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HomeMy WebLinkAbout0158 WEQUAQUET LANE - Health 153 VVequaget Road Centerville P A = 25Q 158 i S,u 0 , UPC 10259 No.H_163O_R NASTINQS MIN 11 w Commonwealth of Massachusetts aq66 -/6g Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes ,r .Owner Owner's Name / information is required for every Centerville ✓ Ma 02632 3/11/2016 = page. Cityrrown State Zip Code Date of Inspection IV .p, 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. General Information filling out forms �?�# ��;J r c360 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection 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 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/11/2016 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of 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: 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM , 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is Centerville Ma 02632 3/11/2016 required for every page. Cityrrown State Zip Code Date of Inspection 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 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•3/13 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 °M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Citylrown State Zip Code Date of Inspection 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 all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is Centerville Ma 02632 3/11/2016 required for every page. Cityrrown State Zip Code Date of Inspection 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: ❑ ® 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. ❑ ® An portion of a cesspool or privy is within a Zone 1 of a public well. YP P P Y ❑ ® 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- 10,000gpd. ® ❑ 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 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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•3113 Title 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 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Citylrown 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: 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 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original system 8/23/83 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baf e 3„ Scum thickness 3" Distance from to of scum to to of outlet tee or baffle 6" P P Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Water level in tank at outlet invert, tank was not leaking and was structurally sound. Tank had a large amount of grease buildup, tank needs a thorough cleaning and should be done again every 2 years for proper maintenance. 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 Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 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 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is located under deck, box was not excavated. 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: t5ins•3/13 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 M 158 Wequaquet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ 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.): Leach pit cover is 4.5' below grade and was excavated with machine. Pit was found to be full to the cover resulting in a failing inspection. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Cityrrown 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 ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Cityfrown State Zip Code Date of Inspection 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 public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately try' t 13 I /A--1 2 S B_i 22 A•? 31 Z t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 158 Wequaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • Commonwealth of Massachusetts �' • Title 5 Official Inspection Form I II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Weguaguet Lane Property Address Edson & Evelyne Magalhaes Owner Owner's Name information is required for every Centerville Ma 02632 3/11/2016 page. Cityrrown 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 ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. I Fee /00 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4pliLation for Zisposal *pstem Construction permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / Q �� � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. v ,52� Sp Type of B ding: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building g ICAQ i�G No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _3310 gpd Design flow provided gpd Plan ' Date Number of sheets Revision Date Title , Size of Septic Tank DOD 6� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) //7$'�ry �/ f��j/� /��,tj��/ Gf ,2 SQj 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 d not to place the system in operation until a Certificate of Compliance has been issued by t s d of He Sign �-^-� Date -,4/ Application Approved by Date Application Disapprov y Date . for the following reasons Permit No. A 16— IC/mil Date Issued __� -------__—_---_------------------ _ - ---�:.�r - — - -- - - k l , t� No J ' '4 I�J — 4'� � Entered computer: �� y" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Disposal Opsteril Construction Permit � Application for a Permit to Construct( ) Repair(.