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HomeMy WebLinkAbout0360 BUCKSKIN PATH - Health 360 Buckskin Path (Centerville) A= Iq) - 130 i Town of Barnstable ' Departinent of Regulatory Services Public Health Division Date lFz h1KtIN 200 Main Street,Hyannis MA 02601 Date Scheduled �n (� ' -- Time_ Fee Pd. 0 Soil Suitability Assessment for Sewa a Disposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address r,/� Owner's Name Fc� 3.e — M o Address Assessor's Map/Parcel: 360 0,jCV_51G1,r f'A 6,,t I Engineer's Name NEW CONMUC 1ON REPAIR b vVJA AN* Telephone# 50 r6 , Z-7 _`? Land Use• IAPI Il lq Slopes(%) ©'` ©/p `� Surface Stones Mo Distancesfrom: Open Water Body- 7�ft possible Wet•Area 7 r—ODU ft Drinking Water Well7 100 fc Drainage Way N ft Property Line _ deft Other • ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands•fn proximity to holes) U ck;Sl�i'n Pao-, r t— Deck cZi r Parent material(geologic) (0 LA Gi o (� r}WaSh D 7 • Depth to Bedrock Depth to Groundwater. Standing Water in Hole:_ A 111 Weeping from Pit Face Estimated Seasonal High Groundwater N I A Met hod Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: In, Depth to soil mottles: In. Depth to weeping from side of obs,hole: In, Groundwater Adjuatment fr, Index Well# Reading Date: Index Well level „ Adj,thCtbr. ,y ,�dj,araUndwater Level,, PERCOLATION TEST bate 1 l Thee : _,2m ? Observation ,,, Hole# �la , Time at 9" Depth of Pere �t Time at 6" Start Pre-soak Time @ D i) Time(9"-6") End Pre-soak • i o0 Rate MinlInch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify.the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\.SEPTICIPERCFORM.DOC 7(in.) P.OBSERVATION HOLE LOG Hole# =1 FSurface Horizon Soil Texture .Sdil Color Soil (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders. o rsistencv.%OraveD A MSL `(� � 3I2 P M LS Cl O-C 5re4. s 0 l s- I Lo Cz Pal.C. Sae%J (a sly Depth from DEEP OBSERVATION HOLE LOG Hole#.L7 Soil Horizon Soil Texture Soil Color Soil Surface(in.) _ (USDA) Other (Munsell) Mottling (Structure,Stones,Boulders. ngistency,% me I� - 3o 6 . _MSS to 3a - 4,— Cr I�l—C G����l M_C SA"a to . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistengySjUmvell DEEP OBSERVATION HOLE LOG Hole# Depth from .Soil Horizon Soil Texture Soil Color Soli Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Man: Above 500 year flood boundary No Within 500 year boundary No✓+ Yes._ Within 100 year flood boundary No.� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi•us material exist in all areas observed throughout the area proposed for the soil absorption system? If.not,what is the depth of naturally occurring pervious material? Certification I certify that on .]NOV. ���- (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required traini g,expertise and experience described in 10 CMR 15.017. Signature Date Q:\S.EPTICIPERCFORM.DOC i No. _ Fee THE COMMONWEALTH OF MA�SSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliLation for Misposal *pstrm Construction Vertu Application for a Permit to Construct( ) Repair(\XUpgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 3 60 �,e�1<��`r Q ram, Owner's Name,Address,and Tel.No. 5c�� V�®c��► ' Assessor's Map/Parcel /? /s o � G :3.,�%:c-Q"��,-, ��� 3 Installer's Name,Address,and Tel.No. 166signer's Name,Address,and Tel.No. L,', Type of Building: Dwelling No.of Bedrooms 3 Lot Size j f_sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 5 j— gpd Plan Date r `�`� ( Number of sheets ` Revision Date Title Size of Septic Tank j 6cZD m S Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ✓�s:3 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 Healt . Date Application Approved b Date Application Disapproved by Date for the following reasons Permit No. /�% Date Issuedto . . � . _ �� No. � -- �` �-.�: A Fee ^ � Entered in computer: THE COMMONWEALTH OF MASSCHUSETTS PUBLIC HEALTDI,V,ISION -.TOWN`OF Ba41RNS BLE, MASSACHUSETTS Yes �4pYication for Disposal Opstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 360 Qc���`�,�/. �Y�, Owner's Name,Address,and Tel.No. S�P 1l�oc�1� Assessor's Map/Parcel ��d `� ' ''� G �,,4�s��� ��� ���� ���~ K .l\�C \\iAC:--� 3 Installer's Name,Address,and Tel.No. e.o: •l '`tr, $t igner's Name,Address,and Tel.No.L,', Type of Building: Dwelling No.of Bedrooms 3 Lot Size S sq.ft. Garbage Grinder( ) Other Type of Building z-; No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) C7 gpd Design flow provided 5 5f gpd Plan Date r o t ( Number of sheets Revision Date Title Size of Septic Tank ti 6Gp a _�� �v� S_ Type of S.A.S. Description of Soil `,<—� �i i Nature of Repairs or Alterations(Answer when applicable) '�,�.5 v \ we ��{_:2CZ � �O uaf�S yJQ�_���l L.