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HomeMy WebLinkAbout0029 HITCHING POST LANE - Health 29 Hitching Post Lane Centerville U A = 173 032 I �J�QEcvct�coy�z UPC 10259 No. H163OR HASTIN0S. MN P#° , Commonwealth of Massachusetts �3 — 03a-- �✓`� Title 5 Official Inspection Form K Q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information required for every ormation is Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information ,�°� N510 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA , 02536 City/Town State Zip Code 508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. 0 Passes 2.. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5-14-20 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of'Massachusetts r7 Title 5 Official Inspection Form w. 'fi l Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments . . ` : 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: - ® 1 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: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "Co nditionalPass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form ' cif Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): r ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval'of Board of Health): ❑ broken pipe(s) are replaced ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ ND below (Explain ) ❑ distribution box is leveled or replaced ❑Y ❑ `N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced El ❑N ❑ ND (Explain below): ❑ obstruction is removed El ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts r� �' Title 5 Official Inspection Form ws r�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1:4. �c• .e jo) t:: 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ` ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 C Commonwealth of Massachusetts ;.,. Title 5 Official Inspection--Form Y hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .7r%I 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) , 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6 below invert or available volume is less than '/z day flow - ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ®' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct;the failure. 5) Large Systems:To be considered a large system the system must,serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no':-to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a'significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No N ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of,water been introduced to the system recently or as part of this inspection? 4 ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A)- ® ❑ Was the facility or dwelling inspected for signs of sewage back up? + ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe 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-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Y I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: , Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 440 Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 5-14-20Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ' ra a Title 5 Official Inspection Form I.r ,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Recor p 9 ds. Source of information: Owner----pumped 6-2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection* Form : f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection, Forme w_ N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or'baffle 26" 1 Scum thickness 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 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baflles,installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln km Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations inlet and ou tlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts r' Title 5 Official Inspection Form w:� .'"I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form a IP'► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form, ws rrl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln `r- Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level,of ponding,,damp soil, condition of vegetation, etc.): Infiltrator field in good working order with no sign of back-up into d-box or surrounding stone. