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Home My WebLink About0102 LIAM LANE - Health I 102 LIAM LANE, CENTERVILLE A= 167 016.011 I � ` Commonwealth of Massachusetts Title 5 Official Inspection Form. a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments tit.. se� 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 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. General Information e7� 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-15-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of u e at that time.This inspection does not address how the system will perform in the future unde the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name requAtion is Centerville MA 02632 6-15-16 requited for every page,,., City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page_ City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ` ` ❑ Cesspool or privy is within'50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 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 ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No 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: 6-2015 Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 4J Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Town--12-2011 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: New leach field. 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank 1980's with new leach filed 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"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. Septic Tank(locate on site plan): Depth below grade: 8"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: 12° t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 good condition with baffles installed and no sign of leakage. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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 t5ins-3/13 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts 4 v Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-3050 Infiltrators ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chamber field in good working order and empty at inspection with no sign of back-up into d-box or surrounding stone. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is Centerville MA 02632 6-15-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s<'~ 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 5 W r 1 Q t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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. t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 102 Liam Ln Property Address Richard Cathie Owner Owner's Name information is required for every Centerville MA 02632 6-15-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I DEC-16-2011 10:27 From:BORTOLOTTI CONST 50842B9399 To:15087906304 P.1/1 FROM :doyn c;aFe engir>eering ino FAX NO. !15083629880 Dec. 16 2011 09:2GAM P1 s ,. l.` �'1iGe�u,t♦ �'. #7iCl�tl:)°, ihsa'eci;UY° �.�nnr rr°rr Ar+y/b j �w,►,� x ��.ITTi'c f�tr�:o1�1,60 �.bfi,v��in�a i 12omieu N{e� ��lse, E?TrCGtl1� IN Main Ntrecj,1.1E'yalluis,-VA 111,61t0 (1ffvt, 109 362-401 Un4 Dwrita sm,119r,PYr.'ua�KE. �! /�/ AmNmar's MIN PTiBY`vd k z-� r� t9a�n to a. UJDL.r6" E y!;I&n Auasto.11ler: /? oG� hu AZ- — ' `. ounri a�clxr t to irima11 3 / I nr_pti�;;t'r5tcixT at�O .__. ... L•.I a r.\ 4-0,r pard olti s>,cllz;Krl 48'Wr41 by '0? (XIS i T veari.fy thal. Cu-: xptir. rgne i TefU2Ua(!VX,1 r11i 0'va WAR '11Hht11c�1 g1111, 1111 iall.y L0 0rrILn.l, Lu the Jf:si;r, whia:Yi truly hir'luda minor appi:Qv:d rolucatiun of the di.3(fib-a ion (loxi♦ZSd/6i�gitirn,ftnk- f um(ify that tha ai.T tx Ta1uencad above was .uviiiiEud. wi1'It,iraf1 m, chu gw (j.e h-Cut" 1116iu 10'Tiiftrul i�:loratip.4 n°�th a SAS or uny vi,.xtxca.l reloaa�tiC u�way comTloui' t Ut�tl:rr(C"ciyelrtfir�a''c n Ad_c say'St�ChLyn)Q rhs1ii_p inr a�'ttn+:uFrndlHnsw , r ru ) dr ypA1HaN JonI fl,M A I.A . w C IE,�i un., DIiu1 raviaia�-v.' 1 No:48502 4 �ss�ONAL B�p� a)p"It.(17,f i�jgW'hIt f,^lF'iX sigE#'q—St at11 eTn) .rA.4, AFIMTTIRN. ''+,? 7�11R.rv.'J.1AWa Mrw,T(. Var1l,�. [ii?':t .LTG T?s y)a3� i� Fi).s, :rIf�T1T iHl AND '�' ;T_GA�RDAL 31 1,'1 G �Y�lERVT'F1 1PNATAB -r-1-TwicagAT'TRUTVI51vr! . Pjcvuu, (3 Ffrnll]i1 4uttrJLplSRiNtInrCwltl'aliim Form 3-26W4.dors TOWN OF BARNSTABLE 4,LOCATION / 4_� L w SEWAGE# VILLAGE ,, 0' ZU9 LL0 ASSESSOR'S MAP&PARCEL_ fE,-T-OIC•C3 ti INSTALLER'S NAME&PHONE NO. .ZeAZ76 L—a `�'7(I Q-3�i9 ' SEPTIC TANK CAPACITY 1c�t(a t Nt4 feA�:o 4a tL LEACHING FACILITY:(type) _t%2 L,-V�f Ga- (size) NO.:OF BEDROOMS jG s-u f of�- �, OWNER PERMIT DATE: f JV-.SP- I P 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) o Feet FURNISHED BY 12&ta ��rci /d� .. _ ��n¢ � . , . _ /�- 1! S � .�� y" �o�� 6.. ?