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HomeMy WebLinkAbout0065 BLACKBERRY LANE - Health 65.' 66-kberry L'arie LL 249:0g2 ° I ° 11 ° I r f� f ° ° ° ° TOWN OF BA.RNSTA.BLE LOCATION _ S����b,erry Ll9a�= SEWAGE # 2 005-OSS VILLAGE ffe1g&013- ASSESSOR'S MAP & LOT .2 5'9-0 INSTALLER'S NAME&PHONE NO. 03-420- 97.54F JOSd{�� f e/3i4rro�' SEPTIC TANK CAPACITY I5 OO > LEACHING FACILITY: (type) �7'7 �&Ior-� z _eZodfLc-,exiize) /-//X 38 NO. OF BEDROOMS G n BUILDER OR OWNER /ji7nk PERMIT DATE: 2 - /9-0 8 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachinV14 ility Feet Furnished by t B/w�k�jcrpy LN�f.C. .. WA3 Gp�►vgd r porc � g ac( f✓��'� Cor,7c r of hovst ►yr�o✓Nc� S°ert��'� � I/Eh7 P�pr porot? _ inSPEcT�on Pouf _. No. ;�00 �.d Feeu;�/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB.LE, MASSACHUSETTS Yes Application for �hgpo!gal *raem Cott--gtructiou Verttut Application for a Permit to Construct( ) Repair(Q- Upgrade(44—Abandon( ) LvJ'Complete System ❑Individual Components Location Address or Lot No. t!OS 8�� berry L4he- Owner's Name,Address;and Tel.No. Assessor'sMap/Parcel $/� C�D A"OX IG7 Za V,-,IIX L o- %s`2 Installer's Name,Address and Tel.No. 08-?g � ,r Designer's Name,Address and Tel.No. 5a8-vr7=S3/3 ✓'s rpti O.c '9Aarro r 15 A/&/Jl.c rNiHy work ' / C/� .,� M ofo,,: royls Type of Building: Dwelling No.of Bedrooms („ Lot Size ag, 030 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 660 gpd Design flow provided 66 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �T;¢l� /S'DO 1!�!u ,� eaJS ©f utelC .S�so��a� d T4 /Yo 'Yr-e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed G �2k2N G� 7�FYGG Date Application Approved by Date ,j.. Application Disapproved by: Date for the following reasons Permit No. qLoy — 055 Date Issued v -------------------------------------------- .� - 1t n1a '+��'°'� j: .��-�+y�.�N""�'.r^1'^tit'f�I"�'+�,�'�LNih '�'ri2.`C��vr.r��ri���r.•�t:,.• .)' d C 0 . No.;:. ; Fee TH�COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes .41(catiori for �Biopogaf 6p.5tem Con0truction Permit Application for a Permit to Construct( ) Repair(ja� Upgrade((a--Abandon( ) 1Z?C'omplete System ❑Individual Components Location Address or Lot No. 6S Ob�-berry Owner's Name,Address;and Tel.No. (�y�gNh�3 C6rfos,r Hoa>� f;.�.w�sa/= Assessor's Map/Parcel 2 tf _062 R �.�x /(o o �S VC L Installer's Name,Address and Tel No. �a'2�Or �7SZ �&- 0'7-5 1/3 ,3 S � Designer's Name,Address and Tel.No. .s �os t'/o/i Oe JAorro f EA/GiN,�r�iwy Work 1 C� *I.` /tor' 6��r ,toys �YI� s' la:, y C oS e/��� Type of Building: Dwelling No.of Bedrooms l Lot Size 2 8 0 3 0 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design)Flow(min.required) 660 gpd Design flow provided 66 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil- Nature of Repairs or Alterations(Answer when applicable) �T�l /S'Od 6o SF/Dl/ Thrl9�l S oafs Of y 91,1-ic% !9' Sur,Vc/ r� UNi1s CyiTG Ala .Ym Date last inspected: ° Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i Signed Date Application Approved by Date I Application Disapproved by: Date for the following reasons �• I Permit No.. LorJ Date Issued - --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( �- Repaired ( �-�—Upgraded ( ) Abandoned( )by 1o5>_0Gv (Z� at 1- o i> , has been constructed in accordance / with the provisions of Titl 5 and the for Disposal System Construction Permit No. goo$ b 5 5 dated A-1 -09 Installer ,/osc4,� �G �lo�'h7S Designer #bedrooms Approved desi ow ,(1 gpd � d The issuance of this permits all o be co str ed s a guarantee that the system un i' a� gned. Date Inspector — �—a--= ————— ---=---_--------�--- /--,--- No. t�0 u p—a-SS _ Fee ( VV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =i5po5ar 6p5tem Construction Permit Permission is hereby granted to Construct ( C,) - Repair Upgrade ( ) Abandon ( ) System located at G.S /514cZh u and as described in the above Application for Disposal System Construction Permit.The applicant re gnizes his/her duty 'to comply with Title 5 and the following local provisions or special conditions. f Provided: Construction must be completed within three years of the date of this permit. Date `G Approved by 02/22/2008 15:47 5084775313 ENGINEERING WORKS PAGE 01 Tows of Bamstabk RegWatory Services Thomas�'.der,Afrector P #�cHeWh Divisku Th nmi Md(eI*,DJreator pusSbWt B,.