HomeMy WebLinkAbout0037 CAPTAIN BELLAMY LANE - Health 37 CAPTAIN BELLAMY ROAD
Centerville
A = 230 - 178
�' Cyr%_�_ _gyp J�aEcrttEo�D
p i tim
UPC 12543 o-
No. 53LOR
HASTINGS, MN
I
_. „
COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTALTROTECTION
TITLE 5
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
�,q��3 %agcec /� �f CERTIFICATION
Property Address: —? i✓l ( kq,vh
e
Owner's Name: E /37eu—,,1 at
Owner's Address: 5;/J1kn e �`1Q
Date of Inspection: 0-7
Name of Inspector: (please print) eV This Inspection is based on criteria defined In Title V
Company.Name: 6J ll .SW-ITC SelZVt -P Code 310 CMR 15.303.My findings are of how the system
M ailing Address: .!So 7 7/ / Is performing at the time of the inspection.'My inspection does not h
a f)0.?-6yb any warranty or guarantee of the longevity of the septic
Telephone Number: Sa E Jo R' system..,nd any of its components useful life.
CERTIFICATION STATEMENT ' Y=
1 certify that 1 have personally inspected the sewage disposal system at this address and that the information=rcpor-cd
below is true, accurate and complete as of the time of the inspection. The inspection was performed based`on my= 5
training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am at`°DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310.CMR 15.000). The sgtim: r.�
'- Passes
Conditionally Passes r
Needs Further Evaluation by the Local Approving Auth nth ® r-,
Fails
Inspector's Signature: Date: '
The syst m inspector shall submi copy/o�Zhisnspection 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.
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 Form 6/15/2000 page 1
r - -
ragr t 01 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 7 (A477 /I PLC o p,,. [�-
�'2n�—e211�
Owner• R/y CLt n So P 1
Date of Inspection: 8-7- Pl-o o-7
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy�em 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:
One or more system components as described.in the"Conditional Pass"section need to be replaced or
repaire The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes,no or t determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is meta d over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infi tion or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a comp ' g septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection t is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years o is available.
ND explain:
Observation of sewage backup or break out or high s 'c water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribute box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe .The system will
pass inspection if(with approval of the Board of Health):
broken pipes) are replaced
obstruction is removed
ND explain:
-2
rage .) or r t
c .
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3
e.-7-rt ity'1112
Owner: ,J o
Date of Inspection:
Cr—Evalugiien is Required by the Bo-ra or uenith.
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is fail' to protect public health, safety or the environment.
1. Syste will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b) that the
system i of functioning in a manner which will protect public health,safety and the environment:.
_ Cesspoo privy is within 50 feet of a surface water
_ Cesspool or ivy is witbin 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that p tects the public health,safety and environment:
_ The system has a septic tank and soil ab rption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface w r supply.
_ The system has a septic tank and SAS and the S is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is 'thin 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less th 100 feet but 50 feet or more froth a
private water supply-well-. Method used to determine distance
','This system passes if the well water analysis, performed at a DEP ceni i laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from p ution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 p , provided that no:other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I I
c
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3 7 LA-
-Py►TL�2rJ�!%-e
Owner• �i�•J /�'!e.LctnS o r\
Date of Inspection: z-7—,9-00-7
D. System Failure Criteria applicable to all systems:
You must indicate "yes"or"no"to each of the following for all inspections:
Yes No
_ �ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
logged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Rsquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
— of times pumped ,
_ �y portion of the SAS, cesspool or privy is below high ground water elevation.
y 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.
_ y 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.)
/UD (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 3 10 CMR 15.303,therefore the system fails. The system owrier should contact the Board of
Health to determine what will be necessary to correct the failure.
To be sidered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000
gpd•
You must indicate et "yes"or"no"to each of the following:
(The following criteria app arge systems in addition to the criteria above)
yes no
the system is within 400 feet of a surfac ing water supply
_ the system is within 200 feet of a tributary to a surface ' ing water supply
_ the system is located in a nitrogen sensitive area(interim Wellhead ection Area- 1WPA)or a mapped
Zone 11 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
15.304.7he system owner should contact the appropriate regional office of the Department.
