Loading...
HomeMy WebLinkAbout0073 FOURTH AVENUE (HYANNIS) - Health '�7r3 ]�ourth�A�en=ue' Hyannis A 246 I i � o TOWN OF BARNSTABLE LOCATION �>& SEWAGE# VILLAGE /fXi-r,w:`otr-'OP*ICT ASSESSOR'S MAP&PARCEL X00'3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ;;M-e,0-CX" 0'e 500& (size) NO.OF BEDROOMS OWNER �'PrPf^' r PERMIT DATE: ��'� 0 COMPLIANCE DATE: J ! 3 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 \ � � QO V. ONN r $► \ c U _ 13X o� 0 NO. FCC / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Mi!6po5at �&p!gtem ConOtruction Permit Application for a Permit to Construct.( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. U�_._ Owner's Name,Address,and Tel.No. azi Assessor's Map/Parcel , a4l . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 014 Type of Building: T 'Dwelling No.of Bedrooms � SLnot ize • sq. ft. Garbage Grinder ( )` Other Type of Building I-e-?elp No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank flier!- /f row Type of S.A.S.7W eW'C-le 04X1' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Raard of Health. Signed Date Application Approved by Date -/0 Application Disapproved by: Date for the following reasons 7 Permit No. 2-U o^ (l Date Issued S "to No. ^:Qlfl — 3� Fee THE COMMONWEALTH OF IVIArSSACHUSETTS Entered;yin computer. ✓ '`;?, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4 gicatiDD� fOT.. i$ lOgaYr�p�tell� Con0truction Verm"it io Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) .Complete System ❑Individual Components Location Address or Lot No.7oG ���T77 � Owner's����e�and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ��� G��vc�Gi� 77J' o�0 7 ��li/� 8/�1�4��✓ � f'� -.� •%ra j Type of Building: , { Dwelling No.of Bedrooms Lot qize sq. ft. Garbage Grinder Other Type of Building �Gtl' e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd L Plan Date Number of sheets Revision Date Title Size of Septic Tank JiGtle- Type of S.A.S. 73ee�ti .t Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ° The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B rd of Health. Signed Date ` Application Approved by iVr. Date 0 Application Disapproved by: Date for the following reasons Permit.No. 9�U 0 — (> 2` Date Issued S'I; —(0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (fompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by dr�/ W G ee�O�`r/�" ' at �-� �'o1-a !/L� has been constructed in accordance / t with the provisions of Title 5 and the for Disposal System Construction Permit No. 1010 -( � dates-L —d o Installer '�i�1�' �n��O�G 1 Designer #bedrooms o� hCee r4j r°� t Approved design flow �U gpd The issuance of this pe it shall not be construed as a guarantee that the system wi111�`u ctibft as desi ned. Date S 1 /oInspector uW - No. Il/o—132, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =i5po.5al �&p5tem Con5truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade) Abandon ( ) I System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ct•on must be completed within three years of the date of th pe Date S o Approved by s�S� tq Z&`droom �4r?. c o w•,/l k /SIoqr/ X_ Town of Barnstable' y� . tip Regulatory Services Thous F.Geiler,Director " a Public Health Division C7,,lFD � Thomas McKean,Director 200 Fain Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Designer: �►gV Installer: J 1 i Address: . Address: 1� On was issued a permit to install a (date) (installer) septic system at 7� r ""���I based on a design drawn lay (address) l V I 17. datedOt (designer) 1-certify that the septic system referenced above was installed substantially according'to "'Elie design, which may include minor approved changes such as lateral.ielocatiort of the di;strrbution box and/or septic tank. . I certify ythat the septic system referenced above was installed with' najoz:changes (j.;e, greater fliaA 10' lateral relocation of the SAS or-any vertical. eiooatioil of arty componaut of the.septir system)but in accordance with State&IgcARegdiat ons. Plan revis ozk of certified as-biii�designer to'follow. J." Vr1 z 61AVID. . (Installer's Signature) � - a• n >. WSW 'rn 110::"66 �e�ST�A� . . . �Sq�17Aa�P�• (I3 er s Signature) (� X e: er''s,Staanp Here) PLEASE RETURN TO BABNSTABLE''PUBLIC_Y EALTH.DIVISION , C RTIFIC TE OF- C2WLIANCE WILLS`NO jiE SSUED_ =BOTH1-TJHS,,FORM BU)<L.T CARD ARE RECEIVED BYiTIIE:RAR SLTABLL PUBLIC IEAL IaIV SIld_� TANK YOU Q:14ealth/Septic/Designer Certificafi -* 'Fora , 3. TRANS.NO.: CITY/TOWN: APPLICANT: ADDRESS: r-i5 Ua7W A 09- DESIGN)FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street,Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided 310 CMR-15.2204 t Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for / components) 310 CMR 15.220(4)] ✓ Easements shown 310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR / 15.220(4)(c)] Location and dimensions of system components and reserve / areas. 