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HomeMy WebLinkAbout0615 LUMBERT MILL ROAD - Health 615 Lumbert Mill Rd Centerville A= 147— 118 - 002 71 S �,r L rA 0 1 No. H1630R UPC 10259 smead.com • Made in USA � Oyu 2 m f y Commonwealth of Massachusetts 1 q I f 0-O� - Title 5 Official Inspection Form I- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name / information is required for every Centerville ✓ Ma 02632 1/26/2021 page. Citylrown 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. Important:When filling out forms A. Inspector Information SI* ( SI'iq on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 City/Town State Zip Code r 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1/26/2021 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts 1- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 615 Lumbert Mill Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a row of Infiltrators. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) 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): t5insp.doc-rev.7/2612 0 1 8 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5ins .doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface P Pe S •Sewage Disposal System Page 5 of 18 P Y 9 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M e 615 Lumbert Mill Road �Lr+i Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per Y(gPd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: system repaired 2004 Were e e sewage odors detected when arriving at the site? Yes No 9 9 ❑ 5. Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.� 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 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 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts fd Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ( F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching facility was video inspected and found with approx 1"of standing water and no signs of past overloading 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 l � ( 1 3� 2 2y � �2 37 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 Lumbert Mill Road v Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 615 Lumbert Mill Road Property Address Thomas Nutile Owner Owner's Name information is required for every Centerville Ma 02632 1/26/2021 page. CityrFown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7l26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ` TOWN OF BARNSTAB14E =tt i / fl, LOCATION (� L � M i N 1 s AGE# O/ VILLAGE ASSESSOR'S MAP&PARCEL k Lk1 a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Q)( LEACHING FACILITY. (type) (size) ' NO.OF BEDROOMS OWNER- PERMIT DATE:Tr�6 _ COMPLIANCE DATE:NJ 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 facil}Iy)� G` Feet FURNISHED BY } F S - -3s No. `-'�C�' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS VY-s Wnation for Misposal .pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. S W,nn�y{,—� a°'11`t 1 Qd Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 141 i tl o Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. k k3 Ot6 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 JyMi Board of Health. / ` ta,7 In iSn / Date / G Application Approved by / h ,� t Date Application Disapproved by _ Date for the following reasons 4 CD Permit No. r Date Issued -- - --------------------------,_rra sv v _� _ __�_ ___ ----- ----- ------ ----------- -- ---- _ _ No. v/ "/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplication for MispoSal 6pstem Construction Permit Application for a Permit to Construct( ) Repair Qo"Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. (��,��,o(��� M i t\ Q J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel u C� '`"�� �` 5�-►5 Q6�e,��b Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ryt !; ;. � Type of S.A.S. Description of Soil ,; y- Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued y/'th Board of Health. tgne,�d .