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0111 GOOSE POINT ROAD - Health
111 .Goose Point Road Centerville P A = 252 043 J � m y UPC 10259No.H1630R HASTINGS ON No. !;Loo (— � r Fee , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppfication for Disposal 16pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) 'Complete System ❑Individual Components Location Address or Lot No. GW5;e i n'/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ZS.Z ?j I I G��5�- 0,11Y Act eg Installer e,Address,and Tel.No. Designe 's Name,Address,and Tel.No. �� ,� 'ic �d Type o uilding: S�3 2� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(k\;) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided -3 y gpd Plan Date 1D et `t, 2001 . Number of sheets I Revision Date ec 5-, 210d y Title S E?v✓'t%Jg-e I s Dp S°?l �'6�e C'Ll 014 1'1 Size of Septic Tank 0S f"J Type of S.A.S. 6n ep Description of Soil See 501 I5 -,&r11 © T Plon Nature of Repairs or Alterations(Answer when applicable) P, p `'! `'1 N h j Cc�SSp��'ls t kaSyyl� �� �� . ��IGh 5'F'fJ7'�iC 7�i�1� , � C�vrlFf I� r�jC,c# Cli'Il� 2 'S��u �fCc�N t�yLln�nt6 <-6��y��t�t'S yv'lI'�j SJ`��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 Certificate of Compliance has been issued by this Bohr of alth. Signed �• Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ` 3� Date Issued 1 .. ....--..,.. ..n.•..•+r..,..o...i.v.,,..�....r-..,,,�,>,.rb..,,,,,�,,,,Yvt v^W-(--v-rw^-.�,ynn,....e+:.--.---`--'----..a.,..n.-...w....r•..,---- •.� .. ,,,..,y,.....r:-Vim,.-..... ..- . -._ ,i 1 No 9 000f—� 3rj _ sue s Fee �vv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION,-,,TOWN OF BARNSTABLE, MASSACHUSETTS, Yes 2ppfitation for bisposar 6pstetn Construction Idermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No. 5e /n y q (�( �jAJ d Owner's Name,Address,and Tel.No. C.&_K+er I I IP Bruce ,bc kc_C v STUA �Z. 2 Assessor'sMap/Parcel Z ¢1. 0I 66a5� s,H1 R4 �pp rdy//� 2Q?7 Installer's,:Name,Address,and Tel.No. Design 's Name,Address,and Tel.No. 56U 400IWIIC V4 4 025¢3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 43 $ v sq.ft. Garbage Grinder(N)f Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y Design Flow(min.required) 3 3 0 gpd Design flow provided 34 D 3 gpd Plan Date Deb ` ', 20P I Number of sheets Z Revision Date Pc �, 2-0g01 Title 5 owCls-e )c P&P s41 S)�S y e K'1 Pl a h Size of Septic Tank t co d rr Type of S.A.S. 6.,/l P f wr` Description of Soil See s. 58y �5 ' 6rm -e r Pluh !QgrT Nature of Repairs or Alterations(Answer when applicable) Pv m P El -? h 4 l b f7 h We h 3 -e55 p?015 1509 ,-444 1 `S0? qnI(oh 11pg6;h 6Pr5 Pytr-ti S�anC' Date last inspected: Agreement: _„ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5;of the Environmental Code and not to place the system in operation until a Certificate of - Compliance has been issued by this Boai'd oHealth. Signed Date 4�4,,,A)v-Lbb Application Approved by Date Application Disapproved by Date for the following reasons Permit No. .2-OO Date Issued --------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) Abandoned( )by ,,/ /0 ,x 4) at 4I I G605 P ��h I QD�'," has been constructed in a 1'2_accccordance 7 with the provisions of Title 5 and the for,Disposal System Construction Permit No. A04'J, ' dated Installer L,(, , 6 5 C1 (4 Designer , #bedrooms Zj Approved design flow 33 O gpd The issuance of this pe/ r it shall not be construed as a guarantee that the system yf i l function as designed. Date (�' d Inspector 9 ',J)Vkl-e --t'" le j y I v e.v . .__.. '_ No. 311 ---_v=,.._ __ ---- .----- -�-----------___-•-_.�__._��-----•-=--=----------==-`� ---�---- THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Nsposaf *Pstem Construction permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at L1 1 60p S P Po y h 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 `- 14- Ll� Approved by Town of Barnstable Regulatory Services Thomas F. Geiler,Director MASS. $ Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Apfl1 Z( 2_0I0 Designer: DhVIO D , CDvG;0tNOW2 R.5. Installer: ��f Address: 43 TR1.WGLL CoZUE Address: SANOWWW, N 02563 Ib� dl d eb Onel'�?Z 7 o was issued a permit to install a (date) (installer) septic system at Goo5a po I tiff Ro A D based on a design drawn by (address) DlIvlb 10. C0U6NAW0WZ_ dated De[. J, 2o�°I — Vey g / (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H OF 414 9 DAVID �yGN o D. firnstaller's Signature) COUGHANOWIR No. 1093 01STe (� s'gNI TAR\PN (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form Town of Barnstable Barnstable i M Regulatory Services Department �6a Of BAkNSM13M s MAC. i634' Public Health Division .�� faA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO November 9, 2009 Bruce Stuart 111 Goose Point Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 111 Goose Point Road, Centerville, MA was last inspected on 10/22/2009,by Brad J. White, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Liquid depth in leaching pit is less than 6"below invert or available volume is less than '/z day flow, You are ordered to repair or replace the septic system within One (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. RDER OF THE ARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#70083230000251781117 Q:\SEPTIC\Letters Septic Inspection Failures\l I I Goose Point.doc r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009. 