�.�•�' � CCC�,>.�` ��-zs—.� `� rows c3� s 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. r Signed Date �? r Application Approved b Date ao ,5��/J Application Disapproved by Date for the following reasons Permit No.�e ff �-c Date Issued -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 111 1p ated Installer `��.pc A �� — - ,�,,c, Designer #bedrooms 3 Approved design flow U gpd The issuance of this permit sha 1 not be c nstrued as a guarantee that the syste will func'on si : ed. Date [ � ( Inspec r --- - - ---- --- -- - - -- - --- ---- - ---- --- - -- ------ ----------- No. CT(a// 'aQ FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem (Construction permit Permission is hereby granted to Construct( ) Repair(&-I Upgrade( ) Abandon( ) System located at 0 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his&r duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must Pe compled ithin three years of the date of this permit. Date (P/ �/ Approved by ,,� i Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director Fp N1P�A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: cf _ Sewage Permit# OC>* QzQ Assessor's Map/Parcel 3 C7 Installer&Designer Certification Form Designer: Csu ;lnc��r�na Installer: ��c�� �c '� -r�c_ Address: Po 6 e.4- 2_­3o Address: `�.d. mac 73- ._VMN Cas!z,3 On--�, Q cQ ass - was issued a permit to install a (date5 Nstaller) septic system at 3CQ `ix� �> `��. based on a design drawn by (address) dated. (designer) ' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if requ ected and the soils were found satisfactory. � LIND J. G PIN nstaller's Signature) " 0 (Designer's Signature) (Affix Designers tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc TOWN OF BARNSTABLE LOCATION'® �c�C,�CS���� SEWAGE#-DOS VILLAGE CC )r,r tj,�\ V- ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Qp c-3 C k C, (size) NO.OF BEDROOMS r OWNER ® C.,J -e r PERMIT DATE: (5�/ g/ I j COMPLIANCE DATE: a f 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 J 300 feet of leaching facility) G Feet FURNISHED BY r S3 -3 C r ��L` : r.7 f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 0 DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 360 Buckskin Path Centerville Owner's Name: F_ Mello Owner's Address: Date of Inspection: Name of Inspector: (please print) Wi 1 1 i am E_ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: ( 5 0 8) 7 7 5-8 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is-true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.1 am a DEP approved system inspector pursuant t7Passes tion 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: AJ b Date: 6 '—d2 6 o The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaRh 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection p cUon Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: �- Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D =und 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. yytem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or reps' ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expl in. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally uns und,exhibits substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the exi ting tank is replaced with a complying septic tank as approved by the Board of Health. • metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance ind cating that the tank is less than 20 years old is available. N explain: Observation of sewage backup or break out or hi static water level in the distribution box due to broken or g P !