� rr, Y'S Date Application Approved by /� Date ' Application Disapproved by '� / Date for the following reasons �'' `' • r Permit No. / Date Issued -------------- -- - - -__ -- ------- ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS r (�� BARNSTABLE,MASSACHUSETTS Certificate of Compliance L/ N THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired('-,I Upgraded( ) Abandoned( )by �`�[ c� �=r-t�/�•� _, at �"'' l�1 r-. r 4-- f`'1 �\ (Z C,c��'L1dhabeen con cted in accor nce -with the provisions of Title 5 and the for Disposal System Construction Permit No. Kted Installer Designer V r b C� r•. ��u-� #bedrooms Approved design flow gpd The issuance of this permit s'all not belconstrued as a guarantee that the system will'functiop as d signed. �� t Date � ra, 1 �J Inspector -- - ------------------------------- - -. - -------------- --- -- --- --------- No. s 5Fee THE COMMONWEALTH OF MASSACHUSETTS / PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Mi posal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located ate 57 Lw-,l�k 1-,i t\ (2 d 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 t'nust be c`mplete. within three years of the date of this permit. Date Approved by F / No. `-' { `� ' , �f yam FEE v Board of Health, MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(' Repair( ) Upgrade(a Abandon( ) - 3/Complete System ❑Individual Components Location 615 � Owner's Name b . Map/Parcel# Address Lot# 9 Telephone# Installer's Name Designer's Name (- t'C S " GGi_-e-S Address Address D\A Wbr . er a Telephone# Telephone# 5 '� Type of Building 'Si n P 1,I,% -71i( �s Lot Size 51/i CJD sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided 38LI gpd Plan: Date 101gri)Do Number �of�sheets 1� Revision DateDaat'e ` ' Title �,L lr � is )C1 yPC� S Ip—M n\o � cP�a ur5r�\. 1�(- N it�loS Description of Soil(s) e. QP1 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation(-(`A 2J DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aLTees to not to cet system in operation until a Certificatuf Compliance has been issued by the Board of Health. Signe Date Inspections FEE ICO No. Board of Health, rn tC�I���_ MA. t APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(," Repair( ) Upgrade( Abandon( ) - O`Complete System ❑Individual Components Location (�1 h rlr ' e _ Owner's Name .1 Map/Parcel# 1 l '� — -� 11' -O� ' Address Lot# ri Telephone# Installer's Name Designers.Name �2 rc, S. oC,la�-es Address Address i W A Telephone# t Telephone# �-/ _ Type of Building S n q)e (t nA I 1-sI Lot Size 5171��D(, sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) ;5J0 gpd Calculated design flow Design flow provided 3UL4 gpd Plan: Date )Q Q4;��Zia Number of sheets Revision Date Title llsc�ir/ade_ \,t )0 Q P_ b�s�\ C_-jU S_� ( f',t np('a p a red W-)r ,mod 'f i r k,U IQs Description of Soil(s) `"ZPO �,Q(1 ^ It { z 4 {'at', Soil Evaluator Form No. Narne`of 4oil Evaluator ,nee l met Date of Evaluation( �) , Q � r , DESCRIPTION OF REPAIRS OR ALTERATIONS , The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place late system in operation until a CertificaKelf Compliance has been issued by the Board of Health. SigneqA94OS6 ��v( Date r�lC1� ¢ Inspections No. (0 FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, �R� b \D , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) 13(Complete System The undersigned hereby certify that the Sewage Disposal System; ConstructedRepaired ( ),Upgraded (,.Abandoned ( ) has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5)and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspec r: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. CDC FEE /0 Q COMMONWEALTH OF MASSAC14USETTS Board of Health, \Q S\--"'b�\Q , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at r—�" 1 �M� ( �� ,Q �\e _ as described in the application for Disposal System Construction Permit No. a�cl^�`��,dated l ?1G� Provided: Construction shall be completed within three years of the date of th- permAllocalGonditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 117A I Board of Heath._ t �r � Town of Barnstable Regulatory Services. Thomas F.Geiler,Director �* Public Health Division ® Thomas McKean,Director 200 Main Street,Hyannis,lllA 02601 Office: 508-862-4644 Fax: 508-790-6344 Installer&Desiguir Certification Form Date: Designer: �����"� �S�of Installer: I�11GL - � Address: --le dt4,etias Sao Address: was issued a permit to install a (date) (installer) septic systa at IG ► - based on a design drawn by ��---- (address) datedT%2.3 (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. • it 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. hA A.A I%AAAL. _R(kOF112< .y, •er S igIIc t �!) RICHA` G� O U N y NCcc 90 � RAJ— .. '� Rf�I•,-�.O (Designer's Signature) er's tamp ym PRASE RETURN TO BARNS T LE PUC F lD ION. CER CATS OF CONOPLLANCE WUX NOT, BE ISSUED UNTIL BOTIR THIS FM'AND BUILT CARD ARE RECEIVED BY THE-BARNSIABLE PIJ4LIC HEALTH_DMSLON. TEL Q:He4tb/SgUeMemper Certification Form T .d ebb =OT b0 02 z00 3 a_. _ _, .'" - ,s r:y_,•-r?..�_.!,.t.zz, — _'�,f CaheL_"' - '.'4..:1 a+_-�'r..+.- ...�.n_..- .u.�,___v.--r_ o ..^J+--.-.,.-r..- ••� - -Y. •a tit\, � r f�l � t � • 1 �t „ p rTOWN OF BARNSTABLE LOCATION j f I SEWAGE # VILLAGE 1--tar ASSESSOR'S MAP & LOT 7” I 'nD2 INSTALLER'S P4AME&PHONE NO.M all I/e, SEPTIC TANK CAPACITY- 16,16 n1J • LEACHING FACILITY: (size) NO.OF BEDROOMS BUILDER OR OWNER Wy qo PERIt4ITDATE: _`I — 11 9. COMPLIANCE DATE: Separation.Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility tj 6 (4. Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) � ah q—, Feet Edge of Wetland and,Leaching Facility(If any wetlands exist within 300 feet of leaching f ili ) Feet Furnished by aA 46,AL9 • i 3 rARKIN bAR 61-s- r � TOWN OF BARNSTABLE L6CAT7ON + (-u ix FJ `f— t t/61 SEWAGE #A 0 hr ---'�:A,LAGE --,9�Ag-S�SSORS MAP & LOT IYU INSTALLER'S NAME&PHONE NO. - ail 11 SEPTIC TANK CAPACITY 1606 I LEACHING FACILITY: (type) �'�o��"6,.''�:ri'S (size) NO.OF BEDROOMS � BUILDER OR OWNER UL 10 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 6 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ��f nN c Feet Edge of Wetland and•Leaching Facility(If any wetlands exist within 300 feet of leaching f ili ) 1 Feet Furnished by ►'111 f t�►nn AI. t�./�-� P j Ft f 31 133 K R �L P -------------- �. pt ASSESSOR'S MAP N0. PARCEL Lb CATION (�. � SEWAGE PERMIT NO. Y`�° ILAGE � bts e P.In �P ►r" c./1 P �INSTA LLER'S NAME i ADDRESS � i i1 C � � 10�.�'b ��t�l S'�d'i.9�t l�► I�'t 'Teic- u ice Ba q iqcL 10ojoit e U I L D E R OR OWN R DATE PERIMIT ISSUED DATE COMPLIANCE ISSUED 2 - hz: . rP - 6 No � SloWECT TO , , .Fsa. THE COMMONWEALTH OF MASSACHUSnT�sCABLE BOARD OF HEALTH COfV MISSICA ...................:........................OF........................................................................................ Apphrativu for Dhipvii a1 Workg Tontitrnr#iun Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l �G r e s� ���f C... ... _ t} ..... . . -••-•----•-----•-•--•----•••-•-•....................•--... L cat' Address or Lot No. r, ...--------- ...2 ...M-6� r .4s�` Ar,. :--- ........ . . . � vner Address - Installer Address Type of Building Size Lot_64,13 ......... feet U Dwelling—No. of Bedrooms.._........`3. --_._.:-•---___.--•_.......Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------------------------------ W Design Flow_______ _ _ ________________________gallons per person_,,P r day. Total daily flow_____ _ ......................gall W Septic Tank—Liquid capacitylPd.Ogallons Length.ff-! ..__.. Width..Y_�_ __. Diameter................ Depth_�r..4Y.11 __. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........__.__.... Diameter....... ......... Depth below inlet........ ..�._._. Total leaching area.. jki.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � I9r9� Percolation Test Results Performed by............................•....._-••-•-----•--1--------•-----•---_... Date.. 1......