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. Important:When filling out A. General Information forms the computer, r,use 1. Inspector: only the tab key to move your Brad J. White cursor-do not Name of Inspector use the return key. Bluewater - _ _ Company Name— ------- - .__�_—_�.�_--_----___ -- ----r-----_.------ _ __ 350 Main Street Company Address West Yarmouth MA 02673 City/Town State Zip Code (508)775-2800 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection e, was performed based on my training and experience in the proper function and.maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: �, ❑ ��PassesPasses © Fails CD ❑ `;Weeds er Evaluation by the Local Approving Authority 0 10/22/2009 Inspector's Si ure Date The syste 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. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is Centerville required for MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information_which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y, N, ND) in the❑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. ND Explain: ❑ 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 ❑ obstruction is removed t5insp.doc•03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.• 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 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. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 111 Goose Point Road -- - Property Address Bruce Stuart Owner Owner's Name information is Centerville MA 02632 10/22/2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ d' Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ElDischarge or ponding of effluent to the surface of the ground or surface waters LM 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 is less than 6" below invert or available volume is less than day flow P rr ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E?"" 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. t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 5 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road— - — -- -- --- - Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) -System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ Ld 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-. T- ---- ----- - ---- -- - -- - ❑ R"00 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.] ❑ Vo' 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 ❑ E 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. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road -- Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 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? E�( ❑ 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? [K. ❑ Was the site inspected for signs of break out? Were all s stem com onents tN�o► he SA located❑ t S, on site.. I Y P � IJ ❑ 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)] t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road — Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design 3 Number of bedrooms(actual): �3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Gpd Number of current residents: - -- - - --jw 2 Does residence have a garbage grinder? ® Yes No Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes No Laundry system inspected? Yes ® No Seasonal use? ® Yes ® No Water meter readings, if available last 2 ears usage d N/A 9 ( Y 9 (gpd)): Sump pump? ® Yes ® No Last date of occupancy: �'` Current Date CommercialAndustrial 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: Last date of occupancy/use: Date Other(describe): t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Nib- System was pumped approx 2-3 yrs prior ---- -- 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: i , soil absorption system Single cesspool [� Overflow cesspool [� Privy ❑ IN p� Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach ch a copy of the current operation and maintenance contract(to be obtained frbm'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: Cesspools are original. Pre Cast leaching pit was added 1983 per permit#83-720 Were sewage odors detected when arriving at the site? ® Yes ® No t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): �� " Depth below grade: A-31 B-30"feet Material of construction: - — — -- -- ❑cast iron — --- ❑✓ 40 PVC - ❑ other(explain):-- N/A Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): W. Building sewer appears to be in good condition. No evidence of leakage Septic Tank(locate on site plan): Depth below grade: N/A 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 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.): 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.): 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): t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert -- N/A 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.): Pump.Chamber(locate on site plan): Pumps in working order: ® Yes ® No Alarms in working order: ® Yes ® No t5insp.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate-on-site plan, excavation not required): If SAS not located, explain why: Type: M/ leaching pits number: -� 1 @ 6'x 6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ob 1-Precast leaching pit in wooded area. Pit has risor 12" below grade.Top of pit is 26"below grade. Leaching pit has a liquid level within 5"of pipe. Does not meet town of barnstable requirements. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road __ --.---_- Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration '--NO-2-Overflow Depth—top of liquid to inlet invert —Owl A-7" B-8" Depth of solids layer-------- ---- - — --- - _ _ _ Both 6" Depth of scum layer Both 3" Dimensions of cesspool Both 6'x 6' Materials of construction Block Indication of groundwater inflow ® Yes No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Both cesspools connect to house and to each other. Both cesspools acting as holding tanks as the liquid level is at outlet pipes on both cesspools. 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.): i t5insp.doc•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 111 Goose Point Road - � Property Address Bruce Stuart Owner Owner's Name information is required for Centervile MA 02632 10/22/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 111 r A t.VG O� CESSPooL A(1) ecs5pmaL. 13 �Z) Ar3 as - (A i1,JoopFp i. ee,4 0` t5insp.doc•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 15 `3 w to�en.�a 1 Commonwealth of Massachusetts Q. I. . 'U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 111 Goose Point Road -- Property Address Bruce Stuart Owner Owner's Name information is required for Centerville MA 02632 10/22/2009 every 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: —�16'+ 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: 111lo- SDW 252/Zone C/Level 47.1 /Adjustment is 1.8 x 12"=21.6" You must describe how you established the high ground water elevation: 110-woo Bottom of the leaching pit is at no more than 11'.There is a slope off to the rear of the property with a pond and water at 16'+. If you add the required USGS adjustment to the total depth of 11, this leaves an additional 3.4'+of seperation. t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 TOWN OF BARNSTAB LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Sc� LEACHING FACILITY: (type) size) NO.OF BEDROOMS OWNER QAqt ^2 PERMIT DATE: O [ COMPLIANCE DATE: �( �J 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 d� ft 4 TOWN OF BARNSTABLE LOCATION l// � /' .C'o/.vT /?� SEWAGE# VILLAGE ASSESSOR'S MAP&LOT 2 INSTALLER'S NAME&PHONE NO. y• SEPTIC TANK CAPACITY a LEACHING FACILITY: (type) (size) �OG2� G NO.OF BEDROOMS BtM;DER OR OWNER 6ma5d PERMTTDATE: -911®1,F.3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility G 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 •, L �q�1 MJY 1 F%T V. L0 C A'T'ION ) EWAG E PERMIT NO. 66 elo X-P VIII:ACE �. INSTA LLER'S PME i ADDRESS e U I L D E R OR OWNER DATE PERMIT ISSUED O DATE COMPLIANCE ISSUED/ t \ i Al of >� Town of Barnstable. P# a 7 74 Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. 1a Soil Suitability AAssessment or Se Performed By: D(li V11) O Cou6H NVO W jL L-SE wage Dzsposal Witnessed By; �/i`�� Location Address //' ,LOCATION & GENERAL INFORMATION 6CO of PQ� h f Owner's Name ruee/ dd__I I � t�(/TE� ' U 1 V Address G l l GoaS� 04/`L /2� Assessor's Map/Parcel: 2G2 / 4.3 Pngineer's Nam � `e% (W&I�l�le �M�a O�W2►^G 3� . NEW CONSTRUCTION REPAIR o 1 A Telephone# vId LandUse 16scleh"t t�-7'7 Slopes(%) -!G' Surface Stones some Distances from: Open Water Body — D b d t I=��_ft Possible Wet Are, ft Drinking I�b Drainage Way y� ft Sv i ft Property Line l_0'tFt Other / ft SICETCII: (Strut name,dimensions of lot,exact locations of test holes&pere tests,locate we tlands In proximity to holes) GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LE VEL \ I BASED ON ELEVATION OF \ ADJACENT SHALLOW POND \ — — ' OBSERVED H2O 33.67 —\ I INDEX WELL A1W-47 ZONE - C \� 7p READING DATE NOV. 2009 f READING 23.0 ADJUSTMENT ' 3.1 ADJUSTED GW 36.77 i Parent material(geologic) 0 l y('441 iVn L`V Cf�� Depth t9 Bedrock Depth to Groundwater. Standing Water in Hole:_ V 1 b VL L° ----_ Weeping 11'om Pit Pace Estimated Seasonal High Groundwater e, Method Used: DETERMINATION FOR SEASONAL;NIGH WATER TABLE �!ee GbD 1r e Depth Observed standing in obs.hole: Dcpth to weeping from side of obs.hole: in• Depth to loll mottles: Index Well# In, aroundw4terAdjUstment in, Reading Date: Index Well level ft. .-w. . _. .Adj,factor— Adj.Groundwater)oval Observation PERCOLATION TEST 'rime. Hole# / Time at Depth of Perc 7� Timeat6" h�9•t ^ SM � Start Pre-soak Time @ Time(9".6") f End Pre-soak Rate Min./Inch Vll 1 Site Suitability Assessment: Site Passed N ` Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole,Data To Be Completed on Back----------- ***If percolation test is to be conducted within 1001 of wetland, you must first notify.the Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPTICPERCFO RM.D OC OF TEST: DECEMB 4. , SOIL TEST LOG SOILS EVALUATOR: 'DAVIID DEC OUGHABNOWR• R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 12776 NO TEST PIT I PAARENOTU MATERIAL:EPROGLACIRALD OUTWASH PERC AT 70 1n — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 53.05 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING 0-3 O WOOD LOAM 10 YR 3/2 NONE FRIABLE 3-10 A SANDY LOAM 10 YR 4/6 NONE FRIABLE 10-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 49.30 45-13B C MEDIUM SAND 10 YR 6/4 NONE LOOSE 41.55 NO GROUNDWATER ENCOUNTERED TEST PIT . MATERIAL: PROGLACIAL OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER E 53.15 