� o structedpipe(s)or due to a broken settled or uneven distribution box.System will ass inspection if with � y P P ( proval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND xplain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pas inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: - L 6' 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 fail g 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 ystem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. ystem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst in is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 I Page 4 of I I ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:360 Buckskin Path Centerville Owner: Mello Date of Inspection: / a G— 6 D. System Failure Criteria applicable to all systems:. Yo 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'/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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: T be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gp Y u must indicate either"yes"or"no"to each of the following: ( e following criteria apply to large systems in addition to the criteria above) y s no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary,to a sm1ace 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 4 If yo u have answered"yes"to any question in Section E the system is c=sidered a significant threat,or answered "yes'in Section D above the large system has famed.The owner or operator of any large system considered a sig ficant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.3 he system owner should contact the appropriate regional office of the Department. 4 i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: C L Y G-" 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 t/ Were any of the system components pumped out in the previous two weeks? I/Has the system received normal flows in the previous two week period? L/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 on: Yes no 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 15302(3)(b)] 5 Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: L-.7-rs —G. 1 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) Number of bedrooms(actual): 3 �7 DESIGN flow based on 310 C 15.203(for example: 110 gpd x#of bedrooms):✓ L Number of current residents: Does residence have a garbage grinder(yes or no).,O Is laundry on a separate sewage system(yes or no):Ae) [if yes separate inspection required] Laundry system inspected(yes or no);/f�a Seasonal use:(yes or no):LL v Water meter readings,if available(last 2 years usage(gpd)): 2000 84,000 gal. Sump pump(yes or no):X, 0 1999 69,000 gal. Last date of occupancy:71 COMM CIAL/INDUSTRIAL Type of es blishment: Design flo (based on 310 CMR 15.203): gpd Basis of de ign flow(seats/persons/sqft,etc.): Grease tra present(yes or no): Industrial aste holding tank present(yes or no):_ Non-san' waste discharged to the Title 5 system(yes or no):_ Water eter readings,if available: Last to of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Y % 'P Was system pumped as part of the inspection(yes or no): b Z) If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP F SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): )�f'Z S;2I /K Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): d 6 f Page 7 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:z(locate on site plan) � t Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) f 0 Dimensions: Sludge depth: -3— c� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: n , t Distance from top of scum to top of outlet tee or baffle: a Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: 0 /��'•— ,) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc. : r GREASE RAP:_(locate on site plan) Depth belo grade: Material o construction:_concrete_metal_fiberglass__polyethylene_other (explain): Dimensio s: Scum thi ess: Distance om top of scum to top of outlet tee or baffle: Distanc from bottom of scum to bottom of outlet tee or baffle: Date of 1 t pumping: Cotnme is(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as rel d to outlet invert,evidence of leakage,etc.): 7 Page 8 of l] OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 360 Buckskin Path Centerville Owner• welIQ Date of Inspection: if / GHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) De th below grade: Ma rial of construction: concrete metal fiberglass__polyethylene other(explain): Dim sions: Capa it}: gallons Desig Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date o f last pumping: Comrr ents(condition of alarm and