-®✓------. a Test Pit No. 1_..? °....minutes per inch Depth of Test Pit... .1._-....... Depth to ground water.:-7_.............. f3 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ -------------------------------------------------•-•----.......-....--------••--•-•---------------_-----.................... ------------------------- 0 Description of Soil.-- -`-` - -- d _ s�! Sa> /c � . src , L$ . •-•------------•--------•-- -••--..-•-- -- ......--•-•--------•---•.............•--•-.....-•---------------•--•---•-----------. 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 iIli U 5 of the State Sanitary 99de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ssued y the b and o.deal . aa YSigned.. .............. �1- �'1 ..._.... Date Application Approved By........... ...•. . .... . .. ........... .....U. ----•----- Date Application Disapproved for the f 1 owing reasons:-------••---•---------•--------------------------------•---...-----------------•-----------...-•--.........--•- ..•-----•..................•-•----•-------------.............._...--------•--•---•--•.....------....-•-••-•-------------------------•--••-----•-...---•-•----•---•---•--••-----••••----•--•-.......----- Date PermitNo......................................................... Issued---------------------................................. Date No......................... Fxs.....................f........ . T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...--... .................................O F........................................--------...............-----...................... Appliratiun for Disposal Works Cfunstrurtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:.. ....:......................................................................••---..............___- ••----•••---•-••-•-•--••-•........•--••-•••--••----••-••-••••••-•••-•.......-••••.....-----....... Location-Address or Lot No. .............. .........._ er•• ---------••-•---••--•------- ---------------------------------•-----•---• •--•••-------•-------•----_-----------••--- Own Address ram= Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. J y 1x Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... aTest 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' •••••-•-••---•-•••--•-------------•-••-•..................-••••••••............•-------.......•--....•-•......-•--••-•----•••-••-.........._...--•----•_----- 0 Description of Soil..................................................................-----•-----...----------------•-----------••----...-------:...--------._...-•-••-•-•-•-•--••------•--- x U ....----•-•••-•-••------•••-•..................................•----•-•-••-•-•-•--....-•--•----•••-•••--...--------•••••---••••--•--•---•-•------•-•----•---••--•-••--••--------••---•-•--••-•--•---•--- w x -••-•••----•-------------------------••-••--•----•------------•-•---•--•••••-•-•-------...-----•--•------------••----•---•-•-----------•-----•-----•-•----•--••-----•-•---------•-••------••-----••_.... 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 TITIE 5 of the State Sanitary Ade—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b9ftsued y the board o eal Signed. --_-•-... -•- ! ..------------------------------ I D..t Dat Application Approved By-•-•----•- ---• ._.... .... . .......... ........... 1� F�....- Date Application Disapproved for the f owing reasons:.............................................................................................................. ---••-•---•••••----••-----••-•------•--•----•-••-----•-••--•---•-----•-••--•-----•---•--••---•-.._....-••-••---•••-•---•----••••----•-••---•-•-•--•-------•••-•--•••-•-------------•------•-••-•-----•-- Date PermitNo....................................................... Issued:......................•---- Date THE COMMONWEALTH OF MASSACHUSETTS / - BOARD OF HEALTH ( WN O F.......(.. .:. . �rf LC_ Trrtif irate `of Tnutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-•-•-•-•••••-...