�, �,w- -- — — — -- `� ,' G s,Q,�� 9 h�V-- No. O Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppYICat10TC for MI8p08Al *psteltt CDTCBtCULtI0n pPrittlt Application for a Permit to Construct( ) Repair(i/Upgrade( ) Abandon( ) [:]Complete System [�Individual Components Location Address or Lot No. J p D�, t!.iC�W> n� Owner's Name,Address,and Tel.No.J-O$-Co �P3 n l �p �iClLtsz� � �� loa Ca`aYr►(�- �ht�r'Uc�� Assessor's Map/Pazc Installer's Nalne,Address,and Tel.No. b -0f)/- 9 3??11-5 signer's Name,Address,and Tel.No. 60 -3Cc;I- �S Co; an oS�USF-rq>�• DIDWn � -i rneerj'?_2 main SF- Type of Building: Dwelling No.of Bedrooms 3 Lot Size Q" FS QCnicp sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided J31 gpd Plan Date Ah, 14� a0t i Number of sheets Revision Date Title 1.-d 5- 0 Qa Q <2e U! /e Size of Septic Tank ` Type of S.A.S. S Description of Soil Nature of Re airs or Alterations(Answer when applicable) S ` ' 0AX - Cz� r- 'le) X 34, 9 G a, : - Date last inspected: Agreement: The undersigned agrees to ensure the construction and ce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro ntal Code not to place the system in operation until a Certificate of Compliance has been issued his Board of He ig 'Of Date l i Application Approved by 61, 62 Date - Aq Application Disapproved by Date for the following reasons r Permit No. 9,21Date Issued /l / 4' lu Fee "J .J THE COMMONWEALTH OF MAS C 'SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSlABLE, MASSACHUSETTS 01ppY1Lat10n for-Disposal *pstPln Construction 3pPrinit Application for a Permit to Construct(i Repair a Upgrade( ) Abandon( ) ❑Complete System [2'lndividual Components Location Address or Lot No. 10. Owner's Name,Address,and Tel.No. Assessor's Map/Parc h 1ec tt` , il' p �, /'j;Cln CCLmi�. low L +cztri LC"!)lE1'(Jc�I� Installer's Name,Address,and Tel.No. 0 -Designer's Name,Address,and Tel.No. 'C Or4,.(o`fi. C.on4n"oo1 Hs xj a 5(-rq P,� 1--Ui )n &_ �-G-r r»ee I'v ✓G1A i 1 O I- . Type of Building: Dwelling No.of Bedrooms 3 Lot Size Ua A<.�<n sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided �,�/ gpd ` Plan Date film a)nr ,, (fin, aOI Number of sheets Revision Date Title 1,, �r> �i �1j pk n. c- /()a L'e sn I n()F Size of Septic Tank ^j, Type of S.A.S. Description of Soil _ZJ -,(7 v Nature/of Repairs /or Alterations(Answer when applicable),J7,,)f4 Ana l +�)/l�Tor t All(F S Jl��n/x/lT�� Sf E�?�F ��f/� X , /�J e f 1l a4n _ r 'l ,f ,( n ,1 � / i Date last inspected: V P, Agreement: The to ensure the construction and undersigned agrees g g mainte ce of the afore described on-site'sewage disposal system in accordance with the provisions of Title 5 of the Environment Code andot to place the system in operation until a Certificate of j Compliance has been issued b this Board of Health. i91 e Date Application Approved by Date Application Disapproved by Date for the following reasons 'I Permit No. Date Issued il -------------------------------------------- ----- ---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 4. tertifirate of (Compliance THIS.IS TO CERTIFY,that the On-site Sewage Disposal system Constructed'( ) Repaired Upgraded( ) Abandoned( )6y / � I at ® �_° has been cons uct"aac a�with the provisions of Title 5 and the for Disposal System Construction Permit No. " dInstallervrC �aS r vim, lr1C Designer -1 / #bedrooms Approved design flow gpd The issuance of this permit shall n t be co-strued as a guarantee that the system i n-f—un—cCli a si n Date Inspector ------------------------------------------------------- ----------------------------------------------------------------------- No. .r•-- /� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *PBtrm Construction Vrrm[t Permission is hereby granted to/Construct( ) Repair Upgrade( ) Abandon( ) System located at A�4 dand as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with P! Title 5 and the following local provisions or special conditions. Provided:Construe on m t be completed within three years of the date of this permit. J Date Approved by / f Town of Barnstable P# ]Department of Regulatory Services Public Heafth Division Date u BAF[NBTAHL4 4 i6 ,erg 200 main Street,Hyanuis MA 02601 Date Scheduled Tilne L= Fee Pd. ,r Soil Suitability Assessrizentfor PA Performed Dy 4=1 Witnessed By.; — U OATION'& GE NE RAL INVORNiI T ION Location Address /oi i L V& Owner's Name t�/1�P✓ eI>° Address n Assessor's Map/Parcel: 16 / 16 '-!� Engineer's Namc W ^ 4e NEW CONSTRUCTION REPAIR Telephone It (((///��/ Land Use' 4-tom`-F� Slopes(%) C7 O �dL Surface Stones NU Distance's from: Open Water Body- _rt Possible Wet Area /1 It Drinking Water Well AIIA:: ft Drainage Way /� _ft Property Llne /0 ft Other ft j SKJLI><'CH (Street came,dimensions of lot,exact locations of lest hales&pore tests,locale we lid nds'[n proxi Ili ty to Boles) 40t � 15 �!Z -b6 J Parent material(geologic)_QlJ'f'(.!