<Upgrade(') Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ! Owner's Name,Address,and Tel.No. Assessor's Map/Parcel CJJ 0/7 Gy. Installer's Name,Address,and Tel.No. 1R Designer's Name,Add less,and Tel.N0 .60 527--w &0' . G- s s .may P� lqoe Type of B ilding: Dwelling No.of Bedrooms 3 - Lot Size sq.ft. Garbage Grinder( ) 4 Other Type of Building �y S e Ot ran G•G No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided '-j 5 gpd Plan Date Number of sheets Revision Date Title - Size of Septic Tank /OaD � / Type of S.A.S..e //ald�� /f Description of Soil Nature of Repairs or Alterations(Answer when applicable) //J S4ic} /1 �/� f�-�j�/,r 4 � 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 d not to place the system in operation until a Certificate of Compliance has been issued by t ' BU&d of He h. Sign Date T�1_15-1b Application Approved by Date y aq / Application Disapprov;,d°by Date for the following reasons Permit No. &(b'' 1717 Date Issued �S Zoi6 s ----------------------- -----------------------------------------------i------- -- ---,--------------------- ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On--site Sewage Disposal system Constructed( ) Repaired(V-) Upgraded( ) Abandoned( )by 4211va /jell at- Ui�A has been constructed in accordance { _ with the provisions o Title d t 'or Disposal System Construction Permit No. dated y g �f 6 Installer 01jil / Designer #bedrooms �3 Approved design flown ,3 S �3 gpd The issuance of thi peit shall not be construed as a guarantee that the system wion as designed. Date 1 Inspector ` V ----------�J----------------'------------------------------------------------------------------------------------------------------------- '-,No. IiCJ Fee�'" I L3 /lj1 u9 THE COMMONWEALTH OF,MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS disposal *- ps�Tw, nstrUction permit Permission is hereby granted to Construct( ) Repair( pgrade( ) 'Abandon( ) System located at Z-57 Iz JQ4a P� �J (n ,� C e/�V/Ile and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co struct n must be completed within three years of the date of this perm' Date r �-7,9 16 Approved by TOWN OF BARNSTABLE I- LOCATION Wn 0 VA C? (/`T L /I/• SEWAGE# W 123 PILLAGE r C_AZ7-,E V1LLe ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. lR pJ n e H SEPTIC TANK CAPACITY p p p LEACHING FACILITY:(type) a S-0 b G L C AqM b,r{size) l,3 x 2 S' NO.OF BEDROOMS 3 OWNER E (/ -L L (A -.S PERMIT DATE: l COMPLIANCE DATE: b 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 i � I h laav 3 � 132 f3 3 Town of Barnstable �tNE Regulatory Services °s Richard V. Scali,Director &UMSTA ASS.BU& ' Public Health Division 039. '°riror� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 419-30(b Sewage Permit# - Assessor's Map/Parcel Installer& Designer Certification Form Designer: i cS 13LIQL16 7 Installer: // o c5 -e V- Address: PU /* (7Z9 Address: ,40 A', (S-iinI)h/lcIf) /- OZ56 3 /bdrp/cup .4 4� On S- �_ Wo 2,97 a was issued a permit to install a (date) (inst ler) septic system at 4J46 ltz/ c/ L ,1/G based on a design drawn by 7;�1110 9�C�?Z/� dated 2UJ,1, (designer) TE7 I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I/A apprciVal letters (if applicable). H OF DAVID (Instal Signature) o� D. FLAHERIY,JR. No. 1211 FGIATSa`` (Designer's ig ature) (A i ' �� p H re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- ,BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAofce formsWesignercertification form.doc l INEZ Town of Barnstable P# f Wo Department of Regulatory Services & j4 Public Health Division Date 3 t MA99 / 200 Main Street,HynnnIs MA 02601 • . rEll/,AXl A t.r Date Scheduled b � ��f�-�`'1 Tune—L f ` (" Fee Pd._ l yU a' Ch., Soil Suitability Assessment for Sew e Disposal • Performed By:_ !ice � � Witnessed By: r r15, LOCATION&.GENERAL INFORMATION Location Address Owner,s Name Address n Assessor's Map/Parcel: ` Engineer's Name NEW CONSTRUCTION REPAIR Telophbne# ' �2 — GY� Land Use /l�✓�1� � Slopes(96) ,/ Surface Stones_ e Distances from: Open Water Body _ft possible Wet-Area �"`�� $ Drinking Water Well Dmihage Way ft Property Line ZU ft Other � n 1 SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands-in proximity to holes) 3 1I YJ Parent material(geologic)�i�l� �� `s'4'�n - , Depth to Bedrock Depth to Oroundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASON•ALMIGH'WATER TABLE Method Used: Depth Observed standing in obs.hole: N� In, Deptll to sell mottles, �/� �„_►n, Depth to weeping from side of ohs hole: _ W. Groundwater dluatment Index Well Reading Date: Index Well level g �� Ac�,•ihCtbr N Adj.Groundwateal PERCOLATION TEST butu3 3d /� ,fie Observation / Hole# l ��� �77T/ Time at 9" �l 17 Depth of Pero Tlma at 6" Start Pro-soak Timo @ Time(91'4") 2m End Pro-soak Rate Mtn./Inch L' z Site Suitability Assessment: Site Passed SitF Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----w ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conselivation Division at least one (1) week prior to beginning. Q:ISBPTICU'BRCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnuctum,Stones;Boulders. rsistency.%'aravall " G L Y y-t.N 3 1.4 Y-e 6 two DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,BouIrs. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soli Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency. .. i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders• 0 t Flood Insurance Rate Man: / Above 500 year{food boundary No— Yea __✓__ Within 500 year boundary No—+ Yes Within 100 year flood boundary No. _ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring porvigus mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorption system? -5 If not,what is the depth of naturally occurring pervious material`t Ceftification l99s I certify that on d' (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin a tise and a eri ce described in 10 CMR 15.017. Signature Da LI(' Q;\SHPTIC%PBRCPORM.DOC Commonwealth of Massachusetts �,5-- Title 5 Official Inspection FoFr n 1,r ,.e, F TU"BUE Not for Voluntary Assessments Subsurface Sewage Disposal System Form : Jr.. "'_' ;; i10 M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000. Inspection forms may not be altered in any way. F---. -- - -- -- � A. Certification ' ` `` 10R Important: When filling out 1. Property Information: forms on the computer,use 158 Wequaguet Lane Centerville Ma. only the tab key Property Address to move your Edson Magalhaes cursor-do not Owner's Name use the return key. 145 Shootflying Hill Rd. Owner's Address OkA Centerville MA 02632 �-- � Cityrrown State Zip Code �, Date of Inspection: Date 5 �.