float switches,etc.): DI RIBUTION BOX: (if present must be opened)(locate on site plan) Dept of liquid level above outlet invert: Co ents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakag into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pump in working order(yes or no): A] s in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 360 Buckskin Path Centerville Owner: Mello Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): _ V(locate on site plan,excavation not required) If SAS not located explain why: Typeleaching pits,number: 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.): � �J/ T it e 9,.a 'S�3 k -� I F T o 1- :r c-t- SSPOOLS: (cesspool must be pumped as part of inspect ion)(locate on site plan) Num er and configuration: Depth—top of liquid to inlet invert: Depth f solids layer: Depth if scum layer: Dimen ions of cesspool: Materi Is of construction: Indicat on of groundwater inflow(yes or no): Comm nts(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) Mate ials of construction: Dime signs: Dept of solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYST EM INSPECTION FOR M PART C SYSTEM INFORMATION(continued) Property Address: 360 Buckskin Path _Centerville_ Owner: Melt 0 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. L S� 1 14 aY 9 3� - 1 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 360 Buckskin path Centerville Owner: Mel l 0_ Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells 0 Estimated depth to ground water 2 0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You my;t describe how you established the high ground water elevation: 11 No. .....:............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 70�� _ . � �.----- oF......... /3/1fv.S �91 .... �R I A Iiration for Disposal arks Tono .rurtion Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: S /� � UOLG ............ ..�'-......y. -........ .. ....� 1� �--. .....�. . ..............c................,� ......... ,Location-Address ...•..............•-----------...--..-....or Lot No. > _6 1. .4..................................... ..................---•------......................._Owner Address ... .... 2....... Y.2r,.�. ............................:... �-:.............. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....3.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Othe fixtures ...................................................... Design Flow..... _.V............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./JOVgallons Length................ Width................ Diameter................ Depth............... x Disposal Trench—No ___�i Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._/%W_:_-_�fameter.................... Depth below inlet.................... Total leaching area........._........sq. ft. z Other Distribution box ( ) ' Dosing tank ( ) -� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit..------------------ Depth to ground water--_.-_----_.__----_--_-. f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ------•---•--••-•••••--•----•-•------••-....-•........................•--•-•------•-----------..----......................................................... 0 Description of Soil.......................... (xj St�i :......_-.d!6r41d.,5 L........V-------------------------••----.............................................................. ------------------------------------------------------------------------- --- ------------------••..__....._ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ••-------- ----•--------••••-----•----•-------••--•-•-•-•----•••••••-------•..................••-•----••--••-•--------•--••------•-•---•------------•-•••••-••--•--•••---------------------.._...------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article aI of the State Sanitary Code—The undersign further agrees not to place e system in operation until a Certificate of Compliance has been issug b the b f health l /_ 101 /_. �. -- �ined•• ---- -- ..._ ate Application Approved BY •-- . . . ,r=�S-../ Date Application Disapproved for the following reasons-----------------------------------------•..._.........------.....----•-----...------------------------•-----.... ..--•---•--•---•.............•---•--•---•--------------•------•......