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0054 CHAPPAQUIDDICK ROAD - Health
54 Chappaquiddick Road Centerville A= 170-028 S M E A D No.2.153LOR UPC 125U •n'wad.com • Made in USA SF� ern SIOYOGYAAI KSOACNOWMEVA" ceao S�URfJIdG WWw,SpgpGRAA&000 /0 I own of Barnstable �#_ 136 73 r �iKE Department of Regulatory Services � /D J/ • y ����e� � P><.><bflic Health DMsyo><>t Date 200 Main Street,Hyannis MA 02601 ,6,51• ti� � lDate Scheduled 1 3o �� Time Fee ball. Soil Suitability Assessnientf o ° Sewage Disposal 1�ME Ij OJAt�4 �!✓Pcrfonned BY: �� witnessed By: v! �'• a - ---�'- — --�-' - LO�ATION ar�:.GEI���L INIf+O][�MATION � l w►�I Owner's Name (� Location Address y` y 11 Cep„„ e Address Assessor's Map/Parcel: ?Q/OZ Ci_)[ Cngincer's Nantc ' �f71vt/ NEW CONSTRUCTION REPAIR Telephone It iU J Land Use' Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area — ft Drinking Water Well ft Drainage Way r— ft Property Line ��' ft Other It S KE,T CH.' (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in pro)Iinuly to holes) TL v ill � (-It- � I Parent material(geologic) r^r7Ln P" t'7 Depth tp Bedrock >AZ��pr Depth to Groundwater: Standing Water in Hole: Weepllig I'ranl Pit f�tlue—Lii ' Estimated Seasonal High Groundwater / " ' e DETERAIINATION FOR SEASONALHIGH WATERTABLEMethod Used: � Depth Observed standing in obs.Bole: N _"'(n, Depth Id 5p1I Depth to weeping from side of obs.hole: --_— l!L Grounr)wuter Adjustment—_ lt• Index Well# Reading Dale: Index Well level AcI.ftletnt' Aaj.f7ruundwuter Uvei e IPERCOLA'ATIONTEST IDtlit:ft Observation Hole# 'u," `_ Tinte tit 9" Depth of Pere ►'JU`IV�"(2 5� Time at 6" _ Start Pre-soak Time @ _ Time(9"-6") End Pre-soak ^��p�/� Rate Min./Inch x ` Site Suitability Assessment: Site Passed Site'Failed: Additional Testing Needed(YIN) Original; Public Health Division Observation Hole Data To Be Completed on Back------------ ***It percolation test is to l)e conducted Within 100' of Wetland,you must first uaotify the. Barnstable Conservation Mvision at least one (1) Week Prior to beginning. Q:\SCf1TlC\Pr3RCPORM.DOC DREP.OBSER 4'A Ie V HOLELO �" Dcplh from Soil Horizon Soil Texlur Hole# Surface(in.) Soil Color Soil•(USDA) Other .. (Munsell) Mottlin g (Structure,Stones;Boulders. ,=� ® Con istenc % ravel % -74 DR EP OBSERVATION H®LI'�L®� Depth from Soil horizon Hole#�Z Surface(in.) Soil Texture Soil Color (USDA) Soil Other (Munsell) Mottling (Structure,Stones,Boulders. Q 2 CV-A u �� Cons! enc %C avel -L 6 Depth from ER D P OBSERVATION HOLE L 0 G Soil Horizon I101C# Surface(in.) Solt Texture Soil Color. (USDA) (M Soil Other unsell) Mottling (Structure,Stones,Boulders. _... Consistency,5r Onvel) — r DRE1P OBSIERVATIONIY®LE, LOG Depth from Soil Horizon Hole#_ Surface(in) Soil Texture Soil Color Soil (USDA) ., (Munsell) 4 Mottlln Other g (Structure,Stones;Boulders, Consistency %Orav� on Flood Insurance Date Maw Above 500 year flood boundary No_ Yes Within 500 year boundary No t Yes ' Within 100 year flood boundary No Yes _ Depth of Naturally ice irrin Pervious lVMaterisl Does at least four feet of naturally occurring pervious mates•lal exist in all areas observed throughout the area proposed for the soil absorption system? ,e If not, what is the depth of naturally occurring pervious materiall ,,e� CeVliffCatlan I certify that on OV. (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection and that the above analy.-is was performed by me consistent with the required trai 1ex ertise and experience described in CIO CMR 15.017. Signature Datb v Q:\SEPTIC\PERCFORM.DOC VYeNo. � Fee THE COMMONWEALTH'OF MAS-5ACHUSETTSEntered in computer:PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zfpphratiou for Bigaal *pgtem Comaructiou J)ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. -5 / 0—hap p o/c/c/icq Owner's Name,Address,and Tel.No. SQ,P 7 7 9-g,3 1 9' C-P-nIfry iI It yvK y vtr _ Assessor's Map/Parcel _-Aiap r 7o P rc S ` / c J In st ler's Nam ,Address,and Tel.No. `b9-'I77_0j;L Designer's Name,Address and Tel.No. JD (Oc� 5 7 I 8 Qva.fton V-' 1)aw0 Ca ineG1 in9 cl o Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date �10 4 ( Number of sheets Revision Date Title I i�'� Size of Septic Tank ' 0600 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sig&d