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HomeMy WebLinkAbout0069 FERNBROOK LANE - Health 69 FERNBROOK LANE, CENTERVILLE A=208-085.017 I UPC 12534 No.2-153 OR * HASTINGS,MN f Commonwealth of Massachusetts dog-COS--07:�L Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address ' John & Lynn Shields Owner Owner's Name information is required for every Centerville ✓ Ma 02632 02/21/2020 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 A. inspector Information filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address Centerville Ma 02632 citylrown State Zip Code r�rro 774-2484850 smjonestibe5@gmail.com, S14522 sean@smjonesbtle5.com Ucense Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 02/21/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5fnsp.doc•rev.7r26=t8 Tice 5 official Inspection Form:Subsurface Sewage Disposai System•Page t or iS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address John&Lynn Shields Owner Owners Name Information is Centerville _ Ma 02632 02/21/2020 required for every _. page Cityyrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 69 Fernbrook Ln Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 3 500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" Y, N, ND for the following statements. If"not Y � } 9 determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.dm-rev.M0120I a Ti08 5 QUAal InspeMon Form.Subsurface Sewage Uisposei System-Page 2 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John&Lynn Shields Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 C /Town page. �Y State Zip Code Date of Inspection' C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below) ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: t5lntp.dae•rev.7/M018 Title 5 official Inspedion Form Subsurface Sewage Disposal System•Pap 1 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 69 Fembrook Lane Property Address John& Lynn Shields Owner Owners Name information is Centerville Ma� 02632 02/21/2020 required far every _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doa•rev.MOW 0 Tllle 5 official inspection Form;Subsurface Sewage Disposal System•Page 4 of 10 i Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f ° 69 Fembrook Lane Property Address John&Lynn Shields Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than%day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design'flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails.I have determined that one or more of the above failure. criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection` Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7ra=18 Title 5 Wool Inspection Form:Subsurfece Sewage Disposal System-Pago 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address John & Lynn Shields Owner owner's Name informationredfor is Centerville Ma 02632 02/21/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered'yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not ® Cl Were note as NIA) ® ❑ 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)) ts1w.doc•rev,7128f2018 Tills 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts =m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John& Lynn Shields Owner Owners Name information is required for every Centerville Ma 02632 02/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 sue- Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes ® 'No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: Date 15insp.doc•rev.7/26=8 Title 5 Off'ida!Inspection Form'Subsurface Sewage Dlspo881 System-Page 7 Of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John & Lynn Shields Owner Owner's Name information is Centerville Ma 02632 02/21/2020 page. C it required for every ylTown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): -- Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5inap.dor•rev..71202018 Title 5 0111c9al tnspewlon Form.Subswface Sewage Dlsposel System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address John & Lynn Shields Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. City[rown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: system repaired 10-6-1998 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 9.5 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.): Joints in good condition, no leakage,vented through roof. dInsp.doc•rev.7/ arms f tle 5 Uffiwal Inspection Form:Subsurieoe Sewage Ursposel System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John &Lynn Shields Owner Owner's Name information is Centerville Pam!®. City/Town Ma 02632 02/21/2020 required for every State _ Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 9 Depth below grade: feet _.._. _._....__ Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons 5„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3' 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 77 ................... _..._.............................._._._ Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance water level was even with outlet, tank was not leaking and was structurally sound. t6insp.doc•rov.7QW018 Tide 6 Official inspection Form:Subsurface Sowago Disposal Syotem-page 10 of 18 c, Commonwealth of Massachusetts Title 5 Off icial Inspection Form � p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address John & Lynn Shields Owner owner's Flame information is Centerville Ma 02632 02/21/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)- Dimensions- Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle ----- Date of last pumping: date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons -� Design Flow: gallons per day t5lnsp.doc•rev,7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John& Lynn Shields Owner Owner's Flame Information is Centerville Ma 02632 02/21/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: - m -- --- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date h Comments condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Q,r 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.): D.-box was-not opened ._.__.___ ..__. k.._........... ___ w_.,... ... ..... _._. .._.m t5insp.doc-rev.7IM2016 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John& Lynn Shields Owner owner's Flame information is required for every Centerville Ma 02632 02/21/2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7126=18 Title 6 Official InspeWon Form:subsuifam sewage oisposet system•Page 13 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane _ Property Address John& Lynn Shields Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page. Cityffovm State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 3x500 gallon chambers in a I O'x40'x2'trench. Leaching facility has access cover on steel ring and cover to grade in paved driveway. Leaching chambers were found dry with no high stain lines indicating that it has never been hydraulically overloaded. Chambers are+/-9'below grade. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer .. . Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t6ln5p,000•rev.112v Dtt! Title b Uf cal Inspection Form:Subsurface Sewage Disposal system-Page 14 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Address John& Lynn Shields Owner Owner's Name information is Centerville Ma 02632 02/21/2020 required for every page City(fow n State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dae•rev,71JMi8 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 0l W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fembrook Lane Property Addreas John& Lynn Shields Owner owner's Flame information is Centerville Ma 02632 02/21/2020 required for every State Zip Code Date of Inspection page• CitylTown D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t o 0 ZL 1 7e Bt ZI �2 30' 3 2 t5uispAoc•rev 7126=18 Tille 5 Drririal Inspection Form.Subsurface sewage Disposal System.Page 16 of 1s Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John&Lynn Shields Owner Owner's Name information is required for every Centerville Ma 02632 02/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated high depth to round water. 12'+ P 9 9 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: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5lydp.dat•tev.MAM18 Tille 6 Official Instovdion Fnim Sul+sruf"m Smafle Dis(xr W System•Paw,17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fernbrook Lane Property Address John& Lynn Shields Owner Owner's Name Information is Centerville Ma 02632 02/21/2020 required for every page City/Town State Zip Code Date of inspection E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc rev.7f26201a Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 7 jV No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTSnteredicomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Oi-4ponY &p$tem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) El Complete System I individual Components Location Address or Lot No. I D /�/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel /J /,v elllfe xy Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No. , 07"tOLO e> no ev"-. ,561 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(AD Other Type of Building Ae _,eee No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1119 gallons per day. Calculated daily flow Z/T® gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �✓�� i)°/6 �i Type of S.A.S. 3—,5'�02P9P AO le," 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 Certifi- cate of Compliance has been issued by t 's Boaz f Healt - q� /� Signed Date / l Application Approved by Date Application Disapproved for the folio reasons Permit No. Date Issued Zoq 0 Fee Y7vV W. r e. ,r stf THE COMMONWEALTH OF MASSACHUSETTS 'ntered i'computer: 000 Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLES MASSACHUSETTS 0[pp1tcatton for Otgponl 6pgtem Congtructton j3,_errmtt y Application for a Permit to-Construct( )Repair(1/)Upgrade( )Abandon( ) ❑Complete System I Individual Compotients Location Address or Lot No. FelOwner's Name,Address and Tel.No. Assessor's Map/Parcel / el-I h-- 6l-111 le Installer's Nawe,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 / - 3e9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(60 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. —3�D9�111� Description of Soil Xge2zr2, Nature of Repairs or Alterations(Answer when applicable) r'a 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 been issued by t is Boar of Health. q� / Signed Date 0-11 Application Approved by r Date „ Application Disapproved for the follo i g reasons Permit No. Date Issued ------ ---------------------=--•-------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE,�tTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (i-- )Upgraded( ) Abandoned( )by /7©/� d�D / �Q�✓�� at /4 /140 C le C G`! /?