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING 0-4 O WOOD LOAM 10 YR 3/2 NONE FRIABLE 4-12 A SANDY LOAM 10 YR 4/6 NONE FRIABLE 49.40 12-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 45-132 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 42.15 DEEP OBSERVA Depth fro TION HOLE LOG _m Soil Horizon Soil Texture Hole# Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co igtengy,9" Gravel F DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil 0 Surface(in.) Other th (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten 1 y .t Flood Insurance Rate Man: Above 500 year flood boundary No Yes within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturallv nrrri*ripe 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? If not, what is the depth of naturally occurring pervious material? Certi_�ficatlon rA I certify that on 1Q6J 19 2 (date)I have passed the soil evaluator examination approved by the f Department of Environmental Protection and that the above analysis was performed by me consistent wit the required training,(`expertise and experience described in 310 CMR 15.017. Signature o dV. G? yy L..SC �`�yZN oF,ygssq �I Date l7eC �', Z da� oho`'. DAVID cym U D. COUGHANOWR Q.4SE1'TIC\PERCFORM.DOC s0��/CENS 0 EALUP No. ' Z;0 3'�/ �E� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for ;Digpogar *potem Construction Permit Application for a Permit to Construct( )Repair( k<upgrade( )Abandon( ) ❑Complete System 1 9'fndividual Components Location Address or Lot o. Owner's Name,Address and Tel.No. ll/ &o®.SF_ aoaftiT R� C £/LT- —B 5Iv,41pr Assessor's Map/Parcel Installer's Name,Address,and Tel.No. er' `°?� �O"� Designer's Name,Address and Tel.No. A l-4 r4, ,-C® -350 1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 £ A4W C E A- 14 /A., .L J/y'r S' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue Ay this Board of Health. Signed Date 7" C7 3 Application Approved by Date q'f`ll 3 Application Disapproved for the following reasons Permit No. 'zoo3-- Date Issued 3 ee Entered in computer: V THE COMMONWEAL-TH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS 0[pplication for Migool *potem Con0truction Permit - Application for a Permit to Construct( )Repair(ti}Upgrade( )Abandon( ) Complete System EJ` dividual Components r Location Address or Lot o. Owner's Name,Address and Tel.No. I1, GaoS E 4Na��t•T R C r•�-r '33�f'vC 7- Assessor's Map/Parcel � `� d O OS po JET Cr 7- Installer's Name,Address,and Tel.No., 5••'6 p 9 7S-,?,P&- Designer's Name,Address and Tel.No. 7- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. ' Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures tj 1 r Design Flow / 0 gallons per day. Calculated daily flow/ gallons. Plan Date Number of sheets d Revis�jon Date Title Size of Septic Tank Type of S.A.S. '` y 1%z.12 Description of Soil Nature of Repairs or Alterations(Answer when applicable) C- r- / iv c, 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- 1 cate of Compliance has been issued—by this Board of Health. Signed 5�: Date T 1 - p3 Application Approved by Date Application Disapproved for the following reasons ' Permit No. (2(. Date Issued ( !9 3 / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( 'I Upgraded( ) Abandoned( )by #4 /�_�'I�/Li C C, 0 W,4,/x- 5 T C,v at 6,q5 f Pam__- iA_Z� C £tiT' • has been constructed in accordance with the provisions of Title 5 and the for Di s sal System Construction Permit No. �0�'�2(o dated Installer �.d- 2.PlL r1' JaApkA- Designer The issu ee of thiss!permit shall not be construed as a guarantee that the system .`. ffunct1 a -srgned. ' Date ��f ��3 Inspector _ l�..� -------------------------- No. 2W3—' (2� Fee 5_0...-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lig;pogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(rvTlJpgrade( )Abandon( ) System located at /// ig OGS 1' 00 a/tiT /P Z (- 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:Constructs n st be completed within three years of the date of this permit. Date: / Q 3 Approved by TOWN OF BARNSTABLE �a SEWAGE # LOCATION _;ll �vDS� � J o�✓���d�11� ASSESSOR'S MAP & LOT �— 0 ,73 VILLAGE INSTALLER'S NAME&PHONE NO. sJC� SEPTIC.TANK CAPACITY LEACHING FACILITY:.(tAA (size) NO. OF BEDROOMS BUILDER OR OWNS JL �4"""o COMPLIANCE DATE: PERMIT DATE: 17 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 fig_ I s TOWN OF BARNSTABLE 4 r.00ATION J/l �DO i SEWAGE # VII.LA,GE 0,!! Z ASSESSOR'S MAP & LOT '�i INSTALLER'S NAME & PHONE NO. ' T3 a4,,✓C0 f SEPTIC TANK CAPACITY Lisy� C ✓�� )--� i I A °a, L LEACHING FACILITY: (tyfp4) (size) NO. OF BEDROOMS / BUILDER OR OWNE 1 %?Oci Tv � PERMITDATE: i IQ COMPLIANCE DATE: V J 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) Feed Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by rRa�� r . i�-� 7 5 a�� � C D �- �-�.'� f�,. '� P� ;r CERTIFIED SEPTIC SYSTEM REPORT 9 ' 19 LOCATION _ �v 111 Goose Point Rd . Centerville, MA. MAP 252 PARCEL 043 LOT 11A & 11B - - - - -- ---- -- ---PREPARED FOR. SELLER Ms . Bonnie M . Dyer, Trustee Goose Point Road Realty Trust 120 Damons Point Rd . Marshfield, MA 02050 BUYER None At This Time . PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection WNW F.WNd Trudy Core Gem a se—Y Argeo Paul Cellueel David B.Struhs Lt awamor Comn�ioewr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1dplvT Gar�S�= �oivr .a Cl �PFil'�T% TR•v5T Address of Owner. Dante of d yArAkc (If different) Name oflnspeotor. 