�,,MA OZW ••off:.s Fm 5O8-79p.63pq r sewage Peru d$- n s'Aa>e , _, eawr rf Map1P 2'4'9 O$ -7-M,-C;oe,'-0C ."y_l� !t z W, Address: CA 01 wu+}-. lza W110 issued a permit to is>sW a l� �-{ n.' asat OR a dc#ip dum by (addrees) dawd septic sYstem referenced above was installed sab to .. which may inchide VdW approved changes such as IateW re & box and/or septic tame;.; I.cm the septic >pmw* lot 113teral�o above was si lted wilt mar (x• n dw SAS or my-vert OW rejOcgdm of sue.)but in accordAncewith State dr Local R+a pki> by des*W to follow. °� I;n PETER T. (�•�) c� MCENTEE CIVIL 4 9 No.35100 ateA� (Aft Dcsigaer s StagIW ) AM x0y, 2-AU Q:Hoollbt8.pllodUdXW Oet�Perm M6.04.doo I ` r Totw�n of Barnstable P# Department,of Regulatory Services Public Health Division: Date: r �t 2001v1aip Street Hyinnis'MA 02601 ' t. DatSCheGiUled. he e _1 n :7"! So'Z Suitability Assessment for.Sewageasacl �e7 Performed By 4��r Me, �� �z WttnessedsBy LOCATION& GENERAL INFORMATION rl' Location address b:: / i t a--_ (.� . Owner's Name H 5 3 G c, i 4':�S . 167 b lZancho e• �+�r�A �0..: I'Pvl ri �s M�" Address �.�. SArt to `-1Zi:Z:? Assessor'smap/, k., Engineer's Name �2 ✓ -L�n ' IN BW GONSTRUC 130N . _ RBPAIR.:> - Tel. hone# S b 8 7 7 3,.3. Land;Use �Slopes(46) Go Surface Stones Distanee9rfrom:: Opea Wgjer-Body 7 ft -Possible Wet Ar� � ft . Drinking Water Wy,11 Drainage Way ft. Property:Line. �ft Other ft �2 30 SKETCi (S*t.name,dimensions of lot,exacclocations of test holes.dt:perc-tests,locateswetlands�n proximity to holes) 00 ' > .. ..moo. Parent.tnaterial•.(geologic) ��U U I J Depth to Bedrock Depth.to Groundwater Standing Water in Hole:NIJ�t� Weeping from Pit POe _. 1 Zo t Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL.HIGH.WATER' , Method:Used: ` tlr•Observedatandin to obs,hole: In, De th to soil mp.W Dep g p Depth.to weeping from.aide of obs.hole: In, Groundwater Adjustment ft _ =-- ,(ndex.Weil# Reading Date: ".Index W611 level,.,,_-_,.,, Adj.fhctor.�,....� AdJ dytgLtt ypt yal,,,, PERM-LATXftTLS:�' n to a. ;�. i 6A, Observation Hole D lD� 6" ' Depth of Pere Time at =.�.. 'Start Pre-soak Time® 3 l(� M I n Time(9"-G7 Ena 2q Rate.Minalnch Site.Suifabtlity-Assessment: Site-Passed- Sit4 Failed: _ Additional:Testing Needs¢ Odgloal; Publid.Heatth:Division Observation Hole Data To Be Completed on B`ask r---'- ***If percolation test into be conducted within 100' of wetland,you must fist Barnstable Conservation Division at least one(1) Week prior to beginntng: ' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Tcxturc Sdil Color Soil'• Other Sufface(gin)a 4 (USPA). . ' (Mtitisellj. Mottling (Structutc,Blanca;l;ouWm ... <� 1-3 , •• .. S611J.1 izon Soil Texture. SoffColor SoilSurface(i'n:) (USDA MG�o-°r8`I C( -CSci At • 4 1 > - DEIP OBSERVATION HOLE LOG Hobe# ^ �• M Dc�figm r $oi)F1iorlson :Soii.Texturc Soil Or.. Soll. "Oth"ery ` _' Snfi'aCe`(in) (USDA) (Muoselq Mottlin g (Structure,Stoneb,Boulders. :EP tOBSERVATION'HOLE LOG Hole# Depth from So,l FiiSrl>con Soil Texture Soil Color Boil Sutface�lq�. Outer (USDA) (Munseil) Mottling (StructuroPIMP,Bouldttrs,. Flood•h L.,.ce Ra, Maa• A� Above lt6 y�nood bouti'd4ry' No Yes ` l Williia 300xyoar bouddary No Yes' , -„ `Wltli€ rlySr floodtboundery No Yes µM six bn} cl✓tM1y � Y f . "P rvlo j e D e at le>i<st>four>�aet of naturally occurring pervious material exist in all areas.observed ahrpughout the° areaiprepos �o>vthe sotl6absorptlOTT iystem? If not,whtlit is the depth of itaturally:o'ccurring pervious material? ., Q tiflcation I certify that on (date)I have passed the soil evaluator examination approved by'the Department of Envimgnrnental Protection and that the above analysis was performed by me consistent`rvitfi the required trainin ertise and experience deseribsd in 10'C1vfIt 15.017. Signatu> ,x ET i Date. i r .