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HomeMy WebLinkAbout0076 ELLSWORTH ROAD - Health r76 Ellsworth Rd. Hyannis A= t r o b e 4 e , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments17) ;{ Lo Property Address T Owner Owner's Name / / -' information is 1/ 1U.6 0( Ca required for every Al '? � Q a� � � U� page. City/Town State Zip Code Date of Aspefttion Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 3 0-5�3 on the computer, use only the tab 1. Inspector: key to move yourV)` cursor-do not use the return Name of Inspector /��/// key L-/V V l 0 Cr C i Company Name Company Address 4f City/Town State Zip Code Telephone umber 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 Inspector Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate wtvc 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /\) �M I if e//f C- 0-- �C1 Property Address H0j .Gj Owner Owner's Name information is b.1 c o l required for every ✓1'�/ �//�' �a page. City/Town State Zip Code Date of IrApettion B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Syste sses: 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: / P l C 4&-v c� ✓`� I n 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. P System will ass Y inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will ass inspection if ii is structural) sound, not leaking and if a Certificate of P P P Y 9 Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a.or 14.1 �d Property Address — Owner Owner's Name information is q V A required for every - page. City/Town State Zip Code Date ofAnsp6ction 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): pipe(s)are re laced Y N ND (Explain below): ❑ broken P ❑ ❑ ❑ ( P ) ❑ 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. w 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.doc•rev.6116 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 /1 6 L--Ilseyo-,f4 v4?j Property Address G VI Owner Owners Name , l information is required for every /—/(,a 4*V 0a`0/ CO �'�L page. City/Town State Zip Code Date of I sp ction 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 ` u 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 ❑ tatic 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'/z day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is #4 y� APA Qa 6 o/ (� / required for every Hc7o page. City/Town State Zip Code Date o 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. ❑ [� 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. ❑ 2Any 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.] ❑ e 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 11 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts G Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address / /O // ✓� Owner Owner's Name information is �f` lI required for every ✓�y/f/ A i� / O d IG 0 1 page. City/Town State Zip Code Date of I sp btion C. Checklist Check if the following have been done. You must indicate "yes"or"'no"as to each of the following: Yes No ❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Lv� as 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: r Number of bedrooms (design). ----- Number of bedrooms (actual): 3-- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3 30 t5ins.doc•rev.6116 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 M 26 4 IlsIIVo,*ti feci Property Address H_o!j Q#1 Owner Owner's Name information is Ax O��y oI v /Ar Date of ns required for every a✓Ih f Y _ page. City/Town State Zip Code ection D. System Information Description: (/) /i'1O &II., JP 7F/G t ti 4, tsTr&L-ho., do O Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection El 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? ❑ YYes No Last date of occupancy: Datee 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is p required for every / A���1 Ax OL6 '0 page. City/Town State Zip Code Date of Ifisp9tion 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 o If yes,volume pumped: gallons How was quantity pumped determined? — — Reason for pumping: Ty��eptic 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.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Sy stem Form -Not for Voluntary g p Y Assessments ry w /6 'Ells C eo� Property Address Owner O wner's Name information is required for every Q,14 1e a / page. City/Town State Zip Code Date of Pfispebtion D. System Information (cont.) Approximate age of all components, date installed (if known)and source of informatio : Ta H&-­ O 12t t#7^ L _ If-et,., Were sewage odors detected when arriving at the site? ❑ Yes to Building Sewer(locate on site plan): Depth below grade: / feet Material of constructio;'4- ❑ cast iron 0 PVC ❑ other(explain): - - - - - —-- - ------- Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material 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: .5 X o Sludge depth: f t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name A4 information is 0.).6 O/ � /Ay required for every /4&7.41441; page. Cityfrown C701State Zip Code Date of I spe ion D. System Information (cont.) Septic Tank (cont.) / Distance from top of sludge to bottom of outlet tee or baffle Scum thickness (� Distance from top of scum to top of outlet tee or baffle �L ,r Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? -- Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I C 4a o(j/ / eeG"S /OLt✓`1 t✓! 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 760 _ Ill f.✓o r � _ �� Property Address /70 IR Owner Owner's Name ` O l 6 v / e information is g 0 y U d (� required for every — — --- — page. Cityfrown State Zip Code Date of I spection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, I liquid levels as related to outlet invert, evidence of :leakage, etc. q 9 ) 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: _.._.. ._per d.. .._,. gallons ay 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address 409i • Owner Owner's Name � information is ✓l y required for every A of 0.;1, co/ C ( " page. City/Town State Zip Code Date 9(inspuiction D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert �e,17 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.): o - e v� AD /VO ze-a4-jc 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.doc•rev.6/16 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 Property Address / i/�O A✓1 Owner Owners Name AS information is /�/ va 6 0) required for every 840U page. CitylTown State Zip Code Date of I spection D. System Information (cont.)oe Type: 000 6'r-110.1 C. 44r" orl 02 . ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -------- --- ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): J. A/0 St •1r 0 7 cli w 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.Goc-rev.6/16 Title 5 Officiai inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 7'O`i q✓1 Owner Owner's Name / l information is e required for every / 0441j page. City/Town State Zip Code Date of I spe tion 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.doc-rev.6/16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage /Disposal System Forrmy -Not for Voluntary Assessments Property Property Address / Owner Owner's Name information is /'� Gi✓1�11 A4 � _ required for every — page. City/Town 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 ;hand-sketce p is water supply enters the building. Check one of the boxes below: h in the area below ❑ drawing attached separately 114 ( 1 J �/ ,Af c ;..1"' Rfs.�i )L '1 30 9 a3 -3 C t5ins.doc•rev.6116 _ Title 5 Official Inspection Forth: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 Property Address /4 O q Owner Owner's Name , information is �n1 required for every A-14 ✓�64if A4 V _ -> b �_ ne page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ll Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date. � Checked served site(abutting property/observation hole within 150 feet of SAS) �with local Board of Health -explain: Ip�s ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You mu escribe how/you established the high round water elevation: ej tl/ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name I information is A���s Od-G 0/ �� required for every r - page. City/Town State Zip Code Dat 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 m Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 12/04/2007 08:53 5084775313 ENGINEERING WORKS PAGE 01 Ziff-cr7 Town of Bam#sble Regulatory Services } Tbomas F.Goner,Director Public Reath Division Thomas MtKena,Director ?O@ 11(aia Street,$ypoals,MA 9M1 Office: .5Q8'662*" Pant 308-79043.04 r Sew'lge Permit#�GV 7 SS.Zq An� �L Asstasor, s MaplParca,���Ge91 WOO': /n�er. /(�.i-5 Inatq�Uer: �Vri (6k Address: Mat 1"1,11 i't'lfa on /-26_e-7 ��� 64 11#�1 uod a permit to install a ,i � (ir�iler) se tic.:a q: t wfi✓)(address) based on a desip drawn by /�C. C% T1n!-�t ��• dated !i410 Eln) I cent +.that the septic system referenced above was installed substantisily ae wrdius to tlim:d ,which may include minor approved changes such as lateral rcloea4aan of the 40� box and/or septic tank. I + tLat the septic ayyss�tecm ref rmneed above was mstaUed with cl Jl 10'lateral relocation of the SAS or any vertical relocation of m;component 4*01 system but in aCCo.rdamt!with State&Lacal Regaiationa. Flan revision or 0e944d asbuilt by designer to follow. "OF PETER T, McENtEr y CIVIL No.34109 ;P. 13tr& �rsfoNAL Mi '8 Sin) (Affix Designer a Stamp HM) N Q:HWdMhPlio4)n1I8W CAr68artlon FoQ+o 3-2fr01.doc .. .. ( - r Town of Barnstable P#_:� 7/_ Department of Regulatory Services >a t Public HealthDiv><sion Hate { 200 Mam Street,H yap MA 02601 �dsy. '♦ y A. Date Scheduled Time 4. Fee Pd :.. � 0 I Soil Suitability Assessment for Sew-age s o al Performed Bye �.1 ,�C Lv��s�2R_ Witnessed LOCATION& GENERAL INFORMATION I.ocatton,Address 7 s�o,�' `. Owner's Name�-- Address i-lv vt�st ,Nlf az(r,� ► Z22 C9 0'. En � Assessor's.Map/Paroel ;Zfo-9 — Engineer's-Name U'Q-j71V1 e✓i 1�eP NBW CONSTKUCTYON REPAIR Telephone 4 7 "3•i 3 Land Use GS �'-�`' Slopes(% 2 Surface Stones N` Distances from: Open Water Body 15,y tt Possible Wet Area?f 5 ft Drinking Water Well" . l sV ft DrainageMay �Cr� _ft :Peoperty Line ��' ft Other ft SKETCH:cstreec name,dimensions of lot,exact locations of test holes&perc tests,locate weElaods�n proxrlruty tv holes) Z1 I I Parent material to lc) C` �`� Depth to Bedrock (B . .g rO Depth to Groundwater. Standing Water in Hole: / . _ Weeping from Pit Face Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL HIGH VlkTEIt::TABIrb' Method Used: Depth Observed standing in obs.hole: in. Depth,to soli mottles Depth to weeping from .side of obs.hole: _ _ ir,,--Groandwater l;;iinie.tt Index Well# Reading Date: Index Well level .„ Adj.Actor ...,T A { dewuttdwater1.evpP,.:. PERCOLATION,xESx D�tp-1r Observation Z Hole# Depth of Perc Time Start Pre-soak Time @ ttimc(9"-6") End Pre- Rate.Min:Mch . Z site Soitabthty Assessment Site Passed :- Site Failed: .T_ Additional Testing Needed,,(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back --------- ***If percolation test is to be conducted within 100' of wetland,you must first nofy he Barnstable Conselrvation Division at least one(1)week prior to beginning. nanvrriv!'1oRb/�Qr1QIU Il(1(' - DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(rn);: (USDA) (Munsell). Mottling (Structure,Stones;aoulders. A 27 AEEP OBSERVATION HOLE.LOG Hole# Z De th from Sp II Horizon $oil Texture Soil Color Soil Other SurPaee(ia:) (USUA)O (Munsell) Mottling (Structure,Stones,Boulders. / c� A. —Lf 3 . 5L. t� y�s`� .. DEEP OBSERVATION HOLE LOG Hole# Depth fro, Soil;Horizou, Sotl Texturc Sori:Color r Soil, Other Surface(iu) ..(USDA)... ..�,_. . (Munsell) Mottling (Structure',stories,Boulders. DLP,OBSERVATION HOLE LOG Hole# - Dep..from S61144orizon Soil Texture Soil Color Boil Other Surface'(in`;) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Flood Insurance Rate Man_ Above SbOyear flood boundary No Yes WithIo:5o0year boundary No Yes 4 '� W(Wrn tOb year flood boundary. No °C Yes 4� D— �Ix v Occ> ins PervIous;,�'lar~ertal Dbes at least oui t"eet of naturally occurring pervious material exist in all areas observed thrpughout--tht3 area proposed for--the soil>absorpgan.sy item? Y� 5 If"not,wliaC is the depth of naturally.occurring pervious material? ', l Cert' Iflcatlon t lI cem that on fY -- 1 (date)I have passed the soil evaluator examination approved by the Deptutment:of Environmental Protection and that the above analysis was performed by me consistent with the'requrred training,expertise and experience described"in10'CMIt 15A17. S Signature Date ��_- ____� _ Q:vsErT►cAR 3190 MMOC TOWN OF BARNSTABLE LOCATION �� 7�,L�� ) /21� SEWAGE# ✓- JV9 VILLAGE ASSESSOR'S MAPP&PARCEL tV441 INSTALLERS NAME&PHONE NO. )IT �® il,' G�� z��i�•�� p� �� ' SEPTIC TANK CAPACITY ZACv L �aH LEACHING FACILITY:(type) SN Cd t eXgv3--,) „' (size)JI.V C�2 3 `" NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: diva 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 1U � � �� � � � � �, •,;� W •tea Q �'` e c.