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HomeMy WebLinkAbout0007 WARWICK WAY - Health 7 Warwick Way Centerville A = 148 066 o � Commonwealth of Massachusetts VTitle 5 Official Inspection Form Subsurface Sewage Disposal System/Form -Notjor'Volunta/ry Assessments WG✓ <G�t/ W G Owner Y Property Address G� inform ON ner's Nameation is C I„vv/ Ile- �/��j D ,&s: / , required for every P✓� ✓'"�/T' o'- 7- � page. City/Town State Zip Code Date of nspection 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. im portant:Men A. General Information filling out fmutop on the co uter, `(y''J`►-��J /v_ use only the tab 1. Inspector: key to move your cursor-do notuse key the return Name of Inspector �/�/✓�0 TL G ff Company Name ` � OJ CompanyAddressz City/Town State Zip Code Telephone'NVfter ��— License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addressaand that the cj-) d information reported below is true, accurate and complete as of the time of the inspection. The-Jin-spec-t-lin was performed based on my training and experience in the proper function and maintenance of on site" sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15:340 of' Title 5 (310 CMR 16.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Nee s Further Evaluation by the Local Approving Authority Inspect is Signature Date The s stem inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"*This report only describes conditions at the time of Inspection and under the conditions of 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. t51^5'yt3 Title50fACial Ins pectojFormSV.S,.,g,pisPOWSystem-Pege1ofl7 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 WGir � cK -t'la') - Property Address Ow ner Information is Owner's Name /required for every ( �eh r✓� Ile le �j4 QJ ?� 1J6 page. Gty/Town State Zip Code Date of Ahspedtion B. Certification (cont) Inspection Summary: Check A,B,C,D or E /always com plete all of Section D A) ;Sy7ste Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15,303 or in 310 CM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15re•3113 TiUe 6 official Ins pec Uon F orm Subsurface Sewage olaposel System•Pape 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage eeJDisposal System Form -Not for Voluntary Assessments Property Address L l /� ;Ye— Ory ner O,a ner's Name inforniation is req u ired f or ev ery 2n �/7// �e /%i9 Qa 6�� gLl page. City/Town State Zip Code Date of Inspe lion B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired, B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ris 3113 No5OfAclallnspecuonForm:Subsurface sewage 015posatSystem-Page 3of17 1 17--Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form • Not for voluntary Assessments r / a.,/ / Property Address J -- /j G Y� Ow ner Cw ner's Name information is / required for every e IVA 'IT Gtyfrow n page. State Zip Code Date o Insp coon„p,Y^ B. Certification (cont.) - 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance; **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate "Yes" or"No" to each of the following for alj inspections: Yes No ❑ 021/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ oa Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Ys day flow t5lns•3113 Title 5 Official InspectlonFam Subsurface Sewage Disposal System-Page 4of17 i Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ,I_ / 74 YPi Cw ner Ow ner's Name /� / information Is CQN 1�✓!�/f A114 o)G L2 9 �� required for every page. City/Town State Zip Code Date of Ins action B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or /"� obstructed pipe(s). Number of times pumped: El2 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. ❑ ld' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ l,d 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 6 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] n flow of 2000�-q The system is a cesspool serving a facility with a design� 9 ❑ 10 000 d. gpd- 9p ❑ The system fftLlgs. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed, The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5iru•Y13 Title 5 official Ins pec don F am Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ay � W�y'WiG� �Gr Property Address 0,v ner Owner's Name information is ,( required for every Love 1 ✓lw l/4 �/7 oa 6 ,7,>- / page. City/Town State Zip Code Date of Inspe tion C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yo �e�-S Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pump ed 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? p ❑ 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)J D. System Information Residential Flow Conditions: Number of bedrooms (design,. s J, Number of bedrooms (actual): ? DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): J 30 Mrs•T13 TIUe 5Of8oial InspecUon F am subsurface Sewage Disposel System•Pape 60f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v � W Gi�G✓�c� W Gi Property Address / /�r� Ow ner Ow ner's Name Information is �lri l /A f Q� required f or every CQN I �� J