HomeMy WebLinkAbout0068 STANLEY WAY - Health 68 STANLEY WAY
Centerville
A= 228 - 111- 001
SMEA
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
FORESTRYY MIN.RECYCLED I
INITIATIVE CONTENTIO%
Candriad Fiber Sourcing POST-CONSUMER®
wwwAlprogrem.org
SFI-01290
MADE IN USA
GET ORGANIZED AT SMEAD.COM
TOWN OF BARNSTABLE
LOCATION 1-13 5jar%0cu W!�W SEWAGE# 2 01 9,. - 2S3
r
VILLAGE CcMcr�it — ASSESSOR'S MAP&PARCEL ZZ$ 0 Q 0 — A
INSTALLER'S NAME&PHONE NO. JG 4A LCxc .%jp_4;O✓\ N97-'UL53
SEPTIC TANK CAPACITY /.SOO q0.-
LEACHING FACILITY.(type) Soo 9;1.I L (2) (size) 13 x 25 x 2-
NO.OF BEDROOMS Z
OWNER LJcnol� nq
PERMIT DATE: 71. 9 - 1 q COMPLIANCE DATE: Z q- 19
Separation Distance Between the:
A—mum'Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Px-vte 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 leac ' cil'ty) Feet
FURNISHED BIY;( �I
Ai- &2'y„
AV
A3,5`.Z„
U,,44I.e A4• 61'S"
s REAR
S a AS- �� s
8 86, $�„�
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3 DL p9�5 H
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No: dolcl
Fee 1.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4pliLation for Nspo8al 6pBtrut Construction j3erutit
Application for a Permit to Construct( ) Repair()Q Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (p g 5}Q�r�y WQ,� Owner's Name,Address,and Tel.No.
C¢r•;-e ru•tl&
Assessor's Map/Parcel -L g LA IIV i
Installer's Name,Address,and Tel.No. Designer's Name,Address,9nd Tel.No..
bJ b C)cCavalron
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures �y,
Design Flow(min.required) J 3 6 gpd Design flow provided gpd
Plan Date '1 I"i 1 1q 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) IA1 o K®o &a\knn-N -}Add. , W10 `n- box
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o ealt
Y-Si ;�P6,_m1m mDate
Application Approved by r Date "-�
Application Disapproved by Date
for the following reasons
Permit No. 1J l Date Issued —4?v
i
L t
I �w
•t.
No.,: �l� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppliLation for VepoBal 6pstrm ConstCurtion Permit
Application for a Permit to Construct( ) Repair(x) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. g rj�an�Zu Wa� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel' ry, Q r.d
Installer's Name,Address,and el.No. Designer's Name,Address,4nd Tel.No.
b `5 � Claak av,on S012 -q '1 •O(o S ahora 'I Y- OoM- ki(o
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2 I
Design Flow(min.required) Z / gpd Design flow provided `f gpd
Plan Date '1�'1 Iq - Number of sheets Revision Date
Title t
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) W �gT4-n� W.2 1�) box
(2) `-12o
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o ealth
K-SSigned Date 7Z - S—f2
Application Approved by Date ?
Application Disapproved by Date
for the following reasons
Permit No.�;L d t ( -- Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
x at j ¢n a c ;\ has been constructed in accordance
with the provisions of itle 5 and the for Disposal System Construction Permit No.a -•,25__3 dated
Installer Designer
#bedrooms Approved design flow gpd
The issuance of 's pe 't shall not be construed as a guarantee that the system will functi desfgned-�
Date ,� Inspector
I
- - - -
-----------------------------------------------------------------------------------------------------------------------------
No. 01 019 1�5-3 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
;Disposal 6pstem Construction 'n fmlt
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
�X System located at „S L,.$ (.)ad C 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 permit., '_ 4� ��
Date � / Approved by
No. �O Fee too
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpliLation for Nsposaf *pstrm Construction Permit
Application for a Permit to Construct( ) Repair Upgrade Abandon( ) ❑Complete System ❑Individual Components
°L`bcation Address or Lot No. Un(�/ Owner's Name,Ad/dress,and Tel.No.
Assessor's Map/Parcel Ge Z1�V j//—/ C��p l�i I'1
Installer's Name Address and el.No. Designer's Name,Address,and Tel.No.
t.,y . C4 t;' on ,�Q8-477
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) 0O I-6go QoJ �5-r zod6p
SO
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board a It
Signed Date 7
Application Approved by Date �c7 " of
Application Disapproved by Date
for the following reasons
Permit No. O�� �'S3 Date Issued -�► ' j�f
L a.
n rl.
it 4 k," y
Fee
.No. 'tr " ? Entered in computer:
. T E;HCOMMONWEALTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Ik Plow
appli ation for." l8tlo8aY.6pstem: Construction 3pPrmit
Application for a Permit to Construct( ) Repair X
Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �1,J f 4 j/7 ley 10,4/ Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Pik { j jj_f 0)e r)f] /� /n
Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.No.