•... -•------...._�---•-•.....................•s-•--•••---•••-•--------•--...........-••..._...--_-- I al e., has been installAd in accordance with the provisions of TIT F 5 of The State Sanitary Code,as described in the application for Disposal Works Construction Permit No--- tom " ....... dated-------If- __ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYShM WILL FUNCTION SATISFACTORY. .... ................................... Inspect f -4L---•--------•-•---.......----------- 7�_ f �J {✓le!�ibAjI%V 'lEt4610 kICIt THE COMMONWEALTH OF MASSACHUSETTS —t1-tC aySt1En, f4 .S-( IM vs-r BOARD OF HEALTH C4dTf1Ae_j) 16� fNIE >a. `fN£. .1 ►tit F GIc x0jS`4,tL4'-1►00, � 171E 5►!a/V��vC7 pwO iN eep, `. `U.......OF.......- ` ! ORE— .... 33 FEE . ............... Disposal Works Tunutrurtum rrmtt Permission is hereby granted_.._. " " Ul_ �-f .p��L i ........ o e �.p.. ..................... .._....' to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No... .. Lsr4VL -1 - 1 I-I- j -------- Street '— c� ./ � �^ as shown on the application for Disposal Works Construction Permit No�'��'."/____ _ Dated_._._ _--- ----•--------------- -- } ��2 /� r ealth DATE----- -.....--------------.................... FORM 1255 A. M. SULKIN, INC., BOSTON L "— j ;I C�. �.L'JV�J T I'' `l J Lo; L 0'r i!7,p, s G� rr .O/jj"(y i I i. 3N loq 0 30 l p / to 10 � IYE�LNiO'✓��� III l��is - ?�.. .. L P 1110 G A�° ��'f I �' �•� `x" L or 70 F 41 ALBERT �ul ttOtiERT aJ, r A• .1 t1.' MORSE N ; - ELDHEDGE \ -z p No. 10951 Q �`` rdo. 19337. �o 2\ s PptISTE LEGEND - . v�-�-�'`�•�.� '�ti �ate. �: . . � _ . EXISTING SPOT ELEVATION 0 x 0 CERTIFIED PLOT PLAN EXISTING CONTOUR FINISHED SPOT ELEVATION 0.0 FINISHED CONTOUR 0 L. Mi,t,:.T �_. - IN APPROVED = BOARD OF HEALTH -44 DATE ',: ii./ors AGENT SCALE: I " = .� DATE r:FENCGINEER DGE ENGINEERING CO IN�G CLIENT _�� I CERTIFY THAT THE PROPOSED ISTERE REGISTERED JOB NO. i.` 4 / _ BUILDING SHOWN ON THIS PLAN IVIL LAND CONFORMS TO THE ZONING LAWS SURVEYOR DR.BY= Jn-r) OF BARNSTABLE , MASS. 712 MAIN STREET CH. BY: ELL;,4AM 16 HYANNI S, MASS. SHEET I OF D TE REG. LAND SURVEYOR A PIU^5C3J woo D77 CZCL +; 1^44L11,97:5:1 r 1020 how i { r oov Graz l 'y V ( L oT TD 1QEMLVETs Fog- /0 Ar r)gou"D �AGII �rT Ti T LE x\. Lox 10, mi p - t0 t 71 -56 OF - 9, v; -No.1095 O;Q I Ewe nF'.� � a LEGE `EXI,STING ' SPOT ELEVATION. OxO CERTIFIED PLOT PLAN EX-1 STING—G0NTOUR•----0._.__ — FINISHED SPOT ELEVATION 0.0- I Lori% X �':�"Z o'Lh FINISHED CONTOUR 0 I u ,APPROVED BOARD OF HEALTH N IN �-vv sir i° �.•�+ DATE AGENT SCALE: 1 = to DATE2mAr. 4 8 LDREOGE ENGINEERING CO. IN _ CLIENT /\licku�A' I CERTIFY THAT THE PROPOSED I 'REGISTERE REGISTERED JOB N0. 841oti BUILDING SHOWN ON THIS PLAN CIVIL • LAND CONFORMS TO THE ZONING LAWS ENGINEER` LSURVEYOR �R•®Y' '� OF BARNSTABLE MASS 712 MAIN STREET CH. BY: R&E , �9hn� HYANNIS� MASS. ---. � : , .- SHEET... OF 3 DATE "REG. LAND SURVEYOR , r, I Completed by 2)FA: t,G Y,..._._. liIGfl GROUND-WAILR LLVLL ,[:Ut1f'UTATION 3` S i te. Locat ion Lor 7/ Lum(3FPT !• �� lgesroNs M, Lot No. Owner: 1icKULw�_. Address Contractor.: Address: Notes: .. STEP - l Measure depth to water tableR .%' to nearest 1/10 ft. . . . _ . . . . . . . . . . . . . . . . 2/2e1;? date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and .determine: A.) Appropriate index well . . . . . . B) Water-level range zone . . . . . 11C --- t STEP ' 3 Using monthly report"Current f Water Resources Conditions" (. determine current depth to y .3 water level for index well . . . 