--------•••••-••--------•-----••-_...••-•-•-------••-•----------------•---------•---•-------•--•-•----••--------•-••-•--------•---- Date Permit No. Issued.-A?— --/Is THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J Applirativii for 15hipasai Warka Tomitrurtion Punfit Application is hereby made for a .Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......... f-- Rr: v ft �/ ✓f� t. x J > f...................✓"s+...................................................., .._ ...... . Location-Address or Lot No. .J s .......................... ...........................__....................................__ • _ ,+ Owner+ Address .................................. ............ `Installer ` ., Address UType of Building Size Lot............................Sq. feet .-, Dwelling—No. of Bedrooms.......,....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons:...._...................... Showers ( ) — Cafeteria ( ) d . Other fixtures ------------------------------------------ ------•---- -----••--•--------•---------•-------•-----•-----------------•--------.......--•---•-----•--•- WDesign Flow....... __.':;%..:.........................gallons per person per day. Total daily flow._._____•,_,,,_„-_,-.......................gallons. WSeptic "Tank—Liquid capacity,',,Vgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No.._f�EJ__:.__ I7anieter............-------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................,.... Date........................................ a a Test Pit No. 1______________„minutes per inch Depth of Test Pit.------------------- Depth to ground water_..-----_--_-.--__-.-_ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------•--------------------------- ----------------------------------------- ••--------------------• ---„_,_•---------- ODescription of Soil----------------------------------------------- ............................................................ --•------------------------------------------------------- ... W ___________________________________________•__.-__-_-___________---____---.�._...__._.._•.._..__.-_._._____--....._.-________.._____.........--_.._________••.....-__.-••......•...___--•.....-•-,.•__ V Nature of Repairs or Alterations—Answer when applicable_____________________________--_,-,-__•,---_______-_•_„--,-,,,-___,______-_____-____-_____,___. --------•------------------------------------------ -----------------------------------------•------------.----------------------------------.__-------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigneA further agrees not to place the system in operation until a Certificate of Compliance has been issue b, the bo health.. r �! {fj �' let's ,'". ate Application Approved By-.----- .. . .._ZZ*e,h: -- =�- -------- ----- ------------------ ..•. ... ------ ...... Application Disapproved for the following reasons:.-11_____________________________________________________________________•._______,_,-•Date __----_...... ..........................................................................-----.......................................................................................................................... Date ri Permit No.. .................................................... Issued__: 'i": �- _...._.. ------- bate THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ri ................. . .OF. .1..:� r r .......................................... 'rrtifirn.ir of (wnntpl aurr THIS IS TO CERTIFY, That the Individual :Sewage Disposal System constructed ( '` or Repaired ( ) by---••----__--- -- ----- .-:_. --•---------------- ._ ..•-- ------...---------...---•---••-----•---. Inst.iLer at wFy t� ' l f,-: :f s s� ` tr ✓C F *°`{ .-•-------•-------•---••- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the .application for Disposal Works Construction Permit No----------------/tAof ._____-__--_:__-:._ -dated---------,' _..��� �__,�_�.__._-_-,•_•. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � f rZ DATE. .. _. r .. ---------------------------------- Inspector . ..! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. .............. j OF. - f �.. .t3 ..fit._ ........ � • . ..._..... FEE................... Biopmal Worms 111amitru ion rrmit Permission i .. ...............