� Date 2. Inspector: Sean B. Skehill Name of Inspector Tomily Corp. Company Name P.O. Box 959 Company Address North Falmouth MA 02556 City/Town State Zip Code 508-563-5877 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection 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 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs her I do y the Local Approving Authority 8/19/05 In is 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. t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form lug A. Certification (cont.) 158 Weguaguet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owners Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: 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. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed . ND Explain: 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 ti t5insp2.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 _ ; V Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 City/Town State ZipCode Edson Magalhaes 8/19/05 Owner's Name Date of Inspection 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 ❑ ® 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] Yes No ❑ ® 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. t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form M yoy A. Certification (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 City/Town State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection 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. t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Checklist 158 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edsdon Magalhaes 8/19/05 Owner's Name Date of Inspection Check if the following have been done.You must indicate"yes"or"no"as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to.Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y Subsurface Sewage Disposal System Form C. System Information 158 Wequaquet Lane Property Address Centerville MA 02632 City/town State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection 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): 330gpd Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): N/A Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A Last date of occupancy/use: N/ADate Other(describe): t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 159 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owners Name Date of Inspection General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 22 years Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 158 Wequaquet Lanr Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection Building Sewer(locate on site plan): 22" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): All in good condition Septic Tank(locate on site plan): 12" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ® No certificate) Dimensions: 1000 gal. tank 5" Sludge depth: Distance from top of sludge to,bottom of outlet tee or baffle 26" 2" Scum thickness 4,9 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Stick Measurement t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump every 2 years with current use Grease Trap(locate on site plan): N/A Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A N/A Scum thickness Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of lastpumping: N/A 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont:) 158 Wequaquet Lane Property Address Centerville MA 02632 City/Town State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A aci N/A Capacity:ty: gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ® No I Alarm level: N/A Alarm in working order: ❑ Yes❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): r Distribution Box(if present must be opened) (locate on site plan): 0„ 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.): D-Box could not be accessed. Located under deck. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp2.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments rV Subsurface Sewage Disposal System Form M C. System Information (cont.) 158 Wequaquet Lane Property Address Centerville MA 02632 Cityrrown -St-ate Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 @ 1000gai. ❑ leaching chambers number: N/A Elleaching galleries number: N/A Elleaching trenches number, length: N/A ❑ leaching fields number, dimensions: N/A ❑ overflow cesspool number: NIA ❑ innovative/alternative system Type/name of technology: N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Grading is good no indications of failures of any nature t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 158 Weguaguet Lane Property Address Centerville MA 02632 CityrTown State Zip Code Edson Magalhaes 8119/05 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids Nfa Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Fore' Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M C. System Information (cont.) 158 Weguaguet Lane Property Address Centerville _ MA 02632 City/Town State Zip Code Edson Magalhaes 8/19/06 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch 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. w�rte� �e�Jru ev�lKs �F/c�ON� i' {o t yf a �y.� z;, R t5insp2.