310 CMR 15.220(4 e ✓ System Calculations 310 CMR 15.220 4 daily flow septic tank capacity (required andprovided) soil absorption system(required andprovided) whether system designed for garbage grinder North arrow 310 CMR 15.220 4 Existing and ro osed contours 310 CMR 15.220(4)(g)] Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH'representative [310 CMR 15.220 4 h and i Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator 310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)'and 310 CMR 15.220(4)(n)] Address 41�' ffi2o--q )ky& Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220 4 m if water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR 15.220(4)(o)] Stamp of designer 310 CMR 15.220(1)and 310 CMR 15.220(2) Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an upgrade under LUA at 310 CMR 15.405 1 k Test hole adequate to demonstrate four feet of suitable material? / 310 CMR 15.103(4)] ✓ Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)( ] Materials specifications noted? [various sections of 310 CMR 15.000 System components not>36" deep(unless Local Upgrade ,Approval or LUA requested) 310 CMR 15.405(1(b)] Address 7 ' "V ejq( iw& Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1) Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR / 15.228(l)] v Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater A (except as described 310 CMR 15.227(5))or permitted for V/ upgrades under LUA [310 CMR 15.40 5 1 k ] Minimum cover 9" (Tanks buried more than 9" must have risers / on all openings and on the d-box) [310 CMR 15.2228(1)and 310 V/ CMR 15.232 3 Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" (by 7/07) [310 CMR 15.228(2)] ow Access to within 6 " of grade -one port for systems<1000gpd, two fors stems >1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation 310 CMR 15.211 1 Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 b First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3 "U" pipe through or over baffle,outlet of each compartment with gas baffle or approved filter 310 CMR 15.224(4)] Address" r yu� T l�"� Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.211 1 1 Cleanouts required/provided? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8)and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2)and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" 310 CMR 15.232(2)(b) Minimum sum 6" 310 CMR15.232 3 e Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 1-5.232(3)(d)] PUMP CHAIMBERS Capacity (emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6)and 8 Stable Compacted Base 310 CMR 15.221(2)] Buoyancy calculations needded� ?1Provided? 310 CMR 15.221(8)] Address 1 ) �V�—�'rl +�� Sheet 4 of 7 r N/A OK NO SOIL ABSORPTION SYSTEMS (SAS)GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 Required separation to groundwater? [310 CMR 15.212)] Aggregatespecified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) 310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] V Each structure with one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253(2)] Aggregate 1'minimum-4'maximum. 310 CMR 15.253 1 b 2'sidewall credit maximum 310 CMR 15.253 1 a In bed configuration, inlet every 40 s . ft. 310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width 2' minimum 3'maximum 310 CMR 15.251(1)(b)] 100 feet-maximum length 310 CMR 15.251 1 a Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches 310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211(1) 4 and Guidance Document] BED SAS(Maximum size of bed or field 5000 d) minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252 2 i U� Address �� � � P l�� Sheet 5 of 7 N/A OK NO DID THE PLAIN Ili TVOLVE Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2)and I/A / Remedial Use Approvals] J/ If used in gravelless system-make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255 3 ? Impervious barrier and/or reta ining wall? Guidance Document Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255 2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2)and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 e Gravelless System[FA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[FA Approval Letters] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? ' Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 4 RLS Stamp necessary on plan if a component is within five feet of property line 310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address l f�U�' r t�/�/ Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 -also refer to Policy�regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well? 