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0049 NORTH PRECINCT ROAD - Health
9 .�, ,Tv rth Precinct Road Centerville A= 148 131 SMEAR No. H163OR UPC 10259 smead.com • Made in USA ,��CYC(, Sq Q� J��RKI I r Commonwealth of Massachusetts � = -+;: Title 5 Official 1!nspection Form - w 1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments (K �`. Jj 49 North Precinct Road Property Address Melissa Ulmann Owner Owner's Name information is Centerville ✓ MA _ 02632 6-23-2020 required for every --- - " --` State Zlp Gode Date of Inspection page CitylTown I 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 A. Inspector Information cSl r 1�a3y filling out forms on the computer, Carmen E......Shay.__. key to move your Name of Inspector cursor-do not Shay Environemntal Services ----- — -- --- --- Company Name .- ------ use the return — - - —'�—�-�---- key. PO Box 1576 r� Address MA 02649 Compan I Mash pee —-- —. S - State Zip Code City/Town — �. 508 294-7498 3080 __..._. -__ ..__ _ .....__. .__ _ _._ .____._ License Number Telephone Number i 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. 0 Passes i 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation,by the Local Approving Authority 4. ❑ Fails i 6/23/2020 __-- �_. Date Inspector � nature The system inspector shall su i bmit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 day s 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. title 5 official Inspection Form:Subsurface Sewage pisposal System•Page 1 of 18 15insp.doc•rev.712612018 { 1 Commonwealth of Massachusetts ,r ^ 62Title 5 Official Inspection Form sments Asses ! _ 'iq Subsurface Sewage Disposal System Form -Not for Voluntary 49 North Precinct Road ......... Property Address M"elissa Ulmann _. -- Owner owner's Name MA 02632 6 23-2020 information is Centerville _.._.._. _..__.f I tion required for every --- — State Zip Code Date onspec page: City/Town 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: System consists of a 1000 gallon tank, a Dbox and Two 6' deep leach pit with 1' stone 2) System Conditionally Passes: section need to be ❑ One or more system components as des e nthe the"Conditional ittoalPareplacement or repair, as approved by replaced or repaired. The system, upon completion 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." hether The septic tank is metal and over lt?ationaosex old* f�It ic tank(w ation or tank failure s imminent.metal System or not) iwill tpass rally unsound, exhibits substantial in 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 ❑ NO (Explain below): Tide 5`Ofticial Inspecliorl Fow Subsurface Sewage Disposal Systen?•page 2.of 18 t5 nsp:doc•.rev 7/2512018 Commonwealth of Massachusetts Title 5 Official Inspection Form I} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 North Precinct Road T— Property Address - � — Melissa.Ulmann — — Owner Owner's Name information is Centerville _ _ MA 02632_ 6 23=2020 required for every CitylTown�^ _v State_ _ Zip Code Date of)nspection page. C. Inspection Summary (coat.) 2) System Condition ally.Passes (cost.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. i ❑ 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 is1eveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspectio,n if(with approval of the Board of Heaith): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ 'ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i ._. _....... 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 31`0 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Title 5 Official inspection Form:Subsurface Sewage Dispo_sa!System Page 3 of 18 15insp doc•rev.7/26120 1 8 . . Commonwealth of Massachusetts ~�~��N�� �� �-���~��*�N� �N��������*0�~���� ����N~K��A � Title ��� n�pn � un�mw~m w� °~~��__~=�°.~. ~ Form - Subsurface.Sewage Disposal System Fonn -NotforVountaryAssessmente recinct Road Property Address Melissa Ulmann owner uwnersmamv �q�nmmrww� - Zip Code � page. "^r'~-' � .C. Inspection Sumoonnov«poy \^v.``./ F-1 Cesspool or privy is within 5O feet ofa surface water F� Cesspool or privy is within 6O feet ofa bordering vegetated vve.Uand or salt marsh d Public Water Supplier, if Board Health (mn O fail unlessthe ou �m ' pru"'� ""=""' °-r ` '' - ^`me|�h— System-^ t h twrnisfunotiom\n0 in rnmnnwrthat protects the public= ^ . D The system has a septic tank and soil absorption system (SAS) and the SAS is within ha supply »rtributarytoaou�am*water supply. � 1O�Oh�e�Vfg �u�a�e�a The system has Psoptr «p' c tank and �* i h Sandthe~SAS haw�hina Zone 1ofa public water � supply. D The system has 8 septic tank and SAS and the SAS iswithin 5O feet nfo private water supply well.The on o Fl S d the SAS is less than 1OO feet but 5O feet o' �~ nannmaphvehawatereupp\yweD°°. Method used ho determine distoncei This, system paoaes if the well water analysis, performed at a OEP certified \aborahory, for fecal w'|i6o!m bacteria indicates absent and the presence of ammonia nitrogen and.nitrate nitrogen.is equal ua| to r less than 54pp ` prdvidedt.a\nn otherfai|une criteria are triggered. A copy of the analysis must be.ottauhedhu this form. � o. <]tMor � ` � Failure'�raahaApp|�au�tof\oSystanmst 4U System You must indicate flYes` mr"Nm"to each ofthw following for all inspections: Yea No Backup of sewageinto facility orsystemuomponantdue0ooverloaUeUor clogged SAS orasPoo| ` of the ground orou surface waters Discharge or di ' of��uentkzthe surface El o due to an overloaded prd8gQed SAS nrcesspool Title s Official inspection Form:Subsurface Sewage Disposal System'Page+of`a mmsp.00c'rev.n26/20,v Commonwealth of Massachusetts Title 5 official` Inspection Form Subsurface Sewage.Disposal System Form Not for Voluntary Assessments 49 North Precinct Road Property Address Melissa Ulmann Owner Owner's Name information is Centerville MA 02632 6-23-2020 required for every _ _ _ ----._ page. City/Town State- Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: {cant.} 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 El ® 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. ElAny portion of cesspool or privy is within 100 feet of a surface water supply or tributaryao a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of'a public water supply well. ❑ © 'Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal`to or less than.5 ppm, provided that no Other failure:criteria are triggered. A Copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd: ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system;owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must`i'ndicate either"yes"or"no"to each of the following, in addition to the questions in Section C.4. 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Supsurlace Sewage Disposal System'•Page 5 of IS Commonwealth of Massachusetts Title 5 Official Inspection Form i l 1 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 49 North.Precinct Road ------ Property Address. Melissa — Owner Owner's Name information is MA 02632 6 23-2020 Centerville, required forevery — _.--_-_-- p __.---.-. _._. ""— — State Zl Code Date of Inspection page Cdy(rown _ C. Inspection Summary (cost.) 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 GM 15.302(5)] t5insp.doc-'rev.712612018 Titles Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 18 Commonwealth of Massachusetts _r Title 5 Official Inspection Form 'I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.; 49 North Precinct Road Property Address Melissa Ulmann Owner's Na Owner ....me. ..__ ___._.M. �_._,... _ ..... .._. information is required for every __Centerville MA 02632 6-23-2020 .. _.__.. ....._.__ _ ...... page. page. City/Town state Zip Code Date of Inspection D. System Information' _. 1. Residential Flow Conditions: Number of bedrooms(design): — -- Number of bedrooms (actual); — -- -_--- DESIGN flow based-on 310 CiMR 15.203.(for example: 110 gpd x#of bedrooms): 330 Description: System consists of a.1.000 gallon tank, a Dbox and 2 -6 deep pit with 1' Stone i Number of current residents: .0 - Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes H No If yes, discharges to: ..... ............. Is laundry on a separate sewage system? (Include laundry system inspection. ❑ Yes Z No information in this report.) Laundry system inspected? ❑ Yes Z No Seasonal use? ❑ Yes ,❑ No Water meter readings, if available' last 2 ears usage d --- ------- - 9 ( y 9 (gp ))� Detail: 2017-23,000 201.8-21,000 Sump pump? ❑ Yes ❑ No Last,date of occupancy: — --- .Date II i ii 15insp.doc•rev.7/2612018 �i Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts Ifr Title 5 official Inspection Form - 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r` 49;North Precinct Road Property Address Melissa U'lmann Owner owner's Name information is Centerville MA 02632 6 23 2020 required for every ..--.... _. . ..-.,_.,-_.__. ___._.__ _..___._� . .._..... page. Gtyfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203); Gallons per day(gpd) - Basis of design flow,(seatslpersons/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: oats Other(describe below): 3. Pumping Records: Source of information: Was system pumped,as part of the inspection? ❑ Yes ❑ No If yes, volume pumped:. __........._- _----_�._— ..-.--:_..._._.._ gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev. Title 5 official Inspection Form.-Subsurface Sewage Disposal System•Page 8 of 18 .-- Commonwealth of Massachusetts Inspection Form Title 5 Official, �-A VA Not for Voluntary Assessments Subsurface Sewage Disposal System Form 49 North Precinct Road .......... ........... Melissa Ulmann_______.,__ Owner Owner's Name information is MA 02632 6-23-2020 required for every Centerville --.......... page. i�,—ty[—Town----'- State Zip Code Date of inspection D. System Information (cont.) 4. Type of System: Septic.tank, 'distribution box, soil absorption system El Single cesspool 0 Overflow cesspool El Privy Shared system �yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the curren I toperation and maintenance contract(to be obtained from system ownerj and a copy of latest inspection.of the I/A system by system operator under contract i Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components, date installed (if known) and source of information'. 