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HomeMy WebLinkAbout0025 POINT OF PINES AVENUE - Health . 25 Point of Pines Ave., Centerville � A=210-108.002 No. 42101/3 ORA ESSELTE 10%(a 0 0 0 0 I Town of Barnstable Barnstable Inspectional Services ,AFMMcaCfiy anUNSTn:OLM& b 9 ,�' Public Health Division r o " 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL47015 1730 0001 4988 0831 September 19, 2019 FEDERAL NATIONAL MORTGAGE ASSOCIATION GRANITE PARK VII 5600 GRANITE PARKWAY PLANO, TX 75024 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 25 Point of Pines Avenue, Centerville, MA was inspected on 09/04/2019 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR J 5.00) due to the following: 0 The distribution box is rotted. You are ordered to replace the distribution box within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\25 Point of Pines Centerville.doc r- �k IKE Tp� " Town of Barnstable HARVSTAHLE. MASS 1639, A Inspectional Services Department ,oTfD µp't Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) (J Repair deadline: IVec^ r- O:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts a�D -�08-6 ad-.. - 1 Title 5 Official Inspection Form - � Subsurface,Sewage Disposal System Form -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name / information is Centeryiile V Ma 02632 9/4/19 required for every page. Cityrrown 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. lmng out forms A. Inspector Information S/ E /y�p�, filling out forms on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HIPS use the return Company Name key. P.O.Box 151 rab Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number 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 9/4/19 "ftector s Sign Date The sys m inspector shall sub a cop of this inspection report to the Approving Authority(Board of Health or DEP)within 30 d s of co pleting this inspection. If the system has a design flow of 10,000 gpd or greater, the in pecto nd the system owner shall submit the report to the appropriate regional office of the DEP. The rlginal form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. a. 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 cam, Commonwealth of Massachusetts �a - ,�,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass. ov 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," explain. lain. P P The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .< 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 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): Dbox is wrotted out on flow line and sand has begone to wash into box ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well ** Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® 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 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 . page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n = R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® 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 ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 25'x13'x2' 2) 500 gallon precast chambers. Existing home 2 bedrooms for 3 bedroom approvel must be made by Barnstable health Dept and Building Dept Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unkown Date t5insp.doc•rev.7/26/2018 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 4' 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: unknown 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.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts r -Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Cityrrown 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: tank unknown Dbox and leaching 1998 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 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: 20+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): o,k t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .. 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal H10 Precast tank �I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6"x5' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? 