1�1411,Mo Hl'_4xle /0�0 U�➢ho�s �� RO. Company Nam4 Address and Telephone Number. 9SO— i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, a=zate and complete.ss of the time of inspection. The inspection was performed based on my training and experience in the proper function.and maintenance of on-ate sewage disposal systems. The system: asses . _. Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails, Inspector's 8111patum: . /�M Dater The System Inspector shall submit a copy of this.inspection report to the Approving Authority within.thirty(30)days_of completing this inspection. Itthe system.in.:a.shared system or has a design flow of 10,000 gpd or greater;.the inspector and the system.owner shall submit.tha. seport to the.appropriate regional office of the Department of:Environmental Protection. The origiad ahoald.be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPZ i'ION SUMMARY: Cheq>EA„-1 C;-crD: A] STiM PASSES: _'bete not found any-information which indicates that the system violates any.of the failure criteria as defined in 310 CMR.15.303. Amy film eritaria not.evaluated are indicated below. BI SYSTEM[CONDITIONALLY PASSES:. One or more system components need.to be replaced or.repaired. The system,upon completion of.the replacement or repair,passes iospaW= Ind wta yea,n4 or not detarmined.(Y,N, or ND). Describe basis of determination in all instances. If"not determined',explain why not) The septic tank is metal, cradled.structurally unsound, shows substantial infiltration or exfrltration,.or tank,failum is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as app,oved. by the Board of Health. (revised 11/03/99) L OnaWMN'Street •° Boston,hlasaaehusetW02108 •• FAX(617)5WIG49 • Telephone(617)292-55m �f Pinned on Reeycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ° - CERTIFICATION (continued) f - PropertyAddrem /// 6e;1-5/E xa G�.riJ�.2�tGE Owner. �c .00ivl R2f�GT1 TRvST Date of Inspection: B]SYSTEM CONDPPIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than,four times a year due to broken or obstructed pipe(a). The system will pass. inspection if(with approval of the Board of Health): broken pipe(s) are replaced -.- ---- - -- -- — -- obstruction is removed CJ 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. 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 orr 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) DErER3WM THAT THE.SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC:HEALTH.AND SAFETY AND THE ENVIRONMENT`. The.system has a septic tank.and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and:soil absorption system and is within a.Zone I of-a public.water supply well. The system has a septic tank and soil absorption system.and.is within 50 feet:of a private water supply well.. The system has a septic tank and soil absorption system and is 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. 3) ®THIS (revised"11/03/95). t 1 - • . { SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A ry CERTIFICATION (continued) ?mperty Addteea: /11 6 �'-5,C �,vTE/1`/IGGL- ?vner. 64.::K'e Date of Inspection: DI SYSTEM FAILS: I ban 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. clogged_ Drseharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or SAS or oesspool. 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 112 day flow. Required pumping more than 4 times in the last.year NOT due to clogged or obstructed pipe(s). Number-of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater,elevation. Any portion.of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water-supply. Any portion.of a cesspool or privy is within a Zone I of a.public well. Any portion of a cesspool or privy is within.50 feet of a private water supply well. _ Any portion of a.cesspool or privy is less_than.100 feet but greater than 50 feet from a private.water supply well with no acceptable water quality analysis. If"the well has been analyzed to be acceptable,attach copy of well water analysis.for cobform bacteria,volatile organic.compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM.FAILS: The following criteria.apply to large systems in addition to the criteria above: Tba'system serves a facility with a design flow of 10,000 gpd or greater fLarge System)and the system is a significant throat to public b.alth and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a.mapped Zone II of a public waxer supply well) The owner or operator of any such system shall bring the system and.facility into full compliance with the groundwater treatment.. its.of.314 CMR 5.00 and.6.00. Please consWt.the:local regional office of the Department for ftirther information.. (revised 11/03/95) 3 - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST i 1 Property Addnw, //1 G OG5,C �Ol v% szD G it o/GG,E Owner. 64kpS'c /gOl,!