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 a Commonwealth of Massachusetts r� Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection Form w: I I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J , 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I II 1 ` d t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r, Commonwealth of Massachusetts Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not forVoluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name information is required for every Centerville MA 02632 5-14-20. page. City/Town State Zip Code Date of Inspection D. System Information (cont.). 15. Site Exam: ❑ Check Slope , ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water,elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts II Title 5 official Inspection Forme - i�l Subsurface Sewage Disposal System Form --'Not for Voluntary Assessments 29 Hitching Post Ln Property Address Mark Corbett Owner Owner's Name. information is required for every Centerville MA 02.632 5-14-20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal,System drawn on,pg. 16 orattached For 15: Explanation of estimated depth to high groundwater included 7 t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Hazardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number ✓`"Actual Amounts - ( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? If none, note that. —""Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted �-- "Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it - note that it was given Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. SBP'I�C'T�TK CAFA�t'Y. OF TOWN $tlp�istioa�16ta11CBwC$11 SIB' �rlaaandum,Ad�ustasli; uadwatr�'�able`�©tf�eBotWm of�each�ngFac�l�ty ' :Fee t_ PnvatetatPPe1i�iac� g Facliq► (MAY ease an site arTieh�a 20Qft¢flwtbv � �d�e o��l�acid andLea +;�� Y'��Y�atlanids exisf with#u�Qt}.fee ti :leRctau�fac�litli`3 �. _ 'Feet... A Q � 3 %�,a -3o' - 36 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE zo 17 Fill in please: 0 ry.Arol,Im�,�ga0,, � ��((3" � APPLICANT'S YOUR NAME/S: 'im BUSINESS YOUR HOME ADDRESS: 6 / 05 T AJ TELEPHONE # Home Telephone Number .fsti^"J��tirc�4u4z,.� +, NAME OF CORPORATION: NAME OF NEW BUSINESS 14toV 6S 1067 E7P,V/LE TYPE OF BUSINESS 1/1C IS THIS A HOME OCCUPA If�N; YES NO ADDRESS OF BUSINESS 77 t n�, I (It MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information'you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town., MUST COMPLY WITH HOME OCCUPATION 1. BUILDING COM SSIO ER'S OFFIC RULES AND REGULATIONS, FAILURE TO This individu I h s o any permit requirements that pertain to this type of bus inTC$6I\1PL.Y MAY RESULT IN FINES. Aut rized Si nature* OMMEN S , I 2. BOARD O EALTH, I 5,/j� (Jrl S• tl'�- This individual has be permit requirements that pertain to this type of business. Z�— (, Authori nature** MUST COMPLY WITH ALL COMMENTS: 7 � kLan, 0AZARD01 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: W TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: &;65(DE- Sri✓/Cc m BUSINESS LOCATION: M119- INVENTORY MAILING ADDRESS: YQt 30.X �5 J j (VIK5i6s,�5 Mj f jS , Nil- 0Z6t1q TOTAL AMOUNT: TELEPHONE NUMBER: 6c>19�-7-Z6 - 7o0-�> CONTACT PERSON: MY9-(-IC rpAlai! - CA - EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: )o`�fL INFORMATION / RECOMMENDATIONS: gjo'g1C,E' M,411Vj7&5%V'E� Fire District: 'Vt79p,a j / C-e- C!)L Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW JWUSED