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Home My WebLink About0019 ELLIOTT ROAD - Health 19 ELLIOTT RD (A & B) Centerville A = 248 = 004 — 002 l o-)Ix� ora NO. 1521/3 ORA 10% ito "A�p d q.�� Commonwealth of Massachusetts Title 5 Official Inspection Form X OX Subsurface Sewage Disposal System Form Not for Voluntary Assessments W 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , 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: - keyto move your cur cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason ,� Company Name 4 Glacier Path Company Address fmo mI East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this adde's anddtha-he. o , information reported below is true, accurate and complete as of the time of the ins ection. Thge insp rtion was performed based on my training and experience in the proper function and.m intenancRf on si a I sewage disposal systems. I am a DEP a y p p `` g p y approved system inspector ursuant�to ection 16.340� Title 5 (310 CMR 15.000).The system: , -v ® Passes ❑ Conditionally Passes ❑ Fats C" ❑ Needs Further Evaluation by the Local Approving Authority • June 30, 2014 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•3/13 Title 5 Official Inspe io orm: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 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 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: The observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 A&B Elliott Road Property Address . Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts \ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 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 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd.. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking'water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section.D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every 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): unit ch Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: 2012; 92,000 and 2013; 105,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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•3113 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 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every ; page. Cityrrown 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: Board of Health 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7/18/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 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: 1500 Typical Sludge depth: 2" t5ins-3113 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 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 42" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 12" 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.): Effluent level with outlet tee invert Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ' ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information cont. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5- Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is Centerville MA 02632 June 27 2014 required for every , page. Cityrrown 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 Level with 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.): Dbox is 15" below grade. No indication of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3-3050's ❑ 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.): Utilized camera to inspect components due to units under pavement. 