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0019 HIGH NOON DRIVE - Health
19 High Noon Dr. (Centerville) .4.-j A= s i t No.42101/3 ORA 10°I0` © 0 0 0 i f u TOWN OF BARNSTABLE %OCATION Q; iqh N4oA SEWAGE# �Z4 'VILLAGE co"* (ilk 9, -ASSESSOR'S MAP&PARCEL 1-1p1- INSTALLERS NAME&PHONE NO. RAcr 14\ a (go A ilk,"'(01 SEPTIC TANK CAPACITY 1 000 W �ko SxA jL lyn k, LEACHING FACILITY:(type(► ScO 6cA 64�cj�.P (size) 11�X�- X�` I r' AC11 NO.OF BEDROOMS 3 ;g OWNER KQ,A1 ®fp NL, PERMIT DATE: '"��`9 COMPLIANCE DATE: Separation Distance Between the: (1 tq� & :Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 13M�. =¢eet 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 to 1 _l I)lq No. , . FEE': COMMONWEALTH OF MASSACH US f BoardofHealth,__......- APPLICATIONYOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application fora Permit to Construct( ) Repair( Upg adeO Aban of ( O mplete System U Individual Components i Location r a A Owner Name f' Map/Parcel# ' Address Lot# Telephone# 77 V a ' 4 Z_ o.-P j Installer's Name / Designer's Name Address Address �+ ¢ate, 9 Telephone# e ..9 Telephone# 67 Type of Building' P��o Nfry�)w Lot Size el sq.ft.. Dwelling-No.of Bedrooms. . Tk omll; Garbage grinder.:( Other-Type of Building No.of persons Showers(' ),Cafeteria.( j Other Fixtures Design IFlow (min.r uir d) gpd Calculated design flow 77 Design flow provided A gpd Plan:' Date i Number of sheets Revision Date Title Desciption.ofSoil(s) Soil Evaluator Farm No:. Nwne,of Soil"Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERAT le'N /� l�1 oerI` �G y The undecsigned:agrees to install the above descri .ed Individual Sewage;Disposal Systeriin accordance with the pro ion further agr ,s to not to place the system in operation until:a Certificate o Com ce has been issued by the.BoardL of Health. 7 SignedL. Date � _ C - •VIA, In, .--..--------------------------------------------------------------------- -- - j.F'14 {�`''^'i� r i �'.- .ter. _ •_^,_; .Fay,. ,..-�•--. FEE No. r A f Q ' f�F 'ibt• t { �IYNS� Board of Health, AP PLICA. TION .FOR DISPO * EM•CO�1STRUCTION PERMIT Application fora Pei-trrrt,t9 Ccinstr`uctO Repau,(:>) Upgrade( )"Abair of O{"( ,O plete:System ❑Individual:components :ovation W Ile 4 A V40#9 VdP.*V;-;, Owner lameVt Map/Parcel# Address ° L. t# Telephone# 71 7 - J& i,, ljp,/ Installer's Name Designer s Name $,lt lY'`� a/!�l �� � � � �ClaI4°4► �s,...y,ee!41..+.Aw ...... Address 170 Address ` to m g ar+ , °C'J •fit) l �✓• ..4� Telephone# —7 74 6 - Telephone# Type,of~Building r,rA`.4, Lot Size oa / ..14 . sq.ft. Dwellimg-No.of Bedrooms:: Garbage grinder ( ) Other-Type of Building _ No.of persons Showers(` ).,Cafeteria( ) Other Fixtures Design-Flow(min:required)r goGalctilated design flow— Design flow provideda41 gpd Plan: Date. Number�of sheets ,Revision Date Title Description;of Soil(;s) Soil E-valuator Form No. Name oil Evaluator ' � ,.of S Date of Evaluation r.. DESCRIPTION OF REPAIRS OR ALTERATIONS 1r, r /R �+ ice► . .. Sbv� o / � r The:undersigned agrees to install the above described Individual Sewage:Disposal System m accordance with the provisions.of TITLE=5 and,.?�,, further agr es to not to•place the system in operation until a Certificate o+Compliance has been issued.by the Board of Health. , /4 Signed Date _ AV/1 � w • r FEE,- 7Ii -- COMMONWEALTH OF SETTS Board of Health, _ MA CERTIFICATE OF COMPLIANCE. Description:of Work: Individual Components) U Complete System The-undersigned . hereby certify that the Sewage Disposal System--Constructed ( )',Repaired Ge) Upgraded ( ),Abandoned O.. ley t T=,t.t rwr" t' .�..a[ ►• ,,,//'''' It A View/. fi1j ^. /A�4—g 71 has been installe. in 11accorda-ce th the provsions of 310 CMR 15.00 (Title 5) and the approved:design plans/as-built plans relating to. application No.� /'7 '� Wated, Approved Design F.low (gpd) Installer e Designer: R o/rtr 0" +A.aw +" Inspector: . 11 VJVM Date.: ! o 1.1.q _ The issuance of this permit shall not be construed as a.guarantee that the system.will function as designed. No.A�PFEE' -COMMONWEALTH Of MASSAC14 SET Board o Health, 1_V Dy DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct( ) Repair` ) Tpgrad ( ) Aban on( ) an indi�idualsewage d sposaI system at.. I /� P.L. �t/d , `��q 6� as described in the.,application for A _ r v. Disposal Systern.Construction Permit No � '' i`dated 19 11 Provided: Construction shall be completed within three years of the:date of this per i All local.Conditions rn List:be met. ,Form 1255 Rev.5/96.XM.:Sulkin Go.ChakStown,Mn: bat e��s % ! L Board of Health :_ i Town of Barnstable Regulatory Services Thomas F. Geiler,Director 'Mks& Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862 /644 1 Fax: 508-790-6304 Date: z! �J� Sewage Permit#do do' Assessor's Map/Parcel Installer& Designer Certification Form Designer: SGJd�"15�+2 � /✓ „r� Installer: Cr- Address: �� 15yJc 7t1 Address: ? ,au � z `��GZIGd s��� �c✓,�o,.