� Recboelt Depth to Groundwater: Standing Water in I[ole: plltg 1'I'0111 Pit NOV, /, Estimated Seasonal High oioundwater DE ERIMNATION FOR S1EASONA]L >F1[l[GH WA7('ECR TABLE Mc(hod Used: ^/ Depth Observed standing in obs.hole: 01/ZOL In, Depth to s9il Iklt�ll158; /V U III, Depth to weeping from side of obs.hole: ff Ill. dYoull�WutuY Adf ualment.� m ft. Index Well P Reading Date: Index Well level Adel,fame, Aal.Ovoti tlwater Uvel 9 Observation ]PERCOLATION TEST `�N3llla ll'!u'Im Hole# I Timm tit 9" Depth of Perc r / Thrtp at G" Start Pre-soak Time @ jv v U Time(9"-6") End Prc-soak Rate Min./[ncll rl� Sitc Suitability Assessment: Site Passed Sile',Failed: Additional Testing Needed(Y/N) Original. Public Health Division Observation Hole Data To Be CotnpteLed on Back **`Ij;t]percolation test is to be comlducted wiLiiin 100' of vvetlialnd, you must firslt Uoffy Mlle Barnstable Conserva6oli Division at least orle (1) wech prior to begim-ling. QASEPTIC\PLIZCFORM.DOC IDIICICIIb•O]f�S —iV �i'][OI�T TILE ]LOB �—'� Depth from Soil Horizon yIole # 5urfnce(in.) Soil Texture Sail Color (USDA). Soil•(M Other , (Mansell) Mottlin O—Z g Can tere,aStones'; Boulders, /L,.� %❑ ra eI 46 IL DEEP 0-PS ]ERVATION HOLE,LOG Depth from Soil horizon Haa f e } Of Surface(in.) Soil Texture Soil Color ---C (USDA) Soil (Mansell) er Mottling (Structura,IStones, 90u1ders. Consis Eric %Gravel /57 41_ 07 a � 1�ICIE1�Depth From OBS]ERVATIOV HOLE L 0 G Soil Horizan S Hole# 5iirface(in.} oil Texture Soil Color `—'--- " (USDA) Soil (Munse'll) MottlingOther (Structure.Stones,Boulders.. ('.onsistency,%0r,vel7 :. ]I�IEIT OBS]ERVA7P.>�OI�, 110LR ]L®� .� Depth firorn Soil Horizon HO)e# Surface(in.) Soil Texture Soil Color Poll - _ (USDA) ., (Munsell) Mottlln Other 1 (Structure,Stones; Boulders, nsi ------------ ------------- - -� ][Vmod Insu ][late Map. Above 500 year flood boundary No Yes Within 500 year boundary No Ves ' within 100 year flood boundary No, Yes _ e1 n oV Plcuten>rI 9Vy_ ccnErrnng pE_____yaous Material Does at least four feet of naturally occurring pervious intiterial exist in all areas observed throughout the a,-ea proposed for the soil absorption system It'not, what is the depth of naturally occurring J)nrvious matot'ial� Ce>Ufica tlon I certify that on . L" (date)I have passed the soil evaluator examination approved by the Ceparbmm, nt of Bi vironmertal. rataction and that the above analy.;is was performed by me consistent with If,e rewired training, expertise and experience descrjUed in CIO CMR 15.017, 01 Signature ` s (_ Date Q!1Sl?PTfC\PRPCr0 RM.DOC � y oFTNEr�,,, Town of Barnstable Barnstable Board of Health BAruasrAsi.E, y MASS. 200 Main Street,Hyannis MA 02601 i639• IN 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING MINUTES Tuesday, August 4, 2009 at 3:00 PM Town Hall, Hearing Room 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on August 4, 2009. The meeting was called to order at 3:00 pm by Chairman Wayne Miller, M.D. Also in attendance was Junichi Sawayanagi. Paul Canniff, D.M.D. was unable to attend. Thomas McKean, Director of Public Health, and Sharon Crocker, Division Assistant, were also present. I. Hearing - Septic: POSTPONED Francis and Barbara Ferguson, owners - 512 Whistleberry UNTIL SEP 8, 2009 Drive Marstons Mills — bedroom count. II. Hearing — Housing: POSTPONED Francis Wurzburg - 140 Willimantic Drive, Marstons Mills- UNTIL SEP 8, 2009 ceiling height. III. Septic Variance (New): A. Peter McEntee, Engineering Works representing The 699 Main Street, LLC - Fancy's Market— 699 Main Street, Osterville, Map/Parcel 141-011, 0.17 acre parcel, approval requested for I/A Soil Air System on failed septic. Peter McEntee presented the observations with the failure of the septic installed one year ago. George Heufelder, Barnstable County, worked with Mr. McEntee on the situation. He told the owners to put an interceptor grease trap inside as well and stressed to scrap all food off items before washing. The solution proposed is to use the I/A Soil Air System. Mr. McEntee expects the system can be installed in September and would come to the October 13, 2009, Board of Health meeting if a 30-day period has passed. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted on an emergency installation of the I/A Soil Air System, pending state approval, with the following conditions: 1) if the DEP denies approval, the Board of Health must be notified immediately and the Soil Air System must be discontinued within 24 hours, 2) must monitor the ponding level two times a week and appear before the Board after the first month to then determine future monitoring, and 3) if pumping is needed or any high water alarms activate, this must be reported to the Board of Health within 24 hours - one working day. (Unanimously, voted in favor.) III-B. Variance — Food (Cont.): David Lawler representing British Beer Company, 412 Main Street, Hyannis — grease log results. David Lawler and John LaLiberte, Bluewater, presented the results of the grease trap pumpings. It was pumped on June 16 and July. Each pumping only had a quantity of 1,000 gallons in the 2,000 tank and the percentage of grease was less than 25%. John recommends pumping one more time at the end of August and then change to a three month pumping. Upon a motion duly made by Junichi Sawayanagi, seconded by Dr. Miller, the Board voted to approve the grease pumping schedule of every three months except during the busy summer months of July and Aug. July and August will each be pumped at the end of the month. (Unanimously, voted in favor.) IV. Variance — Food (New): Caffe Gelato Bertini, 20 Pearl Street, Hyannis, new owner, two variances requested - toilet facility (1 provided) and grease trap variance, same menu as previous, no indoor seating. Cynthia and Tom Duby were present. They are interested in running the Business in the same fashion as prior owner with gelato (ice cream) and coffee (expresso). They said the grease recovery device (GRD) was installed by the prior owner as required. The prior owner had a picnic table outside. The Board requested that be changed to a bench and/or chairs. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted to approve the grease trap variance and the toilet facilty variance with the following conditions: 1) an under-the-sink grease interceptor (GRD) must be used., 2) the menu is restricted to gelato (ice cream) and expresso (coffee) only 3) only paper plates and plastic utensils shall be utilized. 4) seating for patrons is not authorized, 5) the variances are not transferable, and 6) the decision letter shall be posted on a wall adjacent to the food service permit easily accessible to a health inspector. (Unanimously, voted in favor.) V. Informal Discussion: Peter Sullivan, Sullivan Engineering representing Ruth Wells, owner— 35 Navigation Road, West Barnstable, Map/Parcel 156 — 056. Peter Sullivan and John O'Dea discussed the potential plans for the 5 acre parcel. They have run into clay while trying to. replacing the septic system for the 3 bedroom house (currently vacant). They are also interested in setting up a tent for short-term use for a project. Included in the discussion were ideas on composting toilet(s) and self-contained chemical toilet(s). Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted to approve the use of a self-contained chemical toilet for a 60 Day period between December 2009 and January 2010. (Unanimously, voted in favor.) VI. Septic Variance (New): Glenn Harrington representing Steven and Nancy Costello — 255 Scudder Road, Osterville, Map/Parcel 139-014, 045 acre parcel, two, non-environmental variances. Glenn Harrington presented the plan and noted he will be doing a revised plan to fix a type error. The size of septic tank is 1,500 gallons, not 1,000. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted to approve the two variances: 1) a setback from foundation to 14.feet in lieu of 20, and 2) depth to grade will be 3 feet 9 inches in lieu of 3 feet with the following condition: a revised plan showing the septic tank as 1,500 gallon. (Unanimously, voted in favor.) VII. Proposed Revision to Variance Procedure: Proposed Revision, below: rVariances for Septic System Repairs Which May Be Granted by the Board of Health Agent or by a Health Inspector Paperwork and Hearing Reduction Proposals Approved by the ti Board of Health,Revised During a Public Hearing Held on August 4,2009 1) FOR ALL SYSTEMS THAT HAVE NO INCREASE IN FLOW-Septic system component to foundation setback(but in no case less than a 50%reduction in the required separation distance), if an impervious liner is designed and installed. 2) FOR ALL SYSTEMS THAT HAVE NO INCREASE IN FLOW- System component installations proposed more than three feet below grade with proper venting(piped to the atmosphere)and with H-20 loading,but in no case shall the SAS be located more than six feet below grade. 3) FAILED SYSTEMS ONLY—SAS to private onsite well separation distance variances, if located in the same general location as the old SAS and more than 100 feet separation is proposed,both from the on-site well and any and all wells on adjacent and neighboring parcels.* 4) FAILED SYSTEMS ONLY—Septic tank or pump chamber proposed to be located less than 100 feet but more than 75 feet away from wetlands or a water course.* 5) Additional seating at food establishments, if no more than 25%above the maximum grease trap capacity. 6)Proposals for six or more bedrooms,without any variances, are no longer reviewed by the Board. *NOTE: If there are two or more variances requested from#3 and/or#4 listed above,the applicant shall instead seek variances from the Board of Health at a public meeting. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted to accept the revisions (above) in procedure of approval of variances. (Unanimously, voted in favor.) VIII. Correspondence: A. Concerned neighbors of Stewart Creek Letter mentioned a concern of shared septic systems. The Board reviewed and noted the property was permitted for a shared system. No current issues noted. B. Christine Tuck, 379 South Street, Hyannis-Veteran's Outreach Center TOWN OF BA MTABLE LOB ATION /6 L P,yy, ,,- SEWAGE # V.T,ULAGE G�w� errV``��— ASSESSOR'S MNP & LOT � V INSTALLER'S NAME&PHONE NO. �-O G�2 I) SEPTIC TANK CAPACITY /060 p (0-J LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 a �44e e„ r I r L •• Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Ax Environmental Protection � 'r William F.Weld V J' Governor � (P)l S cret liyC.EOo �`�Z9 Davld B. Struhs S !!! Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - F 0 PART A ; ' CERTIFICATION Property Address: loj Li,,4P4 L.crevc— Address of Owner: :C)4N Date of Inspection: to-3-�' (If different) z.. Name of Inspector: —�k2io, -�bG�` Company Name, Address and Telephone Number: CERTIFICATION STATEMENT certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.. The system: asses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signatu Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this . inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection, The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM P SSES: f I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: : One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yest no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) j� The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street i Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 �,Printed on Recycled Paper t ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION (continued) Property Address: R' Owner: i.. Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) r Sewage backup,or breakout or high static water level observed in the distribution box is clue to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: the system has a septic tank anu Soli absorptiun System an6 is witlliil 100 fcct to a sii1i4-1-c 'r`aici Sapp' or tributary to a surface watet supply. The systen, ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private,water supply well. 4-1The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage into facility or system component due to an 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: .KaNK• Date of Inspection: Dj SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. f� Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. CI/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. LU Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 ovater supply well, The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: "3OtFr-J Date of Inspection: f 3_ Check if the (following have been done: V 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. ZAs 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. / TThe system does not receive non-sanitary or industrial waste flow vThe site was inspected for signs of breakout. /All system components, excluding the Soil Absorption System, have been located on the site. 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. N/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. Ile facil;:y c.•.:,c- ;a :c' Occupants, if from ova ner} were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 i Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 0,-4- C Owner: �O! 3�r v1u ru Date of Inspection: to-3"'�� FLOW CONDITIONS RESIDENTIAL- Design flow:� ` gallons Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_ Laundry connected to system (yes or no):,Y-- Seasonal use (yes or no):,_&[ Water meter readings, if available: Last date of occupancy:- 035" COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day f Grease trap present: (yes or no)_ — Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: i Last date of occupancy: OTHER: (Describe) Last date of occupann,: i GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)_ If yes, volume Pum ed -7�U gallon" Reason for pumping: SGG TYPE O 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: �(��► Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 ' w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16ra- 1-1 V*YA CC--A-5C' Owner: o�'ro Date of Inspection: SEPTIC TANK:/`_ (locate on site plan) 1 Depth below grade: Material of construction: oncrete _metal _FRP —other(explain) Dimensions: 7 8 Sludge depth:_ 13tr Distance from top of sludge to bottom of outlet tee or baffle: " Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ u 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, etc.) DO tJo-' GREASE TRAP:-I (locate on site plan) Depth below grade: j Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from butto^ of from M hn1inm of oWle! tee o• ba?Ile' 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, elc.) (revised 8/15/95) 6 I . a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: IQ c� arv., Owner: Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP —Other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_&bT (Locate on site plan) Depth of liquid level above outlet invert: Comments: (note ii levei and distributJw, eyua:, e% drncf of sulid_ ca:r�o�er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:—Lt (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /Oa,l.1ww.