3050's typically H2O or considered such at the time of installation. No signs of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 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 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth cf Massachusetts L Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 page. Cityrrown 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: 20 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: Town Ground Water Contour Map ® Checked with local excavators, installers- attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized Town of Barnstable Ground Water Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 19 A&B Elliott Road Property Address Robin Maddalena, Maddalena Manor Realty Owner Owner's Name information is required for every Centerville MA 02632 June 27, 2014 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1 � Iq3 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536 July 18, 2003 RE: Certification of Title V Septic System Installation: Residential Property 17 Elliot Road, Centerville,MA Dear Sir or Madam: On July 15, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 17 Elliot Road, Centerville, MA, based on a design drawn by Shay Environmental Services on July 11, 2003. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES,INC. OF ygSs9 o� CARMENE. o�GN r SHAY �. No. 1181 Cairfn6 E. Sh , R.S., ,� a President Fo/s T E��c t,,�gNI7AR��N TWN OF BARNSTABLE 2ooLOCATION ``' SEWAGE#� 3 i AS SOR'S MAP &LOT 2`{$ VILLAGE -U0�{-O0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY � �`%�" ` � �� LEACHING FACILITY: (type) s ' S•-�y�C1� Y (size) . f — NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: s i COMPLLANCE DATE: I—I�'03 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by I A- it l7 o 7 e at i s�n� No.�&V-3 FEE COMMONWEALTH OF Mi�SSACHUSETTS Board of Health, MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT p 'cation for a Permit to Construct( ) RepairXUpgrade( ) Abandon( ) - ❑Complete System,*Individual Components ocation I r jl), Owner's Name � Map/Pa cel# 2 QQ Address Lot# - Telephone# Installer's Name a e> v; Designer's Name CZ Address S c v Address Telephone# (old _ 3�d Telephone# 8_� 9 Q25 Type of Building t Lot Size sq.ft. Dwelling-No.of Bedrooms 4 Z— 110, Garbage grinder Nj/Al Other-Type of Building ® No. ersons 4- Showers (L�,-6eteria (VII, Other Fixtures{ w�I�Tf1P�`��\TCfA �\ntZ. Ai aMJ Design Flow (min.required) �(4o gpd Calculated design flow 440 Design flow provided 3 gpd Plan: Date Number of sheets Revision Date �1 Title � S P Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator AD 'GKI SWAY Date of Evaluation Z DESCRIPTION OF REPAIRS OR ALTERATIONS I-AR0 4C vva DESIGNING ENGINEER MUST SUPERVISE The dersigned agrees to install the above described Individual Sewage Dis osal S tem inla'WAUP th ERTIFY 1 I G d further ees t not to pl a eration until a Certificate of m ce WnQ51FCT 8% o > (e ll . Signed Date CCORDAN E TO PLAT g /tY10 Inspections No.� ! .',,,�� ti: _ �t FEE tip` .;IGA.s: t COMMONWEALTH OF MAS9XCHUSETTS a Board of Health, MA. MA. YYY APPLICATION FOP, DISPOSAL SYSTEM- CONSTRUCTION PERMIT /A plication for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) - ❑Complete System,,Individual Components ✓Location F ` 1 1 nt�11-{ C�l IQ v l fa Owner's Name r r `_ �j Map/Pa cr el# Z k / G L '[n� Address �� i �- ��- p (1�KC a J 1�\ l�A 1 . Lot# }` Telephone# i Installer's Name Cx Designer's Name c�,1CQ Ci tl�litC,t �t�`R � �CS. Address 11 Address f Telephone# (�1.� _ �31 b\ Telephone# 5A S-1 71-9(0 Type of Building Lot Size sq.ft. l flDwelling-No.of Bedrooms �1�'� ®4 2' .� �baM S 2 d �i'n Garbage grinder (/fig i _Other-Type of Building .g�1C�C� No of ersons 4 Showers O=!Cafeteria (V✓ Other Fixtures L�r1uATC�.CL� , bC�TC1\ti.