/r '1?Ae4''% Date of-Inspection: Check if the following have been done: ' umping information was requested of the owner, occupant, and Board of Health. L-"None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during.that.period. Large.volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. e facility or dwelling was inspected.for signs of sewage back-up. -(CThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs.of breakout. , All m components,f system ponents,acludiag the Soil Absorption System, have been located on.the site. /Ut'_41 The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baMes or- tesa, material of construction,dimensions,depth of liquid,.depth of sludge, depth.of scum. V/The size and-location of.the Soil Absorption System on the site has been determined.based on msting information or ..appraz:bmted.by non-intrusive methods. ✓Tbe Ldlity owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised-11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address //! de�;t--6,C lqa Owner. Gr;2Sx A�,X -"r l�,e'.9GT% T.QvST Data of Inspection: FLOW CONDITIONS RE SMENTIAI.: Design lbw:_gallons Number cf bedrooms: Number of currant residents:Q Garbage grinder(yes or no):_Y,_F5 Landry connected to system(yes or no):y�'s Seasonal use(yes,or.no):_A/0. Water meter readings,if av le: F1,Y74/.1eE 6ATE Last date of oxupancy:�vlr/T 9�j 1J -- lJ5�0 o�cAS��,riilLG 5/,�iGE COMMERCIALANDUSTRIAL- Type of establishment: Design tiow:_"_Amlloas/day Gramm trap present:(yes or no)_ Industrial.Waste.Holding Tank present: (yea or no)__ Non4anitary waste discharged to the Title 5 system: (yes or,no)_. Water meter.readings, if available: Last date of o=paacy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and-sotupe o information: 9a- System pumped as part of inspection: (yes or no)N? If yes,vohrme pumped: gallons Re"on for pumping TYPE OF SYSTEM . Septic taalddistazbution box/soil absorption system Sim cesspool O"rflow cesspool Privy _Shared System(yes or no) (if yes,attach previous inspection records, if any) Other(=plain) GeSS/ocs ff,y� it LE/�✓//.us /�/T. A"WXD ATE ACM of all oomponenta,data installed(if known)and soiree of information: 'eir _40,10 /,vsT�944!0 /,v 11W 93 Sawa`s odors detected when arriving at the site: (yea;or no) (revised:11/03195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addresw Owner. G-'c'S.E Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grade: Yatarial of amstztuction:_concrete_metal_FRP_other(e:plain) Dimensions: Sludge depth: Distaaea from top of sludge to bottom of outlet tee or baffle: Scum thiclmess: - - Distance fivm top of scum to top of outlet tee or baffle: - - --- ——.-_ __ _ _---�-_•_ Distance from bottom of seum to bottom of outlet tee or baffle: 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.) GPJ ASE'TRAP•.— (locate on.Bite plan) Depth.below grade: Material of aomrtructioa:_concrete_metal_FRP_other(expLdn) Dimensions: &um thielmass: Distance'from top of scum to top of outlet tee or baffle: Diotancel from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, w6dence of.kakuge,stc.) J (revised.11/01/45) 6: - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) property Address: //l (,at�S�£ .Do%vr •c'� G���TG.'�/GG£ owner. Date of Inspection: VA;'Al TIGHT OR HOLDING TANK_ (locate an sits plan) Depth below rude. _mew_gyp_other explain) Material of construction:_concrete Dimensions: Capacity De flow; sallonslday Alarm level: Comments: (condition.of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:= (locate on site plan) Depth of liquid level above outlet.invert:. Cammants' r evidence of leakage into or-out of box,etc.) (note:if level and.distribution is equal, evidence of solids carr9we ;- PUMP CHAMBER: (locate on site plan) p=qw in.working order.(yvu or no) (Hots condition of pump chamber,condition of pumps and appurtenance*, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ - PART C SYSTEM INFORMATION-(continued) Property Addeest /Il GooS Lb/.ri% r�C G�,vTr'iZ!/1GG Owner. Date of Inspection. SOIL ABSORPTION SYSTEM (SAS):_✓ (bate as site plan,if possible,excavation not required,but may be appr=—ted by non-intrusive methods) If not determined to be present,explain: Type: l.sehmg Pita,number: lexching chambers,number:_ yschinB galleries, number: - - _ leeching trenches,number,length: lsschin fields,number,dimensions: Overflow cesspool,number. Comments:(note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation etc.) t�4 $/:•� aY Tv ,P'/ / a%a z �v2'/!. �P2Go.+rh�f'�✓ i� iP/S /I. CESSPOOLS:_ (locate an site plan) Number and configuration: /!'- L-144c Depth-top of liquid.to islet invert: Depth of solidi layer: Depth of sam.]ayer Dimsnooas.of cesspool: Materials of contraction: _,il'Le-. Indication of groundwater: tig9Z/6 inflow(cesspool must be pumped as part of inspection) eb - 4Ccr r GG;GS//I�GT%�i✓ G /• 1-1/74 A!/ ail"l�Ti ,r2W-"'- f} o% y'/o it rio G;`' �2 H"!- 19,v ' �f.�cfir/L h-402-4/ mil' ��5�� o/h' lfA� r�yTL d r TES /36 i.vsr���rp, Comments:(note candition of soil,signs of hydraulic failure, level of ponding; condition of vegetation,etc.) PRIVY:_ (locate an site plan) Materials of-O0 truction: Dimensions: Depth of solids: Cam—, (note condition of 202L signs of hydraulic failure, level of ponding;condition of vegetation;etc.) (rM aed.11/03/95) e F _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) vpsrty Addrei 'n'r. ate of Inspection: (///.,)- %C ; i KXMH OF SEWAGE DISPOSAL SYSTEM: include tin to at Last two permanent references landmarks or benchmarks locate an wous within 100, .9IV Tffit'T i9GL i F P1T �a f G� - - - - ro i 9� 1 I 1 �O/ZG fjl , DZM TO GROUNDWATER Depth to wmd utft 41 7"- feet >Detlyod.of determination or aPP:asimatioa: 13Aa' ST o�G� �/S S'/''•ria•` TN'�" S/�7; f�� '�=` /A �� a': �'p � T/•',� A/T /5 �' OGO� wi?7/ a S'' o� L�/ifal T/t/c S!r''a /s c��,rfs/.y ��y� o�- 5rrsi/ulev Pova �i /�i rr.