� ,_ A SESSOR'S MAP.NO-. PARCEL � ,0 AT10v1 4 � EW E PERMIT NO. VILLAGE I N S T,# llE 'S N'AME li ADDRESS J. U 'yg t UILDE R 0 OWNER DA T E. P E R M I T ISSUE D DAT E COMPLIANCE ISSUED �� 1 � �y � 38 33 � � _ .. `�� ,. �oACa/°Y ASE�SO MAP N0. PARCEL �?- lor,Z ` fp C A T 10 Naa PE RMIT N0. VILLAGE INSTA LER'S *'DNA E _R ADDRESS' (",7 r S Ilk- y I U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Y e Ir 9 14Nlv �— No. O Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplicafion fori *pmertt Coittruction der it Application for a Permit to Construct( ) Repair( Upgrade( Abandon( ) ❑Complete System Individual Components Location Address or Lot No. -7� �lls-ao`'¢4 Owner's Name,Address,and Tel.No. ,? yr-WGCC yn�/��iyl✓� 7� flSms>�4 OD Assessor's Map/Parcel O d i P.. g�����,$ ryr/rJ r�q Installer's Name,Address,and Tel.No. ��� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size %7 ��a ® sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided gpd Plan Date 11 7-O - //Number of sheets C;Z, Revision Date Title �ip�o3�� s�� rc s/ y�r �[� ZaW..'A X 6. &�a aiJ */.z Size of Septic Tank l erG'D a.&� eJ'/+vj Type of S.A.S. ,-4 L G'l,.ae4.,j Description of Soil Nature of Repairs or Alterations(Answer when applicable) �Ppcir �.�'4 ��- ,�G Y 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 rd o lth. igned Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. C:9-c9® Date Issued �� 11� I No.' � s l`� Fee THE COMMONWEALTH OF MASSACHUS_ETfTS Entered in computer: PUBLIC HEALTHDIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZppYtcaf 'fo=r: tgpogal *pgtem Conotruction Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑ Complete System Vindiidual Components Location Address or Lot No. _A10 Owner's Name,Address;and Tel.No. f9Uvr rLL Assessor's Map/Parcel 7f .� d fb r-tof 6 7�D !' NN/!. .�I b Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building:, " ,,,,.: Dwelling No.of Bedrooms 3 Lot Size 7 $3a sq.ft. Garbage Grinder (� `, • Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 ' gpd Design flow provided gp 33� d` i ;i Plan Date' //— 3—p "7 f Number of sheets e / Revision Date Title �inpWee� -s+ �4,A ✓, rf..� r.A,,� -76 �i [�rvrs� 5 /tom i) j Size of Septic Tank /elae 6. F, iJ'Ao s Type of S.A.S. fee6+-1 + Description of Soil T i Nature of Repairs or Alterations(Answer when applicable) t�ci� 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 B rd o aalth. i�ed Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. (:9—c9�r �- Date Issued THE COMMONWEALTH OF MASSACHUSETTS —— `-----.`•�—--—- -I' BARNSTABLE, MASSACHUSETTS i Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( AO)l Upgraded ( ) Abandoned( )by � ���j�df �n.,1 �i•,�c�tir r% at 7 ��//ll�so.. /�/� ,��ird►id has been constructed in accordance J with the provisions of Title 5 and the for Disposal System Construction Permit No. �� dated /11 /"A-7 Installer Designer /Fi..a•/ rsJps•/�i #bedrooms 3 Approved design flow f gpd �. The issuance of this permit shall not e c n r d as a g arantee that the system 9111 �ion4as designed. '+ Date ® Inspector 6 p i J• ,/ti�, ——— ——— -- ± — �-7 a f, No. ' ! —5 Fee ®a —— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwtgpogal *pgteM C95tructton Permit Permission is herebyranted to Construct Repair P U ade Abandon g � ) P � ) p � ) � ) System located at —76 �! and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty I, to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be co pleted within three years of the date of pe it:\ Date / �'� d Approved by 1 _ ___ �'�� v f Commonwealth of Massachusetts Title 5 Official Inspection Fo m Subsurface Sewage Disposal System Form -Not for V untal ssessments76 ELLSWORTH RDQc�t.c� �0C—)-I Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is MA 02601 10/10/07 required for HYANNIS State Zip Code Date of Inspection every page. City/Town Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information cp C 'D, o o When filling out forms on the computer,use 1. Inspector: only the tab key \ to move your Michael DeDecko cursor-do not Name of Inspector use the return key. Compass Realty Development Corporation Company Name rab P.O. Box 2384 Company Address Ma 02649 Mashpee City/Town State Zip Code 508-221-5003 Telephone Number License Number B. Certification �''' ra ,1 e I certify that I have personally inspected the sewage disposal system at this address and that th6 't 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%ite sewage disposal systems. I am a DEP approved system inspector pursuant to Section`5.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 1 10/11/07 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. 76 ELLSWORTH•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form a s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 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: + a ❑ 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. 76 ELLSWORTH•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments wM 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 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. 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. cityrrown B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup_of sewage into facility or system component due to overloaded or ® ❑ clogged SAS or cesspool ® El due 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 O ® Liquid depth in cesspool is less than 6" below invert or available volume is less T than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 76 ELLSWORTH-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA-91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection El 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. 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town 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? ® El available 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)] • s • ti y 76 ELLSWORTH•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information Residential Flow Conditions: 3 Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No rate sewage s stem? if es separate inspection required] ❑ Yes ® No Is laundry on a separate g y I Y Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No N/A Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No N/A Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) a 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: Last date of occupancy/use: Date Other(describe): 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) General Information Pumping Records: N/A 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601. 