►a "~1i� LAQ r*s�.,"t� ~ t r Design Flow (min.required) ( gpd Calculated design flow 44o Design flow provided '�b gpd 'Plan: Date Number of sheets ( Revision Date Title Description of Soils) 1 i s A� ( r ` Soil Evaluator Form No. Name of Soil Evaluator`, LM Ch1 �Z Wij Date of Evaluation 512 VDS r DESCRIPTION OF 4REPAIRS OR ALTERATIONS "k-Cz,(-iL4o C- 1�AcC� The idersigned agrees to install the above described Individual Sewage is t osal System in accordance with the provisions of TITLE 5 and pfurther ees t no'0p, a^e a syste r operation until a Certificate of C !m li ce a een issued by the Board of Health. Signed (/1 Date 1 ri 7/f yw r"x Inspections s No. 'a Ur1 Z' �I FEE COMMON W-ju OF M SACHUSETTS c '•s Board of Health,, J MA:. '# CERTIFICATE OF COMPLIANCE Description of Work: I,'Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired X,Upgraded ( ),Abandoned ( by- . !7 has been installed in accordance with the provisio s of 310 CMR 15.00 (Title 5) and t ap roved design plans/as-built plans relating to application No. UJn3'I-n� �l n, ted Lf'�'1�U prov d D�sn Flow/ (gPd) Installer Designer: Inspector: �f Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. d U U3- I( FEE 1 y MAS Board of Health, S�(,(� MA. DISPOSAL SYSTLM CONSTRUCTION PERMIT Permission .h eby grant-dtt�o;; Construct( �(V )) RepL (0�) Upgrade( ) Abandon( ) an individual sewage disposal system atr) /1.f , as described in the application for Disposal System Construction Permit No. OW3-3I f , dated 7 (V/Q, / Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. J � Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �/ 3 Board of Health 1 / V r FORM 11 — SOIL EVALUATOR FORM Page. 1 of 3 No.: Date: 5/30/03 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 5/30/03 Witnessed By: Sam White—Yarmouth BOH Location Address or#17 Elliot Road Owners Name: Robin Maddalena Centerville,MA Address and 115 Pine Street,Centerville,MA Lot# Map 248,Parcel 004/003 Telephone Number: New Construction : Repair : X OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes X❑ Within 500 Year Flood Boundary: No FXI Yes ❑ Within 100 Year Flood Boundary: No Fxl Yes ❑ Wetland Area: None National Wetland Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal [i] Below Normal ❑ Other References Reviewed: USGS Topoaraphic Map DEP APPROVED FORM 12/7/95 FORM 11 — SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #17 Elliott Road, Centerville, MA On -Site Review Deep Hole Number: #1 Date: 5/27/03 Time: 11:00 AM Weather: Sunny, Warm 78 ° Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 30" AP FILL FILL None <5% Gravel, Friable Friable 30" — 84" C' Sandy 2.5 Y 8/6 Sandy Loam Loam None 15-25% Gravel, Friable Friable Med- 84" — 126" C2 Coarse 2.5 Y 7/4 None Medium to Coarse Sand Sand, 10% gravel, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock: None encountered Depth to Groundwater: Standing Water in the Hole: N/A Weeping From Face: N/A Estimated Seasonal High Water Table None 126" assumed I DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page - 3 of 3 Location Address or Lot No.: #17 Elliott Road, Centerville, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: 126" inches ❑ Depth weeping from side of Observation Hole: 126" inches (observed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature: Date: /t7 � FORM f2 - "PERCOLATION TEST Location Address or Lot No.: #17 Elliott Road COMMONWEALTH OF MASSACHUSETTS Centerville , Massachusetts Percolation Test Date: 5/30/03 Time: 11 :30 AM Observation Hole #1 Depth of Perc 84" — 102" Start Pre-soak End Pre-soak Time at 12" Time at 9 Time at 6" Time (9-6") Rate Min./inch <2MPl Assumed * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Sam