4
Pagc 5 of 1 l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 37 f
_2/rTP�►///ram
Owner: �¢.J Be�nS"o✓t
Date of Inspection: '7—,:Poo:2
Check if the followine have been done. You must indicate'des"or"no"as to each of the following:
Yes No
t—
Pumpine 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?
e/ H the system received normal flows in the previous two week period ?
Have large volumes of water been introduced to the system recently or as pan 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:
LY /no
Existing information. For example, a plan at the Board of Health.
_ ADeterminedin the field(if any of.the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)J
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 37 _ 0f6_La•^i7 L�
C
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): �/
DESIGN flow based on 310 C 15.203(for example: 110 d x N of edrooms): VV6
Number of current residents: . e/ /02 q�t���tiq rr 77
Does residence have a garbageTgrtndcr(yes or no):/l/p
Is laundry on a separate sewage system(yes or no):it/v(if yes separate inspection required)
Laundry system inspected(yes or no): .Uv
Seasonal use: (yes or no): ,'0 0 0 p Yc
Water meter readings,if available(last 2 years usage(gpd)): o C
Sump pump(yes or no):
Last date of occupancy:Z'ui/r.rr1 OC f- p, a v�
Type o ishment:
Design-flow(base 10 CMR 15.203): ZDd
Basis of design flow(seats p s/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present�ys
no .
Non-sanitary waste discharged to the Title S system(yes _
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Gs�llEvt'����3 �7dw�J ate o 2�
Was system pumped as pan o the inspe6ion.(yes or no):.,
If yes, volume pumped:/av2S—galIons -- How was quant ry pumped determined? siG/��jLt/3Z a a u .
Reason for pumping:/»/i n T �G-�
7OF 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/Altermative 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):
Approximate age of all components. date i stalled(if known)and source of informati
,AAC o w
itJecj .501i- !} Sooz4'Toi11ySr
Were sewage odors detected when arriving at the site(yes or no): /VO
6
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 C�
('
Owner:-4 /"1C�CCCrnSo^
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:
t Comments(on condition of joints,venting, evidence of leakage, etc.):
17-U,H T r AldFk--a2 T6/� ilrffn /`i�ll�S�hT/✓7 /Loo� Ny ,EJIDeh�� p
SEPTIC TANK. Zoocate on site plan)
Depth below grade:.//.0-70 -70 P
Material of construction: L,-`concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confir ned by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions:
Sludge depth: 6
Distance from top of sludge to bortom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: .6
Distance from bosom of scum to bonom of outlet tff�o baffle: /PL �� \
How were dimensions determined: /hC4�ral4e 5 Cee
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
related to outlet inven, evidence of.leakage, etc.): o
C-c 0 IA J-Z e IC 2" S Z� c �'
'47— C p�iLei�Z�cre�Z�-�vo Evr� en�e D�G2 f�G2.
Depth be ade: _
Material of cons tion:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet or baffle:
Distance from bonom of scum to bonom of out a or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet t r baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
7
Page 8 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37
Owner:7bo'J /l't�lanSo
Date of Inspection:
Depth be �deMaterial oncrete metal fiberglass_—Polyethylene other(explain):
' Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,-etc.):
DISTRIBUTION BOX: z(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: �� — �o 3 oX GS
i l_6�c rti
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.):" ^�
ok JX S L �� E Ct L 1.� Si- /3�tT7ar� No SoG.vQ /�O
L,!/�fc✓f6-2 �3 G Tu (3 I s/4" 7 a -775 [703a
PUMP C-H'049914i
Pumps in wo rder(yes or no):
Alarms in working or a or no):
Comments(note condition of pum ber; condition of pumps and appurtenances, etc.):
8
Page 9 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 37 C�TGj�GCart� Lf}
-�n —C(tal I I/-e
0wner:71-' �� h'-e j'a
Date of Inspection: e7-7
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain why:.
Type
leaching pits, number:_ P�� Lot,J
leaching chambers, number:
I hing galleries,number: n tr���'O� f�—�C)
leaching trenches,number, length: 2 Ya
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 vegeration,
etc.):
Sn,i_ �GZy . �1v 5',61\ e t C.u/I-Q , iy o odz
Number and configur '
Depth-top of liquid to inlet inve
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
(leeate en site plan)
Materials of con ion:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs o lie failure, level of ponding,condition of vegetation,etc.):
9
Page 10 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3 7 �i�iP'Qii'1 /�CGtgw�y G�}
ire
Owner 1��_f�9Gl�ieS�n
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.