page. City/Town State Zip Code Date of I specton D. System Information Description: / / lS �rS��ion Qa� Number of current residents: / Does residence have a garbage grinder? ❑ Yes S' �No Is laundry on a separate sewage system? (Include laundry system inspection (] Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 21' N'o� Seasonal use? ❑ Yes B No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: " Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? Cl Yes ❑ No Water meter readings, if available: fdn W 3 Title 5 Official Im pec0on F orm Subsurface Sewage Disposal System•Pape 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C✓G rc,/r c� �t/�' "� Property Address Ow ner Cw ner's Name Information is / PN-�g,i(/ o 1'�,4 od 6 �� ✓-{ 9 required for every l� page. City f row n State Zip Code Date f Ins Action D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S em; 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 (descri be): Mns-3113 Title 5 Offlciel Impaction Form Suburface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Q' W C✓'G✓t G� �C! Property Address . 2 t A/6,►"t°i ON ner CW ner's Name information is / required for every C/e✓��✓'lil Ile- '/ 4 Do�-�O 3D . page, Crtyrrown State Zip Code Date of Ins action D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7�f �ti�r D �,h •cam — /lac,/ 5,9.S ano Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): Depth below grade: feet Material of construction; ❑ cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet 7en fconstruction: oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: tits-3f13 Title 50ff>cial Inspection Form Subarface Sew age Disposal System-Page 9of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° (,/G✓WIGGj/ Property Address / q ON ner ON ner's Name �7� / information is cc,�✓vi Me— � od6J required for every —" page Cityrrown State Zip Code Date of spe ion D. System Information (cont.) Septic Tank(cont.) 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.): Q H �✓ 61, Id1 0� Coo C j14 Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins,3/13 Title 5 Official Ire pec tlon F orm Su psurtace Sewage Disposal System-Page 10 d V f Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a~ ua 'W l G 4- �n/G Property Address r�- O'ner Cw ner's Name information is Ljc �c� required for every page. City/T'own State Zip Code Date of nspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc,): "Attach copy of current pumping contract (required). is copy attached? ❑ Yes ❑ No t5m-W3 Tille 5 Official Inspection Form SubsLrf ace Sewage Disposal System Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ner pii ner's Name information information is �Ev1 t/I/< le - required for every — page. City Town State Zip Code Dat of In pection D. System Information (cost.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): ! 10 z -ova, //0 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5lns-3113 Title 6 Official Inspection FormSubsurface Sewage DispoaelSystem Page 12of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address / / ------- Ow ner Owner's Name information Is B required for every �` ice/l ' " '-T page, Cityfrown State Zip Code Date of I spectbn D. System Information (cont,) Type' ('/ J�5o S .�✓T/� 1 �(��✓!� ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): � Q� C'l/1� �b l l ��PG h G'r/► L+ � 14e rC S/r�0-5- 0-/—/" C&C,L4 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 15ins-3/13 Tile 5Official Inspection Farm Subeurtace Sewage Disposal System Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System/Form -Not for Voluntary Assessments dy � W G✓G✓l G� C✓a Property Address / ovv ner Cw ner's Name /"� I information is Leo-ky-y7& required for every page. Gtyfrown State Zip Code Date of spec on D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15tre•3/13 Title 5Ofedal Ins pecton Form Subsulace Sewage Disposal System•Page to of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / 0 ow ner av ner's Name �i¢ 0�6 5� �/`AA- requiredInformation is for every page City Rown State Zip Code Date of 4rispe6iJon D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where is water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately LIJ a , TT_ I ('o rem do" 14'_ 117 der -3 0 63 - /X Wine-3113 Title5018c1al inspeclionfam Suburiaca Sewage Disposal System-Page 16d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal /System Form - Not for Voluntary Assessments a W a, - 6"-ar Property Address G► ic' Ow nor Cw ner's Name information Is � C'N fvt g ��l required for every ll��-- iT '7 page. City/Town State Zip Code Date of inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /IL 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 prop ertylobservation hole within 150 feet of SAS) ❑ Checked wit Vocal Board of Health-explain: 11 G,H S f / ESQ- Al.25 ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: 5�-—�'� J CP✓T t�l`f G a�t oi 417 r ✓tit Before filing this Inspection Report, please see Report Completeness Checklist on next page. t9ns-W 