�4 , Q:1SEi'°1'IC�P1P6"M"bOC 1 E12/22/2008 15:48 5084775313 ENGINEERING WORKS PAGE 61 Town of Bgr Bstabl.,0 ,F Rcffu],A,t®rY Services . .. :. Thomas F. Gailer,dDiMtor Pay-blic H��1� Thomas MCX*an,Direetor 209 MUR Street,flygailis,MA 02601 Office:.508-� ; Fax: 508-790-6304 : Z�Z2lo� Sewage Fwatalit# p, 1�9ffi�9�rflS 1�Is1�la�Y� ,a 4 - s -c�s Address: F , CO,v t weit- I;Z,-4 IS VR 0 c moo_ ( ) was issued a permit to instan a . (installer) 1�c1-t!4;a � � � (address) on a design drawn by ( signer) dated J S ftt the septic 8y8t9m ref®renced above was installed substantial,e�rhich rua pp according to Y include r*or approved changes such as lateral relcscati®n of the (NOW box and/or septic tank.: mw��•W I..cmfify ftt the septic system referenced above was installed with ;or c 10' lateral relocation f the SAS or any vertical relocati®� c9 (mot mf: � c system) but in aceorclAn 6 ass-built by designer to follo�,e with State Local Nations. Pun revigion,or PETER T. �n 9 McENTEf CIVIL 9 No.35109 0 C F9 s10NAL Ws.S ture) (Affix Designer s Stamp Here) � :Ha�ustlrl3' cerdficatioa FOM 3.26-04.doe f Wadlington, Ellen From: Miorandi, Donna Sent: Thursday, February 14, 2008 1:48 PM To: Heath DeptMailbox Subject: j 65 Blackberry'Lane, Hyannis? Just an inmportant FYI that I did a perc with Peter McEntee this morning at this address and after perc.walked through the house to check foundation and bedrooms. Listed as a 4 bedroom but it is actually a 6 bedroom house and has always been that. It is bank owned and has been maintain for it's age. There are two bedrooms down and 4 bedrooms up. The septic system will be designed for a six instead of the anticipated four. Thanks! Donna . i r I tl s i 1 SEWAGE' INSPECTIONS - DATE LL1 _`LF :6C..k-[4 N 6c LOT ASSESSOR'S MAP �VII.LAOE n �'h�— •INSpBCTOA S&nC TANK CAPACITY x� Oo71 (size) LEACHING,FACILITY: (type) NO;OF BEDROOMS BUILDER OR OWNER KJ OWNER MAILING -ADDRESS , L V _ \ r 6� 1: NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:95.5 FOR A DISTANCE OF 15' AROUND THE - PERIMETER OF THE S.A.S. 5-4" POLYSEAL OUTLETS PROPOSED TANK PROPOSED D-BOX PROPOSED S.A.S. � 21" INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT 2" .g 1-4" POLYSEAL INLETS OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE VENT T.O.F. F.G. EL: VENT EXISTING 00 F.G. EL.=99.Ot F.G. EL: 99.Ot ; 4" 36" MAX. COVER MAINTAIN 2% GRADE (MIN.) OVER S.A.S. c�1 U? = QLn 1 INSPECTION 00 L = 20' L = 11 L 8'(MAX) PORT @ S=19 (MIN.) @ S=17. (MIN.) @ S=l% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC ® ' ® ® cv Top View. R �( Section to" 6 8" TO D—BOX 14 INVERT INV.=95.80 48" JOUIO LEVEL ADD GAS BAFFLE INV.=95.42 INV.=95.25 p5ROWS OF 9 UNITS AT 4'/UNIT + 2'(END CAPS)= 38.00' INV.=96.37t INV.=95.55 PROPOSED D-BOX INV.=95.17 SOIL ABSORPTION SYSTEM (PROFILE) ,,moem AIM AM 5 OUTLETS (MIN,) Iona PROPOSED 1500 GALLON SEPTIC TA K ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN SAND (NATIVE OR PERC SAND) I BREAKOUT EL.=TOP OF UNIT NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TOP OF CHAMBER EL.=95.5 ° TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN INV.ELEV.=95.17 ° 0 O SIDE VIEW 310 CMR 15.221(2). BOTTOM ELEV.=94.50 I®nn u u n 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 2•8' EXISTING 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=14.0' SUITABLE INSPECTION PO G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. T.P. EXCAVATION OR SOILS 52" T USE 5 ROWS OF 9-QUICK4 STANDARD INFILTRATOR CHAMBERS TOP VIE 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE W M INVERTS PRIOR AL CONSTRUCTION. NO GROUNDWATER, EL.