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 158 Weguaguet Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Edson Magalhaes 8/19/05 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record N/A If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Reviewed design plans in general area submitted to BOH ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Review of Design plan soil logs in general area t5insp2.doc•11/2004 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 \ commoNwEALTH OF m.AssACIitJs=s EXEcun vE OFFICE OF EwiRoNMEN,7AL AFF-Ams DFPA.RTMENT OF EN-VIRONMENT r JUN 2 4' 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSLTRFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP /SS PARCEL • 1 Property Address: Q4vdQJ �AWi LOT Owner's Name: S�' C(O '`�SP�e f Owner's Address: 0103a- Date of Inspection: L, L iW e 2a- Name of Inspector: (please print).jffi;AmA Kt16- Company Name: 4aLr-e ye. [C Mailing Address: 'P.ID.Mav, Telephone Number: _508 -3fW-7 0 S CERTIFICATION STATEMENT 1 certify that i have personalty inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper$.ruction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000)_ The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority —i 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,M gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office ofthe DEP.Tie original shouid be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments -;"*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 eoaclitroas of ese. Title 5 InspeWon Form 61152000 page i OFFICIAL INSPECTION FORM--NOT FOR VULTNrARy ASSESSMENTS SUBSURFACE SEWAGE DII,SPOSAE Sys;INSFEC 110N FORM PART.A CERTIFICATION(cowed) Property Address: 6 e �caa vet' 1 a. a Owner: M err t O It Date of Inspections: Inspection Summary: Check A,B,C,D or E/ALWAYS.coaaplete aft of , A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR I 303 or in 310 CUR 15.304 exist.An; i. sJure criteria not evaluated are indicated below. Comments; B. System Conditionally Passes.. One or more system components as described in the"Conditional Pass"sec . n need to be replaced or repaired.The system,upon completion of the replacement or repair,as approve y the Board of Health,will pass. Answer yes,no or not determined(Y,N,N-D)in the for the follow" g statements.if"not determined"please explain. The septic tank is metal and over 20 years old}or the tic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration orexfltration or failure is imminent.System will pass inspectianifthe existing tank is replaced with a complying septic tank as roved by the Beard of Health. sA metal septic tank will pass inspection if it is stru Ily sound,not leaidn and if a Certificate of indicating that the tank is less than 20 years old is a Ie. g Compliance ND explain: _ Observation of sewage backup orb out or high static water level in the distribution box due to.brnlcen or obstructed pipe(s)or due to a broken,s or uneven distribution box.Sys will pass b%si if(wilh approval of Board of Health): ken pipe(s)are repbimet bstruction is removed distribution box is leveled or replaced ND explain: The system required -aping more d=L4 times a.yea due to broken or obst acted pipe(s).The system will pass inspection if(with appr val of the Board offfealth); broken pipe(si are replaced obstruction ii removed- NND explain_ Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address* /sue eC.4 u f/l (( Owner. Date of Insvection- C. Further Evaluation is Required by the Board of Heg the Conditions exist which require further evaluation by the Board of Health in order to determine if the in is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 C1vIIZ 03(l)(b)that the system is not functioning in a manner which will protect public health,safety a 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 a salt marsh _'. System will fail unless the Board of Health(and Public ater Supplier, if any)determines that the system is functioning in a manner that protects the publi ealth,safety and environment: _ The system has a septic tank and soil absorptio system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wate supply. _ The system has a septic tank and SAS an the SAS is within a Zone I of a public water supply- - The system has a septic tank and SA and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and AS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Meth to determine distance "This system passes if the well analysis,performed at a DEP certified laboratory,for coliform* bacteria and volatile otanic co uncles indicates that the well is free from pollution from that facility and the presence of ammonia Zia men and nitrate nitrogen is equal to or Iess than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: f • A"S' va A. OFFICIAL INSPECTION FORM—NOTFORTOUMUREY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM EqSPECTIONFORM PART A CERTIFICATION(continued) Property Address: 2 tt.�[nQ Owner 0 O Date of inspection- f7 tl'�o D. System!Failure Criteria applicable to all systems: You most indicate`yes"or-no?*to each ofthe following for ail inspections: Yes No Backup of sewage into facility or systems component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 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 day flow Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s).Number of tunes pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 fee:of a private water supply well" — A_ 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 DE'P certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less tisane 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis!oust be attached to tfiis form.j (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15-303,therefome the system&iis.Jhe system owner silt ld aimactihiBcaldof 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 fac"y a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the fo (The following criteria apply to large systems in addition the criteria above) es rto — — the system is within 400 feet of a s- Viking neater supply — — the system is within 200 feet o tr ibu ry to a surface drinking water supply — — the system is located in a trogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public waL supply Weil If you have answered"yes" any question in Section c the system is considered a significant threat,or answered "yes"in Section D above a large system has failed.The owner or operator of any large system considered a significant threat unde ection E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system caner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address- . f�� 