Cesspool cleaners Zb 2 Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 3p Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) ❑ NEW ❑ USED I TOWN OF BARNSTABLE LOCATION SEWAGE # o?'DOo� VILLAGE AS MAP & LOT ��• INSTALLER'S NAME&PHONE NO. �TlAs SEPTIC TANK CAPACITY /000 &?41 LEACHING FACILITY: (type) ��if'�id J b� iEld a(size)'��''�� ®,�' - NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: -j `'�`�O� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by (7-., IA- /lpl/[per 4rj n A ,t" 7 671 BOX- Pipe- *' Noy.. V Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpphratton for �Dtgogar *pgtem Congtrurtion Vermtt Application for a Permit to Construct( ; )Repair( )Upgrade(25 Abandon( ) El Complete System El Individual Components Location Address or Lot No. �)9 Owner's Name,Address and Tel.No. Assessor's Map/Parcel e7 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. j"i!,?y � �oC`C✓ 1 J"O7 0� •O��//A Pi �fl�J'o 1v dpj y y d� Type of Building: �1 Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons .Showers( ) Cafeteria( ) Other Fixtures Design Flow r 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) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Healt . S` Signe11�d ate '� Application Approved by r2e26Zjj,11 O Date Application Disapproved for the following reasons-61 r (_ Permit No. Date Issued A3 ` Entered m com uteri. THE COMMONWEALTH OF MASSACHUSETTS P Yes PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS " 01ppftcatton for Mtgaal *pgtem Con!5tructton Permit Application for a Permit to Construct.( , )Repair( )Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9� /r��jN4�e J'1 e`e Owner's Name,Address and Tel.Noy, ^` Gcd.t.T VV e«lE' /ylG JGIc�G Assessor's Map/Parcel; / + T . Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No. �'i,s, G' cd-�' �J?"07 0� �1'L/b B/�j,(,ro�• �,3 3 Sr1�63 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 Calculaterd daily flow gallons. Plan Date Number of sheets Revision Date Title f Size of Septic Tank ��c Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when- applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. 3 SignedAIA A A' r--0ate Application Approved by /i _ 0 Date Application,Disapproved for the following reasons ry �.F• a d Permit No. Date Issued -------------,-------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded) Abandoned( )by C7-/"+ -'car.Ae°�i°- at -2 9 bas be onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer �' �"' �C�` '4�`G/r' Designer U The issuance ofthis permit shall not be construed as a guarantee that the syst will f nction�sdesigned. Date _S4 11 1 Inspector --- -- ®---- --------------------------- No. Fee HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwtopogar 6potem Con5truchon Permit J: a 1. Permission is hereby gr d to -ons ) e air(� ) p rade Abryg ) System located at - : Par6nVili6 / 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. i Provided:Construction mus be c4 lete within three years of the date of thi Date: Approved by j i TOWN OF BARNSTABLE LOCATION o� '� / �TG/d P�'•�/®oS7' Jf',6 ' SEWAGE # i VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �TiAI et'f0 fee SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: -� `�O� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Fe_ Edge of Wetland and Leaching Facility (If any wetlands exist . within 300 feet of leaching facility) Feet Furnished by C7",--ft L 44-6' � Adr o A A// 6-7 TOWN OF BAfn LM 'IdSPECTI®In $`1 ) Q / LOCATION Lih •, 1 `�4r� SEWAGE # �� ' y7 VILLAGE Qn cat.,�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY t!/Z!b G�►�, LEACHING FACILITY: (type) �.T (size) NO. OF BEDROOMS BUILDER OR OWNER �IIIt G✓lit PERMITDATE:' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of lea c 'ng facility) Feet Furnished by art SA e NIB At- as__ 3`) r93� 5a yo 3 O 1 iOCATION' SEWAGE PERMIT NO. � J VILLAGE INSTA LLER'S NAME & ADDRESS L ya &J e U I l D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��� r � � ��� `'� � � � , ., ���e� �,�� ,pQS�` Lan{' Cl No................ ....--- -+ Y,. Fps.. ©.... ........... THE COMMONWEALTH.OF MASSACHUSETTS BOARD m LTI-� rd: .-.0F.-..... 1JO .S q.. .................................... for Disposal Works Ton'strnr#inn Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys t . ...lost LA N -: . .......... ... t..� .- ------.-•-- ..................................... o t��ppn-Address r Lot No. ; wner -----_.. -�-----�. -- Ar...------ — eInsta Address 11� Type of Building Size Lot...1_ � _______Sq. feet Dwelling—No. of Bedrooms................��___.__________________-Expansion ttic (� Garbage Grinder Vig A4 Other—Type of Building __------------_............. No. of persons...... �-------.-...•. Showers (f ) — Cafeteria,. Q' Other fixture ____-------•-•-------.....•••-•------ W Design Flow.................= .............____gallons per person per day. Total daily flow------- ' _ _..._._______._____gallons. WSeptic Tank—Liquid capacity:__________gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length......................Total leaching area____.___._..f_. sq. ft. Seepage Pit No..................... Diameter____________________ Depth below inlet.................... Total leaching area_2,6.k0_.....sq. ft. z Other Distribution box ( ) Dosin •t nk ) Percolation Test Results Performed by` 1 '=� Date .... . -�. -----_.._. Test Pit No. 1........_ ....minutes per inch Depth of Test Pit.................... Depth to ground water_.___ ?[ ._.____. jai f=, Test Pit No. 2___ .........nllnutes per Inch Depth of Test Pit......�______ ..... Depth to ground water----NalJz.... ..............................................................-----------•-- ------------------------- ------------ -------- ••-•........ 0 Description of Soil �- -'�---�Q ...."� V 7 :. i 1y1u n''..... 11L Q W ------------------------•-- '. z- r- '� -� � -u. 2 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 TITI.I 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the t/he board of health. Sig Application Approved By...... .. . ..-•- �� !1 a��................... — �/ . ------------- Date Application Disapproved for the following reasons_____________________________________________________ -•-----•----- -•--....._..._ --•----------•-----•---------•-------------•------------------- •----•--------------------- •-------------- --------------- •------------------------------- •-------- 3. Date Permit No.----------•..............••--•------•- Issued-................ = ---•------• Date NO.. FizB.......2/121.7........... THE COMMONWEALTH OF MASSACHUSETTS BOARDeOF HEALTH OF.................... ............................ ......................... ---------------------------------------------- Application is hereby made for a Permit to Construct or Repair an Individual Sewage, Disposal System at e� ..... ........ .......... Location Address 7 r Lot No. o1,L/; /U" CKA 1�Aa, ., 1 iA . . .......... .. ................. .... ..... .... - Owned .Add1res1I •cr 71rLa id Installer Address Type of Building Size Lot_ 1.*A�:P- ........Sq. feet U Dwelling—No. of Bedrooms......A......................................Expansi Attic Garbage Grinder (tj�A4 Other—Type of Building ............................. No. of persons............................ Showers Cafeteria-(—) Otherfixtures ....................................I....................................................... -------------a................................................ Design Flow_______________..3.....b......... `­,...... u­ 'gallons per per day. Total daily flow____.__ .......................gallons. .... ... 9 Septic Tank—Liquid capacity............gallons Length.................Width................ Diameter__-__-____.._._ Depth................ Disposal Trench—No_ .................... Width.................... Total Length-*....................Total leaching area._-....._.e:.......sq. f t. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area�:t�.......sq. f t. Other Distribution box'(. ) Dosing tank, •y......................................Percolation Test Results2 Performed b ............!....................... Date........................................ _:.:_____Minutes N f V Test Pit No. per inch Depth...of, Test Pit__� ------- Depth to ground water_____ ...... 4�. - 1 vo ve Test Pit No. 2...........:....minutes per inch Depth of Test Pit__......`. ..._....... Depth,to ground water.-_..................... ............!................................ ----------------------------------------------------------------------------------------- 0 Description of Soil_( -----------------------------*---------------*---------------------------------------------------------------------------------------------*.................... 14!V 0 U ---------7---------------.............................................................................................................................................................................. 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 T I T TLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed d 1: ....... ..;. � ......................................................... . .. ........D..a-..t.e...................... Application Approved By...... . .. .. . . 7­t� �,� - _V--- . .. Application Disapproved Date proved for the following reasons:........................................................I .................................................. ..........................­7............................................................................................................................................................................... Date PermitNo............... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD—OF HEALTH ....OF....................... ................ ..........................................*.................... Cal tifirati of (tam Ham" I S paired_T I T, -CE TI That the In" i al Sewage sal System constructed (je'T or Re If... ....... ..... ------- -------- .......... ,7 ---------- Ve has.been stalled:in accordance with t ie provisions of of The State Sanitary Code as described in the app'Il'cation',",f'o"r-DispcisaI Works:;Construction Permit IT 7 - -------- ---7................. dated- _..____________,__ THE, ISSUANCE OF THIS CERTIFICATe,�:�%H L NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1.�,,,W,,ILL,.,,FUNCTION,,,SATISFACTORY . ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD "OF HEALTH .................................... OF.............. ............................................................. No 15tr Win rrrmi Perfr>issi6n is hereby granted.,.. ----------�._ ......------ ... ......................... .. ..... ........ to Construct Ih9fivi6ual-,Se,.N s al sy� ............................... or ep,V ( ) 7 at No.�� f V_ 0,11;, as sho*wn"on the application fore Disposal Works Construction e7, t N-'(.. Dated,_ ............. . ........................... L ......t 1Z Z;�� 0 L, akeol e DATE._"._ , ' ....................................................... FORM. 1255 HOBBS & WARREN. INC.. PUBLISHERS 3 O'e �� '' , y� �t5 r.� F. 7 t - '• '..•...��,�. � i f/ k �as ^'.#i ! ��,. ..tY Nd^ �'��xt•. A t �}c tr V /J J 4 r R;� Lor 3 iG J` �9 r� SceA cd pr t �c 9s J a# _ P "t 'sX' lol,*Fit '�.tt od _ + tlr,Vt st K. T A.y A .� '«`+ � }Sqt��r ,•. • �B'-�-- .�„�'+,.. + d /g N(C �f. yh� F�+ yak �6 1 ci '1 g�•y P ark�'4t J".oR; ! •.e y p 9' •r_ o �a Iv 4yy M1'C` •i � SIR 5 ❑❑ ry G rl �/J . •ram P t ��Sr�?da 44���� •uf�'�{ tl"r2Y i*� ,'. t. � .. +r ik 4 � �4 f`} 'L R,g, i* �i �t r a• '.H��'����I.�' P® T + p� t f`s•*`�z rifio: .