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10
Page 1 I of l I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
-CrrrG2 y//!-P
Owner- l7/ ,E /'i2Cct�tSo✓�
Date of Inspection: �{-7—�=00-7
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water g+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)
e ked with local Board of Health-explain:
ecked with local excavators, installers- (attac documentation)
Accessed USGS database-explain: -,C /,{ �CSoticRL2 /►►
You must describe how you established the high ground water elevation:
s S
Cq�op_ C'o e5oglitc e
S4
77 rl
73 oTb7 .rt O N C cJ
• S FI S To 6/2o w,,,�
11
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic,Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
n
I, 41t hereby certify that the application for disposal works
construction permit signed by me dated — 27- concerning the
property located at S 7meets all of the
following criteria:
•. The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
ma.�dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable]
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation 3P +the MAX. High G.W. Adjustment . 7 =
D BETWEEN A and B (A j
SIGNED : DATE:
(Sketch propo d plan of system on back].
q:health folder.cat
9 Q
No. / — f Fee_15-0—
/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprtcatton for Mtgpogal *pgtem Congtruction Permit
Application for a Permit to Construct(/)Repair kupgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.3 ^s N
� and No.
Assessor's Map/Parcel A —
MP - AY) - c F
Installer's ame,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms �! Lot Size -5% sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
`
Design Flow gallons per day. Calculated daily flow 7 Z� gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. :2- 2-a X 2-
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) l
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(p-f-TNe 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu d by U
oard H th. qq
Signed Date G - ! /
Application Approved by Dated
Application Disapproved forWie following reasons
Permit No. - Date Issued
+�
?Y ' Fee 7
/// THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLICCHEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
y ZIpprication for Migozal *pgtem Construction Permit
App cation for a Permit to Construct(/Repair((Upgrade( )Abandon( ) ❑Complete System El Individual Components
„ ocation�L,,o�/tA�No.�� ��i.��e Owner's Nan}e,Ad ress and T�Noi.,
ssessor's Map/Parcel ,^„ L _ n U _ OF
Installer's ame,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 4� Lot Size S sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.' '
Plan Date Number of sheets Revision Date
Title
--^ Size of Septic Tank Type of S.A.S. 2- y%f-
Description of Soil
_ Nature of Repairs or Alterations(Answer when applicable) .
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions(TTitie 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by t is oazd
Signed `�`„ - Date 0
Application Approved by Date
Application Disapproved for Ye following reasons \
Permit No. _� �/rj Date Issued , 4, r
-----------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE that the On-site Sewage Disposal System Constructed( )Repaired (k)Upgraded( )
Abandoned( )by
!M ml_�� - --
at ' has been constructed in accordance
with the prod ' ns f Ti 5Zand the for Disposal System Con ction Permit No. �— �9�' dated
Installer Designer /
The issuance this pe t shall t be onstrued as a guarantee that the sy Zb1"2n17r('A__1A,
ction a desi�ned.
Date ( � Inspector A 1='f �,!!A t�•'�� r
ti
No. / — y Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migozar *pgtem Construction Permit
Permission is hereby granted to Construct( ).Re air )Upgrade( )Abandon( )
System located at i r
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes bis/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: Approved by Q.
J
' 116/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, �`^�`- hereby certify that the application for disposal works
construction permit signed by me dated ( — 27- concerning the
property located at meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no variances.requested or needed.
• The bottom of the proposed leaching facility will not located less than five feet above the \
ma cimum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable] I t-
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation +the MAX. High G.W. Adjustment.
