public I-161th Division ***If percolalion test is to be conducted within 100' of wetland,.-You must first notify the Barnstable Cd.#servation DiNision at least one (1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil ' Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel .611 tl to of N i.gy 10 4 tl, �. M�• 2 -Y 7� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. f� Consistenc %Gra el ti d T11&4m L4 b 0/ l� 1-61 6 DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Ul ther Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones.Boulders. Consisten ra I Flood Ins'nrar&-&�ate'Map: boundary Above 500 year flood bou ry No Yes --- . Within 500 year boundary No X Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou material exist.in all areas observed throughout the area proposed for the'soil absorption system? If not,what is the depth of naturally occurring p rvious material? Certification I certify that on V r (date)I have passed the soil evaluator examination approved by the Department of En 'r nmental Protection and.that the above analysis was pe ormed by me consistent with the required,tra' n ,expert se and ex erience described in 3.10 CNM 15.01 - Signature Date l l l (1 QASEPTIC�PERCFORM.DOC TOWN OF BARNSTABLE LOCATION 249 v as<:l it l ATI-` SEWAGE # VILLAGE C—UNWS LV 1 L LEE ASSESSOR'S MAP& LOT 1-7( �33 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY kcnC7 GAC LEACHING FACILITY: (type) IN t (size) I CTcA L NO.OF BEDROOMS 3 BUILDER OR OWNER NQR.Mdal S-rA-Fa PERMITDATE: COMPLIANCE'DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by tiotylFeLZ EV- _ r i u K 0 CEN TER VILLE PARCEL ID: ci' J 171/34 _ ' Z i, \oti s6 N �2�0 A 441 Q EXIST. 1 ,000G z r w SEPTIC TANK " o W 1> N LOCUS \� f TBM:COR BLHD EL J i 244 TH cF LOCUS MAP i „ # „ 14 OAK TOF=55.00 TH-2 PARCEL ID: 8 OAK ® LOCUS INFORMATION h , 16°oAK J 191/220 PLAN REF: 244/67 G .. Al -, V� TITLE REF: 8622 022 40� s219 / PARCEL ID: MAP 171 PAR. 33 C' FLOOD COMMUN ZONE: „A, PANEL: 250001-0015—C DATED:08/19/85 TOP OF TANK i SEPTIC SYSTEM W ELEV=52.86 J sIM t i/ REPAIR PLAN 0) LOCATED AT: 244 BUCKSKIN PATH 30"OAK ��F CEN TER VI LLE, MA. 24 OAK / GENERAL NOTES: PREPARED FOR ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL N 0 R M A N M . ��� 8c S U S A N ry� 12"OAK BOARD OF HEALTH AND THE DESIGN ENGINEER. Insp. Ports 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS S TR A U G H N o i OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. OCTOBER 28, 2011 N6� 4"QAK J 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE J553.10 DESIGN ENGINEER. ry' > (t 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �� yq OF FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. DA R N M. yG \ h 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. M PARCEL ID: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �32 171/33 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \1 0. 1140 18°SPRUCE ` HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 66 AREA=15,452f S.F. �ry 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �S1ERE� t 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PARCEL ID: TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 171/32 PARCEL ID: 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 191/219 CONSTRUCTION. 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. (LOCATION OF LEACHING IS UNKNOWN)11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION MEYER & SONS, INC. 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY P.O. BOX 981 ti PARCEL ID: { 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING i 191/218 1l 14. ALL PIPE TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) EAST SANDWICH 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW M A. 02537 FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING (5 0 8)3 6 2—2 9 2 2 }'17. PROPERTY IS IN ZONE II OR NITROGEN SENSITIVE AREA. SHEET 1 OF 2 J 1378 NOTE: TO' PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:51.33 FOR A DISTANCE OF 15' AROUND THE ' PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=55.0 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVEROF4s F.G. EL.=5O 2fET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. F.G. EL.=54.2f F.G. EL: 54.0t F.G. IEL: 54.0 (MAX.) DAR E R L = 11't 9" MIN COVER/ j 36" MAX COVER L = 15' L = 10'(MAX INSTALL TWO INSPECTION PORTS (MIN.) '�G/STEM ® 5=196 (MIN.) 0 S=1X (MIN.) 0 S=ix (MIN.) Sq \P� fl 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC NITAR 10' 14" s 11.2" TO v1 r'01V.=51.86 4e" uouiD INV.=51.61INVERT LEVELPROPOSED INV.=51.10 GAS BAFFLE 4 ROWS OF 6 UNITS AT 4'/UNIT 24'/ROW INV.=51.27 DB-5 INV.=51.0 SOIL ABSORPTION SYSTEM (PROFILE EXISTING 1,000 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER BACKFfLL WITH CLEAN PERC SAND 47" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=51.33 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 51.0 GRADE ON A MECHANICALL COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 50.33 EXISTING SUITABLE Egg 310 CMR 15.221(2) 2.83' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF _ TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' = 11.32 f 48" IF FAILED, DAMAGED, OR UNDERSIZED. (6.83' PROVIDED) USE 4 ROWS OF 6-INFILTRATOR QUICK 4 PROFILE 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL.=43.50 - STANDARD UNITS-NO STONE GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION N � 12" N.T.S. N.T.S. 8" DESIGN CRITERIA SOIL LOG P#: 13449 �- 2 r i I NUMBER OF BEDROOMS: 3 BEDROOM DESIGN DATE: OCTOBER 25, 2011 I�34" � SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DON DESMARAIS, BARNSTABLE BOH INFILTRATOR QUICK 4 STANDARD UNIT DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth DESIGN FLOW: 330 G.P.D. 54.60 0" i 54.50 0" A LOAMY SAND ` '4 LOAMY SAND MODEL QUICK 4 STD GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 54.18 10YR 3/2 5" 54.08 10YR 3/2 5" LENGTH 48" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY B B EFFECTIVE LENGTH 48" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY SANDY LOAM SANDY LOAM DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. .74 52.02 LEACHING AREA REQUIRED: (330) = 445.94 S.F. 10YR s/s 10YR s/s SIDE WALL HEIGHT 8" C1 31" 51.92 31" DISTRIBUTION BOX: 4 OUTLETS (MINIMUM) MEDIUM SAND C1 MEDIUM SAND OVERALL HEIGHT 12 PRIMARY S.A.S. PERC • EL. 50.42 „ 2.5Y 6/4 2.5Y 6/4 OVERALL WIDTH 34 USE 4 ROWS OF 6 - INFILTRATOR QUICK 4 STANDARD UNITS NO STONE 49.77 C2 58" 49.67 C2 58" CAPACITY (43.5 GAL) BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) MEDIUM SAND MEDIUM SAND PROPOSED SEPTIC SYSTEM/SITE PLAN (BIODIFFUSERS) 24 UNITS x 4.0 LF x 4.73 SF/LF = 454.08 SF 2.5Y 7/3 2.5Y 7/3 DESIGN FLOW PROVIDED: 0.74(454.08 GPD/SF) = 336.02 GPD > 330 GPD req'd 43.60 132" 43.50 132" 244 BUCKSKIN PATH CENTERVILLE MA PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Straughn NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB, NO. DARRENM.MEYER,R.S. MacDougall Survey NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 po BOX 981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 (508) 419-1086 DATE CHECKED SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam In October, 1999. 508-362-2922 1 D/28/1 1 D.M.M. 2 Of 2