3 TiUe 5 0fficial Ins pecUon F orm SOSLOSoe Sewage Disposel System•Page 18 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a / Property Address ow ner Cw ner's Name information Is required for every C'eo Gd G Z2- l -T page. City/Town State Zip Code Date o Inspe lion E. Report Completeness Checklist Inspection Summary: A, B. C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed "stem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Wins-3113 Title 5Of8cial Inspection Form Subsurface SewegeDlsposel System-Pape 17 of 17 } Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name Information is required for every Centerville MA 02632 August 3, 2011 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use the tab 1. Inspector: to m key to move your VVii (J J cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Environmental IG�1 Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that tie information reported below is true, accurate and complete as of the time of the inspection.The inspe lion was performed based on my training and experience in the proper function and maintenance-'of on sewage disposal systems. 1 am a DEP approved system inspector pursuant taSection 1i?340 of+ Title 5(310 CMR 15.000).The system: - . i ® Passes ❑ Conditionally Passes ❑ Fails - ' ❑ Needs Further Evaluation by the Local Approving Authority ut V August 3, 2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. -**This report only describes conditions at the time of inspection and under the conditions of 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. �f I F 6 t I 15ins•09I08 Title 5 Official Inspection Form.Subsurface Sowag ispo System•Pape 1 of 17 �.. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is 9 required for every Centerville MA 02632 August 3, 2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination, B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal,or not) is structurally unsound, exhibits substantial infiltration or exfltration 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): 15ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts �i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property.Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3, 2011 required for every _� page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in-a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form -Not for Voluntary.Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 Au ust,3, 2011 required for every 9 page. Cityrrown State Zip Code Date of Inspection B. Certification (cons.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil-absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria'are triggered. A copy of the analysis must be attached'to this form. 3. Other: D) System Failure.Criteria Applicable to All Systems: You must indicate Yes or No to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the.distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts wTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3,2011 required for every �g page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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. ❑ Z Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 bxOgpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 C'MR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 5 or 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's,Name information is required for every Centerville MA 0.2632 August 3, 2011 - page. Cityrrown State Zip Code Date-of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No Z ❑ 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 NIA) ❑ 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? a ❑ Was thelacility 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; Q ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x`#of bedrooms): 330 gpd t5ins•09/08 Tille 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owners Name information is Centerville MA 02632 August 3, 2011 required forevery g page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate,sewage system? [if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 59 gpd 9 ( Y 9 (gPd))� Detail: last years Sump pump? ❑ Yes R No Last date of occupancy: not determined Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 3.10 CMR 15.203): Gallons per day.(gpd). Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available; 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form — - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is required for eery Centerville MA 02532 August 3,2011 page. cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner's agent Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons. How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained,from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach'a copy of the DEP approval. ❑ Other(describe): t5ins-09108 Title 5Official Inspection Form Subsurface.Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts G.) Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3, 2011 required for every g page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Age 2+years. Certificate of Compliance dated 6/18/2009(permit 2009-161) Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of backup or leakage into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 ft x 6 ft x 5 ft(1000 gal) Sludge depth: 4 in t5in3•09/05 tale 6 Mist Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owners Name information is Centerville MA 02632 August 3, 2011 required for every —_9 page. cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness none Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design Plan Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years. Tank appears structurally sound and functioning as intended. Grease Traplocate on site plan): ( P ) 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 15ins•09108 Title 6 Off ial Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form - a Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name informationrequired.for every veryCenterville MA 02632 August 3, 2011 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Paged 1 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form R = t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3; 2011 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet invert 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.): D-box appears structurally sound with no evidence of leakage in or out. D-box was perfectly clean. 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.): Soil Absorption System (SAS) (locate on,site plan, excavation not required); If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's.Name information is required Centerville MA 02632 August 3, 2011 `for , page. Cltyrrbwn State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils. 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 15ins-09108 Title Official Inspection Form:Subsurface Sewage Disposal System-Page 13'of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Prop ertY Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 026:32 August 3,-2011 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont) Comments (note condition of soil, signs of hydraulic failure, level of ponding„condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure level of ondin condition of vegetation, 9 Y P 9, 9 , etc.): 15ins-09108 Titles Official Inspection Form:Subsurface Sewage Disposal System-Page 14.o117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name Informatrequired Is Centerville MA 02632 August 3,2011 required for every page. City/rown state Zip Code Date of Inspection D. System Information (cunt.) 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 �-3ox 5� SEPTIC •. IS' 23• T 61JK �J W We 5 OftW hnpeWon Form:& wrfeoe Sewage DIWW system•page is of n T _ Commonwealth of Massachusetts " U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3, 2011 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check.Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11+ ft 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: 6/5/09 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: Septic design plan shows bottom of leaching pit to be 6.21 feet above the bottom of a witnessed test pit in which no groundwater mottling was observed. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments — 7 Warwick Way Property Address Charles and Nancy Girard Owner Owner's Name information is Centerville MA 02632 August 3, 2011 required for every 9 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B,C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Z System Information —Estimated depth to,high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 FROM :down cape engineering inc FAX NO. :15083629880 Jun. 19 2009 10:32AN P2 rrown of Barnstable JRegidatory Services I : '1'l orn.s.,s Te.tacil.cr,Director tapx�rrrnn�, 1 • PuNic Healtb .Divisi.on �d3A rb = Thomas McKean Director 200 Main Stiree414yannim, MA 02601 Offl :: 508-862-46,14 • 5 8- +0-6304 J:�stx.. .0. 7. Twitanller &.Desigper Corti leatioii Fom► . Date: �-�1 sewage Permit# Z00?"16/ Assessar°s 1v apTalreel17 1 � � ;� r Designer: '-��,.r� �` � Ia�4t ler: Address: Address: NI— A42- On �1s�09 ,90/710/®//12�P40;4as issued a permit to install a (date) (iastalter.) septic;system at� �r¢w�ut L�7 based Wi a design drawn by (address) dated 1 certify drat the septic system referenced above was installed substantially according to the design, which may im:lude minor approved changes such ag lateral relocation of the distribution box and/or septic tank.. I certify tliat the septic system referenced above, was installed with major changes (i.e. grmtter than l 0' lateral relocation OF the SAS or any veltica.l.relocati.o►a of any eoin.ponep.t of the septic system) but in accordance with State&. Local Regulations, Flare revision or cortif ed as-built by desiper to follow. (InstAr's S.igalatwure) ° nANIELA, oJAtA CIVI N No.46502 4 ktturO (Affix.T)es.sS�Q , L . ..tp Tiere) P.L.FAS:F: Rw:TUR.N TO 13A-RNSTABLF PUBL:rc I�ocAl..l'.E:1. Q�o.vi�ic,�.