4ew Owner- Date of Inspection: L7 6 Check if the following have been done. You must indicate-IV or=°uo=•as to each of the foilowin Yes No — Pumping information was provided by the owner,occupant,or Board of Health J( 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)art of this inspecrion — 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? X — Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened, of the baffles or tees,material of construction,dimensions,d depth of liquid,depth of sludge and ior of the tank depth of sc for thecondition ?jtion � 9u 4 g depth Was the facility owner(and occupants if different irom owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption Systetn(SAS)on the site has been determined based on. Yes no _ Existing information. For example,a plan at the Board of Health. _X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)P 10 CMR 15.302(3)(b)] Page 5 of I l OFFICIAL INSPECTION FORM—NO'T'FOR FOLtTNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL VVSfTM INSPECTION(FORM PART C SYSTEM INFORMATION Property Address- Owner: Af C 'L'att of i;:�cVitt�Gi: 6 O- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): b Number of current residents: '0 Does residence have a garbage grinder(yes or no): AAA Is laundry on a separate sewage system(yes or no): Nb [if yes separate inspection required] Laundry system inspected(yes or no)-wo Seasonal use:(yes or no): V" Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no):NO Last date of occupancy:-w / COMMERCIAL/INDUSTRIAL Type of establishment._ Design flow(based on 310 C,LIIZ 15 203): Basis of design flow(seats/persons/sgtt,e€c.): Grease trap present(yes Or n0): Industrial waste holding tank present es or no):_ Non-sanitary waste discharged to a Title 5 system(yes or no):Water meter readings,if avail e: Last date of occupancy/use- OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):W.o If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorptive system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous bz;pecriou records,if any) _Innovative/Alternative technology.Attacha copy of the Current operation and maintenance contract(to be obtained from system owner) _Tight tank ^Attach a copy of the DEP approval —Other(describe): - Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): AJd OFFICIAL INSPECTION FORM—*NOT FOR VOLUNT-kRY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtii PART C SYSTEM INFORMATION(continued) Property Address: (Ai Owner: C a Date of Inspection: BUILDLNG SEWER(locate on site plan) a Depth below grade:_JQ— Materials of construction: cast iron ____4tl PVC X other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 9 (lobate on site plan) Depth below grade: ___polyethylene a_L___ Material of consffuction: concrete metal fiberglass —other(explain) If tank is metal list age: _ Is a?e confirmed by a Certificate of Compliance(yes or no): —{attach a copy of certificate) / Dimensions: C? .t Sludge depth: ' r� Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: / P 4 & Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or b_affffle: /S How were dimensions determined: �IG,SyI step' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integnty>liquid levels as relate to ouz}et invert,evidence of leakagge,etc.): art� i►J o �v1 GREASE TRAP: (locate on site per) Depth below grade:— Material of construction: concrete_metal fiberglass olyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or 'affle: Distance from bottom of scum to bottom of o tlet tee or baffle: Date of last pumping: Comments(on pumping recommendati ,inlet and outlet tee or baffle condition,structural integrity,liquid level as related to outlet invert.,evidence o eakage,etc.): •­r�b V VL L L OFFICIAL.INSPECTION FORM—NOT'TOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(congaed) Property Address: Owner: D2te of Inspection: TIGHT or HOLDING TANK: (tank must be pump at time )Oozate cm site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain); Dimensions: Capacity: Design Flow: :ons/day Alarm present(yes or no):Alarm level: Al in workorder(yes or no): Date of last ptmrping: Comments(conditio of alarm and float switches,etc.): 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.): 1 vv ttrr PUMP CHAMBER: (locate on an) Pumps in wanking order(yes or no . Alarms in working order(yes o o): Comments(note condition ump Sichamber,cxmtbt w of ptamps arm etc_): L Page 9 of I I OFFICIAL INSPECTION FORM—RIOT FOR VOLUNTARY A.SSESSN1lENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: fKe Owner: O Date of Inspection: SOL ABSOR I ION SYSTEM(SAS):_-AL(locate on site plan,excavation not required) If SAS not located explain why: Type ' 4 leaching.pits,numben— leaching chambers,number: bathing galleries,number: leaching trenches,number,length. leaching fields,number,dimensions: overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,conditiottn of vegetation, etc.): it KZ2. 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: Materals of construction:_ Indication of groundwater in ow(yes or no): Comments(note conditio f soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRNY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition o oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page I d of i I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTKM EqSPECnON FORM PART C SYSTEM WFORMATION hued} Property Address:--�+ Owner- Aloc-Lio Date of inspection: G - SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within Io0 feet_Locate where public water supply enders the building. r 3� L (kj �- - Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Q mate of inspectiolk: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-Ifchecked,daze of design plan reviewed: Observed site(abutting properrylobservation 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: iNo.a............�d Fizz.... ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1... '. .7................OF........... �J7... j . ApplirFa#iou for DhipmFal Works Tomitnuffun rantif Application is hereby made for a Permit to Construct (✓f or Repair ( ) an Individual Sewage Disposal System at: f ................ .. �rlcc u, .. /1 ¢fir. ,r�f ,,.. 1�'�!a , " .,�z/�..... .: Location-A r ss > o Lot No. Owner Address /G f�6!Zr = ?222/.:I.........��_tl$.:....................... Installer Address UType of Building Size Lot... 1., _ ... _ f t, a, Dwelling—No. of Bedrooms..................3......._...............Expansion Attic ( ) Garbage Gri der aOther—Type g p ( ) — Cafet Other—T e of Building ---------------------------- No. of ersons_.......•............__._... Showers Q' Other fixtures_..................................................................... W Design Flow...................67�................gallons per person per y. Total daily flow.................. ............gallons. WSeptic Tank—Liquid*capacity/POPPgallons Length___ _ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter....../.4t)'..... Depth below inlet............... Total leaching areaR6: s?:sq. ft. Z Other Distribution box (✓j Dosing tank ( ,�)/ '-' Percolation Test Results Performed by.�!4A<<�?' ..... ! `® Date.... I-714�................ 1 0/167 Test Pit No. L.t4..;�....minutes per inch Depth of Test Pit______—I ....... Depth to ground water____/vm . Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •--••------•........ •••........................•....--•/ .......... 1 .. - ` �~`� V ................................. ................ ...... ---------------------------••-------------- ------.-------------------- Uw ---••-•-••-•-------------•-----------•--------------..7--a....------. W----------------------------------------------------------------------------------- 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 iITI,;^. 5 of the State Sanitary Code—The obd ed further agrees not to place the system in operation until a Certificate of Compliance has been i Vdb tf health. igne �� Application Approved BY ----------------••--•-.....• •••-••-• •--. . -----------•-•-------- Date Application Disapproved t following reasons-----------------------------------------•-------._........----------------------•------•----••........_...------ .......--••-•-••••••----••-•--•--•-•--•--•-•-•--•••-•-•------••-••-•---•----••-----•----.....••••-•-•-••-I---.......••••-•-•-------••-----••-••------------••----•--------------•--•--------•-----..•--•- Date PermitNo......................................................... Issued_....................................................... Date a,: Fsa.. THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH '!G/r... ............. OF.. .......l�cir" S.TC. /c ............................ ApplirFation for Diapoii al WorLi Tvmuurtinn "amit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual .Sewage Disposal System at: / �/ t ' L� 1��c �j ri � ,u T .L /� �. 's�T�FiJi(/•G; / Gt 7_`7`Gh/C. / �'................ ............. -•-••••••--_....._...•••••-••-- •••....._•. •...- / - Location-Address v' or Lot No -``C / rL/ �s T A Owner Address W /_//'-- K G 'C' � ............................../. /�!�I G✓�/7 i S . /T_7_�t 5_�_5 • __^_--- --�-'Installer---•-•-- ............:/_._...--.-•--••--••---._:Address... `--^ - YP g ................Ex anson Attic Garbage Gr Type No. of Bedrooms________________ Size Lot_______�__5:3-�._ fe g— P ( ) g Other—Type of Building No. of persons,____________________________ Showers — Cafe P� Other fixtures ---------------------------•-• ---- W Design Flow................._��________________gallons per person per day. 'Total daily flow.................. ..........gallons. G Septic Tank—Liquid'capacityM?oAgallons Length I- .. Width---------------- Diameter----............ Depth................ Disposal Trench—No_ __ _______________ Width .................. Total Length................... Total leaching area.................... ft. 3 Seepage Pit No.______A........... Diameter_ .4� ______ Depth below inlet......S�_.____. Total leaching area s/-SZ•sq. ft. Other Distribution box (✓) Dosing tank '- Percolation Test Results Performed by................................. ....................................... Date•___ 9/ ............... a ! l r69 Test Pit No. ..?-.._-,mmutes per inch Depth of Test'Pit......fy_____.__ Depth to ground water-__. w Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water----------_............. c ...............................................-••••---••• ......••••...._._-_-•---••---•--••-•••-•.._.__..:..----------------------------- O Description of Soil O _5� `;•o................... � .ci............................ro✓ c_� - ------- ....................... -------- _. r-� ---------------------------------------------------------------------- VNature 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'T p 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. ' igne t/....... --_--- -•----. ••--•------•----•----••--•----••---•. ••--•---- . ..................... D Application Approved BY •- I-. ......f-------_--••.._.•••••••••-•-••--•••-•••••--•--------------•••••••. _._:... ...• -• ... .................. Date Application Disapproved r t e following reasons:-........................... •............................................................................. ........................................................................................................................ =-•-•----------•---•---•-•--••-•------------•----•._....._......••••-•-•-•- Date. PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Trrtif it atr of Boaz ph anrr THL T Y, That the Individual Sewage Disposal System constructed ( r Repaired ( ) r....--•-----....... -------•-•-------------•----•---•--.._....._......__ y - ------ ---._... ... - t. ----- -----•-•-•-------------•------- -- - . ,as been ms . ed n accordance's ith the provisions of T i r f The State Sanitary C. gas yes ribed in the "pplication for Disposal osal Work Construction Permit-No.