�w Owner: CSJk�v�euw.c,� Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: ' leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) 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 ground��ate-. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (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.) (revised 8/15/95) B ,i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) Property Address: 60 L -V� ,Lw-M,-p, cc ti z--,, Owner: � O" Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �wvu�f'i 1 i DEPTH TO GROUNDWATER Depth to groundwater: feet 1�>�1�cWtex�S method of determination or approximation: (revised 8/15/95) 9 ASSESSOR'S MAP NO. PARCEL l9 C';-, ION /® `�� ''� SEWAGE PE R M I T NO. V,J, L L A G E INSTALL 'S NA i ADDRESS CT BUILDER OR OWNER DATE PERMIT ISSUED - R6 DAT E COMPLIANCE ISSUED r�� 1 `� j® �. � i �.,��`- �� - �-- i �� . � J � . � � � , �� . � ,` r_ � No.... ..... . : '�� Fims.....�-�-:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . 1 .. ....................oF............... ........................... Apli iratiun for Diipugal Workii Tomitrnrtiun frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. .....1-:4.iam ...............p1.�s. ............... __ ---- -----__--..............._..................... L ca io� Ad 'Tess or Lot No. ----------------------__.`.......---•-•-•.•------�-�-`.......- ....._._._._....•---••-- Owner Address a ....................•--•••------•..::...----........----•---._...•--------._........----•------•-- . .......•---------•---•--•-•--•----•-----•----------........-----•-••------•---•---•---•-•---...... Installer Address Q Type of Building Size LotJ5 4'(I ....Sq. feet U Dwelling—No. of Bedrooms.....__............_....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a 1 Other fixtures ............................ W Design Flow..........J__.!Y3....................gallons per person per day. Total daily flow-------- 1)..........................gallons. WSeptic Tank—Liquid capacity-1441_.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... 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 ( ) ~" Percolation Test Results Performed by................................. ".AIt.'D..................... Date...,S.�U�&? ................ a Test Pit No. 1 ------minutes per inch Depth of Test Pit--- ........__ Depth to ground water,.__ _ ___________ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil......- J A�• �-� =� } x 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 TIT E 5 of the State Sanitary Code—.The undersig d f rther agrees not to place the system in operation until a Certificate of Compliance has been is y the b r ,f h lth. Siged . ---•--- •-- _-• - -------• ---•---------•----• ---��5 `8 Application Approved By......... . -`•!`-•=� ............................. ` ......... ..............'.Z�e�� .... Date Application Disapproved for the following reasons:.--• --- ----••----•-••-•----••--------•--•------• -••-•-•---•----•--------•-••••••----•-•...-•---•-----...... -•-------------------------•------•---------------------------------------•------•---....--••-------....--•-•----•--•--...-•---•-•••------••----•-----•-•-•••----••---•----•-----•--•---•••••--•••--•--- Permit No.--. 1\ - Date--------------- Issued_----...---•-------••--•------••------------ ate.---... Date W Ficig THE COMMONWEALTH OF MASSACHUSETTSH-\POARD A T HE .......... .........................OF....................-......... .. ! . . ...... ...............:-......................j� ... . Appliration for Disposal Works Tonstrartion rutnit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: / y L ....... 1 ............ ------------------------------------------------------------- S res ................ ...L..o..c.a.t.io..n- ............ ....or Lot.N..o.......................................... ......... 0;.e Address .......... .......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons........_....._..__......... Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. Seepage Pit No..................... Diameter.................... Depth below-inlet.................... Total leaching area..................sq. ft, Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by.......................................................................... Date........................................ ►-j Test Pit No. I................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........................ .................................................................................................................................. -----...."--------- 0 Description of Soil............................................................................................................................................. ...................... ......................................................................................................................................................................................................... .................................................................................................................... ................................................................................... Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal Systemin accordance with 1, e, the provisions of T I T LE 5 of the State Sanitary Code—.The unders* �2d fu her agrees not to place-the system in operation until a Certificate of Compliance has been Ys nnocce by the bo of th. Signed ...... ..... .—V.... . . ........ ................... .... Date ApplicationApproved By......................... ....... .... ............................ ............ ............. ........ . Date Application Disapproved for the following reasons:.......................................................................................................... ......................................................................................................................................................................................................... Date Permit No.l-'..- ...... .............. IssuedL............................................ ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 ....... .... . . ....... ..... je..................................... .............OF.!.:.: (firtlifirdr.. if plinurr THIS IS TO CERTIFY,.ThA,the Indi d7uSewage Disposal System constructed or Repaired by................. ............................................ ......----- ............. .. . ......... v.....(.................................... I taller at.......L'6 t-1 . L' i k�•� r ........................ ...... ..... .. L ------------- ------ ------------ ---------- "Se .. .... .... describe in the has been installed in. accordance with-thCjD'_rq'visions of TI Wo The � �;,� . - e State Sanitary ode as descr application for Dispoi-aiAV Construction r ... ... orki nstru e ffiitN6._#' _�._._._L�.AP........ dated.--...... . ..... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY'., I/ DATE....................... .......T.3............................ . Inspector........ .. ..... ..................................... THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEALTH ..............OF...... :�.................................. No.1 ..........a.... F Disposal Works Tonstrudion rnmit 14 Permission is hereby granted...........�,P�Jelyll............. ........................................................................ to Co'ns"d or,,Repair an Individual Sewagp RispoW System ................ ...... at NO(,. A _�...... ....... 7 Street & as shown on the application for Disposal Works Construction Pe mit NoA. .O Dated.....7!"- .......... ............ ................................... -------- �Qth DATE............ ..............................).......................... FORM 1255 A. M. SULKIN, INC.. BOSTON � �. � ►�.. SYS IF-k-o\ vEIS\(J�A S a 2. L% L W Yr-- 4vA °j -- - - _ , 1 o.4 l.�-ate_ '471 : LESS T pia R' 2 t•'t sJ ' 1 Q cN kit •.. 51�.1 L�--�-��'t�L`( , � l3EAR.oat� � 450 pISQDS�L � ��'.._ r„-- r � �S-pT1C N oy- AL DiS9z>&NL Pi-r o- . 1.,E l�«I) Cfl o o C,�t�• t�li�1 � �f �Q �f f W1TJA -dr' Mi+J• CUjIKE-0 SZONE tipbE �IotVA31. \5j e, 2-.3 2b Lo-r 1'1 3o 3J +15 E- l T S _ L2 No (,9,.aQVA0 ATFLY, Po1E e IZLtV l5 STY"- Cf�5SUr1�,r� ILL*b v� F. Go I.FS � • -i==- �uV� 2Z . o � fp --- - ti D I ST 1 Oo a .` •• y- lao n U�L. P►T RAF E�LE.NCE �1 ►T 11 „Qt,t}kEp L,C• P hu 3Ti 1t a� pEEo S, C E117 F Y "C K KT TK C �� (�vS�•r� S k �M P�Y S 1Y ti �E.T R a ID ORAL NORTHERN ASSOCIATES, INC, i II BALLAR D WAY . L AW RENOE k1A,. 01840 TEL , 915 7110 ALL SYSTE SHALL SYSTEM PROFILE M RKf D WITHCMAGNETICTTAPE OR BE NOTES (NOT TO SCALE) COMP4RABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS APPROX. NGVD u{e ACCESS COVERS TO WITHIN 6" OF FIN. GRADE o 2$ 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTINGTOP FOU I El 27.20 FILTER FABRIC OVER STONE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE • 26.