=89.1(TP-2) WITH NO SEPARATION BETWEEN EACH ROW & NO STONE o0 TYPICAL SECTION 8'3IN'VERT SEPTIC SYSTEM PROFILE 48" Pf CAP (EFFECTIVE LENGTH) END VIEW N.T.S. MUI TIPORT END CAP SOIL LOG DATE:FEBRUARY 14, 2008 (REF#12,105) SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS SOIL EVALUATOR: PETER McENTEE PE SIZE (W x L x H)...........................34" x 48' x 12" WITNESS: DONNA MIORANDI RS EFFECTIVE LEACHING AREA: DESIGN CRITERIA HEALTH AGENT BED.......................................................PER CODE ELEV. TP- 1 DEPTH ELEV. TP—2 DEPTH TRENCH.................................................PER CODE NUMBER OF BEDROOMS: 6 BEDROOMS 0" Oil z7CN INVERT ELEVATION..................................................8" 99.2 99•1 VI A FRONT ME STORAGE CAPACITY PER UNIT....................44.4 GAL SOIL TEXTURAL CLASS: CLASS I A SANDY LOAM SANDY LOAM DESIGN PERCOLATION RATE: <2 98.8 98.6 MIN/IN IOYR 3/3 10YR 3/3 5., 6" QUICK 4 STANDARD INFILTRATOR CHAMBER DAILY FLOW: 660 G.P.D. B SANDY LOAM B SANDY LOAM DESIGN FLOW: 660 G.P.D. 96.4 10YR 5/8 34„ 96.1 36" 10YR 5/8 INFILTRATOR CHAMBERS I GARBAGE GRINDER: NO C C PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY M-C SAND 48 M-C SAND N.T.S. 2.5Y 6/4 PERC 2.5Y 6/4 LEACHING AREA REQUIRED: (660) = 891.9 S.F. 10% GRAVEL 60" 10% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN .74 USE 5 ROWS OF 9—QUICK4 STANDARD CHAMBER UNITS W/ NO 92.2 84" f 92•1 84„ 65 BLACKBERRY LANE, HYANNIS, MA . STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 14.0' x 38.0' c - FINE SAND FINE SAND Prepared for: Joey's Septic Construction, 81 Commett Rd., Morstons Mills, MA 02648 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) 2.5Y 7/3 ' 2.5Y 7/3 Engineering by: SCALE DRAWN JOB. NO. 9 UNITS + 2 END CAPS PER ROW = 38.0 FT 89.2 ,201.1 89.1 120" Engineeringi''Works NTS P.T.M. 113-08 5 ROWS x 38.0' x 4,72 SF/LF = 896.8 SF PERC RATE <2 ( IN.MIN HORIZON DATE CHECKED - SHEET NO. / "C.�" ) 12 West Crossfield Road, Forestdale, MA 02644 DESIGN FLOW PROVIDED: 0.74(896.8 S.F.) = 663.6 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 2/15/08 P.T.M. 2 Of 2 i LEGEND N EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE Route 28 . �} W EXISTING WATER SERVICE BENCHMARK '` ,f TEST PIT £ g1U�err Tct Rd TOP OF CONCRETE BOUND EL.=100.00 (Assumed) BENCHMARK a J = 2 1 Y l SO'th o HIGH 4, LOCUS StrePt SCHOOL PG 51 ti ti 31 .4 O - e, ' S19,/ LOCUS MAP � VENT ,�26 `�1 NOT TO SCALE - TP-1 , TP-2 � {� 9s.a1',\ , } GENERAL NOTES: 99.06 --�,,_.__ EXISTING CESSPOOLS 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL -T-'r- -r-T-;-;-�-- TO BE PUMPED, FILLED W/ BOARD OF HEALTH AND THE DESIGN ENGINEER. "99-'-'--- -- SAND AND ABANDONED x 98.36 x 98.47 x 98.86 x 9 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE PROPOSED SEPTIC TANK N N SCREENED, LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: BRICK PATIO' PORCH t 310 CMR 15.405(1)(b): F' >1 A 1' variance to the 3' maximum cover requirement, for 2' of x 97. x 8. ti BHI 8.71 . 2 max. cover. S.A.S. shall be vented and is rated for 6' of cover. TWO SEWER•OyTI,ETS/ d�.� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR S, w /INV.=97.29 & 96.37 m• �; ��y.. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE f c� BRZ. �/ DESIGN ENGINEER. � GARAGE WAY .EXISTING Cb. 2 '/ HOUSE(#65) F OF Mq 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING w I `1\'` SS9, FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN T.O.F.=99.04t' o ./ �f (�} -.. � y��Q' �yG ENGINEER BEFORE CONSTRUCTION CONTINUES. x 98.07 x 00.98 ( PETER T. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. _ McENTEE _ __r1- �'✓ `dJ �' CIVIL v' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF \� sx 98.47 x 98,47 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \ o .-P..A1�2- ~-98-_. - ' CONSTRUCTION. _.._• No 3510 DRIVE - ...._..._......_.._....._._.._._......__............._...._.._. _..._._._......._..............___••- �£C/S1E��� Q 7. WATER SUPPLYRPROVIDED PBY TOWN WATER SERVICE. tip•_ lel?n 4'" 9j _ J APN 249-082 C 8, THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. L=26.59' \ - '' `'� ` - 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS R=52.50' _ __ 96--- _ _ 28 030t (RECORD) Cr 21�15 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. -i'1'37'00" W 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE L=18.78' S r THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. R-18.88 - 9�EDGE OF PAVEMENT 9 +9 +91-1 +9,ts, sr - 6�? 