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HomeMy WebLinkAbout0006 KNOTTY PINE LANE - Health 6 KNOTTY PINE LANE, CENTERVH LE A10 J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitation for -MispsaY *pstrm Conetruttion Pamit Application for a Permit to Construct( ) Repair(I/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6 V^C>��/ ��^je. l cam- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Ci 1, Q 7 J�V k-<,r /A r ro jo Installer's Name,Address,and Tel.No. Des* ner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(No Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��� gpd Design flow provided !�?,T gpd Plan Date t v \-:3 ` L.( Number of sheets Revision Date Title Size of Septic Tank (2 V p0Q GCA\- Type of S.A.S. L L (o Le ctG, rtv G AA(,-tilt Description of Soil M (� CC;11ArS-2_ cSCnr--,J Qk N0 Skme-f_ V_--rl.�-,C) Nature of Repairs or Alterations(Answer when applicable) CQ %-1 a D . c %-j—ate_S SSW-,(- G.r o�nt� Q c�c) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ned Date (d I a 1 1\4 Application Approved by Date 6 Application Disapproved by Date for the following reasons Permit No. 00 "�T �-®'O Date Issued to No. .. 1 ._ty.- Fee F� Q V THE COMMONWEALTH OF MASSACHUSETTS Entered'in co . Ye PUBLIC HEALTH DIVISION -TOWN=OF BARNSTABLE, MASSACHUSETTS application-for Disposal *p8tim Construction Vermit Application for a Permit to Construct( ) Repair( ) Upg ade( ) Abandon(,) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 6\4r,o FAy _ Assessor's Map/Parcel Installer's Name,Address, erN . Designer's Name,A d ss aQ Tel.No. Type of Building: P J S-p r a'7 y p6b`I r 0 V X Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(N J Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd " Plan Date Number of sheets Revis2fa e 1� Title Size of Septic Tank Type of S.A.S. y, J ps ,. O� C U L e-4 L 1 n C tnM a Description of Soilsc sz,�j C X_r\() Nature of Repairs or Alterations(Answer when applicable) G L G iA a o I' v V..>n 6 rN Date last inspected: Agreement: ¢ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si d Date Application Approved by Date Ct a 1 Application Disapproved by Date d i for the following reasons 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( ) Abandon ed b V ( ) Y at �p has been constructed in accordance with the prowslo s o Tlt amend the otor Diiposa System-Construction Permit N . dated h /I v~ If` Installer Designer #bedrooms C(-^ ` Approved esi o �h C�C,J e gpd The issuance of this permit shall not be construed as a guarantee that the system w' ction as a gn d. (D // C - Date Inspector � -------------------- No.`l., �L —� / Fee �Tr�(P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bispo$al *pstem (Construction 3permlt Permission is hereby granted to Construct( ) Repair(/) Upgrade( ) Abandon( ) System located at `/ M1 O t/11.2 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t s perm' . Date Appro ed by t Town of Barnstable E Regulatory Services o� Richard V. Scali, Interim Director, 9 &n Public Health Division �e 039. �0 rEa Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 J Fax: 508-790-6304 Installer& Designer Certification Form Date: -� ( l \ Sewage Permit# \ o 0& Assessor's Map\Parcel��l LO 7 Designer: 5 '��`' ' �`° /+1+-4-5 PE_ Installer: Scoff c,< 2 3 Ri 0z"� GA Address: \\? C ��) G-r�b� a-J Address: g �-` �i►�-��t® mot-po er, H A. ae_ 4-7�' is � On [old-0 (`(_ S o � was issued a permit to install a (date) (installer) septic system at ��!`�- 1.w-� C�1 based on a design drawn by (address) SO/r9Htw f#. H,4,4S. Pd dated ( I (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank.„ Strip out (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in fampliance with the terms of the IAA approval letters (if applicable) ',' , v. I 6' a t+ Installer's Signature) ' c Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNS TABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# Department of Regulatory Services �. • nearterm r Public Health Division Date MA&4 200 Main Street,Hyannis MA 02601 rE[r Date Scheduled .