�di� //'�9 Go�G6 On 0 a 40/ /4�� I�,K r, was issued a permit to install a date /q (installer) septic system at based on a design drawn by (address) °lrTf� Ae-l-V 2-w-41r_ dated AF12. ZO/cf (designer) I/ 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if requir d s inspected and the soils were found satisfactory. tH OF btgSS9�y TERENCE - (Installer' ure " HA ES N No. 979 a f �GtSTER� c- •'r.,+.<=.��c� `SANITAR`F'N . Desi ers i a e .:.... "- ( b'n ' � ) (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. gAoffice formsWesignercertification fonn.doc SWEETS ER BNGINBERING 203 SETUCKET ROAD-P.O.BOX 713—SOUTH DENNIS—MASSACHUSETTS 02660 TEL(508)385-6900 EMAIL sweetsereng@.aol.com FAX(508)385-6991 LAND SURVEYING—ENGINEERING—TITLE 5 SEPTIC SYSTEMS SEPTIC DESIGN PROPOSAL PAGE 2 PROPERTY INFORMATION AND FLOOR PLAN SKETCH[ Please fill out this form,including the floor nlan sketch,and return to us with the signed proposal and retainer. This information is necessary to properly prepare your Septic System Design. If you are planning an addition,we require a.set of plans including a foundation plan Iota!#of Rooms Year Round Home Seasonal Home Owner Occupied Rental e #Bedrooms Family Room/Den _XLivinag Room. Dining RoomAS—#Bathrooms Washer/Dryer Dishwasher Garbage Disposal YGas Service Town Water In-ground Electric Wires* In-Ground Oil Tank* In-ground Sprinkler's __K_In-ground Gas Pipes' Please note on sketch where located. Sweetser.Engineering assumes no responsibility if in-ground components are damaged during Soil Testings,Inspections,Locations of and/or Installation of New Septic System. Cellar: lS Full Partial(Crawl) Slab Wells: Main Use Irrigation Only Tease provide location of all wells) PLEASE USE THE SPACE BELOW AND THE BACK.OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF THE EXISTING FLOOR FLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs; trees,patios,electric lines,tanks,etc. } C 5�'lG 5T"'R.EE'1" CA Q O N� f0 �a - ;- 4 1 N m M O W p - N Vl N " 0 � a � lu O 0 L 01 i 3 3 N a co N � 1 � ! I V. f � \ - C 1 0_._.. c N ' y U U N [1 L Town of Barnstable P# - �p�' '� Department of Regulatory Services BAFMABM ; Public Health Division Date y Mnee. 1619.��� -200 Main Street;Hyannis MA 02601 / 71 �01tL M0� Date Scheduled , . Time I ''1 Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: t/i (� �J� PS LOCATION& GENERAL INFORMATION M Location Address 19 HIGH NOON DRIVE owner's Name KENYON PIKE CENTERVILLE 19 HIGH NOON DRIVE Address CENTERVILLE, MA 02632 Assessor'sMap/Parcel: 192/211 Engineer's Name SWEETSER ENGINEERING NEW CONSTRUCTION REPAIR X Telepphoone# 508-385-6900 ' Land Use Slopes(%) "—<p/6 Surface Stones Distances from: Open Water Body ft Possible Wet Area tJa ft Drinking Water Well �ft .srf- Drainage Way �� ft Property Line Fv�,L_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to h les) Opel .v `h �00Lie 1� R,baCf , f Parent material(geologic) ®y?"� �/ Dep to Bedrock 2'' Depth to Groundwater: Standing Water in Hole: A J o Weeping from Pit Face �v Of Estimated Seasonal High Groundwater / DE TE £a ATI®N FOR SE��SONALHI,GH WATER T L ABE r. Method Used: Depth Observed standing in obs.!hole: in. Depth to soil mottles: in. Depth to weeping from side of ob's.hole: in. Groundwater Adjustment ft. Index Weil# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCO ,ATTON TESTS t' Here Time rf Observation Hole# Time at 9" Depth of Perc _ Time at 6" Start Pre-soak Time @ 0` Time(9"-V) End Pre-soak /✓ Rate Min./InchM Site Suitability Assessment: Site-Passed Site Failed: Additional Testing Needed(Y/N) N E Original: Public Health Division Observation Hole Data To Be Completed on Back--Y---- i ***If percolation testis to be conducted withinJ00'of wetland,you must first notify the BarnstablelConservation Divigion at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC 1 _ . � � ` a DEEP��BSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 2-7--O DEEP O$SERVATION}HOLE LOG ' Hole#��2. _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel C.'o 9-2 7 6 DEEP'OBSERV�ATION;HOLE LOG .: `Hole .,, , Depth from r Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) x I kv DEEP'` �BSE12V` TYUl��HOLEf OG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Gravel) Flood Insurance Rate May: / Above 500 year flood boundary No_ Yes y Within 500 year boundary No, Y Yes Within 100 year flood bourWary No v Yes Depth,of Naturally OccurrinaTenvious-Material Does at