�s/ /Z G��.¢?.try '��/•83 (revised 11/03/95) 9 �No '127-0 FEs.... l2� -• ..... . _/-3 THE COMMONWEALTH OF MASSACHUSETTS L BOARD OF HEALTH r� ...----_).QLVn..-.....-.OF......... a ',n�-/..LiL /-��....................... Appliration for Uiipuiittl Works Tonstrurtilan Prrutit Application is hereby made for a Permit to Construct ( ) or Repair {--) an Individual Sewage Disposal System at: ......... ....................... ------•--------------•........---------.......------................._. c ti Address or Lot No. - L1 � .r'......................... . a�-�..1.... ......------------........---•--- Own r dd ess a ....... :zz),Q. a!',f d�1.5�.f ll . .................................... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...................:........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic uid x Disposal Trench_iq No capacity............ Widthns LenghTotal Lengthidth______________ Total leaching area-•Depth-.•:-::sq. ft. W i Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by_______________•_•__......__-___-___-_....._.............................. Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f4 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ a •••-•••••••••-•••-- - .............................:. O Description of Soil.. -�')A,ac -•-----••- x w U Nature of Repairs or Alterations—Answer when applicable......___.._ � 11�-__ ._ �. ________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. -A............. c ApplicationApproved r--•-- •-- - ................................................................. ... Date Application Disapproved r t following reasons_____________________________________________________________________________•_••---------_._...._______-_....._ ...._...._•-••••--••---•.................•---•-•-.....•••••--•-----------••--•...---.._..._...•-•-•....•--•---••-••---...-•-------•--•-•---•----•--•--•-•-••-••-•------ •-_...--•••••••----•••_-•-•- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF.......... ................................ Appliration for Uiipoiittl Works Tonitrnrtion runfit Application is hereby made for a Permit to Construct ( ) or Repair ¢--j an Individual Sewage Disposal System at: � Lpc ti -Address y� F os' �. 1 ....�. ' � 1 .. ../... .............................. 5 Owngr 5 i Add�ess J� � ........... ................... ............. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms________________________________ _____Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of ersons.______._______.____________ Showers — yp g p ( ) Cafeteria ( ) a Other fixtures -------------------------------•---•-------------------••----------------------------------•-------------......._...------••----••-•---..........._.. w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench-No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I....._..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •---•-------------------------- -._......_...... t .� Description of Soil---•--------•-••--••-•---•- -- ������ ' ..;f_.� t- /-------•---------•-•-------•-•-----•----•------------••-----•--....._.. x w U Nature of Repairs or Alterations—Answer when applicable............. _ t__._ _/ ________________________ ---------- --------••-----------•---•-----•---------•-•--••-----------------•-•-......._._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be�i issued by the board of health,, r� geed �' ' °' ��"_f-- .�6e.' <>a'dt` f ' l ^ —� D to Application Approved f�'� fa -------•--- Date Application Disapproved `r t following reasons:................................................................................................................. ................................................................................................_........................................................................................................ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........).01V n, ........OF..... �. r ' v' ': .. ................. (9rdif iratr of Toutpliorta TLLIS T CERTIFY That the Individual Se,v,.i Disposal System constructed ( ) or Repaired (4--)— by o y z nstall f at••�1 J L} -� / f ' � 1__._.t._� _ r P''l '.................................. has been installed in accordance with the provisions of T ^�F 5 e State Sanitary Cod as abed in the application for Disposal Works Construction Permit No.-_�`r'.__'�_/_ _________. dated--1--_----`-'_� --- THE ISSU CE THIS CERTIFICATE SHALL NOT BE CONS S A GUARANTEE THAT THE SYSTEM IL /FU ON SATISFACTORY. •-••----____---•-•-----------------•------••....... Inspector......._ -------------•--------•-----------.._..-----......---••---......-- DATE... O THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEAL•�-TH J ._....../--0�n.............OF..-.-..a=..,.� 'Ok)1 /�t /.�----•-•--•------.....__. ))/) N�--••r---- ••- FEE- /....-___-l-•_- �i��o��l . oy^�k� �un� nrtion rrnti Permission is hereby granted...--- /. 1 '. ? '• ... to Construct ( or Re air an Indivi al Sew Disposal Sys at No 1 '`��� '. u/ !j T-- c� �l f! 1 i'"� *�'1'° Street ----------•................ as shown on the ap licat' n for Disposal Works Construction Permit No ��:________ Dated.......................................... �y --------...-•-•• .... ....................•--------•-----•-•-•-------...