Date Application Approved by Date Application Disapprov by: Date for the following reasons Permit No. Date Issued VYe No. IFee THE COMMOI W�ALTHIQF MASS CHUSETTSEntered in computer: � a ,-. _�-•µ� PUBLIC,HEALTH DIVISION - TOWN OF BARNS ABLE, MASSACHUSETTS 0.pprication for Migpo.5aY ,*pgtem Congtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,59 C hQp p IJ 1C1rjIL rL/ Owner's Name,Address,and Tel.No. So 7 �/ Assessor's'Map/Parce I CiengerviIIt V u e yvf'r� o 1 7n P P n U� Installer's Name,Address,and Tel.No. 5 -L1 7 7 G4b 3 Designer's Name,Address and Tel.No. 5Q f_3 6Q. 7 5 7 1 518 Ex oval lUn 2)owt) C0-13P fE'L(�r ,rri �r-i5 0 1 V Q n„ + A.4 a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other .Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �j gpd Design flow provided gpd Plan Date 10 1441 1,,1) y Number of sheets Revision Date Title Size of Septic Tank j (�/ off Type of S.A.S. t Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sig d Date I Application Approved by /�. Date Application Disapprove by: Date for the following reasons Permit No... Date Issued —_---v J K T�• AVC( MMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .._ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( �)' Upgraded ( ) Abandoned( )by R; F e h ( A at F�y (r r��� }�rl!r c � V C) ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer h--r + (T 1�, x I Designer ��► f -1 Z 13 1 (I (1 #bedrooms _� Approved de i n flow ' gpd The issuance of this permit sha not be construed as a guarantee that the system will f coon designed. Date Inspector ti No Fee i� NHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS %igpogar *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( r/) Upgrade ( ) Abandon ( ) System located at / ,. �(�, , , S� �, _1 6A, Ly- 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construe ion rqust be completed within three years of the date of this peaMt. 410�; Date A roved b PP y �/ V t FROM :down cape engineering inc FAX NO. :15083629880 Oct. 12 2010 11:37AM P1 + TI 61 '�.'FV6D'4P3I�.� ul'. G.i�fl�::Y"� BYT11"S.��pUY' �:liarrrsais ,I'�I .��r-,aim, DnDr+s'a�C.or 9d�1� 1.0!Itsgi.�rn�,dil•a�r=4:,�41}��r'�mrapr�, I�V.,�, QD7:iroQDq Oft-inn: Ws,iY6?4644 I`ax: 508'190-ti304 g.91t;4vP�1+!"a"�Y LF!$°u'L�hBQ�i��_:�1..V.A�I$1.5ll11A1G$li�F61'J['N1Cfl Date: Pe nu tft# AID qd yie : On _ �. Sa o , / watt iSS'Uo i a pumit to install a septic :ystc~ 1 at J�q busccl ou a.&.sip drawn by. k (a'.ddress (C1t3S1,�,11eT) � I certify'tat the ,,epLic sy,;tem.-1C'TdreT1';0d Libove. wwi irts011od substantially acoordi_n.lr to th.o desivA, which. may include minor approved change;; sctch as latevil rcloeat:ton.of the duitnb lhon box,3 adioj- septic rank. 1. CertifY thuit thO 5epti.a systefn t:efei:elced. above Was i'll'sUled wiLh major c:li.C:iagcS (i.e. center. thim 10, later al rc:locatiort ofthc. SAS or arty vc1tic,91 relnca.ti,on of any cc mpon(mt. ul,1.c septic System,) but in accordance with Striate Local Rcgulaficns. Plan revision or cei-dfic,d as-'built by clesif 1jer to follow_ ��ttil JF.wq��P DANIELA. fir (l st<�.Ll.er.' Oa t urc: OJAr� �^ CIVIL rn Nm 46502 a guc's's ar. ) (�� arr_la t_1LEASE RF,7TTTaTi_ TO ..LCARYJST ibylF, HF,.UJI..B. 0.1VIS10N.... f._,E4'1'1J[+'1�'�'A'�!; t�1F sr�U1NdE'Y,9 l�1'i'.:B{: WTLu NOT Ufi 1Jfr'.4'to, 1U)'J'.a A14D AS.-DUILT CAIU) AAF, D891',C31,f OTEIII BY THE HBjUkNS:U.;AH1f_F,)('tIW,Yf.1��t�;,�y;1:>t�:)f,9{OT1G�119=D}°�,. 7fY�A NK Y0U, t,r;ZJPHII}IISe.Isl.iu`flesiknrr t�rrFiFra':il�n.Fc+rr�+:1-2E-�4.tluc TOWN OF BARNSTABLE I,OCATIONS'S/ C�pa$yi do�i c RA SEWAGE# Q6/O - 510 y VILLAGE Cemn-1 c r g: 11 c ASSESSOR'S MAP&PARCEL /70 INSTALLER'S NAME&PHONE NO. ,[3 Q E X ect v 0d i o n SEPTIC TANK CAPACITY /Oo o go.) tl/o LEACHING FACILITY:(type) -rrc n CA,c S z, (size) a x 3 x 3 Z NO.OF BEDROOMS 3 OWNER Yj K Y u c n PERMIT DATE: f o Is/ /o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Az- 32' Bz- 21 C3- 39 ' D3- ��t Rcar SwcWn9 � c t i V1 O Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: pe!� key to move your cursor-do not Rick L. Wright use the return key. Name of Inspector B & B Excavation, Inc. Q Company Name By 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ��...�. 