� :7_:- -•--- ----•• dated j THE ISSU 'NCE THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUA ANTEE THAT THE SYSTEId � FU, TION SATISFACTORY. DATE__.. ................................................ Inspector....--• r•••--•--•---......•••••--•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................... , No. - FEE ............. ^, din la Fa (1110mitrudwi n remit Permission'is hereby granted_..-- .................-=-••••••-•••---------•-----•••---••---•--•............•-• •--•- -- ................ to Constr 2C Re -ail ) an Indivi al f wage posal System t No _ - Street -as shown on the application for isposal Works Construction Permit No............. ed. . __________________ .................................. . ................................................. ;' and of Health DATE f ...... P.1tx................ FORM 1255 HoeBS & WARREN. INC., PUBLISHERS CATION •,�j-- �� 0 I eTi — NO. As --I. r-0 /��P _ DATE PLITCANT C� FEE DRESS TELEPHONE No : on-refundable ) r ` GINEER -TELEPHO E O n TE SCHEDULED _ (A icant' s signature) O . . . . . . . . . . O . . . . . . . . SOIL LOG JB-DIVISION NAME DATE_ ��9�g 3 TIME PANSION AREA: YES ✓NO _ (>GcIiW14 �-Sd� ENGINEER W _ ,- N WATER�PRIVATE WELL GU h, BOARD OF HEALTH i EXCAVATOR TCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : IoZ,°v5 30 r iz.7,+ III iC'v, -tv \3r� -IV - 2a � tjwAI RCOLATION RATE: ST HOLE NO: ELEVATION: TEST HOLE NO: _ ELEVATION: . 1 ioO 1 2 3 Gl 3 4 4 5 5 6 Cow v \. 6 .7 7 8 �2 wtr� �� 8 9 � 9 10 Sa 10 11 7 ) 1 11 12 Q W (, r- 12 13 1 13 14 14 15 15 16 16 ITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PITS__ LEACHING TRENCHES SUITABLE FOR SUB-SURFACE SEWAGE . REASONS: 'TE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION IGINAL: COMPL_FTFD IN ENTIRETY BY P , F , AND RETURNED TO BOARD OF HEALTH PY: REITAINED BY APPLICANT 70 LOCATION SEWAGE PERMIT NO. Or i-/Z 02 y.,41<f7 VILLAGE I N S T A LLER'S NAME i ADDRESS K. S U I L D E R ON OWNER DATE PERMIT ISSUED OAT E COMPLIANCE ISSUED j 0 I Li �3AC IC 3 Lly I�� cAr��vAQv�T �� �c��T��v► ��� r� A oa�3�- L- ► VdV6- Rooar -- (� TG H Ed J �. p ghTH F DDK a n � � �- B3 TH RDW c*► 5T�1�� 3 F MA51 - � s U �L. QV AA B �R®� I0 5 AA ,a aA56tA£O T �TAI i A 7- �. r �� C^ � U �-C-qo/''� UN FI N 15�1 O 0®M �..o� r �► QA6 Mji Nr st�tRS 3,d Cc0S Ir T — - a � 3 � LOCUS DATA NOTE: 132 THIS PLAN IS PREPARED FOR THE INSTALLATION OF THE SEPTIC SYSTEM ONLY. ST ti'gY Oti�C- CURRENT OWNER EDSON & EVELYNE i LOCUS MAGALHAES / N j ��' LOT 47 �� PLAN REFERENCE 375-20 / �-� rn �' -i DEED REFERENCE 19688-81 Q_" G Q� z V / 28 ZONING DISTRICT RD-1 / Q? LOCUS MAP FLOOD ZONE tsXlt � 45� 4 / S 4• NOT TO SCALE: s ASSESSORS MAP 250 �o 332jy F 16-0106 PARCEL 158 �� OVERLAY DISTRICT ZONE II /, SHED 0�85, K// / k LOT AREA 21.535f S.F. � LOT 45 SHED X 62.0 SITE 8c SEWAGE REPAIR. PLAN BENCHMARK ! � CORNER OF g SHED CONCRETE #15U ^� ELEV=66.0 1�0 o LOT 4 6 63.3 WEQUA QUET L A NE U-POLE ry��p N r3 + 21,535f S.F. 40. CEN TER VI LLE, MASS p LA.LA X 65.3 64.9 � DATE: APRIL 8, 2016 X 64.4 s tS433�` 63.2 / EXISTING OWNER/APPLICANT: 0610 X 63.8 \ +, PARKING °' 1 000 GALLON EDSON & EVELYNE / \\ W,` 649 x AREA / #158 5 SEPTIC TANK . TO REMAIN M A G A L H A E S / \ • PUMP, CRUSH AND CEN TERVI LLE / op\0 DECK 0 LEACHING P TTIIN MA 02632 �aS LOT 43 At \ \ GARAGE ° { D #1 ACCORDANCE NTH, TITLE �(H OF 3 SD SHEET 1 -OF- 2 / �o�� EDWARD y�N 32jh 65.9 X 65.6 X 7, o 63.5 P3 OP025E0 o A. ;* 260 \ Q�p STONE U` 88' LEACHING PREPARED BY: / J X 63.5 # 22.0 S.A.S � No. 289 U-POLE � ,p e , EAS SURVEY, INC. sT R 62.5 -�"1� LOT 44 63.7 P. O. BOX 1729 0 45 60 + X SANDWICH ,, MA 02563 4 PROPOSED ' "D" aox PH. (508) 888-3619 GRAPHIC SCALE: 508 527-3600 = CELL ( } ,1INCH . — 30 FEET: EAS.SURVEY@YAHOO.COM a { k SYSTEM DESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE TOP OF FOUNDATION RAISE ONE RISER DESIGN FLOW _ ELEV. 66.77 FINISH GRADE WITHIN 6" OF 3 BEDROOMS AT 110 GPB/D 3-3-(Z GPD ELEV. 65.0 FINISH GRADE FINISH GRADE REQUIRED SEPTIC TANK 65.1 ELEV. 66.8 ELEV. 63.7 /r�` SH GRADE 63.9 ___330 x 2 _ 660 GAL. v: TOP =64�, 1• ///�� �U/ `� / EXISTING SEPTIC TANK = 1L000__GAL. 18'®5=0.13TOP ELEV 61.00 1' MIN.-3' MAX. COVER SIZE OF LEACHING FACILITY REQUIRED S C H 40 - 4 PVC -" "-' 4" PVC SCH 4002 O 00 00 c o 0 00 00 `o DESIGN PERC RATE __<_2____MIN./INCH ' INV.= 2 MIN-3 MAX 63.05 10"TEE 14"TEE INV.= O O O o c O O O LONG TERM APPL. RATE_ 74_GPD/S.F. INSTALL 62.85 ZlNV.=:t60.43 0 00 0p o o p 0p 0p M SIZE OF LEACHING SYSTEM PROVIDED: OF MgsR' `9 GAS BAFFLE TWO 5'-0"x8'-6"x3'-O" CHAMBERS 330 = 0.74 SF/GPD = . 446 S.F. MIN. REQ. ch' p 4'-1" LIQUID LEVEL INV.=60.00 p _F U 0.26 a 58.0 WITH IG4'OFOSTONE CONCRETE ALL AROUND LEACHING CHAMBERS 1 o e o o ,Lo ,t BOTTOM (13.0' x 25.0') = 325 S.F. #STEM® EXISTING 1,000 GALLON SEPTIC ELEV, 53.0 SIDE WALL (13+25) x 2 x 2 = 152 S.F. TANK TO REMAIN 477 S.F. 477 S.F.x 0.74 G/SF = 353 GPD lY 353 GPD PROV > 330 GPD REQ. = 23 GPD RES. JOB # 16-0106 CONSTRUCTION NOTES: 00000 0 o O 00 00 NO (GARBAGE DISPOSAL / GRINDER ALLOWED) SITE & SEWAGE 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND O O O o o O O O ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 00 00 00 o c 00 000 000 WORK ON THE SITE. REPAIR PLAN 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE D.T.H. #1 D.T.H. / 12 WITH. DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT t ---4.0' S.0' ---I--4.0-�I DATE: D ELEV. 6 DATE: D ELEV. 6 Q IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.� GROUND ELEV. 3. 8 GROUND ELEV. 3. 