D117E BETWEEN A and B
SIGNED : LDATE: to -.7-( 7
[Sketch propo d plan of system on back].
q:health folder:cert
F
t
i
3 ? 2---,
TOWN OF BARNSTABLE
LOCATION 3—7 C��i4 /3'eU4,wl y L9 SEWAGE#
VILLAGE L�'�n7l y///Q ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)_ (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE: W 7 10;1O0
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 an wetlands exist
g g tY( Y
within 300 feet of leaching facility) Feet
FURNISHED BYc�S
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a=3a'--S•" ScpT.�c T�'k pco4 SctPa6ePi
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Commonwealth of Massachusetts WEEK P
Fz-
Executive Office of Environmental Affairs DES ? 3 1996
Department of1�
Environmental Protection
WWlaer F.Weld t j T
c+oNnwr
A pmPaul CNlucel
CatsnlrNarr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
property Address: 37 Captain Bellamy Ln, Centervill%ddreesofowner.. Gene Shwalb
Date of Inspection: 12-3-9 6 (If different)
Name of Inspector. W.E. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8)7 7 5—8 7 7 6
W.E. Robinson Septic Service
P:O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
I oertify 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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site7w :
disposal systems. The system:
s
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails n
Inspector's Signature: 441 Date: —7
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 o!'!'ice of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A.B, C,or D:
A] 8�iI�YPASSEB.
II have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection-
Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or ezfikmtion,or tank faihue is
imminent. The system will pass inspection if the existing septic tank is replaced with a Fonfor ming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
4k
.; One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-NO
s.
Printed on Recycled Paper
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
pPperh,Addresw 37 Captain Bellamy Ln, Centerville
Owner. Gene Shwalb
Date of Inspection: 1 2/3/9 6
B)SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(a). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) THER 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 the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is leas than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis 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.
S) ER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddresc 37 Captain Bellamy Ln, Centerville
Owner. Gene Shwalb
Date of Inspection: 12 3/9 6
D] SYSTEM[FAILS:
have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
Backup of sewage into facility or system component due to an 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.
Iaquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E1 LARGE YSTEM FAILS:
following criteria apply to large systems in addition to the criteria above:
system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
and safety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into lltll compliance with the groundwater treatment program
requirements f CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
pppe1t,Addrew 37 Captain Bellamy Ln, Centerville
Owner. Gene Shwalb
Date of Inspeotiont 1 2/3/9 6
Check 1f the bUowW* have been done:
_✓/Pumpiag information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
v The facility or dwelling was inspected for signs of sewage back-up.
-The system does not receive non-sanitary or industrial waste flow
YThe site was inspected for signs of breakout.
'✓/All system components,excluding the Soil Absorption System, have been located on the site.
(�The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum.
ZThesize and location of the Soil Absorption System on the site has been determined based on existing information or
ZT,
prozimated by non-intrusive methods.
e facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub.
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 37 Captain Bellamy Ln, Centerville
owner. Gene Shwalb
Date of Inspection: 1 2/3/9 6
FLOW CONDITIONS
RFBIDENTL4J-
Design flow: 33 O p1low
Number of bedrooms:_j_
Number of current residents: 4
Garbage grinder(Yes or no):_O&O
Laundry oonnected to system(yes or ao):_ g S
Seasonal use(yes or no):_j_&O
Water meter readings,if available: 1994 — 109, 000 gals.
1995 — 75, 000 gals first F mns- 19F 2R,000 gal:
Last date of occupancy:
COMMERCIALANDUSTRIAU
Type of establishment:
Design Bow:_ gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Noa.saaitay waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and soww of information:
dti e
System pumped as part of inspection: (yes or no)j O
If yes,volume pumped: gallons
Reason for pumping:
YBTEM
TYPE OF,S
Septic tatnk/distnbutioa box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yea,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information: i_q $s
Sewage odors detected when arriving at the site: (,yes or no)_A,: d
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
property Addrem 37 Captain Bellamy Ln, Centerville
Owner. Gene Shwalb
Date or Inspection: 1 2/3/9 6
SEPTIC,TANK v
(locate on site plan)
Depth below grade: i
Material of construction:_concrete_metal_FRP_other(eaplain)
u. ` i
Dimensions: 'f'
Sludge depth. l O . .