0 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tee baffles in place. level is to bottom of outlet no major decay or visable leaks t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c` Commonwealth of Massachusetts ,ip Title 5. Official Inspection Form l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Y/� 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: p 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 v 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. CitylTown 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 resent must be opened) locate on site plan): ( P P ) ( P ) 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.): Dbox is washing in with sand. wrotted through at flow line. needs replacement t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 112 of 18 Commonwealth of Massachusetts 'n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Cityrrown 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: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 25'x13'x2' 2 500 gal I.C. dry and clean SAS in good condition 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 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information.is required for every Centerville Ma 02632 9/4/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts h - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. CityrFown 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 y� 3? 3s- 3 Y t5insp.doc-rev.7/26/2018 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 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: 10'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: town GIS Mapping You must describe how you established the high ground water elevation: lot. el over septic area 42. pond el. 33.5 bottom of leach 4.5' below grade 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 !� Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M � 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for every Centerville Ma 02632 9/4/19 page. Citylrown 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 NM i� Fee��J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ptlfitation for Disposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair(V/ Upgrade( ) Abandon( ) ❑Complete System e1ndividual Components Location Address or Lot No. ia6 ci A�-cj Ai4 Owner's Name,Address,and Tel.No.,nV.-qY4? Lyl d Assessor's Map/Parcel alb 1 lob R' e 2-3 W le g(1 Ve 19d Installer's Name,Address,and Tel No. brS Uf)"$-$S a4�o Designer's Name,Accdddres ,and Tel.No. �0 •(I M tI ,CND nG•o Avg T e of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 104 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank `L' ISFVr� Type of S.A.S.'e-tCIS Description of Soil Nature of Repairs or Alterations(Answer when applicable) fb Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainte o the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental de and to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date / y Application Approved by Date Application Disapproved by Date for the following reasons pr Permit No. 4= ,J P Date Issued 1 L MN Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE, MASSACHUSETTS Ye application for Misposal 6pstent Construction 3dermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ,'Individual Components Location Address or Lot No.a�S ; 4- p AxeOwner's Name,Address, .and Tel.No.'JrJ(�.C�$� Assessor's Map/Parcel a 6 I coy A .� Installer's Name,Address,and Tel.No.j b t(a<,j signer's -87 Qco rDesign 's Name,Address,and Tel.No. �o�o UVIS Uc ICA c.rs39/�M 4 ] / / r p of Building:Dwelling No.of Bedrooms A 1 A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p, Design Flow(min.required) N /� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size:of Septic Tank P k Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 ! Ai r 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 Corde and gprfo place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign,e -�- �..._---- Date Application Approved by / Date �- Application Disapproved by Date for the following reasons Permit No. I ----�r�j Date Issued i --------------------------------------------------------------------------------------------------------------------------------------- �.. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by �� has been constructed in accordance With the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer I ,,. �,. Designer As r� #bedrooms �/ �/� Approved design flow r N gpd , I The issuance of thil permit shall not be construed as a guarantee that the system wil func')ons desi d. Date Inspector S .�`�(.� '.-- �--/� 4HE . No. COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposaf *pstem Construction hermit Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at Y n and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this( rmi� t. Date (( i Approved°b b � I? Y=m.�=1 Subsur€ace sewage Disposal Systann Fora -Not for Voluntary Assessments 25 Point of Pines Property Address Kirsh Owner Owner's Name information is required for evenj Centerville Ma 02632 9/4/19 page. City/Town State Zip Code Cate of Inspection D. Svstem Infoli oration (cont.) 14. Sketch 09 Sep age DisDt3S8i .7V$tet: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately I I i t5insp.doc•rEv.7262D19 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE FnoOCA N Z�� --'Q 1�1'f ®f g%,f1 e5 A i'G'- SEWAGE # �l VILLAGE C e.N1�elf V1 LZ e ASSESSOR'S MAP &LOTIt. oo-1 INSTALLER'S NAME&PHONE NO. J+ /> A4 %4 C'o M fe/t 5 a✓ SEPTIC TANK CAPACITY /1310 t 00/ i LEACHING FACILITY: (type) X a rl-O w C'd A lle ell(size) ii-0 b G A 6 NO. OF BEDROOMS_ BUILDER OR OWNER PERMTTDATE: 9 " I'6 -Y r' 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 r _ --� ��� -�. � R1 � O �� �-C, �� �3 � > . > �� �y.i i �J �y ' -�� � � � � �� - - a No. Fee THE COMMONWEALTH OF MASSACHUSETTSc Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for �Dizpaal 6pztem Construction 30ermit Application for a Permit to Construct( )Repair�X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.2 5 Point Of Pines Ave Owner's Name,Address and Tel.No. Centerville,Mass. 02632 Peg Kirsch Assessor'sMap/Parcel 25 Point Of Pines Ave Centerville Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. Mass. 02632 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XXNo.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder�O ) Other Type of Building RES No. of Persons 1 Showers(1 ) Cafeteria( ) Other Fixtures Tub water closet sink 1 -kitchen sink Design Flow 220 gallons per day. Calculated daily flow 2 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title .Size of Septic Tank Existing 1 000 Type of S.A.S.Existing 1 000 pit Description of Soil Loamy sand to boney sand Nature of Repairs or Alterations(Answer when applicable) Adding 2-500 gallon chambers to the existing tank & pit. Date last inspected: 1 /9/9 8 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Bo d of ealth. Signed o Date 1 /1 3/9 8 Application Approved b Date Application Disapproved for the following reasons 61 -n no -==Q Permit No. — Date Issued No. / Fee $ 5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , Yes ':. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migogar *p!6tem Construction Permit Application for a Permit to Construct( )Repair(XX)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 2 5 Point Of Pines Ave Owner's Name,Address and Tel.No. ,* Centerville,Mass'. 02632 Peg Kirsch - Assessor'sMap/Parcel , 25 Point Of Pines' Ave Centerville Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and`Tel.No. ass. b.3 J.P.Macomber & Son Inc. J.P.Macomber & son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling "No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder PO) Other Type of Building RES No. of Persons 1 Showers( 1 ) Cafeteria( ) Other Fixtures Tub water closet sink 1 —]kitchen sink Design Flow 22,0 gallons per day. Calculated daily flow 2 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1000 Type of S.A.S. Existing 1000 pit Description of Soil Loamy sand to boney sand :w Nature of Repairs or AlterationsC(Answer when applicable) Adding 2-5.00 gallon chambers to LL the existing tank & pit. Date last inspected: 1 /9/9 8 Agreement: The undersigned agrees to ensure�the construction and maintenance of the afore described on-site sewage disposal system in accordance-with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of.Compliance has been issu d by,,thi 'Bpwd ealth. Signed �k%/!r i% QDate 1 /13/9 8 