2 /es- r mo yr l STEP ' 4 Using- Table of Water-level Adjustments for index well STEP 2AJ, current depth to J' f i� water level for index well NY (STEP 3) , and water-level -- g zone (STEP 2B) determine water-le vel adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP 5 Estinate depth to high water by subtracting the water- level adjustment (STEP 4)from measured dept.h to,water level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��JJ Lnr fl V,7J :IJ, r.,I'� .,yam ` lJl/r-- /-' /',.,. .i �l �/i0/G�•/'�'Jn/. PL 2-9.772VAL ' \/\ jj L,:)w fe Io5 , N xq 11Oil `,� - � �� •tip. ��FlG .1pI'� c_ tA P w/ n L 0-r %Q t ,fl ILnT f. � i ALC3ERT. �Lp /NOEiERTA. G� pC3 CDr-MORSE N .i LDHEDGE -z o p Nls co' 1u95L�Q \ (:o. 19337 �o i 9 FO P �y .'2� \i-ISTE sy LEGEND EXISTING. SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 - - - � — FINISHED SPOT ELEVATION 0.0� FINISHED CONTOUR O IIN APPROVED - BOARD OF HEALTH J v/ .. DATE AGENT SCALE DATE : LDR£OGE ENGINEERING CO IN CLIENT':-�. , I CERTIFY THAT THE. PROPOSED ME GISTERE REGISTERED JOB NO. ` L4 loq-6 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY: JDI) OF BARNSTABLE , MASS. 712 MAI N STREET CH. BY: 12BFjAA HYANN I S, MASS. SHEET I OF D TE REG. LAND SURVEYOR N07E.., IFEtTiYER ;TH,FSEPT/G Al � /D�F.T �lN. -'' ."rrR/►%7E�'A "24'D/�4M FT.ER. C`oyG'R.FT� EOkE.t .:.: SNALL.'BF BAP00Gf,/T_. TO G/�A.DE.�i47✓ EXTRA 'PYC plP� CONCRETE 1iEAVy.C.'1, T IRON Co�ER SiyALL.DE USF,D 1D5� CO YiERSJN. O/7tNYS.EyV�Q Y - <. +� • .. PFR t T. i 2�j. MAN. CONCRICTE A► _ dR�IDE COYEf. CL FAN SAJVO r _ BA.C.+CF/ALL '„- SCNEouIA40 i2 Z,LAYER Ii MIN.P?CIl /000 D/ST. ' • • • • s • . • • a •• WASHFO 5rONE SEPTIC TANK . , . :' . . . .0 # • , s . • Or • Old DEPTN • • • ' . o WASAF-P STONE - • /5/x 25= 377 S i s. . ; • a • a • • • 1 .�o PRECAST S-,cZrA6E e i� � • • • .� . • � • a o P/7OR EQVIY- _ 1AIMCA"r ertEYATiays INVERT AT 4[JILD/NG 02 FT. 49 9 '5 cow G D/f1 M. /NLE7 .SsEPT/C rAVK 102-2 fT. +2- f? D/�41►9, C(SFE�98UL.4TJoN� OUTLET SEf>T/C TANK 102 o FT. MfX�Lt✓ 93 4 INLET D/STR/6!?10N BOX /0/•8 A7 SECT/O/V OF GROUND )t�TER TIId,LE nErz N,cr. c✓arF�z k 0VrLErnW57'RfeuT/0N Box 101.6 FT S�yyAGE 0Iso05A t SYSTEM �e INLET LEACN1Xlr PIT J�L�_FT 7/4QVL/9TIDN. LEACHING P/T !T SCALE y4. _ / O' D/MENS/ON /+ 2 �' A DESIGN CR/TER/A DI�fHVS/oN go�—FT. N!./INdER OF BEDROOMS 3 '. D/MENS/ON C � FT.M��/ WROrtGEO/SPOS.lL UNIT �l� SO/L LOG sp1,�, TEST TaTAL ES'T/MD4'•rEG FL-ow 33(G.4L..1DAY SOIL. TEST#/ SOIL 71-ST0,2 � i NUMMe Or 4rACNIAa P/TS 1 f^ELEY.�Z� �`-ELEY. DATE OF SOIL TEST Fgn 2-Fr} 8E S/OIELrACNING PER P!T / s'O F7. _Z RESULTS Pv1,r VESSED OOT'TOM P/r1L:_S.Q. Fr. i-_ n /'E�tCOLAT/D!v P-ATE#/ 7'07A4 LEACH//vG AREA 2 64 SQ, FT. MIN.lI)VCIY QESERIVE LE,4CN/N6 AREA ?yu SQ. F; 2 _ MED,ur-►- FINE ? ti ��' ROBERT ALBERT S B. _ f�ND Lo^ 7/ Lc,m esaT MILL �� �I► m MORSE ELDREDGE rcRr✓r �Vo.10951 O o No. 19367 p r w �� `F QE C E� 71 G EL,DKEDGE x N 1.vA q1A* cov"AG- o� E S/ �`� `ssi Cl,TEk vg 7/2 MAIN 97'.p KYANIV/9, MASS- o� u�r.Q ti' r�,�} ❑ NO GRO[1ND yY,4TER E/VCOCJh'TEREO EL/ENT_:NrCKuLA 5 �T�'!•>'),a R'1 98J� h ISM OLIIVO WsiTER AT FLEi! qo "2 ✓4B /VD �4 ion �ML■1ET�.� �-- �... .. .. -_.. ..:.. ,.:. .._. ..m ,'. ..f.. '->Ktnw n,,,_,_,., .. .;-_.�c••..s•^*,e..--Asa,_r..^".1'.=.'>•�.3,..,^'o",ac.�.r� ^yzs'�'..:.s^.N.?ntt..-s.4.ffi..v,-+w...ax.M....»,......o .nr.sr.��-. LEVY& ELDREDGE ASSOCIATES, INC. ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS LAND SURVEYORS 712 MAIN STREET HYANNIS,MASSACHUSETTS 02601 (617)775-2244 June 6 , 1986 Board of Health Town Office 267 Main Street Hyannis, Massachusetts 02601 RE: David Nickulas Lot 71 Lumbert Mill Road - Marston' s Mills Job #84104-A Gentlemen: A final inspection was made on June 2 , 1986 , and the results are as follows: DESIGN AS-BUILT Top of existing foundation E-lev. 105.0 EIOV.:.105.2 Inv. at foundation . _; .:. 102.4 to 103.1 Inv. at Septic Tank Inlet 102.2 if102.8 Inv. at Septic Tank Outlet 102.0 " 102.6 Inv. at Distribution Box Inlet " 101 .8 " 102.5 Inv. at Distribution Box Outlet " 101 .6 102.4 Inv. at Leaching Pit 101 .4 101 .9 Bottom of Leaching Pit 97.4 " 97.5 The system appears to have been installed in conformance to the minimum design standards specified in our sewerage plans dated March 4, 1985, (revised 10/1/85). Sincerely, LEVY & ELDREDGE ASSOCIATES, INC. X15!�e , 3 Robert B. Eldredge, R. L. S. 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