0 #15 3. ENGINEER TO VERIFY REMOVAL OF UNSUITABLE SOILS PRIOR 13.0' ADJ G.WATER 53.8 ADJ G.WATER 53.0 W Q / CUE- / A n E- TO INSTALLATION OF NEW SEPTIC SYSTEM. SIDE VIEW FILL 8" FILL 4„ C (,lVf'1 VC L /VC 4. NO PARKING OVER SEPTIC TANK.IS ALLOWED. IN GENERAL NOTES: LOAMY SAND LOAMY SAND C E N TE R VI L L E, MASS 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. D A TU M: 10YR 4/3 10YR 4/3 TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS VERTICAL DATUM: B 12" B 8" FOR SUBSURFACE DISPOSAL OF SEWERAGE. BARNSTABLE GIST 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE LOAMY SAND LOAMY SAND DATE:. APRIL 8, 2016 BENCH MARK USED: 10YR 5/6 22„ 10YR 5/6 24" ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING ACCESS PORTS BROUGHT TO WITHIN 12 OF FINISH GRADE. TOP OF CONCRETE BULKHEAD C-1 C-1 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE ELEVATION 66.00 MED/LOAMY MED/LOAMY OWNER/APPLICANT: CAPABLE OF WITHSTANDING H-10 LOADING UNLESS INDICATES DEEP SAND . SAND OTHERWISE SPECIFIED. DTH #1 1OYR 6 6 10YR 6 6 EDSON & EVELYNE 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST HOLE 34" 36" „ ELEV = 61.0 ELEV = 61.0 M A G A LH A E S 5: ANY MASONRY OF ALL EUM TSOUSED TO BRING COVR TO ANY OERS N. TO GRADE � 132 INDICATES ADJ. GROUNDWATER C-2 CENTERVILLE OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. - NO OBSERVED GROUNDWATER C_2 54" CO RS 5A D 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER COARSE SAND MA 02632 FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. INDICATES 7.5YR 5/6 10% GRAVEL & 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF PERC TEST 10% GRAVEL & • COBBLES SHEET 2 OF 2 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE 54 COBBLES 108" THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND C-3 LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. COARSE SAND PREPARED BY: 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN GROUNDWATER ADJUSTMENT 2.5Y 7/4 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT NO G.WATER 120" NO G.WATER 132„ E A S SURVEY, INC. 9. ELEVATION OF THE OUTLET PIPE. . DEPTH TO BOTTOM OF HOLE ELEV = 53.B.O.H. ELEV = 53.0 THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES i 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS P. 0. B 0 X 1729 BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC VARIANCES REQUESTED DAVE STANTON 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NONE: SOIL EVALUATOR SANDWICH , MA 02563 SHALL BE SLOPED 1/4 INCH PER, FOOT MIN. EXCEPT FOR THE �U/QR��I�� ED. STONE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL ( BACKHOE OPERATOR. BE LEVEL /G ,U.Bv'�/� RODNEY FISHER PH. (508) 888-3619 SOIL TYPE: 1 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION i CELL (508) 527-3600 TO EAS SURVEY INC. FOR B.O.H.. AND DESIGN ENGINEERS REVIEW PERC RATE: <2 MIN. PER INCH �`�j LOADING .RATE: 0_74 GAL INCH EAS.SURVEY©YAHOO.COM AND APPROVAL. 13. MAGNETIC TAPE ON ALL COMPONENTS. z I TE- PL A J� Y T YPICAL PROF11 E NOT TO SCA L E SCALE -- / _ ��'' �-� 4- � • � ;.� . -- 18 STD. L T. WGT C.I. MH COVER b4. , 4"C.I, PIPE 4""B/T FIBER PIc l / ,,NT ! /A r -Tf - -� FLOW .L/NE _ - - -- u F pv i Ljop/vT/ DWEL L ING # 2. .-_� /0 /q i n o O C.I. TEE C. J c , - STANDARD PRECAST 7, p CONCRETEEI"" GALLON �'-L:.` .�.+ _. SEPTIC TANK ' LJ 015 TRIBU TION BOX i jf TO BE INSTAL L ED ON I 4 / - r'EVEL , ,STABLE BASE ` (w-4 + SEPTIC TANK TO BE INS TA L L EC ON 1 LEVEL , STABLE BASE 7 t cL- A ;w 4T U. Pr z.. A05 , ;' rr� r ) p � < � L 5�, f�aAl., `� jt7 '7' ve�T AIIrJ t?ALJC-FILL, „ _, �t! /ScJ4TAY�i4 ti1ATIrtZ1 b•E 2" - l/B TO l,•'2 " WASHED PEASTCNE - CEACH/NG PIT epT I G :T'A N V. �_.-L___ - ALL AROUND FREE OF IRONS, FINES BASF TO BE L EVEL AND OUS T IN PI_ACE BRICKS MORTAR COURES 3/4" TO l 1/2" WASHED CRUSHF:"? AS REQUIRED TO BRING STONE ALL AROUND FREE OF rq COVER TO GRADE C. I. MH COVER IRCM. 24 C. FINES A.ND DUST /N PLACE AND fRAM,E `` ,J -_ -,. LEACHING PIT SECTION- IINL ET- _ _ 8` FLOW LINE 7 A_ -- ". p/p£ -`�- - I. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED dV:?H 6 x 6' N0. 6 GA. W.W.M. —T6 Z ' -� - 3. 2' ANC 4' SECTIONS ARE AVAILABLE FOR GREATER 2' E g, t,q. DEPTH REQUIREMENTS.I� � � ` 1 r " ' i I OPENING WITH 4-I/8 # 4 NUMBER OF PITS REQUIRED - I OUTER DIAMETER 8 NOTE. EXCAVATE TO ELEVATION ` G'_ JR LOWER AS = I-314 INSIDE DIAMETER 0' 3_ _ REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT REPLACE EXCAVATED MATERIAL WITH CLEAN u� GRAVEL TO CESIGNED GRADE . I I � l4olml 41-0 1 u r MIN. EFFECT/VE DIAME TER (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) u_ rew ' -- -t-- -•v WATER TABL E SOi'L A 4'D ,Ei C• DATA - GENERAL NOTES ---- PERC. RATE MIN. /IN . h I1)CvG'} NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. ,J I7� �y• v`•, SEPTIC TANK, CISTRIBUTION BOX , LEACHING PITS TO BE STANDARD t + TEST BY fztic� ± �Wiv� • tit V,� . 4z�rIL',i lJe 1 PRECAST REINFORCED CONCRETE UNITS WITNESSED BY J v H aj ' A G y ($ 1 - 0 PJ• 44 - ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR EL.: '/�`� G' DATE '--��`����,___ MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO. I LEST PIT N0 2 SANITr-,RY SEWAGE EFFECTIVE I JULY 1977. � � 0 BOAR YZ� 0' ANY OF N S HEALTH. LTHIS PLAN MUST BE APPROVED BY HE Totem / 5 � ,4 ';` AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, 'HE �! r L�j d+ /I�1 7` ���'� `' __ ' - ' BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION, A/', UIL,k,\ PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE. is ;4;>U k.i t�kA:)A T c f~ DES/GN DA TA BEDROOMS _ _ -_- DISPOSAL F-J U EST. TOTAL DAILY EFF. r"7 GALS I L EGEND SEPTIC TANK ( v G GAL ��L �'� S'3 kvIll-)W SIDEWALL AREA 2' a GAL./SO. FT. BOTTOM AREA i' GAL./SQ. FT SEWAGE DISPOSAL SYSTEM *04 OAcc EXISTING GRADE low LEACHING REQUIRED-��� SO FT -�` ACTUAL LEACHING; AREA ' 'I' "`%' SOFT FOR r -- ZONE o� FINISHED GRADE�L-1______ _-_._ p �f •-•r•- � O . �a INVERT ELEVATION - / DOMESTIC WA-TER SOURCE __-- __ ► �' �_ v../ T. - _ O 4�v �4 -- - ,_! ��. yr 1 �, t�.t 1- --- PROPERTY LINE IU T 1~�z ✓ LL- lv . 0 4 I:z 12T/5%. L 1G', AA ��✓S Pl_-AN REFERENCE ___ MEAN HIGH WATER SCALE' AS INDICATED DATE : ._._L_z L ---• ---- BENCH MARK DATUM: 'J 5 t� � � y rJ " _ � k i> MARSH WIN. M AIARWICK 9 A3S0C1,4TES BOX 80/ - NO R;rH FAL MOO TH Z 0 rLt �r tt 1. U k.J - 14 A 7- A. Cz- o "G , ,'d<:rSA CHOSE T T." 0? 5,56 _ 'liiLr. 'd .�,•�T w�[I�:.�w�`. one_._ � �—a+ �° .r - � .,- .� 4 4x�• -