6�� j 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS I IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). BLACKBERRY LANE 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. # PROPOSED SEPTIC SYSTEM UPGRADE PLAN 65 BLACKBERRY LANE, HYANNIS, MA Prepared for: Joey's Septic Construction, 81 Commett Rd., Morstons Mills, MA 02648 Engineering by: SCALE DRAWN JOB. NO. I OWNER OF " RECORD P.T.M. CHASE HOME FINANCE Engineering Works 1 =30' 113-08 C/o REMAX CLASSIC 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (� 167 LOVELL'S LANE (508) 477-5313 2/15/08 P.T.M. 1 Of 2 MARSTONS MILLS, MA 02648 1 MAP pARCE! LOT B DATE 7115104 PROPERTY ADDRESS:-- 65 Biack&eaay Lane fLyann is, Ala. r 02601 On the above date, the septic system at the above address was Inspected.. This system consists of the following: 1. 2-6 'X8' eiock ce.6.6/?ooe6 RECEIVED Based on inspection, I certify the following conditions: AUG 1 3 2004 1. The •se tic .stem i� In IUvviv�)r0'%1N,-4STABLE /� y /2.¢opea wo1zUrz,g oadea at HEALTHDEPT. the pae sent time. 2. Th.is .i.6 not 'a t.it ee dive septic .6y.5tem. 3. (Ia.in ce,6.6/2oo.P watelt ..to invent was 12". 4. 0veV-eow ces.a/zooi was d?y. SIGNATURE: _ Name: i /tuce Nacal ei.6telt Company:_ a•_P. Macomgea _and_Son Inca Address:—Bon 66 Cen.teav_.�L-2e1( a. 02632 I Phone: (5,08) 775-3338 ------------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY SNOW JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leac'Melds . Pumped .& Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 e COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIR4NWNTAL AFFAIRS DEPARTMENT OF E+NVIR,QN�VI NTAL'PRMOTION y TITLE 5 OFFICIAL INSPECTION FORM—.NOT.-YORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION Property Address: .65 13.Pack9e2/tu Lune Kuann_._6 l7a Owner's Name:Cha.2X e,.i; <M Don4ld Owner's Address: J am e Date of Inspection: 7/15 0 4 Name of Inspector: (please print) _. _.t . . ... _..:.Company Name: �- P. Raaom Lea- & .Son Zrtc. Mailing.Address: Cen e2vc e, 7a-6-6.-02632 -� Telephone Number: 5 0 8—7 7 5:3 3 3 8 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(31.6 CMR d5:000). The system: --Passes -Conditionally Passes Needs Further Evaluation,by the Local Approving.Authority Fails Inspector's Signgta-re: Dater 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.sliallsubmit 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 4pproving. 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 conditions of use. Trtlo 4 T"CnPrgtlnn TRnrm 6/1.5/2000 page 1 _ Page 2 of 11 OFFICIAL INSPECTION;FORM—.NO:T FOR%VOLUNTARY.ASSESSMENTS i SUBSURFACE SEWAtGE.DISPOSAL SYSTEM.INSPECTION FORM. PART A CERTIFI.CATION (continued) Property Address: 65 Blackberry' Lane Hyanni c._=.14A Owner: Chart ec McDoa 1 d Date of Inspection: T i 5 Q 4 Inspection S.vm`mary: Cheek A;B C,D or.E/ALWAYSycomp:lete afl of Section:D A. System Passes: © I have not found any information which in'dibates 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. Comment! l CWOr, B. System Conditionally Passes: 1� 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. fi,QLThe septic tank is metal.and-over 20 years old*or the septic-tank(whether metal ornnot)isstructurally unsound,exhibits substantial:infiltration or exfiltration or tank.failureJs:imminent. System will pass inspection.ifthe 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: 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: 1 1® 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 isiremoved . ' f ND explain: '2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT-TOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) Property Address: 65 Blackberry-. Lane Hyannis MA Owner:. Charles McDonald Date of Inspection: 7/1.5/0 4r C. Further Evaluation-is Required by the Board of Health: 60 Conditions.exist which require further.evaluationby.the Board,ofHeaith:in order.toAdtermine 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 manper-which:willprotect public health,safety-and the--environment: 00 Cesspool or privy is within 50 feet of asurface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. System will fail unless the Board of Health(and Public Water Supplier,-if any)dotermines: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.ofa surface water supply or tributary to a.surface water.supply. 