leastfour feet of naturally occurring pervious material exist in all areas observed throughout the area proposed:for the soil absorptior system? Vol If not,what is the depth of naturally occurring pervious material? Certification / c I certify>that on ( 9/2 (date)I have passed the soil evaluator examination approved by the Department of Environmen Protection and that th ove analysis was performed by me consistent with ttie required tra'�%,ese and experi ce ed in 3 MR 15.017. Signatur � Date Q:\SEPTIC\PERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION F z u d /yqY D d �F z 00 N Fq<7ti1 1k, OBE TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner's Name: STEMBRIDGE Owner's Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 Date of Inspection: 5/17/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Fu er Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 5/17/01 The system inspector shall sub it 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 gild or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Page 2 of 11 y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEMS USEFULL LIFE. 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. n/a 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: n/a n/a 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 _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more thad4 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: n/a Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 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. _ 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to 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 '/z 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 nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X 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. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.[ (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone li 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. Page 5 of i I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided,by the owner,occupant,or Board of Health X Were an of the system components pumped out in the previous two weeks - Y Y p p p X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ 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 ? X _ 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: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.30.2(3)(b)] Page 6 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): YES If yes,volume pumped: 1000gallons--How was quantity pumped determined?n/a Reason for pumping: MAINTENANCE 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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1980 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 BUILDING SEWER(locate on site plan) ' Depth below grade: 22" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 14" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age,confirrimed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: IOOOG L 8' 6" H 5' 7'iW 4' 1011" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _(locate on site plan). Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage',.etc.): n/a t Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert; LEVEL WITH BOTTOM OF PIPE 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.): THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. RECOMMEND MOVING SPRINKLER LINE NEAR D-BOX PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump-chamber,condition of pumps and appurtenances,etc.): n/a t1 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE,MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT APPEARS TO BE FUNCTIONING PROPERLY.THE PIT SHOWS NO SIGNS OF FAILUE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):-NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10'of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE, MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 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. G � a Dp cc a Wl°C� �Q e � C (D 3� �arc I - Page 11+-of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 HIGH NOON DR CENTERVILLE, MA 02632 M192 P211 Owner: STEMBRIDGE Date of Inspection: 5/17/01 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET t } t - ' No. `� � Fee ��i��'✓/ � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migool *p5tem Cow5tructiun Permit Application for a Permit to Construct( )Repair(✓)upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /(� W� ���� Owner's Name,Address and Tel.No. Assessor's Map/Parcel � 9J ��EL =�/ '[� 1R 1f,lGlt,�ir Installer's Name,Address,and Tel.No. QO q19 Designer's Name,Address and Tel.No. grow dlw� t;b E7a°C Z d 1-`r4LS 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 f/o gallons per day. Calculated daily flow 33d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank l00� Type of S.A.S. Description of Soil /13 -7/ )" VIA I/42 �S910 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 Ti le 5 of t nviron ntal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued his B ar f Signed Date 9r1 "Q- Application Approved b ! Date �"��'' ! � Application Disapproved for the following reasons Permit No. Date Issued ` ------------ - --- ---- 1 rNo. .