Application Approved by _ 1 d Date 9 Application Disapproved for the following reasons `- -- Permit No ' K" Date Issued d. =a ——————— , ———=—— ———— ———— THE COMMONWEALTH OF MASSACHUSETTS ✓ s BARNSTABLE, MASSACHUSETTS , Certificate of Compliance ��.. THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X�Upgraded( ) ,Abandoned( )by J.P.Macomber & Spn Inc. at '25 Point Of Pines Ave Centerville,Mass. has constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J.P.Macomber & Son In$. Designer J.P. a %mber & Son Inc. The issuance of this pe hall not ctonnstrue guarantee that the system wilhff nctio a�s.deesigned. # Date n�_. Inspector ' �----� v � 1 -- — ——————————————)11� ————————————— No. f Fee $ 50 .00 THE COMMONWEALTH OF MASSACHUSETTS } PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpozat *pztem Construction hermit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 25 Point Of Pines AtrL Centerville,Mass. and'as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. *. Provided:Ca structio must be c/o 1 ted within three years of the date of thi§arnut. � ° o Date: Z l a Approved by: `r 4 k ' ` t v r slr ; *A r ., 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1,J.P.Macomber jr. _, hereby certify that the application for disposal works construction permit signed by me dated 1 /1 3/98 , concerning the property located at 25 Point of Pines Ave meets all of the Centerville,Mass. following criteria: ° 0 • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) 15 B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED : V DATE: 1 /1 3/98 LIC NS SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER o (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. ' q:health folder:cert Eiyi7'i,rl(1 208v 9y; kQJ4 ldl� 10-46 ® ID ® T' k. usTi ve o —(3 P;JV,S ,. TOWN OF BARNSTABLE: LOCATION / !�✓f OF41hle5 to _ SEWAGE 'VIILAGE C 2N1�PR V/LL e" ASSESSOR'S MAP&LOTeL lG•/oST- 001 II+ISTALLER'S NAME 8ti PHONE NO. �J /. /V1 /Q C�M 1.4e/C " S'C��✓ SEPTIC TANK CAPACITY /0 o D t f!/ LEACHII�IG FACILFTY: (type) Z"- F'LD Ll�Cf1 A N/4eR`(size) ..NO. FI�EDR00MS_�,. ..]BUILDER OR OWNER oy�_ .PERMITDATE: ) I ?� -`/ _COMPLIANCE DATE: :Se*ation Distance Between the: r.:Maxtmum Adjusted Groundwater Table and Bottom of Leaching Facility Feet >PCivate Water Supply Well and Leaching Facility (If any wells exist <<on site or within 200 feet of leaching facility) Feet :<Edgb of Wetland and Leaching Facility{If any wetlands exist : within 300 feet of leaching facility) Feet Furnished by ... ... ......... 0 1h I S LO CATION °'tS SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS -7!�7.3 ��,.y �� S• �.�-�.�-tov GUILDER OR OWNER DATE PERMIT ISSUED DAT E C 0 M P L t A N C E ISSUED No...(�..1 -431 FEB.. ..�......... s. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH " �•' .......----- OF...... 1-1-AL......................................... Appliratinn for Uiipnsal Works Tnnitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: //Location ddres or Lot No. --- �r.`'?_ `!c�`�-?l.:CiC.�--•-- -- •--- -!E _ ............................ ........•-------•--...--•--........_.........----................................................. w erg, ...... Address ................_....•...... ...................................... ....... Installer Address dType of Building 2, Size Lot.................... .....Sq. feet U Dwelling—No. of Bedrooms.............................. .. .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons...... --------------- Showers (Z — Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow.........:0.....................gallons. WSeptic Tank—Liquid capacity./_`Oft. .gallons Length__.._...._. Width..... Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area................___sq. ft. Seepage Pit No---------/'._...... Diameter......&...CL Depth below inlet......&—.y... Total leaching area.4.. _ ..sq. ft. Z Other Distribution box ( ) Dosing t94k ( ) c/ aPercolation Test Results Performed by..... .lC i'�A�....� .................... Dat�.QVA---_----•--------.-.- Test Pit No. 14elS.�_._minutes per inch Depth of Test Pit.................... Depth to ground water........................ IJ. Test Pit No. 2.'�......