00 The system has a.septic tank and SAS and the=SAS is within a Zone 1 of a public waterfsupply. (10 The system has a septic tank and,SAS and:the SAS is within:.50 feet of a private water supply well. 1 �O The system has a septic tank and SAS and the-SAS is less than 100 feet..but 50 feet ormore frog a private water supply well". Method used to determine distance fV ne� "*This system passes if the well water:analysis,performed at a DEP certified laboratory, for coli€orm 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: Page 4 of 11 OFFICIAL•INSPECTION FORM-NOT`FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART:A CERTIFICATION(continued) Property Address: 65 Blackberry Lane Hyannis, MA Owner: Charles McDonald Date of Inspection: 7/1 5/0 4 ' D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to.each of the:following,for all inspections: Yes No _ .00 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:thegr:ound 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 _ AID Liquid depth in cesspool is less than 6"below invert or available.volume is less than'1/2.day flow TT Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped (10 N Any portion of.the SAS,cesspool or privy is below high ground water elevation. Ariy.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 l 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.pf sses 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 niust be attached-.to this form.] (Yes/No)The system fails.I have determined that-one or..more.,ofthe 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 convect the failure. E. Large Systems: To be considered a large system the system must serve a-facility,with a design flow of 10j000 gpd to 15;000 gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systemsin.addition to the criteria above) 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 _ 116 the:system is.located'in a nitrogen sensitive,area(Interim Wellhead Protection Area_IWPA)or a mapped Zone Il of a public water supply well a 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT°FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM.INSPECTION FORM PART B CHECKLIST Property Address: 65 Blackberry Lane Hyannis, MA Owner: Charles McDonald Date of Inspection: 7/1 5/0 4 Check if the following have been done.You must indicate"yes"or"no"as`to each.of the following: Yes N • ' 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 ofthe system'obtained and examined?(If they were;not available pote as N/A) Was the facility or dwelling inspected for signs of sewage backup? Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site? 'r _ 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: Yes nq 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)] .5 Page 6 of 11 OFFWIAL LNSPECTI:O T;FORM—NOT FOR VOLLTNTARY ASSESSMENTS SUBSI ACE-SIEWAGE DISP.;OSAL�SYS'i'WINSPECTION FORM PART.0 SYSTEM.INFORMATION Property Address: 65 Blackberry Lane Hyannis, MA Owner: Charles McDonald Date of Inspection: - 7/1.5/.,0 4 , FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): : . °dumber of.bedrooms(actual): D1vSIGN.flow based 6010 C1GS1:1;15.203(for example:110 gpd x#of edrooms): Number of current residents:._ Does4esidence have a garbage grinder(yes or no):}� Is laundry on a separate sewne.system.(yes ofno):.M [if yes separate inspection required] Laundry system inspected(yes or no):j ���o - i�C� g d� , Seasonal use: (yes or no. _ a , �$��.