� _ —- Time Fee Pd. Soil �+ it ility Vsessmentfior S e Performed By: Witnessed By: 0+ r� LOCATION& GENERAL INFORMATION Location Address �9 Cf c\.C) �+ � � Owner's Name v� A rr o Address .; n 187 'i E Assessors Map/Parcel: ' y Engineer's Name �'. NEW CONSTRUCTION REPAIR Telephone/k Land Use Slopes(96) Surface Stones A-) Distances from: Open Water Body —" A Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line /Z, ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests;locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock �« Depth to Oroundwater. Standing Water in Hole: /� Weeping from Pit Face L'/,4 Estimated Seasonal High Oroundwater .DETERMINATION FOR SEASONAL HIGH WATER'TABLE Method Used: Ad IA, Depth Observed standing in obs.hole: __ In. Depth to soil mottles: in• Depth to weeping from side of obs.hole: in, Ornundwater AdJustment f[. Index Well# Reading Date: Index Well level �� Adj.actor Adj.ClroundwaterLevel PERCOLATION TEST bide �' 'rime �z Observation / Hole# ( Time at 9" Depth of Pere Yy Time at 6" Start Pre-soak Time @. a 'I in -G") End Pre-soak Rate Min./Inch G 2— Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 1001.of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. AA ollubtency,%Gravel) /`� (�Y1- (DEEP OBSERVATION HOLE LOG Hole# -7 Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sister % a A LS -9 (DEEP OBSERVATION MOLE LOG hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Con i ten Flood Insurance][late Map: Above 500 year flood boundary No— Yes Within 500 year boundary No-t:! Yes Within 100 year flood boundary No. Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the.soil absorption system? 5*&s _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on !� S`� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train' pertise and experience described in 510 CMR 15.017. Signature Date QAS EPTlaPERCFORM.DOC TOWN OF BARNSTABLE LOCATION 1 L W`Q,SEWAGE# d 0r(f`a M C VILLAGE ASSESSOR'S MAP&PARCEL'. �`!V /0 INSTALLER'S NAME&PHONE NO. S CA A ��- �� S Zj �Q S%4 06 SEPTIC TANK CAPACITY 4,Y-I�A (00 6 (,rc,L LEACHING FACILITY:(type L C p E f 2 0 (size)/O X 39'+K EL �Qr NO.OF BEDROOMS o- C�,C,,-bArj!�, OWNER_�!cw f'xe-- r_ rr-oT(7 PERMIT DATE: C () Z COMPLIANCE DATE: 7 °* Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet Private-Water Supply Well and Leaching Facility(If any wells exist on p 1 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 see_ CGS/1 { 131 - al Qa xc S-3 �� t • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS MPARTMNT OF ENVIRONMENTAL PROT$CTION 011Z9 191 /0 7 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM PART A CERTMCATION Property Address: v ko Owner's Name: , nd 6 col c_n owner',Address: •✓� " `=' Date of ink. 6 6 r CD 0 ti Name of h opecto g� /� 6 X Company Name: G .� Msi ft Addres:04i� Telephone Num CERTMCATION STATEMENT I certify that I have personally inspected the sewage disposal system at this aridness and that the iMormagion reportod �8 experie�ooe in as of the tune of the inspection,T'Le• pe�ormed based oms aPPr OwW system inspector pa 3ectloa 13.340 at 1Ytie�3 31� �� ems.r am a DF.P ( 0 CMB 15.000� T'he system; Passes Condaronally►Passes Needs Further Evaluation by the LOmal Approving Authomily Fails Inspector's Signature; Date: 6 adhorh The sync shaII t a copy of this inspection DEP9 within 30 days of completing this Win,If the to the Approving Authority(gam of Health or gpd or greater,the inspector and the r'�is a shared system or has a design flow of 10,000 DEP.71e original should be sent to Owner shall submit the report to the appropriate mgiond Office of the y system owar and copies sent to the buyer,if appdicab and the approving Notes and Comments :*"Ts report only describes conditions at the time of' mPwdm And under the at that time This does not address how the system WM in the htare-de conditions �different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(contimmo Properly Addy V?o �� z Owner. o(Sc�✓rl e2v� �aZ Date of Inspection:hLipection p S°MMAy: Chak AAC,D or E/AL AY complete all of Section D A. Sy I haw not focmd any nft=Wn which indicates that any of the failwc c�teria 15.303 or in 310 C R 15.304 exist,Any failure criteria not evaluated an. described is 310 C1VIIt mdic�bad below. Comments: S System Condidonany passes: _1(/ tine or more system Components as described m the completion of the " r+epaited,The system,apart Condrtrarlai Pass section need to be replaced or rip nt or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)m the for the followingatatmnentLif"not determined•'please The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is struchunfly dal iteration Or exfil