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216 1 Miscellaneous Pumping to septic tank? 310 CMR 15.229 Shared System 310 CMR 15.290] EE E Address✓ �� Sheet 7 of 7 t . Town of Barnstable -P# Departmenf of Regulatory Services wttvareet e \ a( D Public Health, Hate r6sq �e� 200 Main Street,Hyannis MA 02601 0 Date Scheduled aba Time Eee Pd.- o d Soil Suitability Asses ent for Sewage isposal Performed By-r �r "`� t��� p Witnessed By: d n IV I:O:CATI6N & GENERAL.IN C RW ' O:1N Location.Address 73 /I 4e- Owner's Name 01A,6, �hh�7f Address Assessor's Map/Parcel: n�� ,� Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,din ensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock 100 Depth to Groundwater: Standing Water in Hole: V Weeping from Pit Paco V-4 14 Estimated Seasonal High Groundwater DETERM NATION OR SEASONAL RICH�WAT.��TA���:: Method Used: Depth Observed standing in obs.hole: in. Depth to Boll mottles: In, Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor Adj,Croundwater Level iC ,Ar ;aN: cTtij e Observation • Hole# Time at 9" Depth of Peic Time at 6" Start Pre-soak Time @ Z/�� Time(9"6") - End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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 notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DQC DEEP OBSERVATION HOLER LOG Depth from Soil Horizon Soil Texture Soil Color Surface(in.) Soil Other (USDA) (Mansell) Mottling (Structure,Stones,Boulders. AD Q3 '7 Consistency,%Gravel (� G AL o DEEP�OROJ VATTON II3'OLE':L'OG 1. FTo1e# " Depth from Soil Horizon Soil Texture Soil Color Surface(in.) Soil Other_ (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i onsistenc %Gravel ZH l i 0EEP`,00SERVAT1rON HOLK.L OG' Depth from Soil Horizon• Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ' � t I , DEEP'O$SERVATION HOLE:LOG :Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA.) (Munsell) Mottling (Structure,Stones,Boulders. onsiste Gravel) Flood Insurance Rate Mal): Above 500 year flood boundary No Yes Within 500 year boundary No Yes._ Within 100 year flood boundary No-Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? � �• If not,what is the depth of natur lly occurring per 'ous materia17-.M'Z:"' Certification I certify that on I2 (date)I have passed the soil evaluator examination approved by the Department of Envir6nmental Protection and that the above.analysis was performed by me consistent with the required training,ex ertise an xperierice described in 310 CMR 15.017. ,t 7 Sign J Date ��G��d Q:\SEPTIC\PERCFORM.DOC I °F1KE r� Town of Barnstable Barnstable 0ftti Regulatory Services Department 1�111 ficaCitv BA.BNS[•ABLE. ` MASS.9. Public Health Division 'Tfv MP+n 200 Main Street, Hyannis .MA 02601 2007 Office: 508-862-4.644 "fhomas F.Geder,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009328 4/27/2010 Martha Chapin 55 Indian Meadow Road Middleboro, MA 02346 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 73 Fourth Avenue, Hyannis MA was last inspected on March 29, 2010, by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH o as c ean, R.S., CHO Agent of the Board of Health t r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address// �/J�✓' ��� l.��tG � Owner Owner's Name n information is N h �j4 oc�6 0/ T ` /0 required for �f 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your cursor-do not Name of Inspector use the return key. Company Name OIL Company Address — (���amj♦/�� �Gs ��� � i� Oo16�l � City/Town State Zip Code 72 s— 2� y� a Telephone N er License Number i B. Certification W I certify that I have personally inspected the sewage disposal system at this address and that the cc r-a inforritation reported below is true, accurate and complete as of the time of the inspection. The inspection o- - was performed based on my training and experience in the proper function and maintenance of on site y' sewage disposal systems. I am a DEP approved system.!nspector pursuant to Section 15.340 of Title�5(310 CMR 15.000). The system: � CI-4 o Q..,. ❑aPasses ❑ Conditionally Passes Fails o 0'Needs Further Evaluation by the Local Approving Authority Inspec is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to-the appropriate regional office of the DEP. The original should be sent to the system owner a 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. . � 1 17 15ins•09/08 Title 5 Official Inspection Form:Subsurface4—goisSystem•1.teOof I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 73 F Gf r441 �y Property Address �j Owner Owners Name information is pqh If Od 601 3—0? W required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 2 of 17 l5ins-09/06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �J Fo W Property Address Owner Owner's Name information is /,� required for , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ 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): Required b C) Further Evaluation is y the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if I the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is a N h,f / Od CIO I required for State Zip Code Date of In every page. City/Town 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 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 uuu clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ❑ /. or clogged SAS or cesspool ❑ �,/ Liquid depth in cesspool is less than 6" below invert or available volume is less than Yz day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 4 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 /q- information is �!%/ 60 A? required for N 6S every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Q/ 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. ❑ [Er""— Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ L 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. [t—]'/❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered 'yes" to any question in Section E the system is considered a significant threat, or answered "yes In Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ' Owner Owner's Name _ information is A� �N�fl /%� �Z�� � �9 �� required for State Zip Code Date of Inspection every page. Cityfrown 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? L�J ❑ 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 U 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? 0/❑ Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? �0 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 Ly' t J 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: ❑ �xisting information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 33v DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•09/08 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 Property Address Owner Owner's Name information is �� 6o required for State Zip Code Date of Inspection every page. CityfTown 4� D. System Information Description: 1000 C-1 //0 41c-- x Number of current residents: �,� Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? [if yes separate inspection required) ❑ Yes [Z� o Laundry system inspected? ❑ Yes ❑ilk Seasonal use? ❑ Yes Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes I� rvo Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No ` l Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Ofricial 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 %Ownef's Name information is required for h every page. /Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information t Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy Septic tank, d' ❑ 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): i 15ins•OV08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 73 F 4 C Property Address C44 Owner Owner's Name information is /�/ Q a �'f ' / n�� as . 9 required for every page. City To`nm State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date i stalled (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 0,440 Building Sewer(locate on site plan): /O Depth below grade: feet Material of construction: ast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): J Depth below grade: feet Material of fiction: oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: X L/ Sludge depth: 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 6 l/lG 1 Owner owner's Name 11 information is ��N �f t 9 ' �a required for State " Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Septic Tank (cont.) 31 Distance from top of sludge to bottom of outlet tee or baffle / Scum thickness el Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): h V4'7/7.?91- 4 �.T �f V-7 o 4 . S �Q1'9 /e rg Gc 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form /-Not for Voluntary Assessments /J 0 Property Address Owner Owner's Name information is G OP GO Z. 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.): 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): I Dimensions: Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address c4a Owner Owner's Name f I - 1 Q information is -J a N N �j u- 4 ( 6 o/ 3 C)required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 s 93 i OUY7 Property Address Owner !Owner's Name information is a, �L_ required for te Sta Zip Code Date of Inspection every page. City/Town D. System Information (cont.) I Type: ❑ 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.): �i 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments FOC4 V- Property Address I Owner Owner's Name information is11L�C4 14 ki tS Od L o required for State Zip Code Date of Inspection every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa a Disposal System Form Not for Voluntary Assessments 3 Fo y r A Property Address //-- Owner Owners Name information is �Co required for h f r �—�— every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where ublic water supply enters the building. Check one of the boxes below: I hand-sketch in the area below ❑ drawing attached separately 3 C01 6d- Lt l5ins-04r0e Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Ile Property Address C-1" -1y 1 P7 Owner Owner's Name information is o/ —7 o?.9—A? required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water I ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must descr how you eAtablished the high ground water elevation: // o � "51 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9,3 FoL,11-1 � Property Address Owner Owner's Name � / _ information is !/ ,g S /' "� 0� � required for State Zip Code Date of Inspection every page. Cityrrown E. Report Completeness Checklist inspection Summary: A, B, C, D, or E checked inspection Summary D (System Failure Criteria Applicable to All Systems)completed [System Information— Estimated depth to high groundwater ZK/Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I 15ins•09/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ek 24537 P:u289 a22558 05-10-21DIO Q 09 = 13u DEED RESTRICTION Be it known that The State Environmental Code Title V 310 CMR 15.000 Minimum Requirement for the Subsurface Disposal of Sanitary Sewage and the Town of Barnstable Board of Health deems the following: Due to septic design restrictions it is allowed that the system be designed to accommodate the existing two (2) bedrooms (as defined by Title V) in the house at the property, but notice to all that the number of bedrooms shall never exceed two (2)bedrooms since the septic system is not designed to accommodate greater than two bedrooms. for the property located at 73 Fourth Ave, Hyannis Mass as shown on Town of Barnstable MagR 246, Parcel 113 with said property being referenced in the Barnstable County Registry of Deeds under Book 23977 and Page 339. Whereas,_JAdkft A as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedroom's as a pre-condition to obtaining a Disposal Works Construction Permit in compliance with the State Environmental Code Title V. Executed as a sealed instrument on the cPO day of l 20 Id Owners Signature;_ , Maw-N A Cyl!j� r) Commonwealth of Massachusetts ,ss .2010 Then personally appeared the above-named known to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed,before me. Notary Public My Commission Expires: BARNSTABLE REGISTRY OF DEEDS ASSESSORS MAP : 7�"23-!!' _..__ _._ _...._. .,_._v�........._ ..__._.. _.._ ;, _-._..: TEST HOLE LOGS NOTES: PARCEL: SOIL EVALUATOR: I FLOOD ZONE: /�:d'11.�%� /� _ __ ..__.,._ v_. W i TNESS : IPSI� 1) The installation shall comply with Title V and Town of Barnstable Board of Health Regulations. REFERENCE: DATE:�- � PERCOLATION RAT : �- , 1�`i l 2) The installer shall verify the location of utilities, sewer inverts and septic • components prior to installation and setting base elevations. hll�t('�g,o� ._ . 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.The first TH- 1 TH-2 two feet out of the d-box to the leaching shall be level. L( 1 ,0 64AW 4) This plan is not to be utilized for property line determination nor any other ll purpose other than the proposed system installation. 3 5 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. LOCATION MAP 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt l / I of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material tp per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from waterline. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if 1 w q-......7 ' `r �- --- applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintained in place. 1 l) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW` ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such 2 BEDROOMS AT GAL/DAY/BEDROOM •�Z7�GAL/DAY exists. 13)The installer shall verify the location, quantity and elevation of the sewer �--- - -"` SEPTIC TANK lines exiting the dwelling prior:to the installation. Sewer line is to be re- plumbed to front of the dwelling. ZAL/DAY x 2 DAYS - GAL �..�� _...__ . IL USE 1tv GALLON SEPT I C TANK - IL ABSORPT 1ONfL-7— �SYSTEM �.. I t l x ti o SIDE AREA: Z 1 12� x` ` orre � BOTTOM AREA: ram✓' 12 X b+ DAV�S6 hla SON to 1066al � TIC SYSTEM SECT I 'ON 0 Log or raxjwnj � ` r 1 �t � GALS "? SEPTIC TANK IW5 A/210 SITE AND SEWAGE PLAN ._---� LOCATION : A,W tom, 1l PREPARED FOR : j I' �1�' �G . ....�... v ....__. . __._ t .. w�. �.. SCALE. l W DAV I D B . MASON `R& DATE: Z010 Z DBC ENVIRONMENTAL DESIGNS W DATE HEALTH AGENT EAST SANDWICH . MA 3 ( 508 ) 833-2177 Z