� •�►�. Fee V V f Entered in computer: `THeCOMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Migogaf *p5tem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map[Parcel / _ ,NOEL s�RDGE Installer's Name,Address,and Tel.No. QO_/rt( Designer's Name,Address and Tel.No. 49 QR�NA rrE C . /Y)IQ5 Type of Building: y Dwelling No.of Bedrooms I? Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Aa gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /40W Type of S.A.S. i Description of Soil io—3 L49�1 D/kT 3 ��Z 5�9 0 1• Nature of Repairs or Alterations(Answer when applicable) Date,last inspected: " r 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 th nviron ntal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued is B ar f t Signed Date Application Approved b Application Disapproved for the following reasons r Permit No. r / Date Issued 4 _ r ' __ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTSf '�� ;f ,f Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired( )Upgraded( ) Abandoned( )by—p /Qhy-1 yOTr4 at #29Y - s been constructed in accordance with the prMKO90, 1Y= Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. ��� / -------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Migpogal 6potem Construction Permit Permission is hereby granted to Construct( L�Repair( )Upgrade( )Abandon( ) System located at Al�-�,[�/f LOao aQ C—666Z. =6 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t ' it. Date: '� �4 / Approved b i /006 GRu,014 ilk Y 1 f � v CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT VESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated /q .`2 , concerning the property located at meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 15o.reefof the proposed septic system, • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility U • There is no increase in flow and/or change in use proposed V • There are no variances requested or needed. SIGNED : DATE: ` 9-9 LICENSED SEPTIC SYSTE STALLER 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). TOWN OF BARNSTABLE ° I q LOCATION ( / :�JII �� , SEWAGE # VILLAGE- ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 9, fqY� � V 0` 129 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) XQ,/ % e NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE:_ " Is '� ? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i} 1� //, TOWN OF BARNSTABLE LOCATION / `G/�IIU1'1 SEWAGE # �� VILLAGE �� �Li�LLL- —ASSESSOR'S MAP &LOT— INSTALLER'S NAME&PHONE NO. l5 t 1 50M � SEPTIC TANK CAPACITYka LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER - PERMTTDATE: �-1 13 7 COMPLIANCE DATE:- . Separation Distance Distance Between the: Maximum Adjusted Groundwater Table and 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 within 300 feet of leaching facility) Feet Furnished by r. qwk --- TR�s�� 1 l 4 Commonwealth of Massachusetts Executive Office of Enviroiunental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 John Septic y D.E.P. Title V c Inspector /ufi-P- 192 Ar-211 P.O. Box2119 Teaticket,MA 02536 WILLIAM F.WELD (508) 564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor 6 �, 117 1 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM \7 PART A CERTIFICATION End .. Property Address: 19 High Noon Dr.Centerville Address of Owner: Date of Inspection:9/2/97 (if different) Name of Inspector:John Graci Bob Ross ti9y I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: Z tit CERTIFICATION STATEMENT i 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 Iny training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This inspection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ W nation B the Local A rovin Authori performing at the time of the inspection.My inspection does Y PP 9 ty not imply arty warranty or guarantee of the longevity of the X Fai septic system and any of its components useful life. Inspector's Signature: Date: 9/3/97 e The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, 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 04/27/97) One Winter Street • Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of inspection:grM7 _ Sewaae backup or,breakout.or, hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to 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 leveled 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. 