tank hilure oard ofHeaftL ��g replaced with a complying septic tank as by t' Systemmmineg will won if the incNcating that the tank is less than 20 years old is metal septic tank will - Pm kq)ecdon if it is sinxtually souD4 AdI �afire a f Compliance leaking and'if a ND explain: oObservation��gc or heck art or high static water,level in the die doe to broken approval of Board of Health): settled a uneven box. System willpass inspection if(with braimn pipes)are replaced m is removed dishtwiti n box is leveled or replaced ND explain: - 71e"m required Pass map MM if(with apprvv tghe Board of Heahh)a more than 4 times 8 Yew due to braloen or obstructed p (s), *,stem will broken Pq(s)are replaced obstruction is removed ND explain; v Pape 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNT ARY ASSES SMEN'I'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) hProperty Address: e,,, Owaer. a""— Date of hoperdow ©� C. Further Evalaadoa is Required by the Board of Health: !l Canditions emst which r+oqua a further evahmtian by the Board of Health in order to Is g to Ps' W P beahth,softy or the environment, determnoe if the system L System will pass unless Board of Health determinq in accordance wilt 310 CMR 1 system Is lot&Wdonhag is a maamer whkt will protect public!a,safely and the 1 the _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or pivy is within 50 fetes of a bordering vepetsted wedand or a salt marsh I System will fail unless the Board of Health(and Public Water Supplier,it any)determines that the system Is Nwdoning in a manner that protects the public health,safety and environment: _ Thu system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributa<y to a surface water supply, _ The system has a Septic tank and SAS and the SAS is within a Zone 1 of a plc water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. �hc system 1 water has a tank and SAS and the SAS is less than 100 Est but 50 text or more from a mPP1Y well Method used to detmmmne dishmoe "This system Passes if the well water anahyds,period at a DEP certified laboratmycoliftm bacteria and volatile organic comma indices that the well is free from pollution pes'f thg Aw �and t eha�eR ere a Of a�ma nitmem and nitrate nitrogen is equal to or less than 5 pM pmvided that no Other 8pMA A copy of the amlysis must be attached to this farm 3. Other: Pap 4of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(condmted) Property Addrm- {'✓`010 Ow /� Q ner•. Date of hupecHm; pS' D. System Failure Criteria applicable to all systems. You mn inmcete`Yes"Of`bob to each of the following for&iaspwtions: Yes Now of sewage into facility or system component due to overloaded or dogged SAS err — P S of effivart to t>te surface of 01 the ground ors AIM waters due to an overloaded or SAS or cesspool _. _ Static liquid level in the distnb box above outlet invent doe to an iesspooi Ovedoaded or clogged SAS of 1�Lsgaid depth in cesspool is less than 6"below,invert or available volume is less than%day Sow Regged pumping move than 4 times in the last year?Mdue to dogged or obstructed pipe(s).Number oaf times pumped !/ Any porfm ofIM W cesspool or piv7 is below NO ground water elevatim -'le ""w won atcesspod or privy is within 100 fed of a surface wakw mPplY or tri'butaq►to a surface - , Any portion of a cesspool or p vy is within a Zone 1 of a public well. _4e/W portion of a wool or privy is within SO feet of a Private weer supply well. Any portion of a cesspool err privy is less than 100 feet but supply well with no rester than SO feet from a private water performed at a DEP artiAed ynho 'lT� Passes i<the well water analysis, indieales that tits welt is free hom�rY.f 0r CWo= rb and volatile orgy empoands pow from that fWAky and the pr+esenee of ammonia and nitrate nlftVM is equel to or Jess than S ppm,provided that no other faidtre erileria are UtpredL A copy Of dic analysis most be attached to this form.] (Ymft)The syabem,fib I have ddermined dot one of MON of the above fffUre Criteria eclat as described in 310 CMR 15.303,therefore the system NIL The owner should contad the Board of Health to determine what will be necessary to cornea the failure. L Large Systems: Two be considered a large system the system most serve a facility with a design flow at 10,000 gpd to ism You must or` e to each of the following (TC following cntm ap*to large