White Comments: Would Not Hold 24 Gallon Presoak - <2 MPI (Assumed) Site Passed X Site Failed DEP APPROVED FORM 12/7/95 l WN OF BARNSTABLE LOCATION J� 1 SEWAGE # 200 3 11 �7IILLAGE y AS SSOR'S MAP & LOT'1q8"UOq-003 INSTALLER'S NAME&PHONE NO. r�C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S D�D S- a (size) NO..OF BEDROOMS BUILDER OR OWNER Gt CV, PERMIT DATE: 1 q"0 3 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 i � CP I jq �7[ S�n� t. OWN OF BARNSTADpBLnEE LOCATION n ,� �_ ��Iw SEW;-GE # 9- � VILLAG ASSESSOR'S MAP & LOT -0 -1,� INSTALLER'S NAME&PHONE NO. V/V c e C't/1 Z, r 7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 7f S (size) ,S61 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: Q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r /,7�r7 � ETC/ -d r h No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for j0i2;po.5a1 *pztem Con.5truction Vermit Application for a Permit to Construct )Repair( )Upgrade( )Ab don omplete System ❑Individual Components JA Location Address or Lot No.iP ` C wnerr'ssAN`ame,Address a9d Tel.No. Assessor's Map/Parcel C:; s 00L� -003 r,4y 6 ) Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building CDIA _No.of Persons Showers( ) Cafeteria( ) Other Fixtures C Design Flow L�Ikd gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I s a- � cxv^ Type of S.A.S. Description of Soil V "—j2 S_ � J Nature of Repairs or Alt ations(Answer when applicable) t 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 Certifi- cate of Compliance has en issued by thr of Heat . Signed Date Application Approved by Date Application Disapproved for the ollo ng reasons Permit No. Date Issued No. ".7 - �w° Fee -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4 r Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE,, 2pprication for 0i.5pozal 6p!5tem Construction Permit Application for a Permit to Construct(,, )Repair( )Upgrade )Ab don omplete System El Individual Components Location Address or Lot No. ` 6 V j wner's Name,Address ano Tel.No. Assessor's Map/Parcel � .O ` C--( -ar)3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. g Garbage Grinder( ) Other Type of Building�c <- �_. No.of Persons 1 J howe•s"( ) Cafeteria( ) Other Fixtures i _ t Design Flow LA Iy gallons per day. Calculated dailykflb4; & ` f gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank S S) 2t Type of S.A.S. ' Description of Soil_ Nature of Repairs or Alterations((Answer when applicable) �CID S F d T r h �- L"�t y-z✓- c.�n Ccc U cT, G�s�� r 2 Tic,l G U?J �� S?C_"�--P 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 Certifi- cate of Compliance has gn issued by tlu f Hea . Signed Date S allow— Application Approved by `Date Application Disapproved for the ollow ng reasons l F 1 . Permit No. �� .�j �l Gs Date Issued ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ; i THIS IS TO CERTIFY t t the On-site Sewage Disposal System Con/strutted( )Repaired.( )Upgraded({� Abandoned( )by / — C _(=s s;= �1 at Q p has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dat&_ Installer s Designer Q O, The issuance of this hall n, strued as a guarantee that the systt Mu ction as es ned r Date Inspector --------------------------------------- No. / ` ` ;J n", Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xigoar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(�bandon( ) System located at .i —C Sp l I 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:Construction must be completed within three years of the date of this permit. Date: /1 79 Approved by �F . 