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 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. se The system has a tic tank and soil absorption system and is within 50 feet of a private water supply well. — Y P 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: 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 in 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 cesspool. X_ — SAS is in hydraulic failure. (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:9rV97 D] SYSTEM FAILS(continued) Yes No 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). — Numbers of times pumped X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. —X• Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. __ C Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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. E] 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: 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X 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 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:9A7 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _y_ — Pumping information was requested of the owner,occupant, and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. — X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X — 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 manholes were uncovered,opened, and the Interior of the septic tank was inspected — — for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. X _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)j I (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:92/97 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): Yes Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): n/a Sump Pump(yes or no): No Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: We Last date of occupancy: n/a OTHER: (Describe) n/a .Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was pumped last Nov.By Ace System pumped as part of inspection:(yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date installed(if known)and'source information: 1979 Sewage odors detected when arriving at the site: (yes or no) No (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:9t2/97 SEPTIC TANK: X (locate on site plan) Depth below grade: 2' Material of construction:X concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L 6'6'H 5'7'W 4'10' Sludge depth:1" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: Measured 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.) Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: n/a Material of construction: concrete metal FRP Polyethylene_other(explaln) Dimensions: n/a Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumpingrva 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.) n/a BUILDING SEWER: (Locate on site plan) Depth below grade: 2'6" Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction line own Diameter: 4' Gvamments:(conditions of joints,venting,evidence of leakage,etc.) (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:917J97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm level:_nla Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) We DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) n/a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n/a (revised 0427/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 High Noon Dr.Centerville Owner: Bob Ross Date of Inspection:9/2197 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan,if possible; excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: n/a Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n/a leaching galleries,number: n/a leaching trenches,number,length: n/a leaching fields, number,dimensions:n/a overflow cesspool,number:n/a Alternate system: n/a Name of Technology:_n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) The leach pit is past the effective depth of leaching.The sas is in hydraulic failure. CESSPOOLS: (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n1a Depth of scum layer: n/a Dimensions of cesspool: n1a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection) n/a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a PRIVY:_ (locate on site plan) Materials of construction: ►1a Dimensions: n/a Depth of solids: n/a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n/a (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 19 High Noon Dr.Centerville Bob Ross 9/M7 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) ry 1' Ded peck, � aA �P vU r� BA (revised 04/27/97) room 9 of 10 • SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 19 High Noon Dr.Centerville Bob Ross 9/2/97 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation.. Obtained from design plans on record. 