1991 per HealthD ------- ..epaltment .....-------- ivi Yes. No Were sewage odors detected when arr ing at the site? 5. Building Sewer(locate on slt:6 plan): 2 Depth below grade: Material of construction: F� cast iron JZ 40 PVC F� other(explain): Distance from private water�uppiy well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): Tate 5 officiai inspection Formi Subsurface sewage Disposal SYstern Page 9 of 18 t5linsp.doc,-rev,712612018 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Vt. - % Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 49 North Precinct Road v, ...... __._____....... ... Property Address. Melissa Ulmann Owner Owner's Name information is Centerville MA 02632 6-23-2020 required for every 4 ..._ _..__._....._. _._...__.._._�_ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank.(locate on'site plan): 2' Depth below grade: feet Material of construction; Z 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 5x5x8' Dimensions: _.-.—. — —_- -__-___ Sludgedepth: 6 ___-_.,._____._.___._._...__._.-..._..._....__--_-.._..-....._...-...-. Distance from top of sludge to bottom of outlet tee or baffle 23- - -- ----- _ Scum thickness 1/2 4 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? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Inlet and Outlet Tees/baffle in good condition. (Sinsp.doc.rev..7 12 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,:System Form - Not for Voluntary Assessments S. 49 North Precinct Road z. .� _ ..........._ _ _... Property Address Melissa Ulmann Owner Owner's Name information is Centerville MA 02632 6 23-2020 required for every --- - -- ___ ......_..__ _.. .._._ _....._. page. Clty/Town State Ztp Code Date of Inspection D. System Information (coat.) 7. Grease Trap (locate on site plan): Depth below grade: feet — —� Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: --_— - -- —__ ---.-_._-. Scum thickness ..... --- Distance from top of scum toftop of outlet tee or baffle — ----- -- -� -Distance from from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal', ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: _..._,_.�.._._.__.____...._._.._-......_._.---.�._...._._._�.___.__.._-_.__... Capacity: gallons Design Flow: gallons per day t5insp.doc•rev:7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 a� Commonwealth of Massachusetts 'Title 5 Official Inspection Form }j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i _ f 49 North Precinct Road µ ...._......_.... Property Address. Melissa Ulmann _ Owner _ _. ___ _m_.�.._. _.---,__------____.-..___ .____....____. Owner's Name information is MA 02632 6 23 ill 2020 Centerville . requiredfoj-every ___._.._.. _.-_._�_. ...._.___._ ___.__._ ... . .__......_._. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cant) 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 _D Box Present/Found 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.): DSOX PRESENT and in good condition. Some eveidence of carryover noted, t5insp.doe-rev.W26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i f `^; Commonwealth of Massachusetts 2 -Iles Title 5 Official Inspection Form E� Subsurface Sewage Disposal'System Form- Not for Voluntary Assessments ( f� 49 North Precinct Road Property Address Melissa Ulmann ----- Owner Owner's Name _._ information is Centerville MA 02632 6-23-2020 required for every _ .__._...-----__ page. Cityfrown ^-- State Zip Code Date._of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ 'No` Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is.a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 2-6' x 6' .—.. ® leaching pits number: — -- - ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,.length: ....--- El leaching fields number, dimensions: —~ ---� overflow cesspool number: ❑ innovativelalteinative 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 Officialinspection Form a v Subsurface Sewage Disposal System Form Not for Voluntary Assessments t ;!� 49 North Precinct Road ...... __- . _.._._....... � Property Address Melissa Ulmann Owner Owner's Name information is Centerville MA 02632 6-23-2020 required for every __._ ...___.-_.. ---~ -- ""`"� - - State Zip Code Date of Inspection page CitylTown 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): Located NEWer Pit from 1991 and found 2.5'water in pit and 3 foot stain line. Pit has 50 percent of its capacity-and more than 1/2 day flow per Title V. Original pit was hydraulically failed in 1991 but still connected via Dbox. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration _.___.._._......... ..__. Depth—top of liquid to inlet invert Depth of solids layer —__ ...—..........._ ...__._.... ... Depth of scum layer Dimensions of cesspool Materials of construction. Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.tloc'•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslom-Page-14 of 18 �.� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form Not for Voluntary.Assessments t 49 North Precinct Road Property Address Melissa Ulmann ------ — — ---- Owner Owner's Name information is Centerville MA 02632 6-23-2020 required for every State --^"' �`--"-"W��"—'-���"�--��- ---- State Zip Code Date of Inspection page Cityrrown 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.).: ,l I I i t5insp.doc rev.712612018 Title 5 official,inspection Form:Subsurface Sewage Disposal System•Page-15 of 18, Commonwealth of Massachusetts . .� a, f. Title 5 official Inspection Form 1, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 North Precinct Road Property Address Melissa Ulmann Owner Owner's Name information is MA 02632 6-23-2020 Centerville required for every —• _—---- — - -- —"""W"{` State Zip Code Date of Inspection page 5ty/fown�� 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 i I i Title.5'Official Inspection Form!Subsurface Sewage Disposal System-Page!6 of 18 t5insp;doc•rev.712 612 01 8 - i Commonwealth of Massachusetts -� � Title 5 Official ' Inspection Form --� tW Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4_ perty Ad9 North Precinct Road Pro dress __.._ Melissa Ulmann _ ___._ . _— -- information Is every Centerville MA 02632 6-23-2020 required for eve __ ervi _. _.._ --__-_ _ ...__.._ _. __.__._ _.,__.....___ Owner Owners Name page. City/Town State Zip Code Date of Inspection D. System Information (cont,) 15. Site Exam: ® Check Slope Surface water ® Check cellar ® Shallow wells depth to high ground 15+ Estimated de p 9 g nd water: feet. Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: Date!_` Observed site (abutting property/observation'We within 1.50 feet of SAS) Checked with local Board`of Health -explain: Checked with local excavators, installers-(attach documentation) ® Accessed USGS,database -explain: . ....... I You must describe how you established the high ground water elevation: SDW 253 Zone C -0.4' foot adjustment. Bottom of pit is ten feet below ground. Hand augered to 12 feet with no groundwater. Pit,is not within groundwater table. Before filing this Inspection;Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.712 612 0 1 8 Title 5 Official Inspection.Form:Subsurface Sewage Disposal:System-Page 17 of 18 Commonwealth of Massachusetts 17 1'it[c 5 Official Inspection Form -_ � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 North Precinct Road Property Address Melissa.UI man n Owner Owner's Name information is MA _ 02632 6-23-2020 Centerville _ ..... required for every -----•---- ----- — - State Zip Code Date of Inspection page City/TownE. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z 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 Z 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 'ISinsp,doc.-.rev,:7,126/2018 Titles Official Inspection Forms subsurface Sewage Disposal System Page 18 of 18 s TO*N OF BAR7.NSTAB E LOCA'C'l4 `T't MAY t f1 6 a SE4V;AC:.L VILLAG ESS'O"R'S tills P 4., LOT l e* -xy/ INSTALLER'S NA14L• G PHONE N0fP '/ SEPTIC TAN:X CAPACITY LEACPJNG FACILITY.47pc} fTf NO. OF BEDROOMS ��PRIVATE WELL OR PUBLIC WATER �a BUILDER OR OWNER �ia DATE PERMIT ISSUED' . DATE CbM?L3ANCE ISSUED- „�, /—�'J VARIANCE GRANTED. 'Yes No 36 i 1 Y Flynn, Judith From: Taylor, Madeline Sent: Wednesday, October 04, 2006 11:54 AM To: McKean, Thomas Cc: Flynn, Judith Subject: RE: Septic System Questionnaires Received/Reviewed Tom - 9 Linden Street is on town sewer. It may be under 9A or 9B Linden St. Would you mind rechecking your files? 40 Maggie Lane has only four bedrroms total.What you thought were bedrooms in the lower level are actually Kim and Eric's desks in their office. 1025 Service Rd -There should be something on file stating that a 5 foot opening was put in one of the upstairs bedrooms. The owner was required to do this when she applied for a family apartment, reducing the total number of bedrooms to three-2 upstairs and one in the lower level apartment. The only rooms that are not labeled are the second upstairs bedroom and the room that was opened up to five feet. Thanks Madeline -----Original.Message----- From: McKean,.Thomas. Sent: Thursday,September 28,2006 10:02 AM To: Taylor, Madeline Subject: Septic System.Questionnaires Received/Reviewed 9 Linden Street The Health Division files were searched and we cannot find any records of the septic system. Please ask the applicant to hire a DEP certified septic system inspector to conduct a full inspection of the septic system. 40 Maggie Lane The floor plans are difficult to read. The basement contains an"office"room and two bedrooms for"Eric"and"Kim"? Where are the walls and doors located? Is this alsix bedroom plan? I count one in the apartment over the garage, two in the basement, and three in the main house=Six total. HISTORY-The Board of Health limited the property to four bedroom (per the variance decision letter dated May 30, 2002. Also a permit issued for no more than four bedrooms dated June 7, 2002). We cannot approve the floor plan at this time. The floor plan appears to show a number of bedrooms which exceeds the permitted number of bedrooms allowed. 