8/30/10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool - El ® 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 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. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'' 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1974 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 1/2' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20'feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good condition - no sign of leakage Septic Tank(locate on site plan): Depth below grade: 2 1/2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 5'2"X 57'X 8'6" Sludge depth: 6" t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound but water level is 6"above invert due to failed leaching Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 5 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): no d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching in hydraulic failure. Water level over invert pipe Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owners Name information is required for every Centerville MA 02632 8/30/10 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A Al = 15 ' o B eZ31 0B2z 31 ' 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: > 13'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Chappaquiddick Road Property Address Yuki Chan Owner Owner's Name information is required for every Centerville MA 02632 8/30/10 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r LOCL710O ,I- ® i 5EW&C.4E .PERMIT UO. 'VILLAGE C72ut11 1tGNl, R � _ IWSTQLLER 5 UWE ADDRESS BUILDER 5 Q &MF- �- ' ADDRE SS -DIQ-'CE PERMIT 155UED _ D ATE COMPLI h,t�lCE ISSUED - S= 3-`7 w �-�- N6-- vD�rre r5' �v 1 I © � i e No.....f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..... ... ... -----------------OF..................................... .................. - Apphration -fur Uiipuiittl Workti Towstrurtion Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: --....... ... . ---... -- --- ..............-------•-- �y 6k dt 1 capon-Addre or Lot N /K hh ._ 2�6crr �c ._... l�hss�psi c.,0ir,� --------- --•-••-••---- ._ . --------- ------------ ----------...........................................................V.......------------.------ W G/ ner Address I nstaller Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms._._-r__._.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .-.-_--___________________ No. of persons.--_-_.----________---_-_.-_ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- -- W Design Flow..............r-.O...............__._._gallons per person per day. Total daily flow-_....._._...!�_O-_D....._ gallons. WSeptic Tank—Liquid capacity./OP.gallons Length---------------- Width................ Diameter---.-_--.-_.__ Depth-__.---.--.----- x Disposal Trench—N . .. Width------------- �tal Leng of le�ng area--------------------sq. ft. Seepage Pit No........ Diameter_._. i et... T6taT eP"aching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) a .Percolation Test Results Performed by------------- _------------------ •......... " a ------------------ Test Pit No. 1................minutes per inch Depth of "Pest it......-_._________.. Depth to ground water------------------------ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ----------------------- -------------------•------------.....--•-•---------•---......••--•....-•---•.........................................................O Description of Soil------------- ---------------------•------------------------- x W U Nature of Repairs or Alterations—Answer when applicable------------------ - ------------IA S7j tt r.. ��-v.a �t .•- �1'�'dr�c ``�� C��zGiiK� 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 undersi ned further agrees not to place the system in operation until a Certificate of Compliance has bee s e y b of Signed...._ �_ ---- •----•-- -------------------------------- Date ApplicationApproved By------ ------- ,% •---•--•----•-•-•-•----------------•-•-- ............................ ...................... --------------- Date Application Disapproved for the following reasons------------------------------------------------------•-•----_---.-------.-.-.-.------_--_-----.-----------....