Distance 5om top of sludge to bottom of outlet tee or baffle:3:; , ,
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:� ,
Distance from bottom of scum to bottom of outlet tee or baffle: /O
Comments:
(recommendation r pumping,cytdition of inlet and outlet tees or b ,depth of liquid level in relation to outlet invert,structural integrity,
evidence of ,etc.) /•� •g• Q l� c i �L L G{-S Vic.%.o .� �' G, ..$ o 6.�
G E TRAP:_
(locate n site plan)
Depth low grade:
Mate ' of construction:_concrete_metal_FRP_other(ezplam)
ns:
Scum
,om top of scum to top of outlet tee or baffle:
Distance m bottom of scum to bottom of outlet too or baffle:
Comments
(repo tioa for pumping,condition of inlet and outlet toes or baffles,depth of liquid level in relation to outlet invert,structural intep*,
evidence f leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddeeaw 37 Captain Bellemay Ln, Centerville
Owner. Gene Shwalb
Date of Inspection: 1 2/3/9 6
TIGHT OR BOLDING TANK_
(locate site plan)
Depth grade:
Material oongrudion: concrete_metal_FRP ather(e:plain) `
Ca Qallone
Design p11ons/day
l:
Comments
(condition f inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOXAZ
(locate on site plan)
Depth of liquid level above outlet invert:_Q_
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of boot,etc.)
PUMP C BTR:_
(locate on site )
Pumps in wor - orden(yes or no) .
Comments:
(note condition o pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37 Captain Bullamy Ln, Centerville
Owners Gene Shwalb
Date of Inapeotion: 1 2/3/9 6 /
SOIL ABSORPTION SYSTEM(SAft v
(locate on site plan,if pow";excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
3eechitlg pits,number:
leeching chambers,number._
leaching galleries,number:
leeching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetatioy,etc.
CESSPOOLS:_
(locate on al plan)
Number and co tion:
Depth-tap of to inlet invert:
Depth of solids r.
Depth of scum lays
Dimensions of oess 1:
Materials Of oo n•
Indication of water:
inflow 1 must be pumped as part of inspection)
Comments: (note n of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY:_
(locate on site plan)
Materials Of oo n: Dimensions.
Depth of solids:
Comments:(Mote co n of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddeesa 37 Captain Bellamy Ln, Centerville
Os„ner. Gene Shwalb
Date of Inspection: 1 2/3/9 6
SXZVCH OF SEWAGE DISPOSAL SYSTEM:
include tiss to at least two permanent references landmarks or benchmarks
locate all wells within 100'
t
a♦
t
DEPTH TO GROUNDWATER
Depth to F andwater. �^ feet !�
method of determ:mination or approximation: 17 0
(revised 11/03/95) 9
................... 1 Fss....... ��
THE COMMONWEALTH OF MASSACHUSETTS
..,,-BOARD F HE
T
r. .fib..:.:.
-
1....0 -���........---OF..... ..........................
Appliratiun for 11isVuuttl Workii Tunitrnr#iun 1hrmit
Application is hereby made for a Permit t Construct (A-l"or Repair ( ) an Individual Sewage Disposal
System at:
.. �.f ...........................................
LocaAd ss Lot No.
..............•---.._..._ ,..:5. j -. _.fe..�v,.l_1��.......--- ..
A ress
��M a -.•-•.•• �..... �-� ._-C............................. ...• .. .: ................................................
Instsaller Address
Type of Building Size Lot-ZV ....Sq. feet
U Dwelling—No. of Bedrooms......... ..............................Expansion Attic s Garbage Grinder. iw
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W
Design Flow............. :...................gallons per person per day. Total daily flow..........--•-_.Q........_..........gallons.
WSeptic Tank—Liquid capacity/000gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No- ------------- ----- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter...._............... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ) //�. ' .-/
'-' Percolation Test Results Performed b .._., �� !��/l1.�C!rf- . Date...._ �_�f�S_
. -- -.- .._.....
Y �.,..... ..
,aa Test Pit No. 1_ _. ----_-_mi/nlites per inch Depth of est Pit__.__ . f_____ Depth ground water....... •__.
Test Pit No. __..minutes per inch Depth of Test Pit.................... Depth to ground water.....�.d ...
r x 4n
----. ............
............................................................................
- -- ----------------
O Description of Soil.... .'
. ....... .._ - ----------_ ._._ �_
x
UNature 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 iITL2 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by the rd of heal
Signed--•
Date
Application Approved By................. Date
Application Disapproved for the f o to ing reasons_________________________________________________________________________________________•-......._......_....._
----•...---•-----••-----...---•-••-------•----------••-•--•---•---••.........-•--------------------------
Date
Permit No....... gS.�.--•------•--------•---.._. Issued-..............................Date
No................-....... F$$............._....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F H EA T
. ,'�+
I.