10/10/07 required for State Zip Code Date of Inspection every page. Cityrrown 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.): NEED TO PUMP, TEE'S INTACT,STRUCTALLY SOUND, LIQUID LEVEL EQUAL WITH OUTLET INVERT, NO LEAKAGE, 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 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 76 ELLSWORTH•06106 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w„ 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EQUAL WITH 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 IS LEVEL AND DISTRIBUTION EQUAL, YES SOLID CARRYOVER, NO LEAKAGE. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 . required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 1/6X6 ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL-GRAVEL/SAND, YES SIGNS OF HYDRAULIC FAILURE, PONDING HAS BEEN FULL,NO DAMP SOIL, VEGETATION -NORMAL. 76 ELLSWORTH•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Ti tle 5 Official Inspection Form � p Subsurface Sewage Disposal System Form Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for every page. CityRown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 76 ELLSWORTH•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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. .,-U' 'f L,4 - 35 -33 63 3$ . u # 76 ELLSWORTH•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 76 ELLSWORTH RD Property Address UNA PASQUERELLA 91 CAMP ST HYANNIS MA 02601 Owner Owner's Name information is HYANNIS MA 02601 10/10/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 44' Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: BARNSTABLE GIS You must describe how you established the high ground water elevation: BARNSTABLE GIS 76 ELLSWORTH•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OF THE Tp� ti�P� ti� Regulatory Services BARNSTABLE ; Thomas F. Geiler, Director ArFp��A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, lease contact the certified Septic p p System Inspector who conducted the inspection. 12/12/2000 15:14 5004269334 EXCLUSIVE BROKERAGE PAGE 14 Wm. E. Robinson, Jr. tf Septic Inspections 43 Tomahawk Drive Centerville, MA 02632 (508) 775-7986 Pager 978-622-8700 Location 76 Ellsworth Road Centerville , Ma 02632 Wood System. is in good working condition at time of inspection and should be cleaned every two years. DECEIVE' ';nil 0 9 Zoo i TOWHELTH pEpTh6LE i2/12/2000 15: 14 5084289334 EXCLUSIVE BROKERAGE PAGE 02 COMMONWEALI'H OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIROMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,SOSTON MA 02108(617)292.5500 SUBSURFACE SMADE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Lot#1 PROPERTY ADDRESS: TO Ellsworth Rd.Centerville.Ma 02832 ADDRESS OF OWNER: DATE OF INSPECTION: 8-19-W NAME OF INSPECTOR: Wllliaan E Robinson Jr. I anti a DEP approved system Inspector pursuant to Seotlon 15—W of Title 4 0310 CMR 15.000) COMPANY NAAIIE: yVaNern E Rodrreon Ssift IrrwDacNone MIAIUNG ADDRESS: 43 Tomsh"Dr.Cenl"le TIELEPHONE NUMSlR: 90L7 7988 CIMEIMI12N 13TATCM I VW I hove powwally Inspected lire isrrego die system d this address and ttaat the bftTnabon reported below is tars, emu►sts and aornnplete es of the tame of Rap6Won. The htspooft wee performed hosed on My trolft and 4gwh =in the Proper rurofm and rnalnter►m of cmde eewW dieposol systems. The system; $ PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS --� r 04PECTOR6 SIGMAYWte: DATE., 84940 The system Inspector shad stbndt a copy of this mapectim report to to ALAl"(1lasrd of Health or DES wahfn Utley(30) ehiys of oompersrtg tttia htspsctim, If fhs system is a shored system or hus a design.flam of 10.000 gpd or greater,the inspector and the uyahrrn owner shall submit the+enact to the appropriate rmglond oftbe of ito Depalbnsl*of ErwkwurmW Prdwtk n. 11he WOW should be @ant to fens system owner and copies swA to the buyer,IT appkabie wW ftw appm*q sadholy. NOTES AND COMMENTS: System Is In good worlting towASCn at Ume of inspedlon. revised 9098 1 o 12/12/2000 15:14 5084289334 I URFACE SENfA® C L SYSTEM INSPECTION FORM SUS PART A 1. - CE;MWICAMON(f:on"UW) property Address: 76 Elfa RS.C.,iltiarvllis Ma 02832 Owner: fffood Dace of inspso"on: 6'"'" INSPECTION SUMMARY cw1k A,a c,or®: Al SYSTEM PASSES: e1y of floe fariln Cototaas`9mW in 890 CMR X I haw rxj found any 01"'fii`t°Irxlk ttoaq tt�e sy _ 15.903. ArrY PASSESg�£C TEM IS 6A6£O ON CONbITlpPl Ow 9wYSTEM IhY YME TOME COAAMHNTtT: $!TE C> THE U OF T1iE gYSTEAA. Op THE INSpECT10N.TH 8 NO�gPANTEE ON 8 SYSTEM CONDITIONALLY pASSF.B=WA The ae wed In to•Carte Peels I0r'rteed ,,rpetraa. One or rnae aYat or MWr'00 sWvmd bV the 13oafd of '"''"w81 • ►Pm�of tl e 1+v in al;n8la oes If'not dam',wo"In-f'l` IftdldtN Yee•no,or rat defeu'mkwd(Y•N�Or NO). 0 tee of de��D° With a Copy Of a C"101" owroer 0r apw t: � to the date of the The tank Is rnOA1,urA" ,ags 't4&m 00) Nms�°`suba�uollal 4nRttatbn or f ft ((t )1 whw� '9 ptn suriecund �e taeok is ropMee d",Ith f c f4an Nil WON" as arwo by me Watt of HOWL o bv�o in ttxe d tyooc Is Qua to txoww or o e4 a sib WW ps SaWW be"or t ' if(With apatxovat t d on Balm of _ vow Pos(*aremoteco 16bW Is wieted Or ,e her torroea a due to broken Of 013e t Tt"sy"n Mquww tv^ °' '!f aPP of the Board o[Healtre): pis) The brd + a)I' paptaced ' r1. 1 1 r 2 revia®d 912/99 t 5�r i , i2/12;'2907 15:14 5084289334 �YBTEWlINB CTIbNr-ORM 8Ug8U qCE 8EWAC3E D18�AR A CERTIFICATION(000"ued) Prd�+�Y Adder To Ella Rd- MOO" Ma 4 � Mhd cwfw' 8-9 DaM10 of Inspec O�yAr NIA Bard of in omw m"or"it the"S" NilinO W Cl f UIZTNER Ey�.t9m►T4®Pl l8 iE®U113E®8Y T�l�� Con twwlc 5g and � � a y }I$10 CNOirI 11i F �piRD OF�EmL7M'�Plto� �E"TM APO SAMV slYd.MIA 1&L PAXI A 1819dY-�- 4 T me o"ME� T or is woln W W of a su"m 1Mw lfttedof a an nearer• APM C or prh��."��68 rad of a LMJC �AND WATER gYSTE� FAA-1 'S��o t AFA R IMT PR�TO THE F �TERMIPOILS Tmr aw sis"M ir�sat� SAS Is VAh'n SAFETY AND TH9 SMVMWOT.. a ffin�and wt (sA8)and The SVG*M t 100 W a arts VVVAM a� a Z*M 9 oe s 1B W wipoy we,. s tpa�and Ve`"AS Ia wltl do 54 to* 100 of AA P �rld sop sys and it+e a rr► � 'ad but 509a aow atea irrog Wtiod no baokoft sne void* wd ntb nano Aw"sue nd valb!•. d t wo deb� y) O779Efa i ' ` 3 revised 9121� 12112/2000 15: 14 5084289334 EXCLUSIVE BROKERAGE PAGE 05 SUBSURFACE SEWAGE DISPOSAL SYSTEM IMSPECTION FORM PART A CERTIFICATIOfl1(cotttinued) Property Addre": 76 EIISWO ttf Rd.Centerville Me 02632 Owner: WNW Dade of Inspeatlon: 4-19-00 01 SYSTEM FAILS:NA You must Indicate~Yes"or"No' to each of it*foi Wft: l have d9wwdrood that one or nwra of the togwi tag fafte conclibmw Guist ae desattbed In 310 CMR 11I.M. The beats IN this debmwilinstim is idarl ftd bateau. The Board o1 should bs to Datefrwoo whm ttA#be tweasse►y to tsorfeoe the gad m. Yea NO Backup of wnge k to family or system*wVww4 dtus to an owoloaded or clopped SAS or case". 