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 Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts 1 (revised 04/27/97) Page 10 of 10 No................ ....... .- - XEE.... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH . --- .......OF......�5a.t.h.z.. 4-�{ ` le .................. Appliration for Disposal Works �C> onstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sys..1 at ' l y®®Z? LQl d �77 �/de- .......................................... ...... .,o ....� .......................... Loc Address oo tNo. _ G!lle o _ vl�� � . a , OwnerC....................... �yddrss ae. �+ &._...........I.. .......4 Installer Address d Type of Building Size Lot!` ?NC4.....Sq. fee NOa Dwelling—No. of Bedrooms.......�............................Expansion Attic Garbage Grinder p-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures�-------------------------------•--••----------------••.-----•--------••-•--•-•--•---•--•---•--••--- w Design Flow...............J._. ` ............_...gallons per person er day. Total daily, flow....... ... ..______._.,':_...____gallon c WSeptic Tank—Liquid capacity/0919.gallons Length.__o ' .... Width___-16....... Diameter................ Depth........___. x Disposal Trench—No..................... Width---_I.-_.._........ Total Length......._.._...f------ Total leaching area....................sq. ft. --Seepage Pit No.......!-........... Diameter..... Depth el ow inlet................ Total leaching area-_a_9%....sq. ft. Z Other Distribution box Dosing tank ( � '-' Percolation Test Results Performed by.... Date......�� �� 7�.._...... Y... J 1 Test Pit No. I... ......minutes per inch Depth of Test Pit-----6 .. Depth to ground water.. .. :1�. .. (r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ If.I _...._-__•_• 7___.._. .. _ ................ .......................... O Descri Description of Soil c¢ •• e r� . ..p `t -----...----•-•---- P y x ----------------------------------------------------------------------------------------------------------------------------•-------------------------------•-------------•- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •••--------•-----------------------------------------------•-------------•---------•--.............•-------•---•---•---------•-----------•--------•---•---------••------•---------------•----....------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT111: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued y t b r of health. Sign ..................•-- -76-------- ��ii �o-- ......--- ate Application Approved By........ ...... v......... .... ... ............................... ... .... ............. Date Application Disapproved for the following reasons:------•----------•.............•----------------......::.--•--------------•--•-•-----------•--•-••-----------••- -------------------------------------•--.............------....--------•----------------------------•-•---------------•-.....---.._..----- -- -- ----- --- --- - - Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT11...OF. ............o6....... ... .... ..................... �rr#�firtt#r ,af fl�nrnt�littnrr I-V 1 O RTI , That the Individual Sewage Disposal System constructed (or Repairedby.. -- - 1 2 ....................•- s lez• .. ate= Z'An............................... 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 No......................................... dated---- 6j/�._7�__._._.__.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE................................................................................ Inspector•-- -----------------------•-•---..............-----•---•---•---------..........--- THE COMMONWEALTH OF MASSACHUSETTS �* /* ... BOARD HEALTH No........e .. FEE........................ Permission ' hereb ranted..._ `...7._ _ Y g ................. to Construct or Re at' ) Individu Sev�ag sp s at - -----R ........... - Street - as shown on the application for Disposal Works Construction mit No _ . 40"_ .. Dated...��-._�._........................ . . ----...-•--•..................._ th DATE........................-..................................... -------------...- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH Y. .................... ; C2. OF...... ........?) vpot""' fur Elispas al larks onstrnrtiun Permit Application is hereby made for a Permit to Construct (Vielor Repair ( ) an Individual Sewage.Disposal System at --• ` .t.