- is �z rt ic:A r OF e:OWI JANCE WILL. NOT BE ISSUED UNTIL BOTH TiTdS FORM AND AS-BTALT CARD ARE, RECETVFn BY THE.BA.RNPs'1ABLE PLIBIAC HE,AL411 DWIS1U1N. T1lA_NK You. Q:H*dthISrpt..its,'BesaE;tua Certi.(it;H ik l Perrin 3-26-04Aoc e S p� ' No. Z B O /"���� Fee /DO / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: (/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatiou for �Bizpozal 6p.5tem Con5tructiou Permit Application for a Permit to Construct( ) Repair(V<'Upgrade( ) Abandon( ) ❑ Complete System 'LJ�Individual Components Location Address or Lot No. ! w 1"f Ick w(tl Owner's Name, Add re and Tel.No. /Adssessor's Ntap/ arcel ' W�`v Installer's Name,Address,and Tel.No. Desi er's Name,Address and Tel.No. ad olo�at�j' �s - 77l Type of Building: Dwelling No.of Bedrooms Lot Size SS sq. ft. Garbage Grinder (-A�-110 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank W Type of S.A. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo2jid of Health. Signed Date 6�s Application Approved by ,.S' Date Application Disapproved by: Date for the following reasons Permit No. d 1�/ Date Issued 4�G c� LSO No. ,r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �x ZIpprtcation for Dioo-qal *pgtem Couttructiou Permit- Application for a Permit to Construct( ) Repair(v)upgrade( ) Abandon( ) ❑Complete System le/individual Components Location Address or Lot No. 7 ),r v rz /l/� Gvar Owner's Name,Addre ,and Tel.No. /L1 f- GCE'rl !!/f Assessor's aO Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. +. Aortolmll Cpo" 77l^19� y �aw� c 36z �sy�/ f - Type of Building: Dwelling No.of Bedrooms Lot Size 5,, 97S sq. ft. Garbage Grinder Other Type of Building rQ,�I. ,fCe No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require d) 3 �� gpd Design flow provided �(� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r ; Description of Soil AI, Z-S' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thisAV : Signed Date Application Approved by Q,.S ,Date ( S Q Application Disapproved by: Date for the following reasons Permit No. C7�( !� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS . Certificate of Compliance THIS IS TO CERT FY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Y) Upgraded ( ) Abandoned( )by ` k4 f r© �j at -7 Awl rwI k_ r°HIL`/�/n Cj'ias been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2�aG1 " I G t dated Ip Installer 1� 4(,pT'( 4 �Gri-+��, Designer Dj W N ('A 19r, #bedrooms 3 Approved design flow S30 gpd The issuance of this p rrmit s'all not be construed as a guarantee that the system wi4�1 u FAV icn as designel.Date Inspector 07 /I No. Zeflo ��1 Fee 100 r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 1=igpogal *pztem Cou5tructiou Permit Permission is hereby granted to Construct ( ) Repair ( � Upgrade ( ) Abandon ( ) System located at 4t,11 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: Construction ust be completed within three years of the date of this permit Date Approved by `e , TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE 4 w7'/,,rr,/lf ASS/ESSOR'S MAP/&PARCEL �yQ INSTALLER'S NAME&PHONE NO. ,U�'�o�1 i�r J��.� o✓ y��- ��� SEPTIC TANK CAPACITY IOo;�t c/ X J�io�s LEACHING FACILITY:(type)Ted,r/, jas? ��!�(size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: �. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY 1 l� r. ,3or _ r - �: TOWN OF BARNSTABLE — �i U I:0CATION / W 0-rCCV—IMA�= SEWAGE # VILLAGE d`��✓✓r 1� ASSES R'S MAP & LOT T� " 6� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C (size) NO.OF BEDROOMS BUILDER OR OWNER a PERMITDATE: Qq70-5L0q COMPLIANCE DATE: �4L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by b �� ���..__ - 1 �' '� � � � r„ � pf � ��. � � ► III ! � � � � � � � r �� f � v ` � I 0 r� � � J — �/ ���5 � o � � `2 J No. u� ��� Fee 3V ��,. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓`� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migw6ar bpztem Con.5truction Permit Application for a Permit to Construct( . )Repair A Upgrade( )Abandon Complete System Adividual Components Location Address or Lot No- ) , ti Owner's Name,Address and Tel.No. As essor' M p/larcel . 1/`�Jl l 1� I I-(V�f ,' taper's Name,Address,and Tel.No. FYI$ $� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Title 5 of the Environmental Code and not to place the system in operation ntil a Certifi- cate of Compliance has been issue , y s 4oard of Hea pAl Signed kuuu 41t2 Date v Application Approved by Date Application Disapproved for the following reasons Permit No. 2[b !d-W Date Issued — )t- -No. 0 1��{ Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓`� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS' application for �Diopo$al *pgtem Construction Permit Application for a Permit to Construct( )Repair( Qi Upgrade( )Abandon( ) ❑Complete System Y&dividual Components Location Address or Lot No. d ` n 1 (A Owner's Name,Address and Tel.No. Ass essor's Ma /Parcel /`J�/� _r-v I a 11�/1L14 C,�(9 " 1 t'C ( '( Hawn/ I r I' I taUer's Name,Address,and Tel.No. �Y►g Designer's Name,Address and Tel.No. V("S CPO f P1bA)( 1�5� n�5 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow gallons per day. Calculated daily flow gallons. 