0lac wge or pond ng of efltuent to ete surface of Ve ground or aurfome walm due to an ow- Lauded w clogpd SAS or ca q;W. Smut Masud tend in ftdbirilmlion bm&bon outlet Invat dae to on owicaded or dogged SAS or cwwpoda Liquid dep@t In cm is WW than S'bakw invW or avabNe whim®Is loss titan%day flow .. r Regsfhed pumping mots fihan A funs®In the W year perdue to dogged or obstweted pipe(s) Number of t)mes psenpod Arty pottiest of Vw SW Abmp bon fin,casspool or privy n better tna high Ipoum*niw Eiviabon. Any portion of a assepoo!or p"W Is vrflldn 100 fast of surface water supply or tributary to a sinfus wooer soppy. Any Portion of a oesepoof or privy is within a Zane I of a puttMo Wsa. Any portion of a csaapod or privy is vA*50 fact of a prhvode water supply well. Any pwbDn of s oaespooi or p l y Is im than 10o feat but greater than 50 fad ftm a pdvaft wdar supply wag with no accede WSW quo*y an08y010. If Ow well has been sne"10 t*scosilb"s. Watt copy of wdi wafer amiyos fw ocWonn befts,vobw organic oarnpmob,ammonia nftoen and nb*e nbousn. E)LARGE SYSTEM FAILS:Mlle. � You must Indiods sOw^las"w'No*w to eaoh of floe following: The foeov"critarir apply to WW system In addtkm to the erltefW above: Tto0 system ssrvas a fool ity w8h a design flew of 10,ODO glpd or grader(Lwa System)and the ayabem Is a shard Wast to public hedth and n"and due wMmmard ba==offs at mote of the lokowty 0ondbM OW, Yes 6V0 the system Is w1hin 400 fast of a surface* tirdtp Water supply - -- lute sysfaee Is room SOD feet of a ttibtrary to a surface drinking wider supply the system is tocaW in s rrlbogen aetw"area(Irdwim welr#W Protection AmeMPA)of Mapped Ions 11 of a public Water sopphF wet) Tits owner or opsraW 01 any such ayshatll 0"upgrsds the system in a000tftm wAh 310 CM 15.904(2). Plows coma the local regiortet office of doe oeparlMlt fofflatfwr I0"Atiort. revised 9/2198 4 f 12/12 2000 15:14 5084209334 EXCLUSIVE BROKERAGE PAGE 05 PropeAy Address: TB Ella w%Rd.Contervige MS 0=2 (Owner: wood Date of inspe 4fon: -18 Check 0 the folkrMnp have been dame:YOU M%W irttlWO WWe YW or-w as to eedt sl#*fol ovAn®: Yes No x putnpinp infatttwt M Wft provided by ttw over,oocapatd,or Dowd of MOO. x NOne of thesystemowWonwft base been Pumped for at Wad Moo we"WO 00 syatsm x has nd been rows tr+p nenrwi low rataise donN that period. Urp vdurnea of water taive nOt bean mW*joed ir""sydw rc cwW or ae part'of M hopecUan. x As wi pim have beam Ob6alrtmd aid mad. Noft 0 OW ate not"Wa WRh NfA. x The fe k or dwaft was Irqpeatad Tar MOM of OWN00 l up. x � The ayotm does not tWWMe rooM4Mnk"or OWUN fal WMOW OW x The as use impeded far We of breeiatdt. X AN system awnpmwta,k"WV the son Aboarpdon Syetanv.hawe been ioceted on the saes. x The 9e06 tank trterftW vwa anowmW,opened,and tiw iv tow of the eepbo Mni<was X impeded far oarrdffin or baffuea or tees,nad'wW of oori mcbm,dlm naaarw,doo of NgVW x Of*Wqe,depth of scum. The We oral Mon of th@ Sail Abawpdw Syftn on the oft x No tit dek"Wred based on. x i kjaariaoon.Ex.plan at B.O.H. x pftwtlnad in Vw ldd(If try of tw Tenure Ocke is related tO isarl C is at imm,OPPMWRMUM x of dtafen0e is ur000aptnbla)(15.91)2(UN x The feOW owner(arid aocupW a,if*ftVlt from v er provldad vA!h Information an x trig proper nwUntanantw of fth-Surh oa System. revised 912/99 5 12/12/2000 15:14 5094289334 EXCLUSIVE BROKERAGE PAGE 07 suesupmcl!SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propefty Address, 70 Ellaw mth Rd.Cemtsrvrllle Me 02632 Ownw: Wood Dots of Inspodlon: S.1940 FLOW CONDITIONS itESl_ DENTIAL: twin flaw: Mt__ g.p.d.,beds;ms.ArS of bedroone C.satusl): Number of bite(design) �----� Total DESIGN flaw 330 Number of cumsnt M$W te: 4 Garb 9dr4 r(Yes a no): No Laundry(esperats®ystani) (Yes or no): No it yea,aepervae Inspection-quad Laundry rystam Inspected(Yes or no): No selm"I use(yres or no) No. water n w+ ,If avraffaw(tenet two(2) WPM 1 Iao 060 J199�t�b 94 5t1fl &np> .(yes or no): No Lard dote of owupenoy: 00C. �°"�,yy�®rra�ibNotl4TFtl.®t-:111tA Deso Type of NshnroeM: Sao of dasigr+slew Groose trap weasnt:(yes or no}: .� lndue4 W Waete Mnt"Tsrdr present:D"or - Non.WW,g ry wsste dh owgsd to the TltIs 5 syslcm:(y"ar run) Weter meter reedinge,M CA&&e: ,.,Be stets of occuper LAW dit of 000+PWW , GENERAL INFORMATION PUMPING RECORDS and source of Information: "`8yown pumped es part of k►aPOMM-(yee or no)if yea,volume pumped: Robson NT pumpkrg . TYPE OF SYSTEM �® BepW sa*Jdhskion bwAd ebeorp m WWn S414 csaepool Ovwkw oesepod PrWy neoorde,4f aury) Shored eyetem(yes or no)(is yes,atlsch prwloua Ir"W"on I/A Tec*ok yy W_Attsoh onpy of up to dsts gmnd on end n os -- TWd Tw* .cow of DEP Appr" 00M APPROXIMATE AGE of all components,date instatlod(if known)and source of information' S 81)-182 10 a►re old - odors deb,4,d when a rMV m Me gilts:bee or no) No rented 912/98 � f 12I12/2000 15. 14 5084289334 EXCLUSIVE BROKERAGE PAGE 00 SUBSURFACE SEWAGE 011"OSAL SYSTEM INSPECTION FORM PA T C SYSTEM INFORMATION(continuedl) Property Addsre": 78 IEIlen aft Rd.Centerville Me 02633 Owner: Wood 10ak of Inspetctlon: 4-1040 SUILDINO SEWER: (Loads on sib*n) Depth below grebe: Material d cordbuaft cm*om 40 wC oew(satpw) Dbtanoa from p Wde s*r+aell oranothn Wm lit midef cornmerfs:(con of fie,VOWAT,&VWWM or ads,ram.) SIEPTIC TANK: (bate an errs plan) Oro beba woo: 1p" Mmteft d oonstr ctlan X oaravas — mdw r. Fibutom Poly dvisns . .. other(e qkh) ff bank le meld,IW age r Is Ape oo*mW by CarMkmft of CompUnce (YsalNo) Dlmwmk m: f,wo QST Sk4ps depth: a, ptstsnco from top of ukWUs kD haAtor>ti d a M We or tmffle: e1^ Scum 01,�: 8` Dwarms horns tap a'scum to bap of We or bait: B' ®*w"ftam bdtom of scan to bottom of outlet sae or baffle: 14' Now dbrw'Ww wore determined Gor ffl. w tee:'. (mcamomidebm for pumping,coadOn of Mtet end outbet tees or befllSe,depth of tbquib Isaac in Fuldi n to sutler irruert,sVuaftoPst tnto^.evlder"of mWage,etc.) Tarrlts needs eNatr%card dmM be e:Iearfsd GRUNSE TRAP:NSA (booft an mac plan) below tip: mstww of oww"atlon oartmsA rn" � fiber __._ Polydhylene � Cftrer(exptogr) Saortr thickness: DIS DYM from fep of am m to bP of outlet tee w baffle: Dlslafte.from bottarn of eaten to batDa i,of outlet toe w blflle: Dds of tad pwvft: Catormrtt0: (reoommendslbn for Wroft cmd" n of wd said autlet tees or bsftM®,dspM