49 North Precinct Road, Centerville OK-Approved for three bedrooms per permit#91-61 issued in 1991. The submitted floor plan shows three bedrooms.. total::— �' 1 1025 Service Road,West Barnstable 1)The floor plans are difficult to read. Lines are faded so walls are difficult to locate. Also not all of the rooms are labeled. Please revise the plans or re-submit new neatly drawn floor plans. 2)The system consists of two"old block cesspools"per the inspection report on file dated 8/16/02, four years ago. I suggest an up-to-date inspection should be conducted to determine whether whether or not the block cesspools are in good condition and are functioning properly. 1 Town of Barnstable Health Inspector pFTHe Tp� Office Hours ti Regulatory Services _ 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 w BAMSTABLE, +� MASS. 9. Public Health Division ATED Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: a Address: LiqNoy, tr UV Map 141 Parcel Name: b:: Phone #: Z'9-0 31 2a. How many bedrooms exist at your property now? Z 2b. Are you planning to add any bedrooms? I If yes, how many? Y 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or 10�� If the dwelling is connected to public sewer;skip questions#4 through#9 below. W 4. Location of dwelling is IZN�SID or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the d elling connected to an ONSITE WELL or to BLIC TER? -Is a disposal works construction permit on file? YES or NO 6a. -If yes,how many bedrooms were approved according to this permit? Bedrooms. r^- 7. (Were any building permits obtained for construction of additional bedrooms? YES or NO t_,. c 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has-the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ---------------------------------=------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. t b ` Special Conditions: D Signed: Date: Z Q;/health/wpfiles/amnestyapp Areo a 18 i ire �6p�Vri Ck O-y Nv\ I 7� zi !IT IZ 57� , 3' 5' r� OF ENTERTAINMENT ROOM N LIVING ROOM N C° N N CV N BEDROOM LAUNDRY Kitchen - '� ROOM cfl - j BATHROOM Zo N 50' ��S �i. i ( l OL 1 lv- 22'-7" 26'-62• BEDROOM#2 `9 (V LIVING ROOM H Q F bathroom #1 2'-6" MASTER BATH bo N 2'-6' N KITCHEN 2'-6" BEDROOM#1 —� 2-6" --� 2-6 �— 2-6 �— �--5' 28'-01 i r TOWN OF BARNSTABLE 10CATIO 4t 444L PrEC>41VI SEWAGE # VILLAG (lit Ao SESSOR'S MAP & LOT 1fV'f-*""1.y1 INSTALLER'S NAME & PHONE NO' f' �-T SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size), CDk NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED? VARIANCE GRANTED: Yes No 1 } . a r 7Pw7 J� Alr-t <P 10 No....47 -- f ..w Fss..., �-- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r TOWN OF BARNSTABLE Appliration for Disposal Works Tontrurtion Verutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ....QJZ.ew.. .............. ...................... 'V�-Vke------------------------- ...... Location Aress .•• , or Lot No. ............ '= = .4--�/,�ljrn�t°� i := 1 'E.� r �y _......5\•\( ................[...._.�..�i Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms____ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures -------------------------------- - . . W Design Flow....... ... .....................gallons per person per day. Total daily flow.. .....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------I.............. Diameter...1.0......... Depth below inlet.._........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --••----••-••----------------•----•-•--•--•••------------••••-••-----....................---•-............................................................. 0 Description of Soil-------------------------------------------------------------------------••--------------------------------------------------......................................... ---- -- ----------------------------- U Nature of Repairs or Alterations—Answer when,appliea,ble_:�-$f�CA.k� _I_4QM_ ---- f -- Z' ...._.. ----------------------------------------- Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss e b and�offealth. Signe --- -- - --------- ------- ------ m re Application Approved By -------------- Y -- . --- Da e Application Disapproved for the ollowing reasons- ---- --------------------------------------------- --------------------------------------------------------------------------- ----- -------------------- --------- q Dace Permit N ./. ^.-, Issued ........................................................ 1 . Dre r ......................... rr � -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH + TOWN OF BARNSTABLE Appliratiun for Dispuiial Varka Tonotrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( )y-ad Individual Sewage Disposal System at: .........................................