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) �. ..,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 operatio/ntiI a Certifi- cate of Compliance has been issued y th'iss oard of Hea � �/I_ Signed v I ,vJ Date Application Approved by AQ ie Date I t Application Disapproved for the fo lowing reasons r Permit No. 9Cia L� Date Issued L/ y L/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C R FY, at the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( by at A ' �(/ has been constructed in accordance With the ovisi ns of Ti e- d the f osal System Construction Permit No. It/ dated C� Installer Designer The issuance of this permit shall not be construed as a guarantee that the sys to ill f nction as designed. Date 1 s, Inspector . 9Z v ---------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Miopogal by,5te Conotruction Permit Permission is hereby granted to Construct( ) epai( ) pgrad • )b�nydon( ) System located at lj (,� 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:Construe 'on must be completed within three years of the date of pe t. Date: `1 G Approved by TOWN OF BARNSTABLE CC. G LOCATION Ujo rOGILVL4&�-- SEWAGE # LE 1 VILLAGE' - -��✓��' �-- ASSES R'S M4AP & LOT I INSTALLER'S NAME&PHONE N0. ! SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Ci r (size) NO.OF BEDROOMS-1)-�&rlc BUILDER OR OWNER O. PERMITDATE: QLJ Es& COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,Si XJ 1;1� /I o Fxs....S,5. ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH .7o0Av..................OF............./ 2-US_ 9 -c�E Appliratiun for Uiipuual Work.6 Tow3trnrtiun amit Application is hereby made for a Permit to Construct (p.-I) or Repair ( ) an Individual Sewage Disposal System at: 3-7 ...... I r la - �-------------------------------------------- ,J J� ---------- (O�.'."----------------------. G...a.,.'�... O ner Address � Instal.er Address /� �7 Type of Building Size Lot________�..................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other-T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures -•--•--••---•----------•-------- . W Design Flow..................5_ �...................gallons per person per day. Total daily flow----............. .3 C�...._...._....gallons. W Septic Tank—Liquid'capacity�ll(?Q__galions Length_._. `.___. Width...._ °.... Diameter______________ _ p ....__. De th...._.. x Disposal Trench—No..................... Width_....._f__-_-_-_-_ Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No........I----------- Diameter___ Depth below inlet....... ........ Total leaching area.5- -&q-€t.G P Z Other Distribution box Dosing tank ( ) 0-4 Percolation Test Results Performed by._.,C.P _.___ .....................ff?e....__�!�`__ Date.._..S_ -Z�.�a'Z ,4_1 Test Pit No. 1___ ___minutes per inch Depth of Test Pit...14.¢_..... Depth to ground waterV4_7- ___ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___.______-____-____. --•-•-••-------------•-----------........---•-•--•--•--•--•---•---------•---------------•---.......-------•------------.......----........---......-- O Description of SoilE_ ._.... :?'T1 _ fl-----pf /\J' x -------•---•-----------------------------••. U ---- •------------------------------------ •---------- ------------------------------------------------------ •----------------•----•-------•----------------------------------------------------•---------- W -----------------------------------------------------------------------------------------------------------------------------------------------........................................................ U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with the provisions of iITI. 5 of the State Sanitary Code— The n furti:er agrees not to place the system in operation until a Certificate of Compliance has beejis ed oa health.Signed-------- --------------• ....----- ----------._._....--•--------•..----- ---D e--..Z_Application Approved By--------------- •-- •-- . ••. --------------------- ----- ... ............... Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ................•------------•---•---------------------------------------•-------•----......-----••-----.------......----------•----•---------- --------------------------------------------- Date PermitNo--------------------------------------------------------- Issued.................................................... I Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........0......�...................0F.........../.�A2,VST7�C3.LE......................... Apphrittiou for Uiiplas al Works Totastrurtiun amit Application is hereby made for a Permit to Construct k) or Repair ( ) an Individual Sewage Disposal System at ..... ......... A. ........................................................ Loc tion-Address or Lot No. ......................................... ....O n .......................................... -••-......