©0o-. Water meter readings, if available(last 2 years usage(gpd)):P Sump pum (yes or no): 4 Last date of occupancy:; COMMERCI-U TRIAL Type of estab ".3iciit: Design flow( on310 CMR 15.203):. d Basis.of d''sig'i''flow(seats/persogs/sgft,etc.): Grease trappresent(yes or no): Industrial waste holding tank present(yes or no): I0 Non-sanitary waste discharged to ihy,Title 5 system-(yes or no): Water-meter readings,if available: 1 ja Lasf date of occupancy/use:+.. W OTIIER(describe):. ; GENERAL INF99MATION Pumping Records �l ^ ' Source of information: j�, f� nm�et^ a 69n Was system pumped as part of the inspection(yes or no):( If yes,volume pumped: 1. 04) allons-=How was quan it'ty pumped determined? gAeaA Reason for.p..umping: TYPE OF SYSTEM p 2 Septic tank,distribution box,soil absorption.system -�f Single cesspool +�Overflow cesspool VNp ivy VW Shared system(yes or no)(if yes,attach previous inspection records,if any) VW_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) �0 Tight tank _Attach a.copy of the DEP.approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 19" ) Were sewage odors detected when arriving at.the site(yes or no)A0 6 _ P41c 7 of I 6T:'F I;�r . 3 �sI' e` ` QI� F.ORM.,N'QT FO'R VOLUNTARY ASSEBS.M.ENTS SU1 F eE�E VA►QIr VISMS'A►L-$Y$TEM WS-FECTION ORM' PA.RT•C -. SYSTET► -INFORNOTION(continued) i'To ct�y/�•ddrCSf'! h� R1 ac1parry r ane o.way..rt g>, , = ��nald Dine of brriPottion•t t, BLkt Dll`fG SEWER(10cavc-o r-site plan) aapth bc19w�li��e:A.9-r4.-"clz3 tv-00 „�..40 PVCatltcr1Pply well ai rv.etioR lima; Cortuncnts 4, h aotsdltl n.° G1cs,vanfillt ,ev.1 lit C k >i u32 VQJ ' SEPTIC T'viK: (locate on site•plttn) Drdtth b.c-low IVade: , .,. I�itcrlil.of sonstrvction: ;,.�,a4n=rotr�„Tmctul,_„frbcrgtass ,,polyethykna. o�tcrtcPlcln� ' w1k rs matillist.+ljaa is ags conCtrttic. by a Ccrxlflo►tc o Compl.nnec(yGs or no),. (ntt�ch a copy of ccrS•if►ante) �dmtns>ans, " . $l dO-th: [ais tics.from top f s tidgc to.Wit=o outlet tsc or baffle;�.3_.� Sct�tIt•icltltcii: „y,,.;:,, Distartca frost.tap of�curn tio.'lop pf 04 let tee or bafl]p: PIS. .cc.f�am.bonom:o f scum to bottom-or outlet tee or bafifle: How wsfc dJmcsiaras determined; AN C.OMM'rtrts.(•.on.pumpin.g rteoM-LMC idiFWTVs, eat lira qut.ei tee or baPtfie eondlidon, structural integr(ry,liquid levels as rcl�4.t ovalct xcrt, rrldcncaf•Is>i�itr8c. etc .• ., .�.• GREASE TRAP&oocatc on slit play Dcpth bxtow @7-114C: 1 ` Mitcrisil.of constrvati0tt: iconcretC�j mFtabcrglasspalyeth)rlana ,�,other (axpli�)t • . . Dimen}lops: Scum tltiC'JCiiefS: ") pistaftee br.Qsn rop o scvm to t.op of outlet(v.'e yr baffle:Ptwc from botwm of scum to bottom of outlet ice or bafllc Diteofltst.p=-P-AAit j4;,,,,,, Corrnm.erus(aft pvmpirtiz rccom�tcntia ipnsv.(nitl.po cvels outlet ice or bafl�e oondidon;structural tiategriry;liquid I ss ra1sted to ourkt invriri;evldcttee 9f:I rttNt,•eta,}; Page 8 of 11 OFFEIAL.INSPECTION:FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION.FORM PART C SYSTEM.INFORMATION(continued) Property Address: 65 R1 ae-khPrr= Lane Owner: C�harzl eg PleDenalEl Date of Inspection: -, i, i„4 _ TIGHT or HOLDING TANK: (tank-must-be pumped at time of inspection)(locate on.site plan) Depth below grade." Material of construction: LcQncrete.I'.�metal ftA fiberglass polyethylene Niother(explain): Dimensions: Capacity: V a gallons Design Flow: allons/day Alarm present-(yes or no): Alarm level:� Alarm in working order(yes.or no):. Date of last pumping: VW Comments(conditipil of alarm and float switches,etc. : DISTRIBUTION BOX: VID (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:ofsolids carryover,any evidence of leakagq in or out 44f box,etc.): ..i-Lb Wfl box (10+ R-LbU4, PUMP CHAMBER:1Z(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): - Comments(note condition o pump ch b condition f pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Blackberry Lane Hyannis, MA Owner: Charles McDonald Date of Inspection: 7 f15/0 4 SOIL ABSO T;ON SYSTEM(S S): ;(locate on site plan,excavation not required) a x6 c�SG��oP� If SAS not)oc ted explain why: loco p -4-64 io T Pe leaching pits,number: VIA leaching chambers,number: leaching galleries,number:- Q 1*40 leaching trenches,number,length. .00 leaching fields,number,dimensions: fOoverflow 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.): r .�. 