of *W In r Mkm to outlet Thurso.seructunil revised 9/2/98 7 12/12/2000 15: 14 5084289334 EXCLUSIVE BROKERAGE PAGE 09 SMUlkFACK SUWAf3E(DISPOSAL$YSTEM INSPECTION(FORM PART C BYSTWm iNIIFORMATION(continued) Property Address: 70 Ellwmdh Rd,Centerville Me 02632 Owner: wow 9ste of lnspectlon: 94940 TIGHT OR IiKWA TAW, WA (Tar*must be pumped prior to,or d Noma,of bwP0cWn1l (locate on alb plan) Depth below grade: MateAilt of oorqstruefth _ ,, cawrow atelYS Fibwglaas _ Pokwhyl0wo (ems) Dlmwaelons: ___ Capedly. rAkw 8 Design flow: Gal wa day Alarm preeerd AWm WM: Alarm in worldrd Order Yes: No Date of pt+a*m pumping: Comments: (wnd kion of I"the,oax tlOn or arm and ksteoddw,W.) DISTRIBUTION 5O%: (locate on alb Plat+) NO Of OQtAi level ataofw adlet Waft Commerrta: (nets if level and dwWWn is equal,evWwm of sonde CerWW.W Of W"W lnto or out of boat,eta,) Box Is in good worm eondillon PUMP CHAMBER: NIA Ocala an ado plan) Pumps in vu kft order(Yea or NO) Ahums in vror"order(Yee or No) Cane ts: (ado condi0ert of pump d9aa1aer,eo W w►of Purrs SW eppuftm noes,etc.) revised e/2/88 8 �S AIM )'r 12l12f2000 15: 14 5084289334 EXCLI_1S:VE BROKERAGE PAGE 10 SUBSURFACE SF wAOE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Gontirlued) Property Address; To Ellsworth Rd.Centerville Ma 02032 Owner: Wood Date of Inspection: 8-10-00 SOIL ABSORPTION SYSTEM(SAS): (,VAG on sfe plan,if possible:;el=vation not required,but may be apprn)&Wed by nan4ntru"n elhods) It not located,explain: Type: LasCh(ng pigs,number: t-LP1,000 _ Leaching chamber'a,nwnbec -- LeechUB peaeriee,number Leeching trenches,number,lerog'Ih: _. Leeching melds,number,dimenaiona: Overflow oesspool,number. A6ternstive system: Nerne of TeduvleW: Comments'. (nose condition of soil,Wm of hydraulic failure,(em of pond ft damp soil,condition of vegetation,etc.) Pit io f.fun Yaeter only In good coneW No stain line abov®14'from top of liquid to inved- CESSPOOLS:NIA (locale on aft plan) Number and conyiourationr Depth-top of liquid to inlet invert: --- Depth of Salida Wtvr Depth of scum bw D►marmons of 08"pool: faater"of cormtru0un: _ -- Indication of grourKWaW. Inflow(oW4001 mined be pumped as pert of IftOW-ion) Comments: (note condition of sal,signs of hydraulic fatlura,,dewed of pending,aon'Mon of vegeta6wn,etc) PRIVY:NIA (Wats on site plan) metertals of construction: - Depth of 9*114C Commer", (nata condition of soil,signs of hydraulic fakirs,level of ponding,condition of vegetation,etc.) revised 912/96 9 12/12/2000 15: 14 5084289334 EXCLUSIVE BROKERAGE PAGE 11 SU86URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM iNFORMATION(conRinued) Property Address: 78 Ellsworth Rd,Centerville Ma 02533 Owner, Woo! Daw of Inspection: 8-19-0 SKETCH OF SEWAGE[DISPOSAL SYSTEM: include des to at wag two pon wwt mftmices W4MkS or tonchMaft locate all wells wlthln 1 Od(locate where public wdr supply comes ir4o housio) revised 912198 10 f12!12l2000 15: 14 5084209334 EXCLUSIVE BROKERAGE PAGE 12 SUBSURFACE SEWA(3e DIS OS SYSTEM INSPECTION FORM PARTSYSTEM INFORMATION(continued) Property Address: T8 E t worth Rd.Centerville Me 02632 Owner, woos Oats of Intspecilon! 6-10-00 NRCS Ropod name WI Type �.� Ty0cal depth to gMuMdVft er US" DMe webs to visk+ed Obse"tion Weft chocked Deep Ground waiter depth: Shallow T Moderate --- SITE EXAM Slope surtaoe Wall Check CoMw Shallow weft Estmeted Depth to groundweler 15¢_ Feet plsese i 10"so the,methods used to determine High Grountturater Uevat m X Obtained fmm Design Ph=on record Observation of Site(Abutting property,WsefvAon h*W�sement sump etc.} Determine it from kxsl condmlonb Check with local Hoard of VWAl Check FEMA Maps Check pumPing r X Check local ex*QV6W►s,inzWefs Use USGS Data Describe in your own words how You astWWied the Nigh Gmun&Aabv Elevation,(MUSA be complsted) reviSed 912/98 11 No... F>c ..�. THE COMMONWEALTH OF MASSACHUSETTS SOAR® QF HEALTH Appliratiun for Uiipusal urk Tung rayrtiun rruat Application is hereby made for a Permit to Construct ( /)—Or Repair ( ) an Individual Sewage Disposal S stein at• it , Lac ion-. ddress or Lot No. ' .... �.� .s..._... 5c. �P------------------- --------•-• ......-- Ow er ........•.......................Address Instal ( Address d Type of Building Size Lot..../7_��------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garage Grinder ( ) Other—Type of Building No. of persons........(j______________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------•.•... . W Design Flow.................. ...............gallons per person per day. Total daily flow__.__........-��....- . ...............dons. WSeptic Tank—Liquid capacit/Poogallons Length ..�� ..._. Width---S�.'�0__`- _Diameter______ _________ Depth.- -....`_....`.. x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area__ ------sq. ft. Seepage Pit No----------/......... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) Z Percolation Test Results Performed by.... ..�--, -� �M ....................... Date__.l ... f.� .__... a PP a Test Pit No. 1......a) ...minutes per inch Depth of Test Pit----_I__g4'....... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ - -------------------------------------••••------- -•.-•-• - • ------------------------ -........ •---------------------- •••------ -......... •--••- O Description of Soil.......M�tam.....'SX/nA 0.�._......�h.... x W ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------......................... UNature of Repairs or rAlterations—Answer when applicable___________________________________________________•-_--__-.-_--__-_-_---•••------••----_-.-•-. Agreement: The undersigned agrees to install the aforedescr' ed Individual Sewage Disposal System in accordance with the provisions of iITAU 5 of the State Sanitary Cod —The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has been i ued b b of health. gned• ......... --•- ----- ............ .. ......................... ................................ Mate Application Approved By--••-••--•• ............... •--_... .. ........................ . ......... A64 ------------ Date Application Disapproved for the following reasons----------------------------•---•------------•-----------------•-----------------------------••-••............_._ ............................................................------••••.......---............-•--•-------•._..---•-••-•••••-•---•••---......••----••-----------••-•--••--•-•----••--------•-••--•......_._ Date PermitNo......................................................... Issued....................................................... � Date i C� t c, No................