systems in addhon to the curia above) no the system is within 400 fat of a surface drinking water supply — the system is within 200 feet of a tnbutary to a surface drinking watt/supply the�W=Is located in s AtroM Zone II of a public water,supply well live area(Inaerim Wellhead p Area-IWPA)Of a mapped if you have `f es to Section above the �quesaon in Section E the 01��d uag,or answered " • wered system is considered a large system has famed The owner of operator of any�"em considered a slPfficM due under Section E or fuledmndec Section D shallupwade the 15.304.The system owner should contact the e`e m with 314.CADt aPP ref office of the Department, Palp S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addrem �O vl D �''� �✓ v r v� Cab 3� Owner: rh Date d hupecblor �119r, Cbedc if the fol1lowing bave been done.You most indictee es"or"no"as to each of the folio wim — Pumping information was provided by the owner,oocup4 or Board of Heahh v ere any of the system componem pumped out m the prmm two weeks ._. Has the system reaeivod nornml flows in the pmevwn two week period — I—` HAV 12W vd==of water been iuftoftad to the system recently of as pet of dw :�; were as built plans of the system.obtained and examined?(If they were not av&gabL up note as= ✓ was the facility or dwelling for sigros of b� was the site inspected far signs of bleak out v — were an system componen,cmhmftg the W located on site were the septic tank manholes mm v rcc%opcned�and the of the tonic the conrbibioa of the baffles at m of cow, d*&of*JW4 deph of sludge and depth of scam 1L— was t>te�cility owner(astd �ffere�fi+on owner)pmvi&d with h0nnatkm on the; pay The she and locat',im of the Soil Absorption System(SAM on the site has been determined based on: Yes no �• c—/ hdxmsdmF0f cMWPk a plan at the Board of Hearth, Determined in the field(if any of the failure criteria related to Part C is at issue �oo is eptabie)P 10 CMR 15.302(3xb)] appmximation of i Page 6 of 11 OFFICIAL 1NSPECITON FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL,SYSTEM INSPECITIOM�FORM PART C SYSTEM POORMATION Property Addrew (v n,0 11 6,10e Z,t Owner: a Date of bgmcdow: (o G 0 g ErlTirA3, IFLOw.CONDIMNS Numbw¢'bedwom(desi�Smk L N=ber of f(acWalr al, DESM Bowbaoed.as:310 C R -15.203(gor Il0Vd.x gofbc&oom)r o2�p Nontm of camas residents:L Does zesideooe have a pftV Binder on or no): AV Is laundry an a separate sewage system or no): vD [if yea separate i�ecticn mquixeQ �y system wed(yea ar no): Seasonal asm(yra or no): Water metermadiam if (last 2 years usage(�): Sump pump(yes or no): Last date of ac upocy: COMMEBCIALMMUSTRIAL Typo of establishment: Design flow(based on 310 C Rt 13.203):Basis of design flow �. Coe=tow present ( of no): te.) Ind6strW waste hoid'mg tent present — Mn-sanitary waste dischwW to the'Tale S system(yes or no):— water meter readioo if available: Last date of oc upencyAw OTHER(describe): PumpinB Re cords GENERAL EWORMATION sowco ofi I?o� �,go C/ t Iwf as��eW as part of the n�pacx�on(yes or no): p�P & —How was p� c Reason for pumping SYSTEM U*dgnNzfm boot,an absorption system —SO&Cass" —Overflew cesspool —Prh7 Sharod system(yes or no)(if yes,attach previous hmp tion jeco,*if my) obtained )technology.Attach a copq of the current Operation and mangengu=contiact(to W —Tiger tans —Attach a Copy of the DEP app m ral —Other(describe): Approximate age of all Components,date installed(if lmown)and sonroe of iaform dm- +71c1h-, -—i:r-Is-I Were sewage odors detected when arriving at the site(yes or no)-,! Page 7 of 11 . OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSFSSMFNTS SMISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0itM PART.C SYSTEM INFORMATION(com3m Property Address: (U r �nDd6 � Owner, ea r jj me1'It ` �-� Date of b&Rmcdm 6 O BUMDING SEWER(locate on site plan) Depth below grade: Materials of .40 PVC cones Diataaoe ii�pries water stlppiy Weg cc i MO-0 atber(expfa�.