//% C as constructed in accordance with the provi ions of Ti 5 and the for Disposal System Construction Permit No. i dated Installer df;12�'eO I�Ll. Designer The issuance of this L77 t shall not be construed as a guarantee that the system will function as designed. Date 10 ! K Inspector M --------------- z—�!!"�-Dc�—J /dl No. Fee/ /✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mtgpogal *pOtem Congtruction Veruttt Permission is hereby granted to Constru t( )Repair(✓ )Upgrade( )Abandon( ) System located at 6 9 f e/ /f 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:Constructio st be compl.ted within three years of the date of tIvr pertltit� (/ Date: . "/ Approved by 1 om/97 A. ._ NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated �° , concerning the property located at6�D meets all of the following criteria: V There are no wetlands located within 100 feet of the proposed leaching facility ,//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 XThere are no variances requested or needed. lf the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert .r. a w` � �n�f� �� I" �� ��� �� �a —� _ _ � �� Q��� ���� � �� 00 ,� ��� Q,�� ��'���a�L�a�Q��-� a�� "- �.. �_�sS� /� ��� ��c,,sc�l� �� � Gnu IO�c 0 a9 J)e4 TOWN OF BARNSTABLE LOCATION ? Afl' 10®1-- Jib SEWAGE # VII.LACE_ GP. ASSESSOR'S MAP & LOT 009-+Vg 0/7 INSTALLER'S NAME&PHONE NO. 771 SEPTIC TANK CAPACITY - I,oo o �- LEACHING FACILITY: (type) 00 Gk ( :�jYa�1��l (size) /a I NO. OF BEDROOMS BUII.DER OR MWNER,)PERMITDATE - �i/-Qg COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility sf 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) ""'7` Feet Furnished by G TOWN OF BARNSTABLE 1 LOCATION ks `�ry��©®k /7, SEWAGE # VILLAGE GeO7` A/i%/e ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 Gw L LEACHING FACILITY: (type) 00 CIUPN�-l (size) /o x 40 ' KA , NO.OF BEDROOMS BUILDER OR(WNER,PERMITDATE COMPLIANCE DATE: 40 6— Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J f 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 0 ys r 2" 34.8 630 548 Receipt for - Certified Mail No Insurance Coverage Provided ® Do not use for International Mail UMTED TE5 GOST�l5E1ST11MCE (See Reverse) 00) rn Street an o cis P ,Sta IP codt, O 0 Postage Go E Certified Fee O LL Special Delivery Fee F(�'sYifCtL+di�pfivaryr Frees' S Ft�tiirh'ftA'ceiYrttgh`owirigt to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date tl ( STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, I CERTIFIED MAIL FEE,AWD CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date,detach and retain the receipt,and mail the article. ?' t 3. If you want a return receipt,write the certified mail number and your name and address on a m return receipt card,Form 3811,and attach it to the front of the article by means of the gummed (a ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. O O OD 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. (. 6. Save this receipt and present it if you make inquiry. 105603-93-13-0218 7 Town of Barnstable BAMU ee[E Department of Health, Safety, and Environmental Services , ' �0� Public Health Division P.O. Box 534, Hyannis MA 02601 # Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 3, 1998 Peggy Kilroy 69 Fernwood Ave. Centerville,MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 69 Fernwood Lane, Centerville was inspected on February 25, 1998 by Carmen Shay, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Back-up of sewage into facility or system component due to an overloaded or clogged soil absorption system. • Static level in the distribution box was above the outlet invert due to an overloaded or clogged soil absorption system. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. R O HE BOARD OF HEALTH TTa 4sT as cKean,R. .,C.H.O. Agent of the Board of Health q\health\dbfiles\title5 i.doc f ' f Town of Barnstable • Department of Health, Safety, and Environmental Services BAMSUSM Public Health Division �F0 MAC p 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: Qec,��, 12, 1-6 n DATE: MCA 3)J l�� C�21v32. ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. ,�r�� rq a;/ The septic system owned by you located at (p9 TunU30 Lane , was inspected on e' s 119 $ by rw-n She, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TLE 5 (310 CMR 15.00)�iue ko the following: G C ,�� (t (p �n ' S r s J Js You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gVunhM&f 1cs\itlesi.doc m SENDER: I also wish to receive the 13 ■Complete items 1 and/or 2 for additional services. rn ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card toyou. r ai ■Attach this form to the front of the mail piece,or on the back if ace does not permit:'.' p p 1. Addressee's Address' Z ■write'Retum Receipt Re uested'on the mail piece below the article number. d d p q a 2. Restricted Delivery y ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 3.Article Addressed to: 4a.Article Number d Ix 6",30 X 4b.Service Type «'� c°� ❑ Registered Certified 9� ,� tified cCD c �J � ' ❑ Express Mail ❑ Insured S N 1E ❑ Return Receipt for Merchandise ❑ COD 7.Date of Delivery o Z � 0 m 5. d By:(Pri Na ) 8.Addrss e's Address(Only if requested w and fee is paid) i C is 6. ignature: (A ee orAgen) _� _X PS Form , December 1994 102595-97-13-0179 Domestic Return Receipt First-Class Mail UNITED STATES POSTAL SERVICE Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Public Health Division Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 1 T. COMMONWEALTH OF MAS 1 SACHUSETTS o EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS p Al I' DEPARTMENT OF ENVIRONMENTAL PR OTE ONE W114TER STREET, BOSTON, MA 02108 617-292- WILLIAM F.WEL'Df {� ,V �. ���<% Governor z TRUDY CORE `� R '°� . G�o Sectttary ARGEO PAUL CE.LL_UCCI gllyg9 f A'V�1D B.STRUHS Lt.Governor c„ SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM °F�sr `9,9'" Commissiorxs PART A. �;' 1�4� 8 CERTIFICATION Property Address: 69 Fernbrook Lane, Centerville, MA Address of Owner: Date of Inspection: 2/25/98 (If different) Name of Inspector; Carmen E. Shay I am a DEP approved stem inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000), Company Name: Carmen V. Shay - Environmental & Civil Engineering- Mailing Address: 34 Thatchers Lane E. Falmouth MA 02536 Telephone Number: 50a-5+8-0796 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience;in:-the roper function and mpintenance of on�ite sewage disposal systems. The system: ' ' 1. _ Passes .__ Conditionally Passes CAFhll ' tNeeds Further Evaluation By the Local Approving Authority ` Fails Inspector's Signature: - Date: 2/26/98 iM. The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days-ti' b' 'pleting 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BJ 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/2S/97) Pape 1 of 20 DEP on the World Wide Web: http://www.rmgnet.state.ma-ustdep a Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 Fernbrook Lane, Centerville, MA Owner: Peggy Kilroy Date of Inspection: 2/25/98 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water-level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution:.box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced _ obstruction is removed 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 the public health, safety and the environment. k 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN.A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water, _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that _ the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 Fernbrook Lane, Centerville; .MA, Owner: Peggy .Kilroy Date of Inspection: 2/25/98 D) SYSTEM FAILS: You must indicate ei;r,er"Yes" or"No"as to each of the following: , _ X I have determined that the system violates one or.more of the following failure criteria as defined in'310 CMR 15.303.-The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes . No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or . cesspool. X _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)• Number of times pumped_. —r X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds,-ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public.health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program] requirements of 314,CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97). Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST i Property Address: 69 Fernbrook_.Lane, Centerville, MA Owner: Peggy Kilroy Date of Inspection: 2/2 5/98 Check if the following have been dons,You must indicate either "Yes"or"No"as to each of the following: Yes No Pumping•information was provided by the owner, occupant, or Board of Health. X _ None of the-system"components have been pumped for at least two weeks and the system has been receiving normal flow rates 14 during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built platys have:been obtained and examined. Note if they are not available with N/A. The facility ordwelling was inspected for signsof sewage back-up. (, _ The system does not receive non-sanitary or industrial waste flow. X _ The site was. inspected for signs of breakout. X _ _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank--,man holeswere uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance o Sub-Surface Disposal System. $ _ Existing information. Ex. Plan at B.O.H. g _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 97 0{/25./ ) Page 4 of 30 , q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 69 Fernbrook Lane, Centerville, MA Owner:. Peggy kilroy, Date ofanspection: 2/25/98 FLOW CONDITIONS RESIDENTIAL Design flaw 0 g.p.d./bedrdbm for S.A.S. Number of bedrooms:_ Numberof current residents:, Garbage,grinde'r(yes or no):_No Laundry connected to system (yes or no): YeS Seasonal use..