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. _ �& CERTIFICATION OF SKETCH AND APPLICATION FOR 00 FORKS CONSTRUCTION PERM WITHOUT HOUT DESIGNED pIOSAL hereby certify that the application for disposal works construction permit signed by me dated Q`� � concerning the property located! t > 1 `�� meets all of the following criteria: 4' • The failed system is conne cted to a residential dwelling only. There are no commercial or business �es 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 C�l 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 v There are no variances requested or needed. a/• The bottom of the proposed leaching facility will not be located less than ma.,dmum adjusted groundwater table elevation. (Adjust the five feet above the thod when applicable) groundwater table using the Frimptor • 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�i G f DIFFERENCE BETWEEN A and B L-46 SIGNED : DATE: [Sketch proposed plan of,system on back]. q:health folder cert 00 o� IK- nsi f Fi�td Map>�acet 248004003 ' n 248004003 Vcui~t 004172i 0153719 v s Parcei id '" � 4 � � � n+ ;�.� N __8 .��Y fir'• y. �cw` .� _ ,� 't ,_ n Yr�Ylr Aevei Lot s, 3 e .2 crs 3 Gurr�,U,M:j MADDALENA,THELMA F& F 101 WEI )MANN,PAMELA 2 0000076 r 2717 PACIFIC AVE r5 SAN FRANCISCO / CA 94115 t Ja :NA, :T..H9E-. LMA F .`:r �:✓f.... s �%r ,.._:, t. , 1/117ar Y y 81u8s z y La 33600 u gs 82400 ea ' esY 0000000000 � c�c idn*-// 17 ELLIOTT ROAD 0492 ire Dish CO Unassigned Road Name n 0000 0000 /xr. TOWN OFFJBARNSTABLE LOCATION fSEW�AGE # VILLAGE .�i e i� ��(Re ASSESSOR'S MAP & LOT A-0 INSTALLER'S NAME&PHONE NO. -V LAO �r►T SEPTIC TANK CAPACITY 1-00 v LEACHING FACILITY: (type - - (size) NO.OF BEDROOMS t BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G ' �I .14 37 A0 7 �3� - �i�Q �gg�yy Og I® _ � \ n06�0 rn >A eR >�%z�� 03 g'a Y O� s?ii0 = c� z n =O Q' - oz CR ;45 �t1i Z Zq mNy § � � � rnN � a ➢cN�zzOg I � i® , oo s z g O � 2Fi s O '� \# �gDO - �« � I C�l 22 Fn y c�� Z � a 3?c F:•�� 10'-5D/A" S' IJ'-61/A" � _ 2' d IFcrZ-13 � �o� ` N➢�< I I�-0--ITV--II I Z Z N L �J m 2A' a a � =FIII/A— a /e z _ � � FOI.nING I2-03 6'-III/4^ _ 6 - � FII i Q as/ zz-hl/z T9 5/4" t ` - I ° d a 6 u® n 000 ' r m 0 z 0 z •, z O z y{v i ci `je{ ' _ ffffJJJ / I � Existing Window Location Existing Window Location 5 1 4 is 33 -; _ ,: 0 �2e LUP71, r J cx I i p" 33 1871.12 Ok _ Ca it r, o Ca N, I 3$ I Room: IIt VENT 4 indlet tdil) C Pm lsmm"WX WALL W m; PROME--,VIP W VP 1EA CAUNC RO IFROMAW iSchedule -,40 PVC-01a rcool IMor Filter 0 BE 4—SCREDU 40 P. �C. ITEM LEV11 M AT LEAV ic o Scole Not t'*"OTE. ALL'PIPES ARE"m ILE V' CM40RM 60�"house to sept!c tank TOF ELEV I �jr 4 I 21 MOW, surned XNOCKOJITS_8%ox US ELEW 97 T A ]rem&"�J,,eefvm V, PAKT oor umu 7-3 1,1011 __�10,0.10 OP 0 S max"mm 0,02 4.00 jx,EASTING�,�I OR ORE ST tax f:,SA 11000 GAL,CMT. 01K Sm '40 ue,P PINE 'STIR7T C:TAW E C H, L -SECIJON MU ta"Colim Depth sioletv Urvits 6.251 T LE H 0 DISTRIB TJON EM PROnL SY E C1`1 SIT.5 NOT.10'tCALE Not to state LOCUS MAP a)'ALL COM ONENTS �6s`0TE. t HAVE SMOW GRADE -t ec Ve Mum 'SOIL.AIMIRPTION-SYSTEM AS)* i 1/2 5'STRIPOUT�AM' 'I'M M"ATEN 9m -f I'd layer, rep oce at*: 'Remove 461 down to tried *on _t" DUNBAR NOTES V. .00 reploce'Wth clean coarse TOR iMOWL bd5b .L[1ADING> ' 4e JWTLTKA 0 Isand w/perc. Certification 0 f1l Material R"r Note. 1 ontrac or lis�resOon§jWe fot�' ig"Tate Im,than at to�1 thin./in. .641 after',placement (OR EQUIVALENT): C t safe notificatio a n prote6bori of'oll-'undergebund utifties,and es.mE�H06HT,'IS 24' id Befre and ftr Pla�rn'ent bj ve,.Analyses aottmn of Test Hok I flev.