-12 G H -------------- le�gc,tom): SEPTIC TANK: 7/( per) Depth below graft r lj Aftrial(If f ao j� _othel(explain). Ktank is metal list age:_ Is ceroi6cate) b a C=VH20W(Yes or no):_.:(attach a ropy of Dissand �to Of a 9 Distaaoe f om top of stem.to top afantlet tee.or ba>De; � 1iDisUM fiom bottom oif scam to bottom outlet tee or b��e:L_ ow mu Coro ° /-1 q tale C1 c e, upttedl�outkjj 'Of r000on%ift aid outlet Re at baffle cc dual integrity;liq�d levels C h GH e rf 41i ✓Y►e. GREASE TRAP.,/ loom e ou site plan) Material of WM&wb n._couc eta meta! (�): — am__.polYethylene_other sous: Scam thidmcs - Distance iirom top of scmm to top of outlet tee or bdk- Diem=tip bottom of scum to bottom of outlet tee or beige: Date of last pumping Comments(on wag re0O1° infer and oudd.tee or boffie as related to outlet im+ 4 evidence of leakage,etc.): ' h', d levels Page 8 of l l • OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE*DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cam,, G O 771 IDWOW. Date of Inspection: e TIGHT or HOLDING TANK-X-- (tack mist be pOnpW at time of > ion)(locate on site Plan) �bebw grade: Mateai of o ooncrete metal fiberglass____polyethylene other(eacpl$in); Dimensions: $ Design Flow: BdlwWdaY Alarm preset t(yes or no): Alarm kvd: Alarm in workbag order(yes or no): Date of last j;;j g Comrneots(con&m of alarm and Boat switches,etc.): DUTMUTIONI BOX (if PucWmast be opemd)(locate on site plan) Depth of liquid kvd above outlet invert: Commends(note if boar is kvd and&5UfliiWt0 outlets eOK any evidence a[solids leakage�h Out Of �,� �y�Vel.my eVl�,0II0e 0� Ni PUMP Cam: (locate an site plan) �in workbag order(yes or no): in woddn8 order(yes or no): Comments(note condition Qfpump dimba,co Wkm of pampa and appnrtenanoes,etc.): Par 9ofn a . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSDCCM SUBSURFACE SEWAGE OLSPOSAL SYSTM MPECMN.FORk SYSTEM EVFORMA 7ON(oaetien� Poverty Addeo r1 / Owner ro e Date d IaapeC•Ijar 6 (-Q--�_ SM A-MRrMN SVS7= If SAS no locatieie aiih why; cx -d o _kachis ,�: Z4) � S � � e avanow CMPWL �V !/ 4(C 4 Comments(Isola i aocn of of tecln:olog�r; CovPv� �df�of hydradic fa/dut+e,level of po�g damp sail,oo�tioa of vegetatiQa �► Dcp& • �be pumped as pert of inspe�m �side Dian) Numberaadoo Depth-top of�idtaialet�; . cf soft ofot Maf�afoot mca&n afffam6aft MOW(gas car w): Coaimeota daA signs of hy*mk faWM k%,d afpm&&ooedaion aft or): PRIVY: �ocate aQ site plan) matad*af Din majow oaf" Comments Om<�e-w- afs� of cfairLvdafpmb&g &Cm&imofygpL e�}:. Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT]FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYS TEM INSPECTION FORM PART C SYSTEM DWRMATION 0ondaaeo Property Address: /✓r�IO]T Owner. kLllev►e Date of Inspeedoas p r SXICTCHOr SMAGIC DEMSAL SYSTZK Provide a dmtch of the sewage disposal system mchWmg ties 10 at Twat two permaaeat reference landmarks or benchmarks.Locate all wells within 1o0 feet.Locate where public water supply enters the bca� ge,-i C,114 f k • Pale 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cozdmxM Date of iron; 6 p SITE EXAM slope �� 9 surface water � Check ceW shallow wells Estimated depth to gumd water�fed �o� 3 9 Please (dieck)all methods used to detain the highly water elevation: owed ftm system des;pilang on ,, -rf ( ng property/obsuvation hole widde 150 adofdW plan m`' '� 1 -13ocked with local Bowd of Health-explain: Chedwd with local moors,installers-(attach docun ion) Aooemed USCS a�a�-ems— o F- You mnst&scnu h you ��,�/�i water ekv� �^ v c�7L `'' `L Z,io c C17`t o ` n ,o , 0 0 0 a �� e in, o 0 s () 00 t���' n 7-09 T N W OARNSTAB,L/E LOCATION ✓I 1✓lt` /,/4' SEWAGE # `VILLAGE 6C 94-1kivi //P ASSESSOR'S MAP & LOT I fo NAME&PHONE NO. SEPTIC TANK CAPACITY / /1 0©a LEACHING FACILITY: (type) G �7 (size) NO.OF BEDROOMS OWNERr n PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: ,7 f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility —5 /`� 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 L N1l °o— % e C d - C4 TROY WILLIAMS SIEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 7(771819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property Kho+4 P)-h a- L Owner's name& Mailing address Date of Inspection 7 /0 ylg5 PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes,of water have not been introduced into the system recently or as part of this inspection. r.k As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. P j The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. • � _yam-_ V 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. VThe size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SSDS. Page 1 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential ,2 number of bedrooms _(_number of current residents No garbage grinder, yes or no 65 laundry connected to system, yes or no 5 seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: �� /0/ v f C / g3 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: �I C ✓l A- 02, h, ; J (n 41.v pl G 4 14 o��- YES System pumped as part of inspection,yes or no If yes,volume pumped /000 u /. Reason for pumping: D, �ti t �•, ,,L fr _ 1-14 CA, »U✓d o S c S b/io ti r L c o�*�+ r•, a L. _� .