(yes or no):_Ka Water meter,rieedings, if available (last two (2)year usage (gpd): a0;z I ocit ,czk6s Sump Pump(yes or no): No Last date of occupancy: Currently Occupied `JJ COMMV�_ML/INDUSTRIAL• Type of eaablishment:_ N/A Design flo�rvc. allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitaty waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of.occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped in April of 1997 System pumped as part of inspection: (yes or no), ND If yes, volume pumped: tzallons Reason for pumping: TYPE OF SYSTEM X 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) 1/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information:1-years old As-Built Plans from B.O.H. - Sewage odors detected when arriving at the site: (yes or no)�p (revimod 04/15/97).- Page S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C SYSTEM INFORMATION (continued) — { Property Address: 69 Fernbrook lane, Centerville, MA ` Owner: Peggy Kilroy P r r .Date of Inspection: _2/25/98 _- BUILDING SEWER: (Locate on site plan) " Depth below grade:_ffLA ,1 Material of construction: _cast iron 40 PVC_other.(explain) , Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: X (locate on site plan) Depth below grade:___R. Material of construction: R concrete_metal -—Fiberglass Polyethylene —other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) r 1 Dimensions: I' Sludge depth: 41 --_ .- Distance from top of Budge to bottom of outlet tee or baffle: Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: _ Liquid level over top of Outlet Tee Distance from bottom of scum to bottom of outlet tee or baffle: 28" How dimensions were determined: Measuring stick and Sludge Judge. .Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Inlet Tee and outlet baffle dbpeared to be in good shape. Dew of liquid level was above ou _1 s d. dUgn lan elevation, lic back-up of livc] id from D-box. GREASE TRAP: NI (locate on site plan) Depth below grade: 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 - " Comments: ... :. (recommendation for pumping, condition of inlet and outlet tees or baffles; depth of.liquid level in relation to outlet invert;structural integrity, evidence of leakage, etc.) (revised 04/25/97.) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Adr1iess 69 Fernbrook Lane, Centervillem, MA Owner: Peggy Kilroy Date of Inspglion_' 2/25/98 TIGHT OR Ir OLM-,'VG TANK: A N_� (Tank must be pumped prior to,or 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:,.7;-_. � gallons/day Alarm level:__ ;, . Alarm in working order_Yes;_ No Date of previous--'-pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) or DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 511 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 6 to 8 inches Of solids observpd in tha 11 Rnx D hnx wgg f„1 1 of 1 i=11id @h0jT2 ].3ijt —PJPP C tart) F.vi deuro of fai 1 crl and/or- G109god—SAS- PUMP CHAMBER:—A/A (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (zaviaad 04/25/07) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued). . Property Address: 69 Fernbrook" Lane, Eentervilie, �"MA Owner:' Peggy kilroy. Date of inspection: 2/25/98 SOIL ABSORPTION SYSTEM (SAS): . (locate on site plan, if possible; excavation not`required,_ but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching-pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: •Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) No sign Of Donding�offsst p tati nn_ However' „i d l prch g in. the'D-box were nver the in�e pipes. Also l�iquiici ever in septic tank waslavove inl faAdd due to h draulic failure driveway and that tog of pits are 8 feet he— P?nw grade CESSPOOLS: N/A " (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation,etc.) PRIVY:�A .(locate on site.plan) Materials of construction. `Dimensions: Depth,of solids: r Comments. . , r. (note condition of soil, signs of hydraulic failure, level,of ponding condition of vegetation, etc.) 77 -. (revised 04/?5/97) Page"! of 10 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Fernbrook Lhni , Centerville, MA Owner: Peggy Kilroy Date of Inspection': 2/25./98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � p O� OF E S� rrJ � rC"tES A -C II,5 L� P� (4 -D Z' E -60 4�- 3 -C at 3-� 29 (revised 04/25/97) Rage 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 69 Fernbrook Lane, _y ' .- Owner: Peggy kilroy. ^ Date of Inspection: Depth to Groundwater�Feet ..; Please indicate all the methods used to determine High Groundwater Elevation: : g_ Obtained from.Design Plans on record I,} X_Observation of Site (Abutting property, observation hole, basement sump etc.)' Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data 4r Describe in your own words how you established the High Groundwater Elevation. Must be completed) Groundwater depth.;wastcestimated based on information obtained from elevations off of a as-built plan obtained from the Board of Health. Additionally, USGS data and site observa�-- tions of the elevation above the abutting pondaAlso confirmed the approximate depth to Qrou groundwater. t 3411 (revised 04/75/R7) Page 10 0[ 10 : t Aq PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 208 085-017- Account No: 127204 Parent : Location: 69 FERNBROOK LN CENT Neighborhood: 49CB Fire Dist : CO Devel Lot : 21 LC 14972-E Lot Size : .48 Acres Current Own: KILROY, PEGGY M State Class : 101 69 FERNWOOD AVE No. Bldgs : 1 Area: 3856 Year Added: CENTERVILLE MA 2632_ Deed Date : 110191 Reference : C124797 January 1st : KILROY, PEGGY M Deed MMDD: 1191 Deed Ref : C124797 Comments : Values : Land: 44400 Buildings : 256200 Extra Features : Road System: 69 Index: 584 (FERNBROOK LANE ) Frntg: 24 Index: ( ) Frntg: Control Info: Last Auto Upd: 110495 Status : C Last TACS Update : 010595 Land Reviewed By: Date : 0000 Bldgs Reviewed By: JG Date : 0187 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [208] [085] [018] [ ] [ ] Fxs9.-_ ..... .......... ^ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ► �� ..............Town.----------....OF.....-------8.axnqtabl.e-------....-----...----•--------------------- Applira#ion for R-4vagFal orks Corm rnrtiun 11trutit Application is hereby made for a Permit to Construct (X�-)or Repair ( ) an Individual Sewage Disposal System at: ,,,,,,,,,,,,,Lo;r<-„21„-Fernb gpk,•Lane,,,......,_-,-,-, ,,,,,,,,,Centerville M-A Location-Address or Lot No. _______________Capricorn Realty„Trust ..........765 Falmouth_Road_,__ Hyannis - . Owner Address W ---------- Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ....Cape............. No. of persons............................ Showers (3 ) — Cafeteria ( ) Q' Other fixtures -----•-------------------------•-.••••• . . W Design Flow....11Q...............................gallons per person per day. Total daily flow.........550 gallons. WSeptic Tank—Liquid capacity_�_5��gallons Length__8'.6"__. Width4'_1-0"-- Diameter________________ Depth5.._8........ x Disposal Trench—No. .._----.-••-----•_._ Width.................... Total Length.................... Total leaching area--____._.-_---__.___sq. ft. Seepage Pit No.................... Diameter......6'..._..... Depth below inlet........6........ Total leaching area---266_......sq. ft. Z Other Distribution box ( ) Dosing tank ) '-' Percolation Test Results Performed by.............E dredg_e___Engineering Date....4-18-85 ------------ Test Pit No. 1......2-------minutes per inch Depth of Test Pit----1 26........ Depth to ground water..none encounterd rX4 Test Pit No. 2....... ...._._minutes per inch Depth of Test Pit....I 32........ Depth to ground water................... a •••-• ••--••-----------•................. . ....•-------------•------•----.......--•-----•--------•-•••-•-•-•------.....----....•. 0 Description of Soil.........0! - 24' loam _and subsoil ...... . ......... •. �C 24' - _120' --medium sand - no water U ----------•-•.....-••-••--•-•...................... . • ••-------------------------------------•----------------------------------------------------..._..._ W x -•---•-•••-•---------------•----•---------------------•---•---•----••---------------••----••---••---------••-•-----------------•-•----•----•--••-•----------•••--••--•----•-•-----•-•-•••.............. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescrib*Fder Sewag Disposal System in accordance with the provisions of iI',- 5 of the State Sanitary Code— ned f rther agrees not to place the system in operation until a Certificate of Compliance has beeue ealth. _Signed-••• ----------- ....................................... ................................ Da - Application Approved By......... ....f.:. :G " -------------------------------- Date Application Disapproved for the following reasons:................................................................................................................ .................•••---••-----•-•-----------•-----------•._...----••---•------•------•----••--------...--I-------------------•--•--•-••---------•---••---------------••--•-••-••--••-----•-----.......... Date PermitNo........ -�9 .` ------------------ Issued........................................................ Date k lb THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •s -To-vin----------------O F............Pa.r..Rc�:La.b le------.-..-..---------.----.-.---------._----- A diption for Bispvii al Works Tontrn.r#ion tIrrmit Application is hereby made for a Permit to Construct GY ) or Repair ( ) an Individual Sewage Disposal System at: ..............1wQt...2,1.... exularonk...Lane........................ ..........Centermille...y;................................................ Location-Address or Lot No. •---••--•-•-.Cumlaomn.--Fleauv...Tr-uat..................... ..........16L...Ealaouth...Izoa�r ii a .is............... Owner ................................Address Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...............�5._..........._..__...__..._Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building Cape.............. No. of ersons......_.............._______ Showers Other—Type g ----: p (3 ) — Cafeteria ( ) d Other fixtures W Design Flow...11Q................................gallons per person per day. Total daily flow........�La Q_.___..___......._..........gallons. WSeptic Tank—Liquid capacity_150f1gallons Length..S.'.6I--_- Widths}.1-.:1.011_.. Diameter________________ Deptlfi.'..8'...___. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___1--------------- Diameter.._..C....___.... Depth below inlet.......fi.......... Total leaching area..26.6........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by____________ _l: X' 5� __. J1,�31rie r 1 T1 ._._ Date---x=.la M S1_................. Test Pit No. 1-----2.........minutes per inch Depth of Test Pit...12CI_'_....... Depth to ground water.11011 ..._enCounte 44 Test Pit No. 2......?........minutts per inch Depth of Test Pit-__1.32.1....... Depth to ground water..........!!............ E5 a --------------------------------------------------------------------------------- •----------------- ------- -------------------------------------------------- O Description of Soil........Q�------241.... , ----------------------------------------------------------------------------------------- '2` �- -.._nvat�U ........---•---•-•-•••-------••-•----- - ----------------- ------------------------------------------------F------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------•--•--------------------.......-----........----------------•----------------------------------------------------------.....--•••--••--•..._.........•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— T nd igne urther agrees not to place the system in operation until a Certificate of Compliance has b ssue th oard, health. Signed -------------------................................. ................................ Date Application Approved By._:_- .--- i ........................................ Application Disapproved for the following reasons:............................................................................./ter `' ----------•---------------------------------••---•-•--------------------------------.........-----------------•-------•--•••-•--•••----•------•--------••••••-----------•-••-••-----•-••••••-----••..--- Date PermitNo. ------------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........lawn....................OF...........Ear.ns.to-hl Barnstahle.......................................... Trr#ifiratr of Tontplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by--------------------------------5-teYe...lie_ el--------------------------------------------------------------------------.................------------------------------------.... Installer at_.L.o ...2.1...Fer-nbro k------Center-vil.l.e IA..-------••--------••----•--•-------------•----•-..................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit q dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHAL NO CONSTRUE® AS Al 6 /ll(NE THAT THE SYSTEM WILL _FyNCjTION SATISFACTORY. DATE .... 2.49............ Inspector........... ....._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............A.OWn.................OF.....B.Arnst.aul.e_................................................ Bigposal Workii Tontrt ion unfit Permission is hereby granted.............SA.e e...Le.be.1------...---•----------------------------------------------.....---------.......................... to Construct 1( ) or Repair ( ) an Individual Sewage Disposal System at No.._LOA---3...2.1...Eexxibxnok.....Cente.ru.ille...TIA.......................................................................................... Street as shown on the application for Disposal Works Construction Permit N <- Dated.... -_ .........- DA1r'r ................................... FORM 1255 A. M. SULKIN, INC., BOSTON .. c> —1-7 �— y�y �. 0 CAT ION SEWAGE PERMIT NO. Z( T �,` S woo !� �- VILLmle-lzv), bLs5 INSTA LLE 'S NAME i ADDRESS iUILDER OR OW NE � ODATE PERMIT ISSUED DATE COMPLIANCE ISSUED �_ � w6 . �r o v�,f `� z� ���; z �� �� �o . � � � ��� , � � � - SOIL TEST PIT DATA: IMICATES MIDICATES SEPTIC TANK DETAIL: sQ� DISTRIBUTION BOAC DETAIL: LEACHING PIT DETAIL: REVISIONS: PERC. - OBSERVED �' : TEST - GROUNDWATER NOT TO SCALE NOT TO SCALE NOT TO SCALE NO. DATE TP i TP TP 2 TP NOTES: I. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON, NO. OF OUTLETS: MANHOLE COVER r-;_GAM eSEED /, 6 _ z y h,��a e�4 0 C 4 7"'e A/ .� REINFORCED CONCRETE. SCHEQ 40 PVC OR CAST-IN-PLACE CONCR@TE. TEES r BROUGHT TO FINISH GRADE OR PAVEMENT !!