A lirtt#inn for i�#rn tt1 arks Tonstrurtinn Permit
Application is hereby made for a Permit t Construct ( or Repair ( ) an Individual Sewage Disposal
System at
--. .-f........ -'-. ..e� ._. .e _Z1 ........
...... .....
'�.'' C.... (i............................................................./
LOea A ess „� t No
..... .............
Ovyner
w �� .� `. .... .- A ress
.. . .................................................
Installer Address r
Type of Building Size LotE...... ..... .........Sq. feet
U Dwelling—No. of Bedrooms........ ....Expansion Attic (1rGf Garbage Grinder
Other—T e of Building No. of ersons........................... Showers — Cafeteria
QI YP g --••-•-••••---••-•--• P ( ) ( )
aOther fixeau .. _..._ ...... -•••••......•-••••......_....
d Sr ....... gallonsperpersonperdaily_--- g P P P Y.. Y ......•--- gallons.
WSeptic Tank—Liquid capacity V.O.C�allons Length................ Width ............. Diameter................. Depth................
Dis osal Trench—No. Width.:.. Total Length •--_----..-.--_- Total leaching area..:..............sq. ft.
x p .......
Seepage Pit No...................... Diameter................... Depth below inlet.................... Total'leaching area... .--.sq. ft.
Z Other Distribution box ( ) Dosing to�( ) .w
Percolation Test Results Performedit_ _.- ate... .
Test Pit No. 1. ._.___minutes per inch Depth of est Plt -: _f__. Depth: ground water_.... �,,1,_
LL, Test Pit No� .___minutes per inch Depth of Test Pit____________________ Depth to ground water..._____._______.....
/ ---•-------------------------------------------•--------------------
...............
D Description of Soil _.. :. + {q... ... ••........
►�i }! fcs a 1+ ��fpv�free J` �'+ d s*��i'
^•..............^ a---------•----.._-----------•---------- _ ....•_ -----•------•- ..........._ 1 ...^--•-----•--------._._._......_....
' 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 TITLE 5 of the State Sanitary Code The undersigned further.agrees not to place the system in
operation until a Certificate of Compliance has been ued by the rd of healt4) 4)
�
Signed r�r Y •---••• ------ -----
� �! !g
Application Approved BY / h1ll� ..... ..�-.y �---------- -------•---•-----------�---•-• ......
• Date
Application Disapproved for the f olfo ing reasons:----•- ----•--------•••.--... _.._
�- '�� "r j �.. '....... .................................•______•___.....___•___.....__......_.._...............___................_•__••_•___.................................................................
t a Date
Permit No.......C S -$ - .....................---... Issued•...............
Date....... ...................•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�-
;........... O F.... ....... �a�...... ,
(Irr#if irtt#r of (111MVI 'Mr
THLY,IS TO- CE TI F,T4a the Individual Sewage Disposal System constructed or Repaired
�� .. -
by.................... ........... �1 A ./._............r.....:.-Installer .. .. ...... ....... ................................................_
.... ..""" .+'' .........................................................................-........................................
has been installed in accordance with the provisions of TITLE 5 of The,State Sanitary Code as described in the
application for Disposal Works Construction Permit NolE-2� ........ dated........ ":��.. ..:_ .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COON TRUED AS A ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........ 0_ .....f...................................... Inspector........ ,�. ...................
THE COMMONWEALTH OF MASS HUSETTS
.. ✓BOARD OF HEAL H
, ✓, ..... oF......'..`> a"' • �• ................
No......................... Fn....................:.
Disposal Worko,%onstrudwit permit
Permission is hereby granted /?"... ... ........?.. !!W....... .......• -••----•-•-----••._............................
to Construct ( r epair ( an Individual Sewage Disposal System
��ZZ
at.No.. ... 3...":�fC� t c� rli.' ......
Street gs i
as shown on the application for Disposal Works Construction Permit No.. .. ............ Dated.... ...........
n DATE............ ........................................
Boar�iiQ�
FORM 1255 A. M. SULKIN, INC., BOSTON
�. PIT 61S
71
pry
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i Qr
? 5
go
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3
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too
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1 Z.57'w/,q Tf/
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' NOr� ASS UMF-/> L.nT ���� 0.