�;a to Type of system Septic tank/ ' ' sod absorption system Single cesspool _' Overflow cesspool Privy Shared system(yes or no) (If yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed, if known. Source of information: A and ,r. �U _rs er i �✓ 4a h +, L1 o vim,a G1 v� tl•GIB N 10 Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) i depth below grade: j material of construction: concrete metal FRP other(explain) dimensions: S ' ,r9 "X 6 1600 sludge depth 16'" distance from top of sludge to bottom of outlet tee or baffle .3" scum thickness distance from top of scum to top of outlet tee or baffle I I' distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,recommendations for repairs,etc.) C�h w f« -�►✓ O u f-�,.L/ o,ti d 6 cL A r : .., -�- .ate dl i�, Gv o✓ /2� ✓l s b r�9 Y�. /�o GcJ 01 e h 1�- ..- o-7'-" ��a ka S �e o✓ C'1c,.►JJ•�e.g e- . So�, roof S.rlo w 44 k bc, 4- #470S ro e �E S �"�rh 6 J t c/l 0.f ' i K, c a7� %V•c I0� L i o Vf T a, � p-N,p� et G•+- -�;....,t or :�.s�oc cftQh. DISTRIBUTION BOX: I./ (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) PUMP CHAMBER: �/f (locate on site plan) pumps in working order,yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 "1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if poss.;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits and number 0 h el X G leaching chambers and number ' leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,r�mmendations for maintenance or repairs,etc.) J kol y I ' -�o•-- 6 J��vc, CESSPOOLS (locate on site plan) number and configuration depth-top of liquid to inlet invert depth of.solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) _. PRIVY: /Y �� (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, recommendations for maintenance or repairs,etc.) Page 4 of 7 f • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' A C.. 56 � DEPTH TO GROUNDWATER depth to groundwater _adjusted high groundwater level method of determination or approximation: Nis Wa+ P_f ::4a Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined(Y,N, or ND). Describe basis of determination.in all instances. If"not determined", explain why not) Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? AIIA Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool<6"below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? j,/ within a Zone I of a public well? /V within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? Y 3 � within 50 feet of a private water supply well? 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. Page 6 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: —ZI have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature S ' Date 7 Original to system owner Copies to Buyer(if applicable) h s Approving authority PROPERTY ADDRESS: Cc h �-tv / Page 7 of 7 TOWN OF BARNSTABLE LOCATION SEWAGE # v9LLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 6,X C 5 i NO.OF BEDROOMS -� BUILDER OR OWNER PERMIT DATE: 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 301 GI � I d e s f ' Y THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OE HEALTH ............._... . . ._................OF..................................... ..-- - Appliration for Rapasal Works Tangtrurtion Permit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: l N o 1T ..... 1 N..r...... 'A H -- --- /— Location-Address or Lot No. f' o—RIYES.�..._w , G�-u �CT� .�^!. __S.M i _N__ vE.:� !A�Pa� ) M -�.O_�1-s_81 ------... . - -------------------- —t— Owner Address ..A........ ...............`h �B N -�x-- C E N T E ��" i L- ---------- ....................................................... Installer Address d Type of Building Size Lot... G..XP_a....Sq. feet U Dwelling—No. of Bedrooms_____________4X.........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building -. No. of persons............................ Showers a YP g -------------------------- P•-- ( ) — Cafeteria ( ) dOther fixtures ......................................................