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. CID \ MINIMUM .75 i 2% SLOPE R IRED OVER SYSTEM OF COVER OVER PRECAST o _ 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS T(TH-10 UNITS TO BE AASHO H-1Q t Road 2'0 4"OSCH40 PVC S R��e PIPES LEVEL 1ST 2' 2" DOUB�& WASHED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. OR GEOT ILE FABRIC 23 O' �' d ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 3 10" EXISTING 14" ;y WITH 310 CMR 15.000 (TITLE 5.) N TEE SEPTIC TANK** TEE I oo cudder y 23.3 f oa0000000000 0 22 5' 0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND L cu GAS BAFFLE..` °°a000o°o°o° NOT TO BE USED FOR LOT LINE STAKING OR ANY 22.68' 22.51 ' 80 2' OTHER PURPOSE. g - .2q 20.5' ` 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �''�'�� ..�' �• `• 6" MIN SUMP H-20 3050 INFILTRATORS *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 12" MIN INTUM DIM. 9. COMPONENTS NOT TO BE 1ONBACKFILLED BOR OARD �o��• �� UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2' DOUBLE WASHED STONE CONCEALED WITHOUT INSPECTION DY BOARD OF PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM HEALTH AND PERMISSION OBTAINED FROM BOARD a a�� tom P **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT COMPACTION. (15.221 [2]) OVERALL DIMENSIONS TO OIJTSIDE OF STONE: 34.9' X 8.25' OF HEALTH. 0� St• 5' 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 6. WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE ( 3 3% SLOPE) ( 1 % SLOPE) CA CONTRACTOR SHALL BE RESPONSIBLE FOR ' CALLING DIGSAFE (1-888-344-7233) AND -- _ S��P'---...'� CONDITIONS IF NOT SUITABLE LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION EXIST. SEPTIC TANK 19' D' BOX 3' FACILITY WORK. O KHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE BOTTOM TH-1 11. ANY UNSUITABLE MATERIAL ENCOUNTERED A IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR NO GROUNDWATER FOU D 14.0 ASSESSORS MAP 422 PARCEL 63 BY HEALTH INSPECTOR _ _ _ �5.2, SH LL BE REMOVED 5' BENEATH AND AROUND E J PROPOSED LEACHING FACILITY. \ \ LITY SHALL BE PUMPED PAPERWORK AND HEARING REDUCTION PROPOSALS APPRO D \ \ AN)12. ERE REMOVED OR PUMPED XISTING LEACHING CIAND FILLED WITH CLEAN IBY THE BOARD OF HEALTH REVISED DURING A PUBLIC \ SAND. HEARING HELD ON AUG. 4, 2009 \ \ 2) FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO \\22. FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED \ 36 AND INSTALLED (10' OR GREATER ALLOWED). \ \ 22.65 SEWER LINE MUST BE SLEEVED E CROSSING WATERLINE IN AREA SHOWN. prDc RE \\ 11 � 34 .SYSTEM DESIGN: TEST HOLE LOGS \\ \ N UAL 2a GARBAGE DISPOSER IS NOT ALLOWED ARNE H. OJALA, PE, SE k 22. \\" POLE 32 ENGINEER: \ X 27.16 DESIGN FLOW: 3 BEDROOMS 0110 GPD = 330 GPD WITNESS: DONALD DESMARAIS, RS \ 6 < GARAGE USE A 330 GPD DESIGN FLOW \ 1 LIRE // 6.76 \ SLAB 3p DATE: 11/14/11 \ 7 Q2 �2 o8 SEPTIC TANK: 330 GPD (2) = 660 PEIRC. RATE < 2 MIN/INCH T 22.35 2.81 s _ _ X5 3o a PAVED - RE-USF.. EXI STING SEPTIC TANK** ` 57 � DRIVEWAY 94 -SLEEVE WATERLINE WHERE �-`- CLASS I SOILS P# 13464 - ( 180INV OUT /i126.76 27.97 WITHIN 10' OF SEPTIC 23 X 923.26 �\PI EL.=23., 39 COMPONENTS LEACHING: � 6.30 SIDES: 2 (34.9 4- 8.25) 1.85 (.74) = 118 GPD ELEV. ELEV. 23.10 EXIST. ST** 27.0:� 4 4 1 24. 6 - 099 25.0 0" 25.2 J 1 �, �,1 / L�24 �03 � / 6.55 BENCHMARK TOTAL: 447 S.F. 331 GPD 21" FILL 12" FILL 1 32 5. 4 TOP BRICK LANDING 1 24 TH 1 / 5 ELMETER EL.=27.7' USE (4) H-20 3050 INFILTRATORS, 71 A/B A/B 24.7 I 71 4.6 / �� EXISTING 3 BR WITH 3.25' STONE AT ENDS AND 2' AT SIDES LS LS I PAVED , 2 \IR DVELLING 1OYR 2/1 1OYR 2/1 I DRIVEWA� OX 1 6.50 TOP FN N. 24" 15" s.o7 25 0" \ 26 93 0 26. 1 _ J \ \ 01 �n' �26 C E E I - `27 NIT .43 � 7.o LS LS \ MA 30" 1OYR 5/1 18,. 1OYR 5/1 �2a \ 26.34 APPROVED DATE BOARD OF HEALTH 2��-- 2 \� B B LS LS _ • . . . 1 36� X 46" 10YR 5/6 21.2' 40" 10YR 5/6 21 9, / 2 230` 2 .33 TITLE 5 SITE PLAN 1 30. OOL C C 5' REMOVAL OF UNSUITABLE SOIL REQUI - ��5(•P OF AROUND PERIMETER OF LEACHING FACILITY, PERC DOWN TO SUITABLE SOIL LAYER. REPLACE 29 X 25.9 X 24.02 WITH CLEAN MED. SAND, TO MEET -28 X 24.42 102 LIAM LANE MS MS SPECIFICATIONS'OF 310 CMR 15.255(3) 31 6 PROVIDE APPROX. 51' OF 40 MIL LINER CENTERVILLE 20.5Y 6 130" 20.5Y 6/6 14.3' AT 5 230SABOTTOM AT EL.S IN AREAOWN 1. OP 132 /6 14.0 2A.79 A � PREPARED FOR . NO GROUNDWATER ENCOUNTERED GARAGE OFMa OF4Mtq 0L.8 ACf D.ANIE! ORTOLOTTI CONSTRUCTION/CATHIE p GJA L A. a � �it> NOVEMBER 16, 2011 N 40980 EXISTING DWELLING PROP. LEACHING IS > 200' TO WETLAND � g° +Q�� s �' off 508-362-4541 X 41.56 �� M�,�s�c °��'`0, Irk+ E = � fax 508-362-9880 D I L yc� QJALA I downcape.com r� 0� No.46502 A. A CIVILdown cape engineering, inc. �80 P ��G/ �� civil engineers o Scale: 1"= 20' 1� `'t�' ��°`aM I land surveyors j 939 Main Street ( Rte 6A) 11 -258 o 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675