•-•------•-•--•-•-------••- Board of Health DATE-- .-�.----:�`�---- •-�-•---••-----•..--•----------------------------- FORM 1255 A. M. SULKIN, INC., BOSTON - II ALL PIPE SPECIFIED ARE ATIONS F L O N PROFILE EXPRESSEDLINV DECIMAL FEET NOT FEET ANDT INCHES.TIONS TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE EL = 55.18 +- ONE INSPECTION RISER FOR LEACHING GALLERY TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. 52.50 ALL PIPE TO BE /D-BOX MAX SCHEDULE 40 PVC 3" DROP pf AND TO PITCH AT FLOW LINE 49 50 1/6 to/Ft MIN. L�) 5 10 14' 46" GASH® PRECAST EXISTING BAFFLE DRYWELL 49.25 6 in BOTTOM OF STONE LEACHING LEACHING BASE 48.88 GALLERY 49.50 6 in STONE BASE 49.05 GALLERY 46.�5 5.00 Ft + 1500 GALLON 48.�5 (END VIEWS o) 22 ft b) 66 Ft SEPTIC TANK SEE DETAIL ON REVERSE c1 96 ft 20 Ft. o) 5 ft bl 15 ft A ADJUSTED SEASONAL y 36.77 \ HIGH GROUNDWATER Z= m °� lmz ;u ro m rn m uM -0x -0y°0z < a°c d(f) m� z n o o o n o `� w )jn -i)�Tl� ��m m o cn co U-o \ Z O 3 °D 7C � � z �\ ° O n m °� rn O r fin' m zrn zcm OOC- m c°m m rn °z �m r r m ` N r C �1 rzc� -Ti C)�o OOO w m°� � (n Z m r a \ ��y T� m I� � / N •\ Y m W O d'N I m c 3 o maro In OQp o 2 m (r-rq N ro Z C nR 7 \ ~ / \ n I V h m / rq < m \ \ ' 3 m cn L � ` J0 0 Z3(�. 2r0Ton=� >c� oa r- Ornnr� o zn 0z0 w c�z ® �e ♦ v y JP � ioomom m = cco � R� m y 0 , ��m�cn ) 3 m �� Cll 71 a z O N o Z > ED ID Q o � �� aD ,cyl � 00 N� T. -0 w CY)F I \Y/lx. 9cznD>z m mr �� �y� o 3' O O i (I) �7 COM,y \\ i Oo a a r W � m O n>c=oz m rn Z ° m C > a� ��Z o `� rn m ��;�W O o o nG� n rnm S- y 0 = a o O \ o m m cn�c O f�l O A -� rn 0 rn �7 rn N� a -� a < „ �4 �m>mA N 3 y z O z m O S w cn 3 ,l n 70omm� N 3 O Fl� m O m -0 2 F`o �a . F O `A r m�W o c � N 2 �rn n X O Sll�s� °�� °m m �x w 6, z 0 z o ul o o f Il Ul ° y mm mn O i cn m O JID9N SNI>19fiH c m a rTl< Z7 y N 0 -0 p -� n "a m° ~ y -I t�� OVO� (n 0300-< m F �J z r coM,yo =gym ° ° mz o' oo czi m In a � y r z m o -J �.�,� �po N� m A N op ~ cNn r a r p r�� cn �p O N ❑ co \� C - rH, 3 --in ® O� Z2 '� ��z0cn z r 3 m D z z v < ?"� mm m o2 Z o r z m�a 4 S f7(n Z 3 G F a by �1 O NG < �or�� (D > C 0 y� O �y omA o k O o r ORf�VIFw <y y� rr-. 0�O3p 0 Z n R Sli�s� T :?,. . SOIL TEST L O G DATE TEST: DECEMBER 4. 2009 SOIL EVALUATOR: D •D. E A R.S. WITNESSED BY: DONALD DSMARAIS. HEALTH DEPT. DESIGN - CALCULATIONS PERC NUMBER- 12776 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS PARENT MATERIAL: PROGLACIAL OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) PERC AT 70 in - 2 MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A THE LEACHING GALLERY DEPICTED BELOW CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Abot = ( 16.5 x 21 ) - ( 3.67 x 10 ) = 309.6 sf 53.05 A s d w = ( 21 + 12.83 + 10 + 3.67 + 11 + 16.5 ) x 2 = 150 sf 0-3 O WOOD LOAM 10 YR 3/2 NONE FRIABLE Atot = 459.8 sf 3-10 A SANDY LOAM 10 YR 4/6 NONE FRIABLE Vt 0.74 x 459.6 = 340.25 GPD 10-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE USE THE LEACHING GALLERY DEPICTED BELOW. Vt = 340.25 GPD > 330 GPD REQUIRED 49.30 45-138 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 41.55 NO TEST PIT 2 PARENT UMATERIAL:NDWATER ENCOUNTERED LD OUTWASH �� ����� GALLERY 2 MIN/INCH IN C SOILS USE SHOREY PRECAST 500 GALLON NOT TO 1500 GALLON SEPTIC TANK LEACHING DRYWELL (H-le LOADING) SCALE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DIMENSIONS AND DETAIL NOT TO (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONSTRUCTION DETAIL USE SHOREY ST-1500-H-10 SCALE 53.15 0-4 O WOOD LOAM 10 YR 3/2 NONE FRIABLE DRYWELL UNIT 4-12 A SANDY LOAM 10 YR 4/6 NONE FRIABLE E 12.83 ft STONE TAPEIrl R 49.40 12-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE ' �'- 45-132 C MEDIUM SAND 10 YR 6/4 NONE LOOSE m 42.15 �o 5 Ft- �t Q 3.67 ft. 0 8 In 4- m� m N Z 4I GROUNDWATER ADJUSTMENT N p 1� DISTRIBUTION BOX 4 ,e EXISTING,-zGROUNDWATER LEVEL k. T.•�` 'BASED Q N .ELEVATION O F DIMENSIONS AND DETAIL USE SHOREY DB-3 H-10 r. 10 f l ADJACENT SHALLOW.'. POND m .OBSERVED- H2O ` 33.67 O f t B.5 f t O f t 'INDEX WELL A1W-47 12 in INLET CENTER OUTLET ' r4ZONE G NOT TO 16.5 Ft END COVER END READING DATE NOV. 2009 SCALE MIN READING -- ', = 23.0 FROM —� 3 IN DROP ADJUSTMENT= , 3.1 O c TANK TO 500 GALLON DRYWELL FLOW LINE _. .,ADJUSTED GW 36.77 O b SAS DIMENSIONS AND DETAIL FROM 10 in 14 TO + p (0 INSTALL ONE INSPECTION BUILDING ' USE H-10 UNIT RISER TO WITHIN THREE In J f D-BOX 1� 6 to STONE BASE INCHES OF FINAL GRADE 48 1n AND INDICATE LOCATION LIQUID GAS 15. 1�5 CROSS SECTION VIEW ON AS-BUILT PLAN LEVEL BAFFLE 33 SEPARATION BETWEEN INLET AND OUTLET TEES N 0 T E S o0r, 000 In SHALL NOT EXCEED LIQUID DEPTH oo�ooca CoCo1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK.2) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. lee In 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS CROSS SECTION VIEW SEWAGE DISPDSAL SYSTEM PLAN OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 2 in PEASTONE 21n PEASTONE -TO SERVE EXISTING DWELLING BEFORE EXCAVATING FOR SYSTEM. BRUCE AND DOREEN STUART 51 ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 28 3/4inro 0 EETIVEft111 GOOSE POINT ROAD CENTERVILLE. MA 26) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES In - '^ � to AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. ECO-TECH ENVIRONMENTAL 7) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-32731 DECEMBER 4. 2009 12121