<fa�....1k. 022......d,r4..............`' ...... ' _ . ��:.�c1. e.N /.//&-------------------------- Locaglon Address o_ �� or/Lot _..-•------- -. 7.6../ft.r..�C_r.!!1.��.�.•k�_ Owner . ddress .................l�/. --- -- /..1... ....... Installer Address a Type of Building Size Lot2_Q..7..1.Z------Sq. feet U Dwelling—No. of Bedrooms... Expansion Attic/k Garbage Grinder Y` u `14 Other—T e of Building ............... No. of persons............................ Showers — Cafeteria 1�•1 YP g ------------- P Other fixtures -------------------------------• - W Design Flow.................A_L'6_ ..............gallons per person per day. Total daily flow........ .. t ........._............gallons. Septic Tank—Liquid capacity/0.00.gallons Length....._. Width__..6_._.__.. Diameter................ Depth....,._I..... 'V'A;x.;.,x` Disposal Trench—No. .................... Width-...�.............. Total Length..........._...... Total leaching area.................... ft. Seepage Pit No..._.../.____...... Diameter.._..cr'�_.._..... Depth below inlet.....�i........... Total leaching arear .Q1...sq. ft. Z . Other Distribution box (� ) Dosing tank ( � Percolation Test Results Performed by.... >�',CaNE'-K'..y........ -- ------------•- Date._..._,ll. t �. .7.8......... Test Pit No. 1....�......minutes per inch Depth of Test Pit___._�t.._......_. Depth to ground water.._ .. _��7...W f , Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water..__.................._. a I G x ...... �j � r /�/ �O Description of Soil---------------- �:� -- _.......--------- w ••------•-••----•-------... UNature of Repairs or Alterations.—Answer when applicable...........................•_•.........................._......................._.._........... Agreement: The undersigned agrees to install the +aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued}�y th b ar of health. gn` o G.. ate ,/� I . 7 ...... Application'Approved By.....-.. :r. _. Date Application Disapproved for the following,,reasons.........................•_______----_----•-•----••............_........_•....•... ._.....__..___ Date Permit No.............................----------------------- ------ Issued....................................................... Date TEE. COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ...........OF........... ,.C��!�I. ...... f�rrtifirtttr of f�nm�li�nr�e T I TO ERT Y, That the Individual Sewage Disposal System constructed (-,-for Repaired ( ) d ...... ...... ..... . ......... ......... --.............................-•-•------- by_'" f� utalle at-� s�0• ►.s /- dl o il1-_---------_------_----•- .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 No.......................................... dated__ THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.- DATE........---•-----...-••-•-•-••••..........................•-••......••-•-•••---• Inspector=::............................................................................... THE COMMONWEALTH OF MASSACHUSETTS ' BOARD F HEALTH No....... x.... FEE.. .,4 --------- Bui?. - r I nrk �u trnrtinn Permit r Permissio hereby grante p._..:+.. .:.f ........................•-•-•-••••-••-...._............._...___..... -to Construct ) or RepaiIndivid Sewa isat Noy» •----•-- -- .• •,1 -i,..... "�j_� Street - -I �-_ •. -..... as shown on the application for Disposal Works Construction I' rmit N . ..... ....... Dated..-,. ... r��.......... { kr / / o r .3"d"oa R {n �+v{+ DATE.......................................................................•---•----• ,, FORM 1255 HOBBS &;WARREN. INC.. PUBLISHERS S ,Ls 7 G 71_7 '��" co 7-�,S /,zl C / l V )1l M ,/7 r r 0 ll e r •�J/�/ s� .i a�u:," I.+�' NJ ® ' it �+ y 1�k•.`, 1I 1' /0 Cf 6/ t/ Y ; �.�^•'`+ f•'�.. /(L. ,A �,✓' `mod-- �, O ` Its ,r c - - .,� �2 w C 7 4 .moo r' ,2 1 ca m A Ze-1..5"5 C 1/7 , '•itz- . ��. � 1 �o� •�� �'�-sir, r-� � �����.� w t of Mrs`.,11111 . OF •{ •. ., •4 .4 - .«' .„'." .a .r �.+ r FRN i FRANK ;. t?ONER •CON�RY r y .. � ..y,�,.X, .+ ,��-+.�` - ra• t �.r•' .;e.« + , .. '^ !'cl.....>'r. 6a.,,,,x:.i•" .awnd^�... ..>-^". r� .Q,,. .ha. . r: .,,rr. {{'-X. .....q. +..+Y:.:s ,.,k.Yv` •C,. s ...o- .+;r ..,� .l. ,7�n_4�'1y s...C� t..r. , qn . i::.r .. >.. _ , sx•'. Sw4, .ay.r#+7+ .. ^_ .',ci. . ,w",. t . .'f�.. +. N..M'�'r _ ,.. ..' - " _• ,N�.t !r �•Mat#.%,.,.iL'.Jky..,�,,,� �^4 '>:3 � r,'... � ,. • ,- . � � • '1�-'��a: � I � a sum � ssrGN�ti��- . . • PLAN 6or'LAND ,+! - ;y "'"i ,,,,i,a,. • yn .4' . ..y. y. Vie_ N'. r:n '.n ��"/y < +u AS • ,-1 •. � � ���!/•!� � '_,,/A ,f"� ��.d4X del , to ,L i 4 0 A H _,. FRANK-GO�iERY 5 TRENTON ST. ' y • . ! i + O YiYANNIS, MASS. 02A01 ' • aFrlST6MD EM IMSXR @.LAND 4URVEVOF} , � a • • SOIL TEST BIMMARK TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE _ _ i DATE OF SOIL TEST APRfL 4. 