1.i re. o , v "WQA—,d)V) l7 l akk) o© . L-Q . CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) r i Number and configuration: Depth—top of liquid to inlet invert: 1 Depth of solids layer: Tre+ 0— Depth of scum layer: 3L" Dimensions of cesspoo—l: C� S' Materials of construction: &ncfrAt Indication of groundwater inflow(yes.or no):fla_ Comments(note condition of soil,signs of hydra lic failure,level of pondin a condition of ve a tion,etc.): 14 c . o V D' O PRIVY: (locate on site plan) Materials of construction: 16\ Dimensions: lu Depth of solids: — Comment;(note con ition of soil,pigns of hydraulic failure,level of ponding,condition of vegetation,etc.): ` 9 Page 10 of 11 OFFICIAL.INSPECTION FORM.-NOT FOR VOLUNTARY:ASSESSMENTS SU$SURFACE`SEWAGE DISPOSAL SYSTEM'INSPECTION FORM PART C` SYSTEM INFORMATION(continued) Property Address: 65 Blackberry T.ane Hyannis.,—MA— Owner: Charles McDonald Date of Inspection: 7 11 5/'(r4 ' 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. I, 10 Page 1.1 of OFFICIAL INSPECTION FORM — NOT FOR VOLUNTA-RY ASSESSMENTS SUBSURFACE SEWA.CE DISPOSAL SYSTEM INSPECTION FORM PART C •.. '\, SYSTEM INFORMATION (continued). Property Address: G5 Blackberry Lane Hyannis, ,NIA Owocr: C_harl Pc McDonald Date of lnspcctioo: �1 5 IZ Q 4- SITE EXAM Slope . Surface water Check cell ai Shallow wells Estimated depth to ground water S`7/ feet Please indicate (cheese)al.1 method's used to determine the high ground water elevation: _Obtained from system-design plans on record • If checked, We of"desip plan reviewed: Observed site(abusing property/observation hole within 1,50 feet of SAS) _Checked with local Board,of Health-explain: Checked with local exsa.vators, installers. (attach documentation) _Accessed USGS database explain: You.must describe how you established the high ground water elevatlon: Leaching Pit I ;cct Groundwater. Feet Below Bouom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Mcthod 6.(.j T?urefore,the vertical.separation distance between the bosom of the leaching pit and the adjusted gToundwatergable is-' / II n t..�nl'I•I�Tr• rn:nn'..TT.fR-nf*a�•xrnn•.Tr++Tvffl++.+f*+A+ m•►n•V 1�r�f�� 11'ONN OF Barnstable LIOARD OF 11EAVII SUI)SW(FACR SEWAQF DISPOSAL SY9TF.M Ia, CTION FORM - PART D •- CERTIFICATION �n�•rrnr�.�+�.Tremr+n•...r.-T•••r—•�• —. �•••T•t-T""•' —T• �n�,,,r�y,.,,.�;�IT.,Tn,•cfirnnrrr, _T 1?.Z OR PRINT CLEARLY- P/IOPERT y T NSPECTED STREET ADDRESS 46 Neadow Lane ASSESSORS MAP , BOCK AND PARCEL # 133-020 OWNER'' s NAME Bizian S.�ewaat PART' ll - CCRTXFXCATXON NAME OF INSPECTOR Rzuc.e .Naca.Eiizt.ga COMPANY NAME Joseph P. Macomber ' &­Son Inc COMPANY ADDRESS ^ Box 6� Centerville. Mass 0263.2 Strevt Tovn or Qlty stall CIP COMPANY TELEPIIONE ( 508 ) 775-33-38 FAX ( 508 ) 790-1578 . n Cr.R'rIVICAT1ON. STATEMENT I certify that I .. have personally inspected the sewage •disposa`i system r this address and that the information reported • is true., accurate , and complete as of the time of ,inspection, The inspection was performed and any 'recommendations regarding upgrade-, maintenance ,- and repair are consistent with my' training and experience in the proper function and maintenance of or site sewage disposal systems . Check one ; S.ys teoi .PASS.hD The inspection i4hich I have condu-c.ted has not found any information which indicates that th.e system fails to adequately protect public Iiealtll or the environment as defined i:n 310 CMR 16 . 303 , Any • failt{re criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED The inspection which I have cond''C1tted. has found that the system fails { Protect the j-it{b.lic health and the environment in accordance with Title 51 1..10 CMR 16 . 3Q3 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form., 4 Inspector Signature . ate �` - ;;ne copy of this c,_rci-fication must be provided to the OWNER, the DUYER '( Nhere eLpplicable ) and the 130t�RD OF 1{EAI,4`I{. .If Che inspect, ion PAILEDI t,h!e• ownar or.."op.©rator-shah upgrado ' the gyetem within one year or the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 3:06 . partd . di