•• .......................... '*"r to Construct OX°) or Repair'( an' Individual Sewage Disposal System •... F. '" at No.- :. ✓ � ,�•s 4 ;.r.'t '_�_.......r�.'° r,.�`-----•--------------•---.....---.......................... Street 'as shown on the application for Disposal Works Construction Permit No.... ......... Dated......:.. ... ...:::. r •, P r''4 " -'.s f,` csa€d of Ii.............................................. .... _...-•.......•............._ DATE----- -- r:� 4 �* ,. .. FORM 1255 HOSES & WARREN, INC.. PUBLISHERS ,r. TOP OF FOUNDATION 24'diameter concrete covers a CENTERVI LLE, EL=50.G raised to within 6"of finish grade r� MA (or as noted) TWENTY(20)ADS ARC3G (3G I GBD2) LEACH inspection Port and cap with magnetic CHAMBERS IN BED CONFIGURATION IN FOUR(4) marking tape to within 3"of grade 2� m ROWS OF FIVE(5) UNITS EACH Oo Existing EL=49.5+ EL=49.5+ EL=49.5(max) 25, O a j\N j ice\\ boa 2� 5.0' 5.0' _L 5.0' 5.0' V 5.0' Z c J n 1 8"min Cover for w N 48.0_ 477 H-20 Loading Existing { 3 _ 46.5+ n N Ln 2` � L d x m D-Box �' - cn 4° Ea5tg 46.6 46.3746.10 O 46.20 t� Existing _ Existing cv N l0 LOCUS Gas Baffle 45.20 Inspection Port(See Note#W � Congest Run TWENTY(20)AD5 ARC36(36/629D2) 5 7+ PLAN VIEW N �� i 27 9' LEACH C/1AMBER5/N BED n oa'a Existing DO-6 CON)'/GUPATION WITH FOUR(4)ROW5 SCALE: I" = 10' �o EX/5T/NG /000 GALLON (N-20 Rated) OF Fl V,-(5)CHAMBERS S 1 T E LO C U S SEPTIC TANK D-BO1y LEACH CHAMBfR5 EL=39.5� Bottom of Test Hole NOT TO SCALE FLOW PROFILE NOT TO SCALE 2.) .) Assessor's Map 19 I Parcel 130 2.) Deed Book 145G I Page 3 10 3.) Plan Book 244 Page G7 CONSTRUCTION NOTES 4.) This property is not in a Zone II of a Public #_ Water Supply 1 .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (3 10 CMR 1 5.000): Bth STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, AND EXPANSION Kitchen Dining y� 5.) Flood Zone: C Bdrm OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT AND DISPOSAL IBth \ �' OF 5EPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. Garage 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 Living LEGEND LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. Bdrm Bdrm V �h9A o 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A STABLE NO rj,� EXISTING SPOT GRADE MFGHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. (o� o �q. \ 24x5 PROPOSED SPOT GRADE EXISTING CONTOUR 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND THE 4 R SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING FIELDS, FLOOR PLAN /y \ G g e 24- PROPOSED CONTOUR 7 W WATER SERVICE LINE TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL HAVE AT 0 S LEAST ONE(1) INSPECTION PORT CON515TING OF PERFORATED 4" PVC PIPE PLACED VERTICALLY TO THE O O OVERHEAD UTILITY LINES BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC MARKING TAPE, NOT TO SCALE I \ � - U UNDERGROUND UTILITY LINES ACCE55113LE TO WITHIN 3"OF FINAL GRADE. -- Oata� c GAS SERVICE LINE 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A \ - - TOP OF BANK MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2% FROM THE BUILDING TO THE SEPTIC TANK, AND +--�--�- LIMIT OF WORK NOT LESS THAN I%OTHERWISE. EDGE OF CLEARING LOT 49 G.) DISTRIBUTION LINES FOR.THE SOIL ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE 40 PVC Area= 15, 122p� 0�O TIP FENCE ) OR EQUIVALENT LAID AT 0.005 FT/FT. UNLE55 OTHERWISE NOTED. LINES SHALL BE CAPPED AT END S.F.± 0d'�z� / TEST HOLE LOCATION OR AS NOTED. 0�a�,o �� ® SEPTIC TANK 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2) FEET BEFORE PITCHING 0J�aa j DB DISTRIBUTION BOX TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO ASSURE EVEN - F 0� u'O 5 SOIL ABSORPTION SYSTEM Reserve RESERVED FOR FUTURE USE DISTRIBUTION. 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN �! � iy;;�ij%� �-' UTILITY POLE SYSTEM DESIGN CALCULATIONS /3 (ED CATCH BASIN ORDER TO PROVIDE A WATERTIGHT SEA L 5FWAGEDE5IGN FLOW REQU/RED:3 BEDROOMDWELLING @ j 8 ® FIRE HYDRANT 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE /IOGPD/BEDROOM=330GPD REQUIRED ^�� DRINKING WATER WELL DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 0 CONCR T OUND 5EWA6,ff DESIGN FLOW PROVIDED: TWENTY(20)AD5 UN/T5 fN BFD 49. `� /-1� TIP-1 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 1, ALL SYSTEM COMPONENTS SHALL BE MARKED WITH CONFIGURATION/N FOUR(4)KOW5 OFF/VF(5)UNIT5 LA CH MAGNETIC MARKING TAPE. f t TIP-2Vt=((330/0.74)/(4.8 FT2/FT)/5.OLPJ = BENCHMARK �� ��„ Propo5ed5A5 I l9 A05 UNIT5 REQUIRED(20 PROVIDED) Top Corner Concrete (See Plan View) LINDA J. I .)