� ORD. EL. i� ? ORD. EL. ORD. EL. GRD. EL. --.._._ _ TO BE CENTERED UNDER MANHOLE COVER. NOTES: , . j, y' --= 1 1 GW. EL. GW. EL. QW. EL". /`/. 1 GW. EL.� 2. SEPTIC TANK TO WITHSTAND LOADING 7— s�u._1!_._i� _ UNLESS UNDER PAVEMENT, DRIVES OR � f l DST. BOX TO WITHSTAND H-10 LOADING 2"MIN.OF Ve" " � �• L Joe Or = TRAVELED WAYS,WHEREIN H-20 LOADING 1 RAVELEESS DDER MIAYS WHEREMiPAVEMENT, DRIVES OR TO H-20 LOADING WASHED ' 12"MIN. FILL �� 4. SMALL APPLY. U PRECAST F_ STONf. I SHALL APPLY. 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER �!,� I DIST. I 4 :; - , T ' d.... �- PROVIDE CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE '� BOx 2. INLET TEE OR BAFFLE WHERE SLOPE OF 1 "ca4 90 ❑ a [= O C 1 p INLET PIPE EXCEEDS 0.08 FT./FT. OR IN pVC INLET PIPE�'_ _ _ I i PUMPED SYSTEM. - -, (hP�. iTJEoi Ui'�! 12"MI i----r--ti----� M n o r� c� cn c1 0 ❑ �` � NOTE. i/ COVER 3. FIRST TWO FEET OF PIPE OUT OF DIST = LEACHING PIT TO BOX TO BE LAID LEVEL. C WITHSTAND H-IO LOADING GENERAL NOTES: . - .. - n p C] C] C7 t C•—] co C' C7 , ,.j^IqA-,e) — -- ; Jr ° • _ ! _ _'. . - - PLAN VIEW n "' . UNLESS UNDER 'S ti D I -- 4-�' RE MOVEABLE PRECAST tl�p°' PAVEMENT,DRIVE OR 1. THIS PLAN IS FOR DESIGN AND i T NORMAL WATER LEVEL COVER w 3�4' rC I I/2' D © C] [-7 C3 C7 n a THAVELEG 'NAY WHEREIN o N-2O LOADING SHAL '- - - - - - DOUBLE LEACHING PIT 4 4� CONSTRUCTION OF THE SEWAGE - v WASHED _r c:� :� APPLY. PROVIDE -- r U- I STONE DISPOSAL FACILITY ONLY. INLET TEE ----- �.__ WATERTIGHT `\ T u- (nr finest . �� PRECAST — I,_ yR) I. r y.. __. 3�;. , ALL CONSTRUCTION IV1E .1 HODS AND zt C. SEPTIC , Q���s ♦ -0" MIN OUTLET :,• INLET r ��NOTE 2 I 1 1 ►:! . Lt"10 DEPTH -------� TEE f t f`>Dr.•G _ TANK .._ , -�' I 4 INLE , _ �.= --.---... — �.►; r ---- -- _-__ _ ..,': 0 la n C� C� � C3 n a ' ,, MATERIALS SHALL CONFORM TO i 1 11 � - 4' OUTLET I ;o- o MASS D E Q E TITLE 5 AND LOCAL M ,, 1,✓,� �.� ":L 1• B F HEALTH REGULATIONS. -_- - - - - - -- - - - - - -f - -. -- - - -- . . - - -- - ----- D f A - +- � - - — _ BOARD O HEA R IONS _ - -- ----- - o o•c�Gti`, BOTTOM ON LEVEL STABLE BASE ..7:�-'S',i� �_ , ..,iy�c. �'" �FVE STABLE __.._ _-_.---------_.___._ ... /G.>> DIA '. . _.._ ._.._ .+.. q O {1N J ALL PIPES LOCATED UNDER PAVEMENT /t/r CROSS-SECTION '�` Tr%.J,f1iiM�- BASE l PLAN VIEW CRo_sS-SECTION VIEW OR TRAVELED WAY SHALL BE — ��--S-Isc_?L�_ SCHEDULE 40 OR EQUAL DATE: DATE: DATE: DATE. , -4 -,� e, �� -;ram - INVERT ELEVATIONS: -- _. ------- ✓ .F'F,. f� ,.ti T . ✓,Cap. �. . TEST BY: TEST BY: TEST BY: TEST BY: 4" INVERT AT BUILDINGS ate r WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: ( ,T,,� �� � , .- 4" INVERT AT SEPTIC TANK(in) _. 6, 4 INVERT AT SEPTIC TANK(out) PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: f ,• .. �., lg � _ - 4" INVERT AT DIST. BOX(in) MIN./INCH ___ MIN./INCH MINJINCH _MIN.IINCH ` " ""' _ 4" INVERT AT DIST. BOX(out) CONSTRUCTION NOTES 4" INVERT AT LEACH CHAMBER =' SUITABILITY OR SOILS FOR DATUM: BOTTOM OF LEACH CHAMBER "" FOUNDATION PURPOSES AT THE VERTICAL DATUM: �! G� v ;}, r� '� , ,. .. T �a \`0 - .____. ADJUSTED GROUNDWATER ELEV. � � LOCATION OF THE DWELLING ,�' SHALL REMAIN THE DIRECT OBSERVED GROUNDWATER E L E�V. ..._ BENCH MARK USED: �� zS ` Gj-r:;r.�. = si "� L ?' 28 w• "''� _ �" RESPONSIBILITY OF THE CON A U G cr�irec- 2 ` N TRACTOR. >'� ����1 C:.��..tE'7..�. r�'ac�n.!(.,.�r:�,p�"r�..t �" 4,1,,'r•��t:,F� ,� � c_.=,c.�._....a � ,t� f�,� :_ : � '' ..__ s .� -'• . -5 T r� /� yft f�'tJ A_11 ,. . r .' IleW , O N ' ell 14 Te DESIGN CRITERIA DESIGN FLOW' _..__BEDROOMS AT Ilf-I_G.P.B./D G.P.D. - - T z4 CAPE COD SURVEY REQUIRED SEPTIC TANK. CONSULTANTS 91" \ ,_ - . '� �'� ':; - -- s��` n_— GAL. -- -- -, r! ' - n !,� .. �. � r i � 3261 MAIN ST.,'ROUTE 6A 4 ._ -. l ,,. .. SEPTIC TANK PROVIDED: L-2--� GAL. '� �! BARNSTABLE VILLAGE, MA 02630 33 SIZE OF LEACHING FACILITY REQUIRED: DESIGN PERC. RA IN./IN H DIVISION OF r. 1 .• .� " �. ,,,, D SIG RATE: � M C Q o �. .. —-------- -- ---- —-- _ _.__ ---- --_ ST N SURVEY CONSULTANTS INC. `� BO O E � Al' .. .� ENGINEERING • SURVEYING • PIANNiNG o tI f' - ``` -- TITLE: SEWAGE DISPOSAL SIZE OF LEACHING FACILITY PROVIDED: SYSTEM DESIGN ' l y F'•. 1 ` { , �1 � � .... ..... � --'�-�L:ll.l..�.f1'..f.L.. K .1.,....__..._ ./,�[•• '^/�/.,r.KnJ LOT 21 - _ t F-' �� `�,- .� Jr '--.. __ .f.. r. �' ..., .3,D 1 ('�^ „ '"""".'""w.,_"°""ry'.-.„•,.,. _ _.--- '�.8- .L-...X.. z .PC? _.e !R� *''"'__ ' :.i.__ _ .Y =f� C AV BARNS TABLE MA SS , o - .:.., ,�-- ....._ �?3. 1,6�► �' ` _— '��w ,.-...,C?�'., � �6�{*� _..._... < � _- -----_ __------- " � - s-- -- ( E N T E R V(L L ti ._ ._ . �-�• _ r r' - .. ��� A •� LOCUS PLAN: PREPARED FOR: CAPRICORN REALTY TRUST L"t+.l0F,AVia+ rs'r. +_% ! l.:% SETCeftc..6 4,1 . _..t. .e� - d��. �'r..�' '}" �� � �4ol .. F` .�' � ..,./ ``- �� ��c c.+� ,• �,�-__.-~-,.�•ram' r.. . GAG. I PA 0 'rf f' rr + ' �r 1"' DATE JUNE 17, 1985 r+ COMP./DESIGN: lam. __.. --... CHECK: /''l , a.3/3 t& tI I t ---W+ _ + �� DRAWN: A D L . �. i PLAN VIEW _� �. - ,,, "� �� �.,.. FIELD: D J B SCALE 1 " Ir (. _. `,. . FILE NO: DWG NO: 9 51 JOB NO: 03 1584 0 . '� , PE E T SHEET: / OF: J