-� ... ..... ..... t� ,,,,_'��ocation�Add`roe s *�..� S\-- or Lot No. ..................' ` ..........._...._._._..-_.....•.......... -_---- __-_-____________-___------___ ----_-------_--_-•---_-_-- - -. Ow L ner ddress Installer Address U Type of Building Size Lot____________________ _____Sq. feet I—, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P I Other�fixtur=es. .........................•----• . WDesign Flow............................................gallons per person per day. Total daily flow.................................:...........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--------------_: Depth................ x Disposal Trench—No_ ____________________ Width..................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No..........I.......... Diameter.......A_q..... Depth below inlet____.__�._..._. Total leaching area:..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ fxq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W4 ........--•---------••••----------••._.......-••.....................•--•-•---•-......•-•--••--•--•.......................................................... 0 Description of Soil...............................................................................:............-------•-•---------------•----------------------------------.....__._..._.. x U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•--••---- W -•---•--------------------------•-------------------•----------------•--•-•-•--•-----••-••---••----•----•--•-- ...... f U Nature of Repairs or Alterations—Answer when applicably_________________________ __________________________________________�.._._______________.. ..................................................tG ---------='------t S -_-_--- --_� TL Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the Compliance in operation until a Certificate of Co has been issue&by the=board of-health. • Signed_ �4", ' k � . Dare - Application Approved By .... G.•� . ----------------------------------- ......-------: ..---.3...... e.. ..- .R.. ......:... ......... Dare Application Disapproved for the following reasons: ................................ ------------- :.. ........... ................................... ......... ............................................................. ................................................................. -----------............................. ^ , Permit No. ......----.1... Gl.................................. Issued ...... "-:...... Dare .......... - to Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cextifirate of C�nmpliance THIS IS TO CERTIF��yy�� That the�Indiuy;dual Se ,,cage,Disposal System constructed ( ) or Repaired el lwf Iv- � X� S �n c l l by---...............................................--------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ Installer _ at ........................... A.c1...------/VO .----. l. C. .. `+.f--------...... ................................. ...... _ .....----............................. has been installed in accordance with the provisions of TITLE 5 oThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ........1...-. ..'--. ........ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..- .�...... ....". ,m ........................................... Inspector ..........................................of`//....r</ �.......... � % � z. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.....,.�.r.-Zn/ TOWN OF BARNSTABLE _ r..... FEE... ...... ..... Ropood arks Tn #r iurt rani# �-�r PE L-V4-1Y S'�Fffe .- Permissionis hereby granted.--•--------•...............................................................................••---......................_........_....___------ to Construct ( ) or Repair 6 )an Individual Sewage.,Disposal System at No......................iq r 1�/C-CC I ` k� I ._.... ................................................. ..................•--._....--•---._._...•----._..._.............. Street as shown on the application for Disposal Works Construction Permit No.. �.-`\-../.. Dated.......................................... Ix .`��?__.1............... Board of Health DATE -•-•--....---•-•---•-•--•--•..............................•---- FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS 0/9 'L C A T 10N -S E W A G E P RMIT N .` LOT �c� ';2� lel a 6 V LLAGE INSTALLER'S NAME & ADDRESS k_ H le-r-0- i U I L D,E R OR OWNER Me-kLor) DATE PERMIT ISSUED ho,/ez DAT E COMPLIANCE ISSUED_���7�8.2 I_ c,� id c :951611 ..1 1 Y YzE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 1..................OF... .... rn-% k ............................. App iration for Uhipviial Workii Cfnnstrnrtinn andt Application is hereby made for a Permit to Construct (X� or Repair ( ) an Individual Sewage Disposal System ►.-- at: _ -.. _ /L D i Location-Address or Lot No. ............................................ ........... •-••••.•••- ...._..(��_r,. Owner Address =Wl IS.�ec 'kl.: ............................. ....---._..__..._...