_....... FEAQ;r. � �.`.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r{ .. .. r . ..............OF........ ..---...-- ........ApplirFatilan for Diapoo al Works Tnnitrurtinn amit. - Application is hereby made for a Permit to Construct ( L ) or Repair ( ) an Individual Sewage Disposal System at: _ r� -- .4�--- �G---------------.-, - .......... .............................. ..........-----,--...........-• I Location-Address or Lot No. ly1 �f t1 C ........................-- -- - ------------------------•. ...........-..................................................................................... l Owner Address W Installer Address d Type of Building Size Lot..-.J_ .,,_ `-.-.-..Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons ............... Other—Type g ____________________________ p � Showers ( ) — Cafeteria ( ) d Other fixtures ---•---------------------•••••......--••-•-----•--•--- W " Design Flow...........................................gallons per person per day. Total daily flow...........................................gallons. WSeptic Tank—Liquid'capacity":...........gallons Length........ ...... Width.'*........... Diameter--.-----------.- Depth.....--......--- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--- ......sq. ft. Seepage Pit No..........f.--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( r ) aPercolation Test Results- Performed by....l _'.!__---:_- t-.r_.___!.`..-.t'--'._.�._.._................... Date...........:... �.•........ a Test Pit No. I.....: -r'....minutes per inch Depth of Test Pit....1....':........ Depth to ground water-----. ............. Test Pit No. 2................minutes per inch Depth of Test Pit...---.............. Depth to ground water-:......................... O Description of Soil------ ' ? '...... `=--{' -......`::...- !--••------ -------------------•---- -�.��`vs-------------------- -------.---•--•---- U ;. =s-------------------------- W ------------------------------------------------------------------------------------------------------------------------••--------•-: =............................................................. 0 Nature of Repairs or Alterations—Answer when applicable......................................................................................•_ ------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescy bed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Co- —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued h 4q -d of heath. »._ 1 e ...�......--•-•-•...-_...• --------••.........-••------ e x Date Application Approved B .................................... --------•••- ::::: ...... Date Application Disapproved for the following reasons----------------------•-•------------•----------------------------------------------------------•••-•-•........-- ------••------•--•...............•-------------------------.......-------------------•---•-••------------•-•••••••---•---•••••••-••--••-•••-••--•-•--•••---•-------••-•-••-----------••••-•-•-•....----- ` Date PermitNo.......................................................... Issued-.....................................................-- _ _ Date THE COMMONWEALTH OF MASSACHUSETTS 4M (A , BOARD OF HEALTH 'fir, ..........................................OF..................................................................................... CCntifiratr of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System,.constructed ( ') or Repaired ( ) by......�`�-= j S..........................................`....------------------------------------.`....................------------------------------------ ----- Installer at...... Ot ; ;.;; 1 ( ~4, ------------------------------------------------------•--------------------- has been installed in accordance with the provisions of IT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----." _-"- .--- dated-.....�t.. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -" :.. 1.. .. Inspector ........................................................ THE COMMONWEALTH OF MASSACHUSETTS ,—W BOARD OF HEALTH ~ ............................................OF..................................................................................... Disposal Workii T.031notrndinn rrntit Permission is hereby granted..:.Ai!' !f!,_nt................. to Construct `( ) or Repair ( ) an Individual Sewage Disposal System at No......-' .-------kn.i` r.4? s"" .------ -.. .�;.,�..d Street as shown on the application for Disposal Works Construction Permit No..................... Dated _.•._ ................................... �. ------------------ �., � �Boma of Health DATE .. . s------------------------ FORM. 1255 HOBBS &'WARREN. INC.. PUBLISHERS ,K./TCK/END ' LEGEND Sr MAIN Sr - °. N 100.11 Stree �� c pine 100.08 �85 X 98 0 7• C EXISTING CONTOUR —q p4- — EXISTING CONTOUR I naa Lr a 100,00/ St°ck°d6 F 0.44 f ® TEST PIT �a Carlotta q„ oi'\e� �r LOCUS PK/SET ence a o� e m / S W EXISTING WATER SERVICE �:� o\aGc jogs x �67626., t G EXISTING GAS SERVICE OId o"n o e �o,d d �, Q �x 100,03 10U,36 4.93, E ,,, OVERHEAD WIRES aWn tiP ° r°"° ar Rd o O (; n... 0.H. W. o 0 stOhe \'�- BENCHMARK �10 0.01 '�G �r/�� '. 02 4,4 100,93 101,08 t x 100,35 �� STK 'CK/END o �\ x 1o0.6U , r LOCUS MAP N.T.S. 1 7 81 10054 V °' •EXIS77NG 100.18 10�c HOUSE (#76) i 0 : k P. TP-2 i j;T0F=702.19;/�_ 1 o� GENERAL NOTES: Assumed i TP—t 702 p �i / ~ " x- 101.24 a. a 103.27 0 /`j ; /,!, / ���� 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 0Q) ! _ l!ti/DH/END BOARD OF HEALTH AND THE DESIGN ENGINEER. a /,/, / '}{ fA—'~,,. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS <V7 101,20 j / / / _ ; s� 99,89 100.60 f; •x 100,44 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE `1 LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 00,91 x 10y .71 DESIGN ENGINEER. 100,29 kpd �� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING CB/SEAL/END Lot ' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 00.4�4 17 832.t S.F. �r 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 0.41E AC. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF X' 100.80 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Map 269 x loo.26 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 1) 7. WATER SUPPLY PROVIDED BY TOWN WATER. Benchmark set 4/ 6 — 966• Parcel Q 8. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. Right cor. bulkheod 9��¢8;; uj ALLTO A R AS DI AGREED DISTURBED DURING UPO CONSTRBETWEENUCTION BE RESTORED OR. El.