__ ----------------•--•----------------------•--•--••------------•-•-----------•-•--------•-•-•---------•---------••-•-----••-•--- --•-••---•---------•----------_-.------------•----------•--------------- Date Permit No.___-___---F/ ---------------------•--•-------•-•.. Issued------..., ........ Date .......... ........ THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ............ . ... ... .................O F......................................... .....---.....------................I.....---- Applirtttion -for Diiipoottl lVarkii Tianotrurtion Vaniit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ............................................. .... -----ice' Location.Address or Lot No. �/!c ey li h �............•---- .-r 00-er Address Installer Address QType of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms---_- _.-_�____v----•___________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.i Other fixtures ------------------------------- - - -----------------•---•--•----------------- W Design Flow.............?..._ ?_____________-_____.gallons per person per day. Total daily flow--------------3.G__�'.-........_...+...gallons. WSeptic Tunk—Liquid capacity_-_ vl�gallons Length______________ Width.___-_---_-_.. Diameter__.--..._._.___ Depth--..----_--._... x Disposal Trench—No_ ____________________ Width.................... Total Length-------------------- Total leaching area....................sq. ft. t Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water------------------------ 41 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--._.___----____---_.--. lX -•----------•-•---------------------------------------------------------------------------------------------------•-----------------------------------_-•--- ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ V ---------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------..-..----------- W VNature of Repairs or Alterations—Answer when applicable.-.__........................................................................................... �J 15'//. 1 r, 41 0/ — �///✓r''< - rtt6t �0 / --------------------•---._...._...._.............._....._...._............I--------•----•--_--- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee . s er f e 0 Si ne --------------- -------------------•--••--------Date Application Approved By-•-- �------- /L= -- f Date Application Disapproved for the following reasons:-----•------------•----••-----------••-------•-•----------------------------------•--•-------------------------- ----------------------••----.._..•--•-------•----•-------••-•------------•••-•---.----------••------------------------------------------------------------------------------_---•--•------------------- Permit No. ` Date - ------------------•-------------------. Issued....-----•?_...--� ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .. O F..... -s rhh/ .............................................................................•-- Tntifirttte of f IlImplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (; ) by / ...... .......� -..=�-------------------------------------•- ---- Installer at.......... ............................ ... - ------ -----•-------------------•-------•-------------------•---•------------•-----•---•----•------- 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._--._._ �....:...................... dated_..___!�.___ ' _._____':....%._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE _ -7`,e Inspector.,' -- ---- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T� h�,�_ .. . - fa ' ...I................................. OF...� . ----.....--------....-------------•--------------........... No. FEE --- Dinpofittl lVarkiiCnontrnrtionrrntit Permission is hereby granted----------4 r.%__..__._ .------!'_ ______________________ ----------------------------------------------------------------------- to Construct ( ) or Repair (X) an Individual Sewage Disposal System r, Street ----- Dated ---- as shown on the application for Disposal Works Construction Perm N .�_.