731 Q �XUIVaflvn SD8-477-v653
Type of Building: v
Dwelling No.of Bedrooms C ` ""^ ,:_ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building r� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided \ �/ gpd
Plan . Date .1-7 I Cj Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description=of Soil
l
Nature of Repairs or Alterations(Answer when applicable)#'.',R I O. 1-6 0D Gi: 5 /V
d 5
Date last inspected: ° f
Agreement:
The undersigned agrees to en u're the construdtio�nd maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board fT-fe`lthYA"
�. Signed r Q Date?`�-1 9
Application Approved-by r Date -�7
Application Disapproved by f Date
for the following reasons
Permit No. O�, 2 �7 3 Date Issued
------------------------------='--------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
y (Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
at 1 has been constructed in accordance
t �
with the protiis'ons'of Title 5 an the for Disposal System Construction Permit No., Dt -)63 dated 1
Installer _ - Designer
#bedrooms 2 Approved del!n fl gpd
s}The issuance of thi' permit tall not be construed as a guarantee that the system w l functio ast design
Date 1 'Inspector
_
No. 011 — >
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS
Disposal 6pBtrm Construction permit
Permission is hereby granted to Construct( ) Repair{(xx ) U grade( ) Abandon( )
System located at T" 1 !!C {' { P
r
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:Construes n must be c ted within three years of the date of this permit.`
Date T I Approved by
Town of Barnstable
1HE Tph� Regulatory Services
Thomas F. Geiler, Director
ASS.Mnss. Public Health Division -'
y nc � �...._ �
1639.
Argo��,�a Thomas McKean, Director
-200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304c
Date: 77-Z3- l9 Sewage Permit# 2o19. 2 53 Assessor's Map/Parcel 22$- I I I - 1 4 ';
UY1
Installer & Designer Certification Form
Designer: Floher_ca —Cayi rorne Installer: (3*6 B EAea.L;c1A i on
Address: P.O BW- 33L Address: A-,y Ric 13o
laces i c 6�e ScMi tl l c,V-�.
On 'rl-9-1 9 4,B EXh�.�i o✓� was issued a permit to install a
(date) (installer)
septic system at (,g S-Joy-%I—cu Woubased on a design drawn by
'(address)
nc�.ve. �Iec-�u dated 9
(designer)
_X 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
distn4ution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with mayor 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. Stripout(if required) was inspected and the soils
were found satisfactory. + '
• DA"D
D.
staller's Sign re HERTZ,JR.
No. I I
(Designer' Signatur ) (Affix Desig @ p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH[ THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice formsWesignercertification form.doc
y°F T"e
Town of Barnstable Barnstable
�0 Inspectional Services Department `�`"'�`e��j
BARmaABLB,
9 M139.
i639, Public Health Division
Aldov A 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4987 9750
July 9, 2019
BEARSE, THURLOW B ESTATE OF
23 CRESTVIEW DRIVE
EAST SANDWICH, MA 02537
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 68 Stanley Way, Centerville, MA was inspected on
05/29/2019 by Paul Martin, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Liquid depth in cesspool is less than 6" below invert or available volume is
less than '/2 day flow.
You are ordered to repair or replace the septic system 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
o as cKean R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\68 Stanley Way'Centerville.doc
IKE
Town of Barnstable
BARNSTAHLE,
9�A b 9 ,.� Inspectional Services Department
tfD MA'S A
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)
OTHER
A4 ,,7 uJ'S' -o -I /erf 7 c, � IE1owl in-ed or- G v^.'�-,b( Val,,-�e
'eIJ I h A h � 0/a� - o W.
Repair deadline: V ec y'
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
i
Commonwealth of Massachusetts
A ,` Title 5 Official Inspection Form
rI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c
y i
•� 68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owners Name
information is s.
required for every East Sandwich MA 02537 5/29/2019 s ,
page. City/Town
State ZipCode
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 e
A. Inspector Information
filling out forms p ��# r
on the computer,
use only the tab Paul C. Martin
key to move your Name of Inspector
cursor-do not
use the return Cape Cod Septic Services Inc.
key. company Name
350 Main St.
„a Company Address
West Yarmouth MA 02673
City/Town State
508-775-2825 Zip Code
&n Telephone Number SI5016License 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
6/4/2019
ns�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 1 e
Commonwealth of Massachusetts
-j ,� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
., 68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. CitylTown 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:
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.7/26/2018 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
68 Stanley Way Centerville, MA 02632
Property Address
_Wendy King 23 Crestwood Dr.