_._minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ a . ---- O Description of Soil...... ....._ -- 3.. ............................... W --•------------------- -•-------------- --•-• ...... UNature of Repairs or � env r wfien applicab e------------ ---------------------------------------------------------------------------------- ----------------------------•----------------------------------•---•--------------------•--------------------------------------------------------------------------------------------------•-------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d by the bo of health. ' Signed. .. ...... .....• ..-•--• ---• ••. -- .®tea. -------•-- �D�e Application Approved ..... lb'1 Date Application Disapproved for the following reasons:.................•---------•--••-•--------------•-•---...-•------------------•---------•-•--••--•----........_ ....-•----------------------••---•-••-•---•-••-•••--•------...----•---•-•••-•----•--•-•-•---•---•-...-•--•-•-•--•------•--•---••-•-••--•••-----•---....••--•--------------•---•--••---•-----•---••-•-•-. Date PermitNo......................................................... Issued_....................................................... Date Na1..............._....... FEs.............................. LTH THE BOAR®AO OF MASSACHUSETTS TS �+ Z -------...Z-0.....................OF...... ... . ......---c#...------------------......................,...... ..Appliratiun for Uiuvuual Vorkg Cfun,itrudiun j1prutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •"� G ....6�-•- i �l-----------------------•---- -•--....----------....__._.._....._..---•---- . --......--•----•---............--••---••--• Loci .. . ress or Lot No. �t . ... ................. Ow Address --•-•---•-----•............................. Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons........_'.----------- Showers (Z) — Cafeteria ( ) QI Other fixtures ......................................................... W Design Flow............................................gallons per person per day. Total dai flow.....3.3.0-......................gallons. Chi Septic Tank—Liquid capacity 1�4S5gallons Length___. Width....... ...... Diameter................ Depth................ Disposal Trench—No_ ____________________ Width..... 1 L_.__-_--- Total Length......4&...y... Total leaching area....................sq. ft. Seepage Pit No-----------,L_...... Diameter----- ....... Depth below inlet........ ....... Total leaching area.-Z.G--4?...sq. ft. Z Other Distribution box ( ) Dosing to Percolation Test Results Performed b ... ���'!'f_ _. .__. !? __._.___._ Date__ . ......... a Y r= Test Pit No. ltf. c r minutes per inch Depth of Test Pit.................... Depth to ground water........................ LL, Test Pit No. _._minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•--------- D Description of Soil......I _____ _ �.. _______________ x V ..................................----.._.. ................. - -- W ------ --------------------------------•------•-----------------------------_..... 0 Nature of Repairs or Mre—r-aztle Answer when applicable.-_,__:______________•--____-__•-------_____._...__............................__...__._.._..__. .•. •. •• •-••- •-•-•••-•-.......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to placeZsystin operation until a Certificate of Compliance has been ' d by the d of health. Signed -----•-----_---------- ---- Application Approved BY........................ ........--•-•-••. ----•----•-•• „�,,,,,�.� _.�'y- ....►� . r���•----•-- Application Disapproved for the following reasons:---•---- --•---=--------•--•-----••-----••-----••--•--•••-••-----------•-••----•--------------- ---.......... ---------------------------------------------------------------------------- Date PermitNo.................. ..................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH ..........................................OF.................. .........*...... (Irrfifiratr of Tout atta THIS I,S T CE TIFY hat the dividual Sewage Disposal System constructed ( . or Repaired ( ) by.... —ZVf-�/j�--.....�.