�.... " Board of Health DATE -- �-----------------•-••-•---•--•----••••••--•- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS SHALL SYSTEM PROFILE MALL ARKESD WITHCMAGNETICTTAPE OR BE NOTES j COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. '20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE % ro 2. MUNICIPAL WATER IS EXISTING c TOP FOUND. EL. 53.3' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE o o 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. a a o MINIMUM .75' OF COVER OVER PRECAST 2% SLOP /QUIRED OVER SYSTEM a 4. DESIGN LOADING FOR ALL PROPOSED PRECAST i PRECAST H io UNITS TO BE AASHO H-j_Q RISERS (TYP.) J 2 0 51.04' 4"�SCH40 PVC 2" PEASTO OR GEOTEXTILE e� 5. PIPE JOINTS TO BE MADE WATERTIGHT. 0 PIPES LEVEL 1 ST 2' FILTER FAIJRIC OVER STONE zr 49.4' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" EXISTING 14" U WITH 310 CMR 15.000 (TITLE 5.) TEE SEPTIC TAN 49.64f*' ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° r ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° o ° °. ° ° ° ° ° ° ° ° ° ° ° a °°°°°°°°°° 48.91 0°0 ° o °o° GAS BAFFLE. ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 46.76' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Locu ,�°°°°°�°�°� °°°°°°°°°°°°°°°°°°°°°°°°°° ° O°O°O°°°°°°°°°°°°°°°°°°°°°°°°°°°°°° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY hoo :.: 4' LIQ. LEVEL (ACME OR EQUAL) ." 49.13' 48.96' \30' of 4" PVC SET AT .00��'/' SLOPE . OTHER PURPOSE. 09 °. ON 6" DOUBLE WASHED 3/4" - 1 1/2' STONE .. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 12" MIN INT. DIM. 6" MIN. SUMP (2) 32' x 3' x 2' DEEP TRENCHES 5, °' (6' BETWEEN TRENCHES) 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION, (15.221 [2]) HEALTH AND PERMISSION OBTAINED FROM BOARD Zg Roue ( 1 % SLOPE) ( 1 % SLOPE) OF HEALTH. BOTTOM 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST. SEPTIC TANK 51 D' BOX 7' LEACHING TH ELEV. 41 .7' CALLING DIGSAFE (1-888-344-7233) AND FACILITY u VERIFYING THE LOCATION OF ALL UNDERGROUND& LOCUS MAP OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE ANY UNSUITABLE MATERIAL ENCOUNTERED H PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 170 PARCEL 28 WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND50.26 SAND. 99 - EXISTING CONTOUR / 51 \ �` X 99.1 x 51.25 EXIST. SPOT ELEV. SYSTEM DESIGN: 99 PROPOSED CONTOUR x 51.96 GARBAGE DISPOSER IS NOT ALLOWED �g8.4] PROPOSED SPOT EL. O ,°s°o TH1 x/ \ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD TEST HOLE �0 / 32 52 USE A 330 GPD DESIGN FLOW 2.11 X 2> SLOPE OF GROUND G�- oo 14" F PINE SEPTIC TANK: 330 GPD (2) = 660 `� UTILITY POLE 5ti 20' WHITE PINE x 52.07 RE-USE EXISTING 1000 GAL. SEPTIC TANK ** FIRE_HYDRANT _ NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING x 52: 4 LEACHING: ■ / 12" OAK 1 SIDES: 2[2 (32 + 3) 2 (.74)1 = 207 GPD T u i E LOGS X� TH 2 / ' oA// i4" OAK BOTTOM 2[32 x 3 (.74)1 = 142 GPD TES O 51 23 / BENCH MARK - TOP of ' �/ `O x 52.86 TOTAL: 472 S.F. 349 GPD DECK CORN. ELEV 53.9 2. / ENGINEER: DANIEL A. OJALA, PE, SE / 1 �/ 52.57 52.89 USE (2) 32' LONG x 3' WIDE x 2' DEEP WITNESS: DAVID W. S / h� LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE STANTON,' ^ 53.93 © 2-93 DATE: SEPTEMBER 30, 2010 / X 2.19 ^ 56 o x 56 x 52.88 PERC. RATE _ < 2 MIN/INCH 5x\ DECK 52.66 CLASS I SOILS P# 13073 52.77 / 52.65 GAR. l- ELEV. ELEV. 51-45 2.21 SLAB x 52.97 �� 52.41 2.66 x 5 .96 MA p" 52.2' p" 52.2' s� x 52. 5 .oa APPROVED DATE BOARD OF HEALTH 51.14 x 1 c) EXIST. DWELL. 0 0 TOP FNDN. = 53.3' 52.85 00 0 211 2r' 50.49 1.43 51.72 52 51.28 A A k 50.38 0 O� LS Ls , �o TITLE 5 SITE PLAN 10YR 4/2 10YR 4/2 \ ti 0 7� QP LOT 6 s OF 6» 6» 15,616 t SF 52.47 54 CHAPPAQUIDDICK ROAD B B so LS LS9.81 CENTERVILLE c /a o THOFA,i 10YR 6 6 36 10YR 6 6 49 2 ID ° HOFn,Asj,� qC PREPARED FOR n / , n / , \ 8° J a l J. ASS 36 49.2 soy DANIEL 49 52 �� �/ - DANlELA. �� !"- A. OJALA I'jI UJALA �: B&B EXCAVATION//YUEN IO \ o „• CIVIL ryt.p C C Q� ��� mt'o. o �� �O� ss��`�P OCTOBER 4, 2010 PERC C off 508-362-4541 LV M/CS M/CS �0 � � ti DANiEL sq�G ��` �" `" • q � c fax 508-362-9880 \ ° DANIELA. �� A. 61 I downcape.com 48.81 OJALA .a OJALA I 1OYR 7/4 1OYR 7/4 C€VIL Coll , 40980 down cope engineering Inc. 126 41 .7 126 41.7 �Nb,465020 c �. t, civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20 / ® �`f_ 1� � u - laud surveyors 939 Main Street ( R to 6A) 0 10 20 30 40 50 FEET �.72 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 10-212 10-212.DWG (SBO)