20i 9 10 FT. MINIMUM FROM SLAG SOIL TEST DONE BY SCR N .VEERING ELEV. _ ���_ 10 FT. MINIMUM CLEAN SAND T T P l 5956 /ASSUMED, r r WITNESSED BY ,(L_�,.,_AN Q�_a..,______.._ ONCRE•E INSPECTION PCRT _ COVERS 4" SCHEDULE 40 PVC PIPE 7�A�M A.ND SEED TION HOLE OBSERVATION i Vi�1 H> .G. tLE J.s__9$.6 MIN. PITCH 1/8" PER FT. � 2" LAYER OF ' I r \ 1/8" TO 1/2" PERCOLATION RATE _ MIN./INCH AT _ ;NCHES WASHED STONE ! I i .� ` \OR FILTER FABRIC'�NT f DEPTH I HORIZ i TEXTURE COLOR MOTT. jOTHER f MAX ( 4" CAST IRON PINE &10 " 97.25 Mkt. NOT REQUIRED 0--8' IA.p LOAMY SAND 10YR4/1 NO ROOTS f I (OR EQUAL MIN#Ivtl1M !'C` ____. _._ _ _- _.___ ! PITCH 1/4") PER FT. i F OW � —� TEE \ y I 8-27 *8 LOAMY SAND �1 JYR6;"4 �it0OT5 r _ } _ tt I LE LERS { \ \ i 127-132 IC MED./COAR. SAND 2.SY7/4 FLOW LINE , C� _ $ ' r � f NO WATER ENC �NTERED AT �32 _ ELEV. _ $7..6___ ELEV. a _ o o o c c] OBSERVATION 1 �w� '; M►N. OBSER c'LE a 9s.B J. _96.43_ L 'dEL 1 °; °f � � � ❑ C � � C � ❑ "? ° °} f ELEV. _ Q_J ADD GAS ELEY. _ �6" SUN!P `—ELEV. _ _ _ o o` —� ,. rti ° °# i DEPTH HC?R#Z TEXTURE _ Cl7LrJP fl iOTHER BAFFLE �-t o o 0o rmor7omoo !c 2' a t DIS I - �. o of o o ---a—_� __..._� --' LLE r. / C7 i C; 0 0 u I"7 D E7 C L 0y$" A FOAMY SAND s�YR4}' NO ROC' S f t L#rQUID OUTorE':_ © +q �' _ �'' o ' o° o o of EI.E'4. _S'.f.7'S i$-27"_.� B �OAivlr SAND {3vYR6 4. RCO?S DEPTH ?Eer a XI5TING) BOX � — ' 2 `500 GALLON GALLEYS WI7 + 27-132 ;C JMED, COAR. SAND i2�Y 7 f 4 4 FEE, 14 NCHES , TO BE ''WATER TESTEv FEET 9 itr'CI+ES i E? STONE #N AN � ' T 132 _ 87.6 ---� FEET 24 INCHES i # IF MORE THAN ONE C3UTL�, NO WATER ENCOUNTERED A. __ ELEV. — _ 7 1 E-i 29 ItiCHES f a. (TO BE PLACED ON FIR{ SASE) {' 12' X 2r X 7' TREI*Ci.4+ F'sKtJATiCYIv ; ��i.15 zi � y__._��_ # 8 FEET 34 INCHES ! SEPTIC ! s`► t " - -----j ZONE. 3/4" TO 1 1/2" CLEAN -' SOIL ABSORPTION Nj NDE DOUBLE WASHED STONE AD„i15T___a._... DESIGN CALCULATIONS ULATIONS FREE .'?.F FINES & S#LT S (SAS) � : NUMBER OF BEDROOMS � GARBAGE DISPOSAL UNIT w I� SYSTEM PROFILEi TOTAL ES'9VAT " FLOW >CALE uSGS RROSAE§i.l WATER TABLE ;7LEv 110 GAL/DR./DAY X ....+ ..,. GAL./Da'' a �� REQUIRED SEPTIC TANK CAPACITY GAL. OBSERVED WATER TABLE ( / ; i ELEV. = ------ GAL- BOTTOM OM DE TEST HOLE EL E`v. _ A UAL SIZE OF SEPTIC TANK {��� 1 GAL- SOIL CLASSIFICATI N DES PERCOLATION RATE _< � IrIFt N' LOADING RATE ... GAL./DAY`/S.F. LEA .G AREA P wE~ . APAdIT {AREA X RAT ) GAL/DAY 4-MOO X 0.74 PESO r.--E LEACHING CAP.AC?7_ ._ QNf,_ GAL,, DA f f NOTES. /f ' 1. ALL 'KMANSHIP AND V.4"7tRiALS SHAILL CONFORM TC b F.P P,%i AND THE TCMN'S RULES 'ND RE'ULAIIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE, 2. AL' .COVERS TO SAKI BAR, UNITS� SHALL ALL BE BROUGHT i4 Wi r,ii?4 6" OF FINtSHEO GRADE, 3. ALL COMPONENTS Cif' THE SAt*diTAsRY S�SItI� SHALL BE CAPABLE OF WITHS"ANDtNG trI-10 LOADING UN=,.E557 THEY ARE UNDER OR WITHIN 040 '0 FT. OF D iiVES OR PARKING AREAS• H-2O LOADING ShALI BE USED UNDER OR ""HIr; t FT. OF DRIVES OR PARKING AREAS. GRADE ll ��'J• ohi:6` £ 4S z " TLS .4. Y tfIC rsBE MORTARED # PEA i 5, NO OVE Arm CA RE MADE A� " COMPLIANCE W w1eL1 .^yc�`i.T S 38TAN SUCH DE`ERM-NAT#Ct,4 rKvll APPRI,PRIA pJ. i 'I!.TIES SHOOK ARE APPROXIMATE G#'id`, '' --X,-A ATl0N .C,h�TRA tTtv[DF, 92. 1S TO CA 'Ills .zAFa" AT 8 344-_7233 A, L«..? „4° 7 '.ak+.±'T , ' f. N PRIOR T ! ''0MMFNC;,N0 WORK ON SITE. 7. CON-TRACTOR IS TO VER, AND El_EVATO2:5 A4 L AS SITE C0?,t0I`TCNS PRIOR "iCiNG WORK DN -),iE, .Ate' aA!2#d,E'CINI f IS TO BE BROUGHT TO THE Al"" "`'I(?tl OF THE DESIGN ENGINEER f r'99,4 `, 8. PARCEL IS IN FLOOD ZONE `-. �� 9. LOT SH{WN C a ASSE O'CS ��AP-1�792 _ AS PARCEL _ 211 O. EX(STit9G LEAC`+ PIT IS TCi BE PiJMPEl3 AND BACKFLED- r TH£ INSTALLER IS TO GIVE THE ENGINEER A MINIMUM OF 48 HiOURS '2 WORKING DAYS) NOTICE FOR THE F#.tvsL INSPECTION (NCIMSER BE!—OW', t BOX �, xr'•rv.; i Rs.n & �q>-,e �. OF P a T r s SOU �. TIE N. . + O OY �� SEPTIC r (` F ` A 98.08OX 1090 GALLON SEI'+jIC TANK ' \ .SON PIKE x 7 99.0 x 98.7 LOC19 G NOON DRM Al PIT cz XTEST IL SOIL t CT� 1 TEST 2 ,2 ' 98.8 r��r, . i.�/V I _ E T I�^ qLOT 20 � P. Cl BOX 713 �, 2 621.6 t S r �s�`3 IOf It +_3R5 59 i _ 5�? �'�'. NUNS, MASS. C�21560 EXISTING SPOT ELEVATION 010 0 ��, •°� , _ __ EXISTING CONTOUR -- OO---- .r 4. �.1 `f ._. SCALE t4 _ ,! 209 FINAL SPOT ELEVATION �' J. __. a_ _. __-. " 9 -3--Iry --r �J' d „` 99.3 S T t`L."q- "_-._ '_ s FINAL ONOv►<-- - --1 _ .. - r- --E) C --- �' ' f 1 t SOIL TEST LOCATION � At_ L � k 00 U14L,TY POLE 1.49- TOWN WATER 'W`fir W _ _ ._.__ _ _ __._. ___ _. __ .a CATCH RAS N GAS LINE 1 CLEAN OUT J4�fS, � L z P N"': 1� � add.� i