� r. r��.r - � ------------------- ,J...................................................... Installer at................... ---••- ------.r---------------------- i � - . ............................................ has been ins'txl1 'iT['acEord" ce *ri*:?i_e pf Ons of T9LE vj�o�'�he State S nrt ry/Ae as described in the application for Disposal Works Construction Permit No-----__f�_?_�_. __-?_-- ........... dated-.........I.... ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL &? BE- STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FA�T�ORY. DATE... q VV`"' i ,•• Inspector........ .!._ -------------------•--- 3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p .......OF..........................................................................:.......... No.--•••-9— FEE........ ......y�e Disposal or u Tunu#ra iu rrutit Permission is hereby granted.-----./?���!I! G •---- X, `� ' 7 Q. l - ................ to Construct ( ) or Repair ( ) an Individual Sewage ge Disposal System at No. v ----- ••-- °, 'y` tion gonstri� stetas shown on the application for Disposal V�1: Permit Igo..................... Dated.......................................... ~ -•-•-•--•-----------------------•-•--------•--------------- DATE f a lth FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 1, 0 OF Mqo t 1 S W;L'-4 1-1 `r N 74 � r/ T6� 30 F.S. 6• / � � No si;av�y � 4 ,,, 00 py �NA LEAG( Box 4 + V TANK ` �QO,1 STKso-,-T73M f ( Ey�Pi1NSiC)y EL - 100,oo A� �i o FDA- � 'd I.iC3IE; Cotiri=�ACic"�' -O �XCAkAIF_ 4` F�It�W 9CQ- "99 ----- X f-IQM of It AC�fir.1C�. PIT ( I.E. EL- 5(.5) ItiI�,.,(?ty ti�c� WAT�JL P�ESer`iT LEGEND �I �f i NGst74lLl.i JG �GT1G 'SIST�M G.. D T J \• ,- �. .•.s • V4 ` �HOF�,fAS CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION 0,�0 s, EXISTING CONTOUR .-_-• 0 o AL poi FINISHED SPOT ELEVATION o /Aar �, �,`-,,�,._ ..� ;,, • FINISHED CONTOUR RSE N No.10951 O APPROVED BOARD • OF HEALTH °�o�sG►STS J� �� S/ONAI S A A R S TA L ,,.i A DATE AGENT SCALES DATE' _71/f �" RE®GE EN131�9EERBN� G'� 9 CLIENT "' I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB'NO.. g � BUILDING SHOWN ON THIS PLAIN CIVIL LAND CONFORMS TO THE ZONING LA # 1. DR,BY . f OF BARNSTA®LE, MASS. 712 MAIN STREET;• CH. QY'` J :�. H YA N N I S,, M A.S S. .�� SHIEET� OF � DATE REG. LAND SURVEY01t NOTF /F E17WZR 771E SEPTIC TANK OR 20 FT." M//V•, /E�4CH/iVG PIT ARE l`'JOR� THAT"/ /2��BELOrV :SRA,DE� A 24'D/.�M ETER CAMCR.�TE COVER /O PT MIN. SHALL BE ®POu�sflT. T®' G/��$DE.�fiN EXTR/q CONCRETB q'PYC P/PC JNE,4VY CAST /RO/Y COINER S AIA.L L. !3E USED COVERS M/N. PITCH !F/N DR/VEh/.4 Y FT. A - a9,,,p E CO VE�� CLEAN .SANO •�- L�JJ/D LEVEL '- - .�' j: ��/ y *LAYER CAST - 4•o • � QF SIB+- 3/B /ROJV, IPE l e O J GAL. ° "¢ MIN: /TChI D/ST, • 1 • • • .• • • • • a •, ;-IASHFO STn/YE PER's SEPTIC TANK 1 • •, 04. .rr� Boy O I b • ' I • • 1 • • v• • 1 1 •EFPECTI VG' t5 :', • • • a DEPTH ° • 1 ' ° v m IVASt/ED STaXE i. 47 7 8 X 1,D = 78Y or r • • • • • • • • • o o P/T OR EQL/!V, 1 v&A-' &ARVAT/ONS SIT ClPelc/7`y s_ `8 .rGAL;/D�y - • _ EL.= ` n. 5 ry a. 5 �T INVERT;:AT BU/L®/ Cv !L _ SEE Wo-MIL-A7 oN !HEFT :SEPTIC T�4/VK q e) .O FT r f? O/AM• C > , �, OU.=7'SEPTIC TANK `l-I..S FT. �'` /AIL-r D/STRI�!/T/DA/ BOX 9-7.3. SECT/aN OIc G�OuNv Wf1TER TABLE OtITLETD/STR!®t7T/O!d®OX 91. 1 FT. S 0/.S/��SAL /FILET LEAcRnva owl T -1 to, 5 Fr. .S�•5r&ls'1 7A- 8Z1LATlDN { L Cf//NG P/T �� � l EN.S'/O N A3 FT. SCALD' DESIGN CftITe*TIA D/`9EN3/aN $�FT. NUMBER OF&EDROGMS 3 D/MEA/S/4N C CiA RCA GEAISPOMI- !JN,r OG TGTAL EST//44-I•ED FLON/ 3 3 o ewL./oAY SO/L TEST A/ SO/L 7ES7-.02 NUM,8Ee aW LEACMINO P/73 f`ELG°Y 99,3 '01—A �•K DATF OF SOIL TEST SIDELeACH//✓G-PER P!7 -Stv► I=T. RESULTS Yt/I WESSED BY r�E �r1F FU�J� 4507_T0/+9 La4CNIA10 PER PlT�_SQ• F7- U - 2 PERLC0XA7-1Olt RATE,0/ "�S !7!/Vy1INCH �'c FERCOLi47'YON I�.47'E f � rfNMl1V:�/NCH ,Ti>1�4L LEACHING AREA RES G'HlNG AREA ,E,�R�Z3AiS' ARE EYr-A\.J4rOF fCe�W ? , / � st(a �OETo / - ' 0F /rf` f f�OF �kkOFMgS,, P�tT L U7 F o`erN, o� To i tJ Su 2E U ALBERT !%W'ATt21 P?EciT INSTALLIU6 SE'Gi?C { c S C" o ORSE cn .: 29874® 0.10951 -P fE��pQ` A90ISTEP���� F[ V i��-3 712 A7A/ay S7- s yYR�/A//T, A4AS.S. SUR'IF' FSS/ONA� © NO GROlJNc7 kV,4TE�P ENCOUNTfR60 CL/EhlT,1h`lc��.�•- s DATE 7/ /4 �z- i GIeO UA/O Y✓ATE.� AT ELEV - .JOB NO. SHE.�T?-OF t--