ON pe--R. A lid 7.ZLI
11/0r/ ALBERT \'e v_ RO SERT
A. o DREDGE
. '
P�[Gk>c
Ai
LEGEND rP` 77
i
W. 7fEXISTtNo SPOT ELEVATION 0,�0 CERTIFIED PLOT PLAN _. t
+lntiSTIN• CONTOUR --- 0 --
' IIINISNED SPOT ELEVATION L v -r C.4�T &c-1 6-4 rr
} NISHEO :CONTOUR ---.0 7 ✓ AtiE
, k ' The'location of any existing under�_und sewerage IN,or other utilities shown on. this plan is approx-
tieonly Aatw determined from records.. and/.or verbal � ����,
�►atit�ti,-;The-,Cont,ractor is a?+esponsible for the
rl Yc 4-theex vt- ,n& 1pcations,• in the field. rCALE: / "= goy DATE d,2.4 8S
LQ.RL�'DCE ENCaINEFR/NQ CQ /N CLIENT I CERTIFY THAT THE PROPOSED
5
EGISTERE REGISTERED JOB NO.8309 BUILDING SHOWN ON THIS PLAN
CIVIL LAND /t,� CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR DR. OF BARNSTABLE , MASS.
712 MAIN STREET CH. BY: 5 ?�
;. . H Y A N N I S, MASS. / Z — - ---- —=-
,, SHEET OF ATE EG. LAND SURVEYOR
:Y`..� '' '''�,-•? `. '`'..y-h` �+ .0. �� -_ :S. titi s 4 'yt'uL,-A' S'�F., '"� i:.F t+.:t {:"E-Y^': -cJ =,y�j :r 'R:.,3„h}_.u` yz .su' ;;`a'F .5`.. ,s
�� �. •.. � f"..may. ,. .,. :: gw,s.,.r s .m�'�e- rw,;�, j�.�-r>' 'v�r .,,^ 1? f, s "r €- '±} - 's�"p �-.
—77
a3,.. r..,t. .'+- :w in :.y.�s_.- ?,.,>+J 'wa sy , ,x,. r.. ;., sc L•4 y s;.-,..�.,irC'4: :f i •``F :,l Y>V 7:ice'„. ,.•dc�i.�.l�: a.a'�.:.i r ;7
.q.8:3w.. v-• A. Y°j1...S``r '' 'P",� Sa....N�«h y'�'-w. }9^ .._ y. _,••y .�G /' - iF� ^"?'.2.42 )w ril. 4'!.; '1•
ra. �•�'"�_ ,+lCly��l�; :PST s4Rl•;.:��ORE TJSi/!!1/ Jl<.dEIO .
lRA + / l. T.E!Q
i 5JV1lLl L :E< N JEXTRA
4 PYC PIPE.
CCNG/CErE } ?/EAVy ,CAST J�O iYALL. 8E uSE�
g1 _SS..O cDYERS MIN- PJTGN JFIIV DRIYL�IVAY
pER FT '2 nlfw. C"GNCRtrTE
Ar: dJ�.4DE CGVER CLEAN .SA/YO11-7
w� BACXFI.L[ '
4 cm IA • o 'e C]F. IB -s'E• 1
�=r 1+�I N.P/TGId G.�L. • • • • • • • • • ' • •. WA SHED 57-•'r E
.. DIST,
SEPT/C TANK " • •i• • • • • ,•+ • ,
BOX • • • • • � • •
i _
• • t,Ecr/ram ' • : 3/4'
.ti• • • • � •� DEPTI+� ' • • ' • � ; WAS/1ED STah'f
.377Vb: •� • • • • • � • . • oO • pRECASTSErjio6£
C'LEVA7'/&VS P/T CAP.4C/T� 45 �i4L`1��4y s :.• • • . . . . . • • opGL �6 0 OR E�U1V.
INYEAT AT QUIL.OI/VCP S�°FT 3 J i r D/AM.
INLET .SEPT TANK S 1.5 FT. /Z f7. PI,4)W. i C
O�J?'LET SEPT/C T.�NK -s'•3
INLET D13TR/dVTION BOX 50.8 AT SECT/ON 4F GROVNO l447.CR Ti1dLE
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