Owner owners Name
information is
required for every East Sandwich MA 02537 5/29/2019
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:
15insp.doc•rev.7/2 612 0 1 8
Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 3 of 18
I
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner information is Owner's Name
required for every East Sandwich MA 02537 5/29/2019
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
a, 4
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Stanley Way Centerville, MA 02632
rroperty Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
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 '/2 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 d-
10,000 gpd. gp
® 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.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal system•page 5 of 18
Commonwealth of Massachusetts
iip Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
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
.......... 68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): N/A Number of bedrooms (actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A
Description:
Cesspools. No design criteria on file.
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
information in this report.) ❑ Yes ® No
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: Unknown
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
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner information is Owner's Name
required for every East Sandwich MA 02537 5/29/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day.(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present?
❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use:
Date
Other(describe below):
3. Pumping Records:
Source of information: No Records
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
r
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�a
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owners Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑ Septic tank, distribution box, soil absorption system
® Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: Multiple lines
feet
Material of construction:
❑ cast iron ❑40 PVC ® other(explain): Orangeburg
Distance from private water supply well or suction line: +10'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Lines checked with sewer camera. Some lines partially blocked orangeburg lines. Lines from house
need to be changed. Interior plumbing needs to be changed and combined into one system.
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
+ " 68 Stanley Way Centerville, MA 02632
Nroperty Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich City/T MA
page. own
02537 5/29/2019
State Zip Code of ti
D. System Information (cont.) Date Inspecon
6. Septic Tank(locate on site plan):
Depth below grade:
feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass 9 El 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:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 1 a
L
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�L 68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade:
feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass 9 El 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 9 ❑ 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
y~l�� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
em
68 Stanley Way Centerville, MA 02632
u, Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
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.):
Cesspools no Box.
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
R Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u 68 Stanley Way Centerville, MA 02632
Property Address
Owner
Wendy King 23 Crestwood Dr.information is owner's Name
required for every East Sandwich MA 02537 5/29/2019
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 pla
n,p excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
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.):
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 2 Found
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction Concrete Block
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Multiple Cesspools on property. Some not able to be located due to crushed pipe. Plumbing needs to
be rerouted and tied into one new septic system. Pools that were located were found to be in poor
condition.
t5insp.doc-rev.7/26/2016 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
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner information is Owners Name
required for every East Sandwich MA 02537 5/29/2019
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
0
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
V/
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner owners Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
-----------------
t5insp.doc•rev.7126/2018
Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
y` } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,. � 68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner Owner's Name
information is
required for every East Sandwich MA 02537 5/29/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water:
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 not determined due to system issues. Groundwater will be determined during perc for
new system.
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
f ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�Q Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
68 Stanley Way Centerville, MA 02632
Property Address
Wendy King 23 Crestwood Dr.
Owner information is Owner's Name
required for every East Sandwich MA
page. own
02537 5/29/2019
City/T
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.7/262018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
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COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE
TOP OF FOUNDATION BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services
EL. 64.0' EL. 58.0' (not t_ o_ s�� INSP. PORT W I 3" OF GRADE
CLEAN SAND P.O. Box 331
2"of DOUBLE WASHED EL. 56.0' Han�vich, MA 02645
4" CAST IRON or EQUIVALENT
PEASTONCOR GEOTEXTILE 774.994.1166
MIN. PITCH 1/4" PER FOOT FILTER FABRIC
a^SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE ;
FLOW LINE VENT IF REQUIRED
Inrst2 to seven
2' 30.8°/ 5 (19b) EL.53.9'
:•� ' o°o°o°o°e
L. �LS
'0000000 [_ °060°o°oc
00000 0 0 . o005.25' L55.0' 100 000 0 0 0 0 c
o°o° 0°0°o°o°e
EL.53.7' ° o°o°o°o°o°o° o°0°o°00 2.0'
o EL.53.5' o°o°o°o°o°o°o°o° ® 0°0°o°o°c—
0'MIN.t2.5 kL GAS BAFFLE o 0 0 0 0 0 0 0 �. ® o 0 0 0
•'�• (H-20DBOXJ o00000000° o00000 • ' , ;a' .. ao°o°o°oc EL.
.,.
STALL INLET TEE SOIL ABSORPTION SYSTEM 1,° 'j •• •• 6"CRUSHED STONE OR 1"ABOVE OUTLET INVERT
AE•sr ' ' MECHANICALLY COMPACTED (2) SOO GALLON H-20 CHAMBERS
9000000000 3i to 1L" WITH 4'STONE AROUND IN A
WASHED STONE
REAR 1500 GALLON SEPTIC TANK DOUBLE WASH
---? 12"83'X 25'X 2'CONFIGURATION
X'IEL.56,5' (PROPOSEO) STANLEY WA Y BOTTOM OF TEST HOLE EL. 45.0' EL. 45.0'
(DATUM: ASSUMED) '-� USGS ADJUSTMENT: N/A
LocAr�oNnaAP
47,00• 4=33.0 ' GROUNDWATER ELEV: N/A
I N TH
1 Main St. Plne St.
LOT 6A
22,100 SFt
MAP 228 LOT 111-1
DRIVEWAY
LOCUS
62
C.O. I 62 y�H OF Atd
C -
c A. ,��"
DA
PORCH
s 2I
BENCHMARK: EXISTING ( cP
TOP OF FNDN 2 BR i GARAGE �N
EL, 64.0' DWELLING 0$
60 �t.TIkRI�'�
56
C.O.