-87M' fTE ,OVERALL:'14EIGHT.OF�,lNnL71�ATOR IS 3W./EFFEC pip i',"The%sOptic.tdrik i6nj distriout*4, box shall bd set,.6--af 's 4, /2 st6rie.,�-be',c eon" son �o ravel wit 2-11r DIAM. kW4 ANHOLES G LEACH' PIT TO 3 Mill,should I d r,,a ones ver, n"size hLittl N PIUMPED & is Sys, n during,,insi lidtion FOU b OR REMOVE6 IF ND, TO W,NECES TO'4NSTAU_ NM �SAS;�'� 4' Th* terd SARY it,thii te e 66trC6 ccor a ce a Aw�,'STRIPPED NOTE. )u assdchtis�tts state eo�,the a pp to ed plan PER --8 n ci B DISPOSED `U11of,e" EXISTING 'LEACH PrrS/CESS1P0 wi0 E d OARD',0 H TW -'COVWS Felt 'W,t&l1C TAW.CCESS NS. IS"OEEPM IHAN 6 lNCWS 8EWW F"SHM em bny ET -site condition s that different be�pontrodt r, hcotint u6n P, EALTm sminwo DISIRIBU7M Box AND LEACHNG COMPONENT soi n h' 6oi og or n 'our esign-1 ro se �s owft',�,oh t d SH&L BEAAM40 VAYNIN O'OF �QUESTEI f h , h,VAIAN6ES S installation must bit imrnadiate,,,,"nbbf tidn o'cb be CAS t u e e- h e a hou e I-166te ed b Ah id J ormen Envi 00 QUALS me e- a r6nmentol rvices,�-_ nc z rou,ridatiori*6tyi.20,feet to 10.-Jeet. A bb Liner has 0 avy mac iner)l -.dr"Ibeen Proo6se 7 'N' :v;ehicli or,, 6 n S_sep id�uys ern unlest noted at ompOne-PONFMCED PRE-, 'I,, d t, t H-20 4fi6 P V1 tw 8. Install lufl�rite recIuals on 'd Aiet te�e ends', plpes�iorhetet�S�dh�d e All Dis ribution lines thati.tie' 4 'd' 4.REMOVIkk S NSF M t ees Ip ping, A a-Ishdll,be', ',diathe er,�0 40 4 P,c dule.,40,INSF, VC��Ot P cloormce. 'PC We' to The Resi en n a er is afin to,�&" -, I I 1, ": : I I �� , I � I , Cter,W 1%1� Pro erties MR i6,1 00 p I 'NES E�: I MATE,eTHE:-'0ROPEF&,V AIR APPROX COMPI'LED.FROM -,PLAN HE GENERATED BY ARSE`&`�KELLOGG'OF �CENTERVILLE,��CERTIFIEW'PLOT 'PLAN 'OF 'LOT,'j17-:1LLIOTT ROAD V4TITLED `D `h ATED' EBRUAl 23".1 956 D "TO URVEY'OLOT PLAN LOT #2 ,��,M IS lN T INTENDED-��SECTION EN D SHOULD BE-I `F6R�_NO� PURPOSE OTHEO'-THAN iN1JP ArMue�D. Maddalena HE SEPTIC SYSTEM INSTALLATION,H—10 "SEPT TANK LJSE�':EXISTINQ,,I 000'�`GALLON IC PROJECT,'BENCH MARK'TO SCALE UNDATION N 0 T fop�, OF,'FO L` END med)'ELEV.' 100.00 :(Assu' D D ENOTE8','PROPOSt i 04x i SPOT GRADE IX 104 'EXI TING S"P E R C 0 LATI 0 N: ,TEST-,,,, DENOTE t TDote'bf Perc6loti on,,,,, es Y 27, 2003 6,S-d ,SHAY, R.S.'.Test Perforine By",CARMEN P _RTY LINE'A Resulti With'essed By: SAM WHITE( Bom stobte',B.OJI.)n ronmetital ��"es; J4 9.85 5 9 P '.,PROPOSED: 'CONTb(J1R Id h 0 0 84"- Below 'Land urface S�Pe,roldticin"10 - S 3 00 e8t Mae ........ 79 Gr�,CONTOUR 0 "LOT cb I 'DEEP,�: EST HOLE,tt;I #3 95 kh'Pit 97.50 qt4a" +/7' PERCOLA 1OWILST:. .......... 4 00 14 0 95 6 FOOT aii MckADE FE'k�.'U r '0 Why$and BEDRO BEDR OF:THE PROPERIT-21--THERE VR 15,M 50 H01 MCNO WMMDS WITHIN,"2 C. t 7 2,0. DROOM Sol* A,1 7.n 44, PLO A I64'';��:Depth tat�Perc: 84 , to I 2 SYSTEM UPGRAX �"`P R 0 F?0 S F 0: Perc'Rot *Less j1hd 1 MPI rbu Od :"MAD'D,AL',E N�,,,PREPARED 50P G ndwoteir"Not,.Obseiyed,f o,O'4 bserved1,ESHWT 'None ADJUSTED-11201�Elev.��'IAl X/F 'O US7A VE"ALBER TI L]0 TT RO"'D EL 01 el 1t6�VIL'�,-RUbb er,Unet V 00';T F�n -ca,Icu a ion (440 GCI.�� yon f`SAS 6e: Dwsilin/Day ay Min per, Title PREPAREU,"S of Ootboge�`Grinder- No Ledchku o C4aPCCItj,Pr6 Y Whirruirn, V)x 4-0 I,'T k. onk.�;d dy v�'880,k USE 1j'500, AL. Septic 7 PTION �iAR Usdrig�perc at on ird# of M.in ;6rich V S W d 9 0.00 BottoM Area- -ft x, 418sq-,-,ft: V14ROAIMNTAL.-,SERVICES SOIL,AB I' jo ons :So' oWn F,�4UL t3U;ZAST,�FALMOUTH 0 454 �q, 6116n_q.';,TT. peM,r rate thd n-un..-Coarse S a M Side ,of[ '*ecr 0.7* A 6' 45.04 7 DON 5 ie:, GH 14 VING M8ERS,' A p acemen(S��',F.001r�!�$TRIPOU A k6UN6'A CHA A x SIDES,AND KA tHE", ULY 2 N,1,t WASHED' W 3" .5 IH-WASHED`S*Uf4t�bk r I 4-0_C&:7DO_N ' 5EWo,C�E PERMIT UO. � �/ILL p GE "• - — - __ __LNST.I� LER_5_►J�M.E_T_� ADDRESS_ DATE_PER-M1T__LSSUED _- - — __D.ATE COMP_L.I_W ACE. ISSUED; ) 4 l� ti