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. EL=50 00(Assumed Datum) Existing Septic Tank to be ONTO ^ (/) 12.) FROM THE DATE OF THE INSTALLATION OF THE 501E ABSORPTION SYSTEM UNTIL RECEIPT OF THE 355 GPD PROVIDED>330 GPD REQUIRED - - - - -- ---_ Utibzed(5ee Note A20) 4 CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT USE OF 5EPTIC TANK CAPACITYREQUIRED: 330 GPDx200% =660 GPD REQUIRED So THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. i �4 1� �GISTE�� 5EPTIC TANK CAPACITY PROVIDED- Exf5TING /000 GALLON 5EPTIC TANK Existing Septic Components to 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS CONSTRUCTED ��` be Abandoned(5ee Note A2/) A4 E AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE DESIGNER. A GARBAGEDl5PO5AL 15 NOT PERMITTED WITH TI115 DESIGN FLOW 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE 9e� BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE EA S'uI'Pep 1Porlr by D15POSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. A & M Land Services TEST HOLE LOGS 618 Route z8, Suite 3 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR IlPest Ya=outfl, HA 02673 DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO SITE PLAN 0� Pb- (508) 737'-1"7 Einar: aw&and®comeast.net COMMENCEMENT OF ANY WORK.THI5 INCLUDES, BUT IS NOT LIMITED TO, REQUESTS TO DIGSAFE, ANY Test Hole#I (FL=49.5±) P#1332G 90 PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. 00 Depth Layer Soil Class Soil Color Comments _ 90 1 G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TEUNE5 ARE CONNECTED BY WATER TESTING WITHIN SCALE: I 20 cL REVISION OG/29/I I : Relocated SAS THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 0"-9" A Fine-Medium Sandy Loam I OYR 3/2 This Area is Served 0) 9"-28" B Fine-Medium Loamy Sand I OYR 5/8 by Town Water Prepared for: 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY SEPTIC 28"-45" C I Medium-Coarse Sand I OYR 5/G GO%Gravel SYSTEM COMPONENTS. 45"-1 20" C2 Medium-Coarse Sand I OYR 5/4 Perc @ G7" Jeffrey if Lynne Mower 360 Buckskin Path, Centerville, MA 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. 517E PLAN SHALL NOT BE USED FOR STAKING, OR ANY OTHER PURPOSES. Test Hole#2 (EL=49.5±) I CERTIFY THAT I AM CURRENTLY APPROVED BY THE Proposed Sewage D15po5011 System 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING BYLAWS, DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO 3G0 Buckskin Path, Centerville, MA SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT RESTRICT(ONS. Depth Layer Soil Class Soil Color Comments 3 10 CMR 1 5.01 7 TO CONDUCT SOIL EVALUATIONS AND THAT THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CON515TENT O"-10" A Fine-Medium Sandy Loam I OYR 3/2 WITH TIE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE Prepared by: 20.) EXISTING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON INLET AND I 0"-30" B Fine-Medium Loam Sand I OYR 5/815.017. p y OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. y DESCRIBED IN 3 10 CMR 1 5.01 7. 1 FURTHER CERTIFY THAT THE 30"-45" C I Medium-Coarse Sand I OYR 5/G GO%Gravel RESULTS OF MY 501L EVALUATION AS INDICATED ON THE 2 1.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND 45"-1 20" C2 Medium-Coarse Sand I OYR 5/4 ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN CSN ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. ACCORDANCE WITH 3 10 CMR 15.100 THROUGH 1 5.107 � DATE OF TESTING: OG/24/1 I Engineering INSPECTION NOTE: 501L EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING BOARD OF HEALTH AGENT: DON DEMARI5, BARN5TA5LE HEALTH DEPARTMENT -} 0 20 40 GO PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C"LAYERS p�Jb a t t� P.O.aBox,AfA Phone:(508)8-547850 PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM Teaticket,Me4 02536 Fax:(508)548-54T8 NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. NO GROUNDWATER ENCOUNTERED Linda J. Pinto, Certified Soil Evaluator SCALE 1"=20' C:\C5N\RR-Buck5kin\RR-Buck5kin-5DS Plan.dwg Date: OG/22/1 I Scale: As Shown I By: UP I Check: MA I Project No.CSNO 178