20.21 PATIO DATE.717&019 REVISED:
58
TH-1 PROP. S.T,
LEGEND 5 12.0' '` :: TH-2 cP 56 SITE AND SEWAGE PLAN FOR
B& B EXCAVATION, INC./
-6 6 -6-5— GAS LINE
WENDY KING
W W W W WATER LINE
68 STANLEY WAY
E E EXIST. ELECTRIC 10.6'
99 EXIST. CONTOURS 202 MA
98, a CENTERVILLE) BARNSTABLE,
--——--— 99 PROP. CONTOURS SCALE ■ 1 -' 3 0
yes QWS U E UNDERGROUND UTIL.
REF.-PB 118 PG 1512 PAGE 1 OF2
.............. ........... ................................................................................................................................................................................................................................................................................ ...................................... ........................................
GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental Services
P. 0. Box 331
1. ALL PRECAST COMPONENTS TO BE H-10 Harwich, MA 02645
RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 2(DESIGN FOR 774.994.1166
DISTRIBUTION BOX AND ANY
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
(110 GALIBRVA Y X 3 BR) 330 GALADA Y
ALLOW FOR THE USE OF A GARBAGE
GRINDER.
3, MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
25' -
4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1500 GAL.(PROPOSED)
310 CMR 15.000 AND ALL OTHER
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION
CODES AND REGULATIONS,
5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLA TION AA 7E <2 MIN./INCHVERIFY ALL ELEVATIONS AND DETAILS
AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING R4 TE 0.74 GALADAYIFT2
DESIGNER PRIOR TO CONSTRUCTION OR 12-83'
LEACHING AREA
ASSUME ALL RESPONSIBILITY. (2)x(25.01+ 12.83)(2) =1 51 SF
6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF
RESPONSIBLE FOR MAINTAINING SAFE 471 SFx a 74 348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)&0 GALLON H-20 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATION ASDIAGRAMMED
CONSTRUCTION.
Z ANY CHANGES TO OR DEVIATIONS FROM
RESERVE LEACHING CAPACITY NIA
THIS PLAN MUST BE APPROVED IN
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CHR 15.000 (NTS)
UNLESS SHOWN PER PLAN,
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED
TEST HOLE V TPT#19-74 TEST HOLE#2 TPT#19-74
AND REPLACED WITH CLEAN SAND.
Evaluator.- David D.Flahady Jr.,RS,REHS Evaluator. DavdD.Flahady Jr.,RS,REHS
OF
10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755
WITH WATERTIGHT ACCESS PORTS BOH Witness: David Stanton,RS BOH Witness DavidStanton,RS
WITHIN 6"OF FINISH GRADE. Date: JuLY3,2019 Date. JuLY3,2019 AN I
11,ALL SEPTIC TANKS, DISTRIBUTION F
TH-I ELEV 56.0' TH-2 ELEV 56.0'
BOXES AND PIPING TO BE INSTALLED
WATERTIGHT. 0*-r A SL I0YR2& 0'-7" A A I0YR212
12.NO KNOWN WETLANDS OR WELLS TE
WITHIN 150 FEET OF PROPOSED JAVItTARi
LEACHING. 7"-25' B A 10YR 514 7'-25' B SL 10YR 516
13.THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
-a
7 car*that on November 12,2002, have passed SITE AND SEWAGE PLANr) Pam
PLAN TO BE USED FOR ZONING OR
the examination approved by the Department of
BUILDING PURPOSES. Environmental Protection and that Me above analysts
FOR
has been performed by me oonsIstent with Me
14.LOT IS SHOWN AS ASSESSOR'S MAP 228 8 & B EXCAVATION, INC./
25'-132" C MS 2.5Y616 25'-120' C MCS 2.5Y646 requIred&aInIng expefte and-penance dawnbed
LOT 111-1 in 3 10 CMR 15.018(2). WENDY KING
15.LOCUS PROPERTY IS NOT LOCATED
68 STANLEY WAY
WITHIN AN AQUIFER PROTECTION (CENTERMLE)
DISTRICT(ZONE 11). G.W ELEV.NIA G.W.ELEV.AVA
BOTTOM TH-IELEV 45.0'- BOTrOM TH-2 ELELEV. 46.0' BARNSTABLE, MA
PAGE2 OF2 DATE.•612512019
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