--------------•--•----------.....------------•------------•---------------......------•• W Design Flow.........X.1v....................... al ons per person per day. Total daily flow.........,.�lJ...v......................gallons. WP q Septic Tank—Liquid capacity�..O°... aIlons Length---•--•--------- Width---------------- Diameter................ Depth---------------- x Disposal Trench—No......... ,�idth.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.----�60a...s`Dia eter................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by......... --------------••--•------------------------••-•---•----------... Date.................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......_.-_-.--.--_------ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 - ----------------- ODescription of Soil----------M .......:------------------------------------------------------------------------------------------------------------------- .......-- -- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the board of healt . Signed....X------ ...... ------ ------ Date Application Approved By-------------- Date Application Disapproved for the following rea ns------------------------------------------------------------------------------------------------------------------ -----------------•-------•-----------------•----------------•--------------------------------------------•------------•--•---•---------. --------------------------------------------------------------- Date PermitNo..--- .-------------------------- ------ Issued-_--------_--------- ............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .......................O F......................................... Apli iration for flap oal Worku C ontitrurtion Prrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. Owner Address W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------......s ............ ...............Expansion Attic ( ) Garbage Grinder (. ) ---- aOther—Type of Building ............................ No. of persons..........------------------ Showers ( ) — Cafeteria ( ) dOther fixtures --------•----•----------• --•-•--••-•-------•---------------------•----•---•---- Design Flow...__...:`?..............___._____....gallons per person per day. Total daily flow........_:=_!'_!--------------------------W i,;,,,, WSeptic Tank—Liquid capacity_=_........ga�ons Length...........:.... Width---------------- Diameter---------:...... Depth................ x Disposal Trench—No.......... a_._ 'width______-__--•---____- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........................ Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date---------- Test Pit No. 1................minutes per inch Depth of Test Pit.....................Depth to ground water-.-__----_--------.-_._. (_, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-__-__-_.---.--_--.-. a' •-•--•-- _ _ ODescription of Soil---------- -=t =``�......--...•-•-•----•---•-------•--------=------------'-------------- . --- --- ---...-------- --- ----------------------------- x U 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedzby the board of healtl-c' Signed._24/.------..vo--&` •----- Date --- ------------------------------- . Date Application Approved. BY..............1-----'`='-� ===-........................................................ �, ------------------- _ ------------ Application Disapproved for the following reasons--------------------------------------------------- ---------------------------------------------------------- ..•-•-•-•'-'-•----•••'•--'------•_--•-•-•_•-------------"-----•-••---•----•-__-•••_-__-__•-•--•--••'__----•------------------------------------------------------------------------------------------- Date ,r- o. Permit No.......`--'=.. '" - Issued. �a+f Date f THE COMMONWEALTH OF, MASSACHUSETTS BOARD OF HEALTH ......:..' rs....................OF............�^ ::�� ...... ............................................ e 10'prtifiratr of mWIMplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) i . f.: I / In staller has been installed in accor lance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....:.____=_'..:.-r:"_________________ dated-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE......... = --'-•-•------------•--•-------------------- Inspector----(/. ....... COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..