__._................. Address Type of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms.......... _.___.___.__:________________Expansion Attic ( ) Garbage Grinder (gyp) aOther—Type of Building ____________________________ No. of persons............................ Showers ( I ) — Cafeteria ( ) d Design Flow fixtures •-gallons er-'--•---•-----------.-••-•••---•-•-••....---••------------••••--•-•-••••-...__._...••••--•---•--•---•............... W g g p person per day. Total daily flow__________________.a®__._____._.___gallons. Ra Septic Tank—Liquid capacityl.04.0gallons Length................ Width................ Diameter.... Depth___! ....... Disposal Trench.—No._______A_________ Width___.):® ._.___._ Total Length �_.._._ Total leaching area__3�$_:..?-.sq, ft. x Seepage Pit No--------1------------ Diameter__._..l0-P...... Depth below inlet....:IQr_._..._. Total leaching area_5`I8.s_Z-.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) l Percolation Test Results Performed by-____R?....�(.1�i`�__________________ _______________________ Date__'7�7r2-/a_�............ Wa Test Pit No. 1 X._2.A�'___minutes per inch Depth of Test Pit_.t_ZF�.Z!___ Depth to ground water_._,_ Z_______- . 44 Test Pit No. 2.�Z�®_minutes per inch Depth of Test Pit.......y?�: ___ Depth to ground water_____1-t__�.___._... ................................ a Description of Soil--TC -- nv- -•-- -------------------------•---------------------------------------•----__-_------------•----•----•--- U - - p applicable................................................................................................ of Repairs or Alterations—Answer when, -----------------------------------•-----------------------•---------------•--------•-<----------•-----•--••----------------------.................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 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. ' Sign ``"� P-/ 2_.. Da Application Approved BY �_ .t...J, �%%% � _ _ .4f 1� d �'......... •--- Application Disapproved for the following reasons----------------•----------------------•--------------............................................................ ---------------------•-----------•-------•---------•--------....-•-------------------------------•---------•----•-•---•••---•-••--•-•-•-•---•---•••---•-•••------•--•---••----••-•••................... Date PermitNo...................................................... Issued....................................................... Date ��Qp t' C No...Y...a-S! i FEB....... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.!OW.v1................_OF......... _f n1�'�'�kt.,,►..---------......_.......... AvOrtttion for Eigpniia1 Workii Tutor urtion Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst at: �.........Sr..: ..---...... .ec ��,�IL....--.M ------------------------------ Locatio -Address or Lot No. .......................................... ........... •.......................•-------...------ Owner l Address Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..........3.....................:.......Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin yp g ____________________________ No. of persons............................ Showers ( � ) — Cafeteria ( ) � Design w.Other by res-----•---....----gallons per perso.--------•--------------------------------------------------••--•------. Desi Flo ......-•---------•-•--......---• W _ n per day. Total daily flow...................39.0.............gallons. WSeptic Tank—Liquid capacity.�Q_Q.Qgallons Length................ Width................ Diameter----V------- Depth..... '....... x Disposal Trench—No..................... Width.....IQ!....... Total Length......14.,**..... Total leaching area....................sq. ft. Seepage Pit No--------!........... Diameter......It)........ Depth below inlet.....10........ Total leaching area..�q&.?.,.sq. ft. Z Other Distribution box ( ) Dosing tank ( ). aPercolation Test Results Performed by._.._MIC'____ .................. ...................... Date...."1/i ........... Test Pit No. 1_�.lt4__minutes per inch Depth of Test Pit...�:1.._�..... Depth to ground water.... .............. (=1 Test Pit No. 2_.A Z. .minutes per inch Depth of Test Pit......V.76..... Depth to ground, water_._.t.7!.A....___. ------....-• ................ . .-•-- j�. o " �t�n�-+Tc �� ^^t2.'t• !lac �ur...__5Ai�.- . R U Description of Soil... �' �'N� taQAf!!�vt �?,p.:$�`C ---- 4'_. 8iV-"------K=�c Y.m....S�-1 W i UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•-----------------------------------------•------------------------------------•-----..........------------....------------------.......--------------•---------------------------------.........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 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. r.! / SigZtl��p ^ :._ L ......................... •---- Dat Application Approved By.__.—.- ........_ �... ...... --....... Date Application Disapproved for the following reasons-----------------------•--------------------------------•---------------------------------------------------••--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�q!