§+ �,[}w '�'�i :T y' \ •L A 1`IF .. _ 'F+ t t'°�!°•�i,y M - } �t � r r2'e Aft - �1- • - .A\ , AL ��i�J'�.k,N. }�' .A}.• tF J Of M i l G q E E N,17 SO CERTIFIED P 7104 9P0T ELEVATION 0x0. o ROBERT ' �c LET 0CA# . � POT ELEVATcI ON- P. 0.0 � BUNIKIS �T 3'� :flJrGfilRta ' /� F p i C6NTOUR 0 ,p No.22162 O Q --- l..�l!!'>� �M �� Ag "' ®a.:BOARD OF HEALTH � s� Of sT6�� @N � ` NA •! AGENT SCALE I rr _A�Oe DATE ^. . E E*NG/NEER/l!lG CO. lIV CLIENT I E N:T 5 " k - - I CERTIFY THAT THE PRO:P�P$EE��s'�� `. TEIRE REt31STERED JOB�NO. 9/ans BUILDING SHOWN ON '�Ht.S '� ., N QJ "pR ` R LAND DR.BY _rAD CONFORMS TO THE ZONII E -R SURVEYOR „, . . , OF BARNSTA E MAS �G 712 `MAIN ST. CH. BY HYANNIS, MASS. ��� v — r• SHEET. L OF' DATE REG. LkkD SUR'#f YORE' _ �•�• 'MMlll Wk t '�,��„,'...�� x?L- �"4 d' 1?' "y.�_ �'3L' t:• J� • ,r-�•' �. � '��.s�• Jy y d a � r, i\.. t.G` fir`. '^ � �: Kr.: � ` .`" . •P t� ..-4 4 ry ... a"iI k.. •ej� �.. t CO:PeOW Q "f�.p CAST ^ .n a _ 4.' ,• .2 AY ER /RO Ny P 0 0 b /�17V :PITcd t'A - CPA ' 0 0 0 0 0 0 0 0 • o ' n. m - _ a WAS-VeD SMNE %4 G PgR>:T SEPT/C 3 TANX D l sT. ` m A 00 O O D ° 0 o 0 p o d Box o 4 tra* 4`f a rx p EFFECT/VLF s v ® ® DEFT!/ ° o e • ° ® WA5HE®:5740NE •.C� iII.-.���r'��trt.": �x i�'�s• ; ..�., ��-~�„ 7�.. � -a� � O e p 1 0 0 O ® • ® �'0 ®� p O � - -- a D/?EOAST SEEAAGE s� . X r cY o 00 00 0 0 0 ° oo a oo A 0 0 o e es o P/7 OR EQL!/E/- !1l%ZR7_El EY /N11ERT 4'� U/1D./J�/G7• /A4/-ET.:SFf�TJ.[' "T=.4%VK .:PSGj T_ f t" i_ �_ F7. 0,44M- C SEE7�lBUL..4TlON� ® 71-F7-:SEPT/L 'FCT/O/a/ O F' 007ETD/STRo-BIPT/ON Ba. —7 . /NLET.LgACH/IYG J?/T,,k ,7 :'`.:! Plc a•'4,' si •—,rt i r :�.�.c -.,�• t" u'*�n 1.5A.CHl C, ACe O - �• $GALE fg ' _ ! - ®" DIMEM.Sl0A/ A 3 � F!. FT �. . AlUMHER ,0)=.:&4EAR0Oly S CAR9AGE,PISPP sAL uv/r SD/L L..®G TOTAL.FSTiwI.��"v :�l.o.w��6.az/0.4v 5-071 TEST-�! So/L 725-sT'02 !6/!/A98ER QFmLACJIMG PJT3F1Y.. 9 O r`-�L�D! ,D�)7-Er SOIL TEST 6, a �• ®�3 c S/®E AXACHI'VG PER P%T RESULTS d�/ITMESSt�® BY Gl Sl,Al. AERCOAAWON RA7-ZF#1 o r f byliV�eA/CiH •OTAL.IEACH%/VG -AREA ,§�Q 7�RC®e�pl®GZ!i?A�'��¢� 722 ® o RR3BRYE LEA.CwIIYss;gREA, $Q. FT. '- /p' S'gyp.4ia .� 2. fr rt � !, t+ OF�'�A r i S •,ELF �& 0 A$ x � O r f- i v 4 too.za fia OIL �-1 �'D !._ SING A 1 v ' t .ram `S llEg. nn - - "�?;aif'.�„ ��_ ....ex-�, "^'T �'� .+��/.�, ��: •� �.. ..,. � �♦ ape -- +•i a ,u- °s py. _ 5,_ a `�Mp ,. ,ry,.,tr '>. -; -a z N3 '�' . ;�+ -' ., .a -:^ �. ..� ,,. "� _.z st•,� �'�a� ''. ^.� • s.— .;. _S.'?�:. ... '._ - •: - - .?` ..,.�. r.;- ... :�'n,a•�• �f' -sr e f x ''$` .:_-�-�,fia• .. s'z"�:�. � �,._ .. �"--.� '� "—...�7�� `� �u ASSESSORS MAP : L �1 _._ TEST 1-101- 1 LOGS , V PARCEL: Z __ �'V. I ►T���> ,v�� _ . _. �/_ WITNES L_I-�o lA��llq•�_.._._._�. � ��r,(: �_�lfj_ Z_�(� T � ___ _ SOIL EVA LU TOR : FLOOD ZONE:—. � W REFERENCE: ��Ati- DATE: " ���-.����•V _� - `t�l 1-1-0� PERCOLAT E 1(4# �4ON p TH- I TH-2l _ It S you -t> � oT �s(1-Wr. t.. /�b LOCATION MAP _ _ �jµ?, tow �,f �rVAA 1 � ---- --- ---- _ :_ _ �r Low - --- -� SEPTIC SYSTEM DESIGN FLOW ESTIMATE 1� ' LBEDR)OMS AT ( �D GAL/DAY/BEDROOM - L6) GAL/DAY SEPTIC TANK P��HOFMASs GALDAY 2 DAYS DGAL DONALD L 9csG ` N DeLANO "� /� 7C USE / il . GALLON SEPTIC TANK v No.29868 �._-- / (mil !�t2f3�},;,.� _C,./LIG•Jj��/Z.--�D?_ �LL�I.V�� ��' � SOIL ABSORPTION SYSTEM tiosucr� S �,;) 0. � S10E AREA: i4b Q I I B01 T OM AREA: ,Z� of -7 Zq7 ►� _ EL SEPTIC SYSTEM SECTION AAK , _ &5.bD , w -- w loco „ � ...�• �y ► l� l WUEr 9i /� Z . 3�8..'� r ,� '�13i`f ._r � "Nd , ' 5 sy �3a C�D,l6 . =.7 ,,' D-BOX 59,57 ---- /�,70 �� GAL & A. - - w l0 t�►� SEPTIC TANK ,5 ��lyi'' Poo 39,zs x !a,g3' 100 SITE AND SEWAGE PLAN LOCATION : 2� I-�T�►�11,.� 120,5-T Rower PREPARED FOR : n1 ►�kl UA 112 SCALE: W DAV I D B . MASON,R� DATE: 12.. Z D� 0 DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA W DATE HEALTH AGENT ( SOH ) 833- 2177 3 W Z