=101.54 (Assumed) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 100. 1 CONSTRUCTION. x 100,54 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). EXISTING S.A.S. ��� OF MAssq TO BE PUMPED & FILLED WITH SAND o�P PETER T. � 100.54 PROPOSED SEPTIC SYSTEM UPGRADE MCENTEE EXISTING SEPTIC TANK CB/DH/END CIVIL 1.3 o " TOP OF TANK, C 76 ELLSWORTH ROAD, HYANNIS, MA No. 35109 GISI INV. =98.9Ut ( ) Prepared for: Una Pasquerella, 76 Ellsworth Road, Hyannis, MA 026 OUT01 � Engineering b Surveying b SCALE DRAWN JOB. N0. .� EngineetingWorks WARNER SURVEYING 1°=20' P.T.M. 238-07 12 West Crossfield Rood 22 Long Rood l Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. 1 (508) 477-5313 (508) 432-8309 1 1/3/D7 P.T.M. 1 of 2 i . NOTE: TO PREVENT BREAKOUT, THE PROPOSED TOP OF FOUNDATION 1PROVIDE RISER OVER D-BOX L: .4t FINISH GRADE SHALL'NOT BE < EL:97.5 F.G. E 100 `,.TO WITHIN 6" OF FINISH GRADE FOR A DISTANCE'OF 15' AROUND THE . EXISTING F.G. EL: 101.2t t F.G. EL: 100.4t PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. 4" SCH 40 PVC PERFORATED PIPE WITH SCREW CAP SET TO WITHIN 3" OF FINISH INSTALL RISERS W/COVERS OVER INLET 2-500 GALLON LEACHING CHAMBERS GRADE TO SERVE AS INSPECTION PORT. a' & OUTLET TO WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES INSTALL RISER OVER CHAMBER L=76' SHOWN ON PLAN AND SET COVER L =5' WITHIN 6" OF FINISH GRADE 4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2" io" ' 14" CAD S= 1% MIN. - L ' ®� �® DOUBLE WASHED STONE (MIN.) aa;, S= 1% (MIN.) ®®a0®< EXISTING 48" IJOUID 2' EFF. DEPTH j ®®® i (OR APPROVED FILTER FABRIC) I �,. LEVEL INV.=97.27 7.10 3/4"-1 1/2" BAFFSIE PROPOSED D-BOX 4' 5.2' 4' DOUBLE WASHED INV.=98.90t EFFECTIVE WIDTH = 13.2' STONE EXISTING 1000 GALLON SEPTIC TANK EXISTING r - INV.=97.00 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.=97.8 —BREAKOUT ELEV.=97.5 PIPE INVERTS PRIOR TO CONSTRUCTION. i INV. ELEV.=97.00 ®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=95.00 INCH CRUSHED STONE BASE, AS SPECIFIED 3' 2 x 8.5' 17.0' 3' IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED.OUTLET T.P. EXCAVATION OR G.W. (3) 5" DIA.OUTLETS 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION 1 �I '-12„ AS MANUFACTURED BY TUF—TITS, ZABEL OR EQUAL."„ NO G.W. AT EL.=89.0 SEPTIC SYSTEM PROFILE 15.5" -+-y � r< 8„ 12 N.T.S. �. T l 2' D-BOX I4 DESIGN CRITERIA N.T.4 ,F " NUMBER OF BEDROOMS: 3 BEDROOMS S01L LOG TING SOIL TYPE: CLASS I DESIGN PERCOLATION RATE: 2 MIN. IN. HOUSE (,3�76), �,,n,^y..�..,,,, DATE: � ��� � NOVEMBER 1, 2007 (P-12001) y TOF=102.19 "y. '�, SOIL EVACUATOR: PETER T. MCENTEE P.E. DAILY FLOW: 330 G.P.D. WITNESS:' DONNA MIORANDI—HEALTH AGENT DESIGN FLOW: 330 G.P.D INVERT r0LT ® O u®®® ,, " GARBAGE GRINDER: NO ® 33" ~ " Elev. TP:`— De th Elev. TP---2 pepthLEACHING AREA REQUIRED: (33D) = 445.9 S.F. 24" ®®®®®®®® h 100.5 0" 100.5 A 0„ .74 102" \ FILL SANDY LOAM EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 10YR 4/2 SECTIO 100.0 A SANDY LOAM 6 100.2 B SANDY LOAM 4„ 10YFt 4/2 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES � N — >>, 0�, Mry 99.7 B 10" 10YR 5/4 SIDEWALL AREA: 2(13.2' + 23.0,) X 2 = 144.8 S.F. 4" KNOCKOUT h SANDY LOAM 97.o C 42" BOTTOM AREA: 13.2' x 23.0' = 303.6.0 S.F. za" oin, COVER s> > 10YR 5/4 97.0 42" 44" TOTAL AREA: 448.4 S.F. 4" KNOCKOUT O�4" KNOCKOUT 62" -- C PERC t 5s" DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. 4" KNOCKOUT I I^ PROP. S. M—C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN I ,, 2.5Y 6/4 E�----23,--1 M—C'f[SSANU SOME COBBLES 76 ELLSWORTH ROAD, HYANNIS, MA 500 GALLON CAPACITY, H-10 LOADING 2.5Yi,6/4 SOME COBBLES Prepared for: Una Posquerello, 76 Ellsworth Road, Hyannis, MA 02601 k Engineering by: Surveying by: SCALE DRAWN JOB. NO. CHAMBERS 89.0 I, 138" 89.0 138" Engineering Works WARNER SURVEYING N.T.S. PTM 238-07 KTA 12 West Crossfield Road 22 Long Road NO GROUNDWATER OBSERVED Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. S.A.S. LAYOUT PERc RATE <2 MIN/IN.("C" HORIZON) (508) 477-5313 (508) 432-8309 11/3/07 P.T.M. 2 of 2 r 't ♦mow• . .. _ • ,�' .bt r 8 dw '• � � i• � .� a: 4'�y:d.,a y o �-p'..�''d V ¢/'•.a• ti a °d a."� Ap Apt . o ✓ a' 'aP '0 s' / d o o•ao:•6 O CONC.pETE COVE.Q - M/N- wT• /00 L BS. __ o OUTLET q/.pE LEVEL _. ' cvo loArArt,iTONE .., 0— vr► 4. d. ' b w► x s.�.,..o... B. •� v 6- ♦ �sr..7r•r,t^,7r, p """two-.. : .r.--. 3W'. 0 �� t o J b. s.v!l.it/ "v o•�'•6•'♦� c p• I+ v .. t of •v •.r c.v KC. TEES '. - 7 _ .•� A. ' +• •]�: 114 S o(/TL ET r4 ( a 63MT. FL w 1000 o/v � Box d /NS7-1�7L L ON G EVEL B•gSE `310 TO vo .°RECAST CONCRETE wf7syEo +er- w - O RE/NFO�PCED Q° c.PusyEo I °° SEC r `d °v, � i .j� 9. :4-r? d -,,,..� r,'�,.A.V oa9 ',q.°ss.+♦'a'o-O.-D� Y. 1Y ' .V a.0 v C>-.b' 'u.. �. 4:'V !e „7", .,Oj 7.40. .a '•'.Y '.0. uV ! 0 SEp T/C Tf7/�/� //VSTiQLL O/V GE✓EL BA SE " ` a ^,.. . NO TE� EXCf7V.gTE TO ELE✓. 3 "J ± OR `e_ ;, � ,-i-' ' a o . L ON/ER TO R'EMO VE /471-L 40AVI-7 OR c4A7Y ---•-- __._ M.�7TER/IqL BELOIV TfdE GEf7C.y/N`i r57rPE/�7. H _--- RE.oL.9CE EXC.47V.QTE10 MATE�P/AL W/TN C4 C-A7 V7 CL f7Y--EPEE G,p.S7VEL. Y io~EPEE 7/✓E G�1�7ME TER ,1 � GENERA`. NO TES .S.Wo^I V Bq,SEO ON A C-, s LEA CoXV1 y y I� I T 7 2 .�7L L .�/.DES /N SYS TEM MUST B'E C�7S T/RON `J `t OR .SCf/E"O4/4E 40 i4V,C. /NST�7LL ON LEVEL B� SE 3O T.yE" B 0.57RC OF NE/7L,TN 11ol6/S"7- B E NO T/F/EO "'-•--- ___.___` _ I✓/+/EN CoNSTRUG'Y/cif/ /S COM.oLETE, .�R/O� ® .gAIY Cf+/f7NGES //V T.A•r%S' �Lf7/V MUST BE A7.oP.PO✓EO T E J... V1i. _1����,��.�, � � BY Ti�/E •BOF'i"PO OF Hcf'.QL Ti�s��7, /VD T.�/E ENS/it/EE�P ,o`c-,pCOL 1,7T/ON R/�TE� yV.S/OSE STgM.o go�'�`f7iPS ON .4CIL.9N. < M/,000v © M.9TER/�7LS A+ NO> /N,57-q1-1-.97-IO/V Sf1157LL BE/1V �yITNE.SSEO BY .9CCOR0.47NCE IV/TN Tft/E COOS - T/TL E V .qNO GOCAVZ- .47.��L/CF�BL E OES/GN L��T/�'f� RUL ES /7NG RE G uL T/Ows. ,=, :`•; . BO. OF HEAL TN 14 _~ ® V0RT/,/ .q.PROW/.S NOT TO BE !./SEO FOB >. K ✓: � • ,c�+ t 3 B -.,`.-' -•,- -,=�- SoG qR .oU.P,00SES F� 5 Q .f G ' �L` g�A f-r Cj'�.�. O7. .�G o Op .S�i4�'A'RO ZONE ._.., ��• O�/L Y FL O�✓ + "�G�4L. r ;-- h//4 TER SU.oioG �. - . ,._ •='•a�w, i�,, �i.IBSDii..... SE.oT/C - "Q'O. 0Gi44. �5' C, sir: TE MEDIUM -75 SAND PRECAST CONCRETE � °` B�'y"' •'4I ""#� ' � • , 1 �✓ G+oO _ �9 r LEACHING PIT r L EGEN� L EA;7 h F.POh0SE40 E4EVf77/ON N �,� E k, 144 ® oB sE-.P✓.q Tia/✓ .o/T K V 15 F a O/,S'T.P/BUT/O/✓ C 0,V M/N/Ml/M CODE O/STi?NCE - RICHARD` � Wks OO L f7Cf/!NV /�/s-. y� /p" E '� �VCr. 9�4� �<. r 'Ruc ry . 0 o SEAT/C T.qN. w •, +w (AIMI RESE,?VE A;� -AWE-AV L u IDQ TA [ r of /r,► p. e LJ H --- . AW Z Y LOT �r�Ir►