=l=:: -' -•------- FEE-...................... Permission is hereby granted-------'ft ...................................................." c%?--`--�_ - -_------------ ............................................ to Construct or Repair ( ) an Individual Sewage_Disposal System at No.•'-•/ ',; I------=f- 'c:4.. mot- "Oei A, ==- •-- . J Street as shown on the application for Disposal Works Construction Permit No-------- _2__rf' Dated-__- °'%! ---------------•----•----------------------------------------------------------------------------- Board of Health DATE FORM 1255 HOBBS & WARREN; INC.. PUBLISHERS ACCESS COVERS MUST BE Wl THIN 9" MINIMUM. s..I N VER T EL E VA T I DNS : DESIGN CR I TER I A : GENERAL NO TES : 6" `OF 'FINISH GRADE 3' MAXIMUM COVER INVERT OUT SEPTIC TANK: 96.5 FIRST 2'--T0 - DESIGN FLOW: BE LEVEL MIN 2" OF PEA STONE INVERT IN DIST. BOX: 94.27 2 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OR FILTER FABRIC INVERT OUT DIST. BOX: 94. 1 BEDROOM EQUALS 220 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. •v" orAM PIPE 3/4" - l 1/2" DIA. INVERT IN LEACH CHAMBER: 94.0 o NO GARBAGE GRINDER 2. VER T l CAL DATUM IS ASSUMED. FOR BENCH MARKS 96.5 94. l /2" H-20 %° DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 93.0 BAFFLE 94.27 � � 94.0 a) 93.0 ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED: SET. SEE SITE PLAN. 3 OUTLET 4 LC-6 LEACHING CHAMBERS OBSERVED GROUND WATER: N/A E 220 G.P.D. X 200% - 440 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX W/3.5' STONE AROUND. 10'w x 38'l x 12-d BOTTOM OF TEST HOLE #f : 86.7 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR t SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DES l GN PERC RATE C 5 M l N/l NCH PROFILE : Nor TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER N 220 GPD / 0.74 GPD/SF - 298 S.F. REOUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED: 4 LC-6 LEACHING CHAMBERS W/3.5' STONE AROUND. A-476 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR TN y LANE NE 476 S.F. x 0.74 - 352 G.P.D. APPROVED EQUAL. Moo D E V r 1 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED 1 SOIL TES T PIT DA TA & PRECAST CONCRETE OR APPROVED POL YETHYL ENE. 95.2 / I BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER i I SPIKE/FN INDICATES _� INDICATES 97.3 i PERCOLATION OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE \ \\ \\ N 85-44.22"E I TEST - GROUNDWATER OUTLET. 154.39/' TP #I P#14354 TP #2 7. BEFORE CONS TRUCT l ON CALL "D l G-SAFE". HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. N \ i\ I 0" 96.7 D" 96.7 FOR LOCATION OF UNDERGROUND UTILITIES. Q LOAMY IOYRF Q LOAMY IOYR \ \ \ \ \ \ \ l SAND 2/2 SAND 2/2 L 0 T 38 / 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE \\ \ \\ 96.9 \ �\ 2/ • /+ S.F. /9? LOAMY IOYR LOAMY IOYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION + \ \ \ \ D SAND 4/6 B SAND 4/6 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE 4 LC-f PRECAST CHAMBERS \\\ ^�30" - - - - - - - - - - - - - - - - - - - - 94.2 28" - - - - - - - - - - - - - - - - - - - - 94.4 CONSTRUCTION INSPECTIONS. W/3.5 STONE AROUND\ \ \ \1 \ `� \\ \ C/ MED-COARSE IOYR C / MED-COARSE IOYR .� 9. EXISTING LEACH PIT TO BE PUMPED DRY AND oa +9I 6 1 \\ o-eox \\ SAND AND 5/6 SAND AND 5/6 BACKF I L L ED. cp. \ 94.4 of GRAVEL GRAVEL \ I \ + \ 5 44" 97.5 EXI'STING LEAC4 PIT ` NO WATER NO WA TER 86.7 I� EXISTING \ 1 \. )SEPTIC TANK \ II ` \ \ 1 \ ` \ DATE: MAY 9, 2014 BM. CORNER WALL \ >' \ \ '99 2 \ \ i \ \ ` TEST BY: STEPHEN HAAS O \\ \ \\ I \\ WITNESSED BY: DONNA MIORANDI PERC RATE: C 2 MIN/INCH ® _ PA VeD p \ 1 1 \ TP/FND \ pR/VEI{q y lbi � 1 SE7P T I C S YS TEW DE' S l ON I \ m IINVV 28s25w`\\ \` 6 KNOTTY P l NELANE MAP l 0 / PARCEL 107 STOCKApE FENCE BARNS TABL E ( CENTERV l LLE ) MA . PREPARED FOR : WEOUAOUET °CU LAKE LEGEND J A v / ER ARROYO w CB CONCRETE BOUND --W WATER LINE SCAT E l 20 ' JUNE l 3 , 2014 . a HYDRANT ;k a GAS LINE STEPHEN A . HAAS W_ OVER HEAD LIGHT POST WIRES _ ENGINEERING , INC -E- UNDERGROUND ELECTRIC LINE i + 9 2 3 FR o u t e 6 A o a -T- UNDERGROUND TELEPHONE L I NE / i�� / 1 \`�� \ Y a r mc> u t h p o r t , MA . 02675 h a -CT V- UNDERGROUND CABL EV I S I ON LINE � � ( I� o � �� � � \ ( 508 ) 362-8 'I 32 +40.4 SPOT ELEVATION ­_..40------- EXISTING CONTOUR LOCUS MAP 0 /0 20 40 40 PROPOSED CONTOUR JOB NO: l 4-020