----------•-••------------.........------es.s .......................................... Owner Address W Installer Address ... QType of Building Size Lot.�J��__g7.S....Sq. feet Dwelling—No. of Bedrooms................. ....................:....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ...................................................... Design Flow.................5'��.-..................gallons per person per day. Total daily flow................ ._3©...............gallons. WSeptic Tank—Liquid capacitylOL�h•-gallons Length... ...._...... Width.... ....... Diameter................ Depth...`�'f....... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......../..-----.--- Diameter../ d..',zr._. Depth below inlet........t......... Total leaching area..��..�t. .."r. /'P Other Distribution box X) Dosing tank ( �)/ _ Percolation Test Results Performed by..:G.C�w!.....r.....-��.L:�-C_.....•...`?'JCr... Date.......:'. -{4" ....... Test Pit No. 1.. ---minutes per inch Depth of Test Pit../¢.4-."._. Depth to ground water .7'.. Gi0 �,t ED _ Test Pit No. 2________________minutes per Inch Depth of Test Pit.................... Depth to ground water..-.....'u7....__...._..... ----•---------------------------------------------------------------------------•---•--•-•-•---•----......................................................... 0 Description of Soil-------�C-:.--------- '"_T..f}.Gf ...... -------- -------------------------------------------------------------------- U ••---••------------•--•-••-------•.............................•----------•-------.............-----------•-----•....--•-•--••••-----------••--•-----•-----.....---•------...--------••---------•-..--•- W -----;-•--------------------••••-••-------•-----------••-•------------•-------------•-•------•---------•-----•-•-----•--------••------•--•---------•-•--•-••---------•--••••-•----------........_....... U Nature of Repairs or Alterations—Answer when applicable.............................•.--................................................_.._.......... ------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------...-••-••-•--•-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE-, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health, Signed...................................................................................... ........................... .._. Date Application Approved By............ -��' -- •... .................... ,....._.. .. Application Disapproved for the following reasons: ---------------------------------------------------------------------------_ --------------------------------------------•-----------------•----------------------------•---............------------------------------------------------------------------------------------.......... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......... .............................. ` ^&'tifirFa le Toutph aurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructedL) or Repaired ( ) by------------------- -:••-•-----01 ....--------------------.....------...------------------............--------------.........---•......_....... Installer at.-- • -- ---.- _ -----------------•-----•------------------------------------- has been inst" alled� ccordance rt ie provisions of TI L:'�' o he State Sanitary Code as described in the application for Disposal Works Construction Permit No.--.--- -t- .. .... dated.......................... ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT''BE &O STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY. DATE......................... _` '-------- -----------•---. Inspector._.. X AU............................................................. E _ THE"COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF............................................................................. FEE. ram"` Disposal Workii Tonotrurtivat amit Permission is hereby granted.......... ... .......- .__ .�_. ........._.,- to Construct (�or Repair ( ) an Indivl�ual Sew DIspo System .- r at No....... .......... �........... '` l ..................................................................................... treet as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... If -- -i-A- ° - -----------------------------------------•------- / �G� .�f��a''�as' of DATE--------------------------------��/ . ------------ L Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS LOCATION SEWAGE PERMIT NO. At 2 2A!A-, Ax;4 O - 9-8V ` VILLAGE INSTA LLER'S NAME i ADDRESS emcx SU.ILDER OR OWNER DATE PERMIT ISSUED lg DATE COMPLIANCE ISSUED-6 } Z e �1 0 t ti. SYSTEM PROFILE ALL SYSTEM CCMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR ds NOT TO SCALE 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) o Three PROVIDE MIN. 20" DIAM. WATERTIGHT � � COMPARABLE MEANS FOR FUTURE LOCATION. Locus pon ACCESS COVERS TO WITHIN 6" OF FIN. GRADE Ro e.Lane - PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING \ OP FOUND. EL. 60.9 no, MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER STEM 58.3 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST z Q° UNITS TO BE AASHO H-10 r° 58.6' 4"0SCH40 PVC 2" DOUBLE WASHED PEASTONE PIPES LEVEL 1ST 2' OR GEOTEXTIL FABRIC 5. PIPE JOINTS TO BE MADE WATERTIGHT. �o EXISTING 56.0' 10" 1000 GAL H-10 14" 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE SEPTIC TANK TEE �� Locu (RE- o0000000g000 0 55.51' 310 CMR 15.000 (TITLE V.) d GAS BAFFLE 2; 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 4' LIQ. LEVEL (ACME OR EQUAL) '': 55.68 55.51 $ _ � g 53.51' NOT TO BE USED FOR LOT LINE STAKING OR ANY 00 �� OTHER PURPOSE. � 6" SUMP H-10 3050 INFILTRATORS 12" MIN. TNT. DIAM. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. � 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF ' OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' HEALTH AND PERMISSION OBTAINED FROM BOARD 6.21 OF HEALTH. 10. CONTRACTOR SHALL BE RESPCNSIBLE FOR ( 2 SLOPE) CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP ( 1 % SLOPE) VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF EXIST. 76' BOTTOM TH-1 & TH-2 47 3' WORK. NOT TO SCALE FOUNDATION SEPTIC TANK D BOX 2 FACILITY NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED, *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 148 PARCEL 66 PROPOSED LEACHING FACILITY. ' UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS _ _v. . __Pt�IC3F�l O-INSTALLING ANY PORTION OF SEPTIC --SYSTEM 12. EXISTING LEACHING FACILITY S9'ALL BE PUMPED NO CONSTRUCTION PROPOSED D AND REMOVED OR PUMPED AND FILLED WITH CLEAN GP DISTRICT LEGEN SAND. / 6.88 99- EXISTING CONTOUR / \ 99x1 EXIST. SPOT ELEV. Pj�� +\57.02� 99 PROPOSED CONTOUR P S %°�/ 5 R= \.04 SYSTEM DESIGN: 99 PROPOSED SPOT EL. �� --�56.3 rH1 TEST HOLE V`v` / // .001 GARBAGE DISPOSER IS NOT ALLOWED / b 57.(3\7 221A SLOPE OF GROUND / +58.60 ( DRAIN 57.15 DESIGN FLOW: 3' BEDROOMS ® 110 GPD = 330 GPD UTILITY POLE �` ASEMENT \moo USE A 330 GPD DESIGN FLOW 5 9g ` 0 +59. 5 \c HOLLY 8 FIRE HYDRANT am i 82 + 7.3 3 + MITE PINE 17" � �'�8.8°. \o� SEPTIC TANK. 330 GPD (2) = 660 ly, 5� NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING / 58 +58.25 LPI j BCC +s .50 '6 \ RE-USE EXISTING 1000 GAL. SEPTIC TANK** 7.96 /�^ ' \�L 57.72 \ HOLLY + 7 58.98 TANK \� LEACHING: TEST HOLE LOGS ATV ��� f�; °5 \ SIDES: 2 (30.4 +10.2.5) 2 (.74) = 120 GPD RISER r`rv, C� { +57.26 �' , L 2� �Cy { } 6 + \ BOTTOM 30.4 x 10.25 (.74) = 230 GPD ARNE H. OJALA PE, SE RISER 9_20 {ram! � � 6o.a6 0 ' S8.83 �Yir"� { 11 +�57528 TOTAL: 473 S.F. 350 GPD ENGINEER: ELEC. { f 58. WITNESS: DAVID STANTON, RS PAD 59 39 59.43 QPR N / \ USE (4) H-10 3050 INFILTRATORS, DATE: MAY 29, 2009 58.32 + 60.02 PAP( / 58.3 \ , 59 7 �57.42 WITH 1 STONE AT ENDS AND 3 AT SIDES PERC. RATE _ < 2 MIN/INCH 59.78 S / / �.0 \ 1 2575 BENCHMARK 8 s9 EXISTING GP// DRIVEWA CLASS SOILS PAV P# COR CONC. BLKHD DWELLING +6018 0.09 / \ ELEV. = 59.8' TOP FNDN. . / ELEV. ELEV. SUNROOM ELEV. = 60.9' o // \ [1 ON POSTS) \ 6 22 0" V 58.3' 0,, 58.3' < 1 \ A A .40 �, \ SL SL MA 6" 10YR 4/2 6" 10YR 4/2 s. �'` \\\'' APPROVED DATE BOARD OF HEALTH 1H1 '' � } 57.59 E E 2 3 - TITLE 5 SITE PLAN FS FS LOT 37 8„ 10YR 6/1 8„ 10YR 6/1 15,875 SFf OF 7 WARWICK WAY SL SL e B CENTERVILLE 10YR 5/6 10YR 5/6 �'I' o�aa� �N o ft v � . �� ss� ��� As�� W PREPARED FOR 27 6.05 27" 6.05 � .�ti t � c 4 o DAN,ELA. DIEL C�JA A. �, BORTOLOTTI CONST./GIRARD C C 'd LA �� 'o .3 _ OJALA E° Nn. 502 �I No. Y09 � V r€ �Q `� �Ic .1 JUNE 1, 2009 Q� fit; t nESS PERC . MCS & GRAVEL MCS & GRAVEL �'1 ¢'? y� ,•tAOFMgss�c ���ZHoFMAss9c off 508-362-4541 fax 508-362-9880 DANIEL 2.5Y 6/4 2.5Y 6/4 0� OJALA yGa D DAANIEL ' �� downcape.com U � U CIVIL OJALA down cape engineering Inc• 132" 47.3' 132" 47.3' 46502 No,40980 Scale:1"= 20' 75o��FG ST ¢ �\�4 ��o Fss\ o civil engineers NO GROUNDWATER ENCOUNTERED �_ 1-O� s8/0 AL�� SUR land surveyors 959 Main Street ( Rte 6A) 09- ' 03 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 09-103.DWG(SBO) f"�' �}Qx }_. .. 1-- • 4^tea+. +++:..:+{„ ........_. .. Oi * f /G3 //o. So ' x C E�3GN Pit, k x foo,00 /09.63 L/ NED c.J� 2. ' o � �. . /Odo A 2 r A` Y 4f f I D /o q. ' 103. 38 + r� + -- -- — -- — — e x I'.-S 4- � q r o u r'7 O �r r.� e V E A�- 7_. S L E- -- � -- -- - -- P'- Posed ground Pr'of'lle nir-»ur-n 1 " fi � r- -ICoo- ) 2 O� %g - ,�Z cw�czshec� Sfone - ZQ - - `3' _ -7 i - D/sT BoX ° 6 SurnP a ° i el o • I_ o 314 / /ooc GAL SEoT- C T91:K ° 14 l c-, O G D - _ oOM HOusC- DF� 7 c _S- z5-S TES ; BY : Gores/ € LvELCE.e iA/G �hd d�s.00.s�r� tv Tf�/E S S �'• Gi FFOf2L� en-t L3 ' r-ra-f-a.b/� M �/ NCH L3cya..-; � �;� TEST H0LC- / TE ST HOL C- SC- /000_ TFAA-/k E 1O � T •ti' � 99. 4 /44 . r G L- w Av 0 A/ -r,L �; ��. �A-j r_)o F3 A C k E Q(✓! M E&/T-S O F T-f /E V/C 7-0�e / ,Aq Z'//,C A Y T o w n1 0 �,�,ems SrFiC3 L E C E N T&-A�? ✓ e = 12 1=0,2 . e E t^. 1/S GOB DOAJ �tN or P'fRs w A.' EVEREII - 'S10 HIr:Ga t� H HIrpKL STS no i3�:. J Fr It ., 90� GISTS �.� N, SOON G_ L/ l/ E- t L E- F y �E of eE•r-)E ti T-S d� oL -'57 �C3L __ 1 At <3 //3