^'Y\.....................OF........ .n Pr ?. .......................... Trrtifiratr of (�umpliaitrr �v, ` Sewage Disposal System constructed (� or Repaired ( ) by------. ................................... IS..S._...._ T Y That the Individual ---------------------------------•-•------------.._..........-•----------...._._...--------...---------- nstaller at •--- b -- -----i7p------00;-=�AN-----. �" �^ ----....-- has been installed in accordance with the provisions of TIT E 5 of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No..... a-' ..__.._... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................q4�.� ............. Inspector......R._�11G_-................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ppZ'' ly ...................OF........ .........:... ............ No....._...... � FEE.....7............... Utopias&�V\ nrk mArnrti.on rrmit Permission is hereby granted...... ! ---- ' to Con truc (Y�l or Repaid ( ) an Individual Se age Dispos Syst at No.. # i .. O t` .....� _l.!r� - _ V .- �'1 Street Q' as shown on the a plicati , for Disposal Works Construction Pe mit No.....................�ed..... .��._._�!...--....--.-....-_-. t 2� ��„-„ rd of Health�� DATE......... ///7----- - ......................................... \ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS `\�. 8 <<a-6 . 92 TEST ± �� FWVEMr jl s TEsT r%oc E CQ� � v l� 9 tl O 8lS- ° r,r 104 7 0' O c �p0 N o , 0 . �' cl 0 f" Lu '( OFJON MASS �� ✓ '4 � B 4 1 r` /0 2k �\ �(? F �aTE P� 43,5(.o F. ►5p 'FKCx.l;l' a TT '. C4-4APT�L,G-,-�, ,... LEGEND t1OFM CERTIFIED PLOT' PLAN l EXISTING SPOT ELEVATION OHO �,�.��, a {, EXISTING CONTOUR ---- 0 —�---- 0=3 AL E oy FINISHED SPOT ELEVATION s �-�':to ' No�� F�Eciu�tLoD FtNIHED CONTOUR -- 0 ---- SE crrEkd fLl� h, �1 o p No:10951�O N APPROVED. BOARD OF H .LTH °FFSSONn � l+ e a ` DATE AGENT SCALEt / "= 10 DATE 619 82'` L®RE iGE' ENGINEER1NG e m CLI TT�-------- I CERTIFY THAT THE PROPOSE® , Y' 82°�2�r BUILDING SHOWN ON THIS PLAN EGISTERE RE0l9TtS JOB t�0. .. ,,.._. CIVIL LAND CONFORMS TO THE ZONING LAWS t .E R [AURVEYORDR. ----- ®F _®ARNSTA E, ASS Euc�T '. 712 MA! N STREET;. CH- By, M YA 6�N I S,. M.A S 3.' SHEET.!. OF 2 DATE gG. LAND 5U VEYOR, 2A FT. M//V•.' /1lOTF = /F E/TNER T//E SEPT/C TANS OR LEAC.�//nIG P/T ARE I`90RE TN•9;•/ /2"BELOJV ` /D �- M/N• rRAOE, f� 24�171�4M ET,ER COnJCR�TE COVED' 1*7 S o0 0 A u T G J�/ LL E BR �/lT AOE. .�N 4 PYC P/PF. CO A R R E.4 Y C S T / o/v SN CONCtt2'TE h'. Y � L L3E USEO ys., P/TCN /F/N DR/V4=WAY • ELE"IIt. to/.D COYE/RS �B"PFR FT. s• • 2 ° MsN. CONCRL�7-E o_ G, .4O2 CO VE.Q' CLEAN SANG L/QU/D LEVEL ' 'L AYE R 4., fig"C.l3T � /RON PIPE �dDCJ (►AL. v a o a °o QF ��8•- �B /b11 A/.P/TC/V D/ST. • � • • • • ° • e o ► > •e WA SHED STONE i P2R.><T; SEPTIC TANfC ` • 6 a • . . . • a o e . , BOX o • • � • • • • o • off° • I •• e • a eEf-iECT7VC • • r 4 i • e • D&PT// ° e o • ` v o 1V/�3XED STONE t � s . o • • • o a e • e 1 p o • ° n. • a • • • e s • • p°b p PR'ECA5T 5LEP.4GE or P/T OR ZVU/V. l�IYG• ' EVL�YA�"/®/V S (25. •:X 2.5, 314.,3 6 -g 3 b I lMyFigT,�4T �U/L®IMG INLET .5EP7"!C' Y.4//l�f � FT to lO. f7. 01,4 M. .J C(SEE TAaL/L.4T)O/4/} 40071.ET SEPTIC 7i�AO�t,' 9?7._ F P cAPAc� 392 8 �/� /Iv/LET 49157iil41997i0eY.BOX 4- FT GROUND WArE,r TAKE - OtITLETDISTRiat/'oN BOX - ,Z A - - - /ML.ET LEACWl&a PIT •SE1�VV�G� �Ia��®hS•�1. .'��.$T'�/� SCALE %s" a /= O� DlmEN.S/O/Ql A 3 FT. I D.F.516 / CR 7,65A1A DIA9.EMS/antV "t FT. NUA9DER OF DE®ROO/"9.� 3 F T. GARe.��E®/s�os.�aL uw/r Ivy SOIL Z-0 ra7AL E3"P1R A74jFL) =40*V . 33 O G.4t.1,0AY `SOIL TEST A/ SO/L TEST#R IvuNfBER OF t„eQCX/NG p/T.S fELe�e� 94 z �-�LoY 9 3, I p.4TE of soli- 7"EST S/QE LEACHING, PER PIT 125.7 ,per'FT -L I ` _:O — /z RES[ILTS AV1TNES5--D By JIj f fir=oR 6oTTOhPL6a•ICH/MG PER_P/T 7S.S �. FT 404,"1 R� d-OA �. Pt&C04AT/O/Y RATE / L��-S M/NI/NCK -- Z-vPs.o rL_ TOTAL LEACH/N<r •aRE 398.2 SIP.Q, fT. �''Ol't s d��� � e � � / , PERGOLAT/aM RATE A2 Ti'•fh-N• /ylly�lNGN. R ERNE LEAC'N/N6 AREA 399.2 5•Q FT. 2-0 - o. m 0 f OF of • m 6,P 1 M �1 I; � ZN bgssq (N �,, i 02 N o? AL yc w a �C Cc�t`t J' 1 ' U No.10951 O N ® p �. , .. �L DR'�`®Cry EIt�C�'l N i4IAIC CO,I A/G. f SUR��o� 9o�FSSONA F1.7 - ['LEI/ 84.E 71Z 14AIN ST• , f/Y.4NNI.S. MASS. l Q NO CF/TOV,,VO kv,4TER AWCOUiVTFREO CL/�/<1T; `,a cc�I`.; `i'c. DRTE • g.9 ����, �J � GRO[JNO YvA TE.P /9T EL.Et� �`�•6 Joa VO.• LO :� ATION SEWAGE PERMIT NO. N. ,. �s VILLAGE Cen erJjh, IN-S,TA L, LER'S NAME & ADDRESS l G rv+e s 4�a//a w A v� C,e n+e,r y %i C, B U 11 D E R OR OWNER 6 DATE PERMIT ISSUED /7d DATE COMPLIANCE ISSUED —�� - � � 1 Crais� e, 0Cd s _ , -f- `ice:= � `"'�"l�/•" �6L `.�„� � � 'O.00t, I t i 35 s i i 'S 1 s i --- f � a � � � I t ��--1.�.I'.1..����I.I1 r" .. ..I.-.,I.���...I;F II I,.:I:..I.�..I...�-...�-'..1..1I�-.:.,.�I.....-�I:.I.��.�..�-I I I 1�.Ir-I-1�-�..-.1I�.:-. . . . . ...�I.... 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