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0011 GREENWOOD AVENUE - Health
dll.* 'feenwood Avenue '" a Hyannis e s 6 e No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitatiou for Disposal *pstem Coustruttiou 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon Q� ❑Complete System ❑Individual Components Location Address or Lot No. ( V GAjSW1UJC0h AtV E 04 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a� 693-�© �2a A Installer's Name,Address,and Tel.No.542-40�`r7-2r'9?-7 Designer's;ZA Address,and Tel.No. � G6wl� � t c.C.. !v Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) c 6X I cS- fife 6a Em _ sz t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in k accordarice 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 issupbDthnis Board of Healted Date Application Approved by ® Date / Application Disapproved Date M for the following reasons I' Permit No. Date Issued k�l IV -_ '----------------------------------_------_--_- • '" 1.2 Sx. {� ugyy .2tNJM C��s'.im"'G yp�_ n .a Ir ti OFFICIAL cc] Ln qPostage $ 02 6 p r-9 Certified Fee d (p�t mark �1 os 0 O (Endorsement ReReturnegt Fee Heer Endorsementnt Required) 11�y Restricted Delivery Fee l7 . (Endorsement Required) C3 r � rU Total Postage&Fees r-1 Sent To a O Street,Apt No.; N or PO Box-No. 00 -- Clty Stat, IP+4 Certified Mail Provides: T o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years .r. Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee" addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery", o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for disposal-6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(* ❑Complete System ❑Individual Components E Location Address or Lot No. I I Czm,�004 )}V 6 "'Owner's Name,Address,and Tel.No. ' CPAIC—, 000-M Assessor's Map/Parcel g 093:0 I AV t! Installer's Name,Address,and Tel.No..5G0—q7'7—$'9'7—t Designer's Name,Address,and Tel.No: �tWtDG �$DES L/—C— N)liq Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) :464i'-b ox-, 6X[5--r ti-) SQ L S�fs7 c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt PSi ed Date 3 Application Approved by Date Application Disapproved y V Date for the following reasons f d Permit No. �' Date Issued --------------------------------------------------------------------------------- ---- ------------------------ --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal -system /Constructed( ) Repaired( ) Upgraded( ) Abandoned(yj by Cf'(1z[iWj� 0JMCr&&; 4�•� at f�-3_�14)Q 7 has been cons uct84;�CIM e with the provisions of Title 5 and the for Disposal System Construction Permit Nod Installer �j�`t01 nQ tDJ� �� �_ Designer��1A #bedrooms Approved design flogv gpd The issuance of this pel mit shall not be construed as a guarantee that the system wi -function as d signed. Date _ } Inspector (�� .. .• �T _----- - -------------'----------------- - p No. �� Fee 'HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 33isposal 6pstem Construction 3pPrmlt Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at E and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co st c st be completed within three years of the date of this permit.77 Date Approved by , . . ON DELIVERY a Complete items 1;2,and 3.Also complete A. Signature A item 4 if Restricted Delivery Is desired. ❑Agent I W Print your name and address on the reverse X, ❑Addressee so that we can return the card to you. B. Receive Tinted Name) C. Date of Delivery a Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from ite 1? ❑Yes If YES,enter delivery address below: ❑No crzxi5 a004 , o SNY ,,' &� � Ui i05 Se ic yp f� ifi Mail® [3 Priority Mail Express' Q Z� ( 13i8tji Bred ❑Return Receipt for Merchandise --�'lnsured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (: (Transfer from seMce IabeQ r ; 7 Oil 4' 12 0 0 0 01,,0*3 56; PS Form 3'811,July 2013 Domestic Return Receipt I i UNITED STATES POSTAL SERVICE First-Klass Mail I Postage&Fees Paid USPS Permit No.G-10 I • Sender: Please print your name,address, and ZIP+4®in this box* I ' Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 l�llli111,i��'11i111�'l��t�ll.1„lFl�ill.jll�►i,�,11���i`lili'III� Town of Barnstable Barnstable Regulatory Services Department jc j HARNSTAHM 9 MAS& 039. ,m Public Health Division fD"" A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO i CERTIFIED MAIL# 7014 1200 0001 0358 2349 February 9, 2015 CRAIG BOOTH 11 GREENWOOD AVENUE IMPORTANT NOTICE HYANNIS, MA 02601 Map & Parcel: 289- 093-003 DEADLINE APPROACHING According to our records your dwelling at 11 Greenwood Ave, Hyannis, MA, should be connected to public sewer on or before 3/30/2015. This is a reminder that all permits need to be in place before this date to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. 2) Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at (508) 790-6244. LIMITED TIME FOR.SAVINGS ON GRINDER PUMP The Department of Public Works (DPW) is still offering grinder pumps at no charge, if 1 you obtain your permits and connect to sewer promptly. (This can save you thousands of dollars, but this offer will expire.) Please note: You must pay the installation cost of the pump through your own contractor. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. I Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health f- i Commonwealth of Massachusetts w Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises-P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is Hyannis MA 02601 7-7-2011 (Revised 8-17-2011) required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: i The garbage disposal has been removed from the kitchen sink, and the plumbing work has been inspected By Don Desmaris of the Town of Barnstable Plumbing Department. The System is in working condition and is functioning as intended. None of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 existed at the time of inspection. i j i B) System Conditionally Passes: i i ❑ 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. i { ❑ Y ❑ N ❑ ND(Explain below): j 1 I i l t5ins•o9f68 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. City/Town State Zip Code Date of Inspection 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 A. General Information (� forms on the `J\►�I / �� computer, use 1. Inspector: 'u/n only the,tab key to move your Joseph R. Smith cursor-'do not Name of Inspector use the return key. Bennett Environmental Asscoiates, Inc. Company Name ' 1573 Main Street/ P. 0. Box 1743 Company Address Brewster MA 02631 City/Town State Zip Code (508) 896-1706 S14994 Telephone Number License Number B. Certification t - 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 ❑ Falls] __q ® Needs Further Evaluation by the Local Approving Authority _n w 7-7-2011 nspe Signature Date 1 fV �The system inspector shall submit a copy of this inspection report to the Approving Authority(Bard of Health or DEP)within 30 days of completing this inspection. If the system is a shareNystem 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. -711 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Di posal System•Page 1 of 17 i Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health.. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown 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 pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N FIND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of He alth 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: When inspecting the septic system, a garbage disposal was found to be installed in the kitchen sink. The system design plan by Eldredge Engineering dated 2-18-1985 does not permit the use of a garbage disposal for use with this system. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 ti 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Septic System with an engineered design plan by Eldredge Engineering with a plan date of 2-18- 1985. The system serves a three (3) bedroom residence and is comprised of a 1,000 gallon septic tank, D-box, and a leaching pit with 2' of stone around it. Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage See Details 9 ( Y 9 (gPd))� Detail: 2009: 53,863.2 gallons 2010: 57,603.7 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Currently in use. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 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 M 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner, Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityfrown State Zip Code Date of Inspection I D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i i General Information Pumping Records: Town of Barnstable Board of Health Source of information: j Was system pumped as part of the inspection? ❑ Yes ® No i j If yes, volume pumped: gallons j How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system i ❑ Single cesspool ❑ Overflow cesspool ❑ Privy i f ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) i ❑ 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. A ❑ Other(describe): i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 N, Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: February 18, 1985 —Town of Barnstable Sewage Permit Number; 85-174 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 100'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints and venting are functioning properly, no evidence of leakage encountered while Inspecting building sewer line. Building sewer line is schedule 40 PVC piping. Septic Tank(locate on site plan): Depth below grade: 1.0 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 gallon septic tank with Schedule 40 PVC inlet tee and a concrete outlet tee, both inlet and outlet covers to within 12" of final grade. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6" L x 4'10"W x 58" H Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is Y required for Hyannis MA 02601 7-7-2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Measure, Sludge Judge, Probe Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not reccomended at time of inspection. Both inlet and outlet tees are functioning properly. Liquid level as related to the outlet invert is at a normal operating height. No evidence of leakage encountered while conducting the inspection on the septic tank. Both septic tank covers are within 12" of final grade elevation. 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-09/08 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 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•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 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Effluent at outlet invert is normal 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 distributing effluent to the leaching pit. Some evidence of solids carryover present in the D-box, no evidence of backup present in the D-box. No evidence of leakage into or out of d-box encountered while conducting inspection of the D-box. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Leach pit exposed and inspected t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -(6'x 10') ❑ 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.): The leaching pit contained 3' of standing water at the time of inspection. No signs of past(staining) on interior pit face or evidence of hydraulic failure encountered while inspecting the leaching pit. Vegetation in the area of the leaching pit is normal and sidewalls free of algal growth. i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert I Depth of solids layer i Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 I _9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 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 Form=Not for Voluntary Assessments 11 Greenwood Avenue: Map 289, Parcel 93-3 Property Address D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information Hyannis MA 02601 7-7-2011 required for Y 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 1 00 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately -,� - ►J _ f r 5 r r o i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i t Commonwealth of Massachusetts 4 v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA 02601 7-7-2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6.0+ 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: 2-18-1985- Eldredge Engineering Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Established estimated depth to high groundwater by referencing plan by Eldredge Engineering with a plan date of February 18, 1985 wherein it is noted that the elevation of the bottom of the leaching pit is 6.07' above the high groundwater elevation. Also the soil test data which was conducted by Eldredge Engineering and witnessed by Ron Gifford (Barnstable B.O.H) also notes within the same plan the that groundwater was encountered at elevation -0.54', which puts groundwater at an elevation greater that 6'+from the bottom elevation of the leaching pit. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 11 Greenwood Avenue: Map 289, Parcel 93-3 [N/F Robinson] Property Address j Federal National c/o D.B. Enterprises- P.O. Box 1257, Mashpee, MA 02649 Owner Owner's Name information is required for Hyannis MA. 02601 7-7-2011 everylpage. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist i ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i i I i I I I I t5ins i 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 !� ' '- 000 'OWN OF BARNSTABLE z _ LOC6hT144- %Q�a�— ` "�� f�� �SEWAGE # VIC-,AGE ASSESSOR'S MAP & LOT - 9 INS "ALLER'S NAME&PHONE NO. �kLQ SEPTIC TANK CAPACITY LEACHING FACILITY: (type)d Yet(lam- �� (size) 02!S f �, NO.OF BEDROOMS J BUILDER OR OWNER C5- �APThzv PERMITDATE: COMPLIANCE DATE: I-C-n-i�S 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 CATION i2 S Z�- / VILLAGE *, A & B CESSPOOL SERVICE 4' i ^'3128 BISHOPS TERRACE, HYANNIS, MA 02601 ;d BUILDER OR OWNER oAj �� w Q DATE PERMIT ISSUED e 1 DATE COMPLIANCE ISSUED at � o �` i 0 93 N o. �O FimB........ ................... THE ONWEALTH OF MASSACHUSETTS >BO )OF HEALTH IA 7-.--. - ...............OF....... . ............................... ton for Disposal Works Tonstrurtion Prrutit ication is hereby made for a Permit to Construct -kl' or Repair an Individual Sewage Disposal System at: I .4k) 0 Sc 'IfP-1.17 .......... ........... ..C--------------------------------------------------------- �i.��nA Address r e s s or Lot No. IS ..... .......... .................. Address All11�.,.............................. i4;a 7... 'Address Type of Building Size f t U Dwelling—No. of Bedrooms.... Garbage Grinder .............................Expansion Attic P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria A4Other fixtures ...................................................................................................................................................... Design Flow..............53........................gallons per person per day. Total daily flow.............336 ................................gallons. 1:4 Septic Tank—Liquid capacity.A�,?A.gallons Length.A.A Width._-4X."... Diameter................ Depth.-5/8", Disposal Trench—No. .................... Width............._._._.. Total Length.................... Total leaching area....................sq. f t. Seepage Pit No......../------------- Diameter......I.q....... Depth below inlet.._.... ...... Total leaching area..j?-3-;EL._sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by__.. ......................... Date..... 7............... Test Pit No. 1...:5;:...�..minutes per inch Depth of Test Pit......t7p......... Depth to ground water..... ............. 0 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__._.__...___......__. P4 ........................................................................................................................................................ 0 Description of Soil....... .........GoA �..7z'p_A!?�/t............ , A�,, -P__SA,14C> ............ .. .............................................. -----------------------*----------**------------------------------ ---------------------------------------------------------*-------------------*------------------*------------------------- ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.............................................................. ................................ ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Ti U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee Is ued by the It,h. ( - 7 Vigned .... ... ................. .7.......................... ......2.......1................... Application Approved BY77Z�.... ...... ---- .................. ...... ... ........:75�?ta:5�...... - Date Itt, Application Disapproved for the following reasons: .. .. . ..... . ........ ............................................................................................................................................................................ ......................... r <-)D Permit No....... .............. Issued............ -� . ................ D to ---------- �d \ No..�.�.S--. .:1. Fps..-.:�. ?............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.W_200��...........OF....... B�rnivsT��.�� Appliration for Disposal Works Tomitrurtiun 1hrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ....e __...1..................y�APl7lcG1C1.L?. .. 'l�.d?D!•P .......................................................... Location-Address or Lot No. . !!................................................... i � .1._ -.�-3'------------------- pT.. Owner „ Adflress ........ , , A//- 1.. l.. ---.. .1�15.�...................................................................................... Pnstaller T Address U Type of Building Size Lotl/ ...Sq.#,fe Dwelling—No. of Bedrooms....--:?..............................Expansion Attic ( ) Garbage Grinder PL, Other—T e of Building .... No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- 6:5— w Design Flow............................................gallons per person per day. Total daily flow----.......33a gallons. WSeptic Tank—Liquid capacity"!"..gallons Length 4.`.-...... Width.-4-'4'.._.. Diameter---------------- Depths,8.`..--. x Disposal Trench—No. .................... Width.................... Total Length..._.:............ Total leaching area....................sq. ft. Seepage Pit No....../------------- Diameter.....�o..-_..... Depth below inlet...... ........ Total leaching area.Z3S_G•_sq. ft. z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by...��-�����Lr.....�"�.0......................... Date_._.9jlZ(�f-3.At............... 4 Test Pit No. 1--29r-.-3-...minutes per inch Depth of Test Pit.....17 ........ Depth to ground water.....P;!.............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•-••--•-•----------------•••--•--••••---••--•--••--•-------••-...--•-••-••-•-...----•-------------......................................................... D Description of Soil......0_.... a: Loog" 0 7.FP Sail" c>A------M .............................. x ................... w VNature of Repairs or Alterations—Answer when applicable...---.....::.......................:........................................................... •---------------------------•---------------------------•--•------------•----••---------------•-•-----•-•--••-------------------------------•------------------------------------------.....--••---••••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued the b o ealth. Igned - .. _..._ Date Application Approved BY -•--- ----- . '? ' r .}........_ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------••------•---•- ...---•----------------------•-------•--••--••---------------...----•-••------------•----•-•---------••--•••--•-•----•----•--•-••--------••--•----•---••-•••••-•••-••--•---=---•---••••---••••-••---•--- Date PermitNo........................................................ Issued...------•---•••-••-----•--•-•••--•---•-•-••--•------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............T ...!.`..............OF..............5l.............................I................................... (9rdifiratr of Toutplianre THIS�SqO C TIFY, That the Ind* idual Sewage Disposal System constructed (&..}—or Repaired ( ) by--- ...•............. . .. ' In ller `�� � has been installed in accordance with the provisions of TITLE 5 of The ate Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated................................................ ------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•---•--......-•---...---•--•--•--•----.......-------••---••....... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j T ui ai OF..... � 'his T•4,g.4. =F............................. ,,---� __. ... ............ 0......................... FEEv>s:.LL............ Disposal_Works TWanstrnrtinn Uprrutit Permission is hereby granted------. ....71 . .-••••.......-••-••.................•-----••-•••--••- to Construct (✓,I or Repair ) an Individual Sew ge is osal Sy atNo...--.. -1>.1......1......... ------- ............... .•S- .z.---........ Street as shown on the application for Disposal Works Construction Permit N, ...... Dated.......................................... fi ..� Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN,.INC., BOSTON - I �. ' r 1 f ! , �.� '�. d _ . ��y ` ✓ ,��� � � t i i � '� ' � i , �. s is 1 r i 1- s � � Y f � y lJ �� f. //// �'� � rl � i ��' ' �: l� I \ s 4 i` 7 dL• r1 G • 5 � q 0' 'k 4t a3 Lo7 — /4 76o . l , a nos« q 4l v4 O /o' ��:'� fox „� I�'• ► � • fs'a,o o ,- 3 3 NbT �Z�1/�jU,v 3 46A-.1&7-> Oti W�9Tff72 ?�3BLE� 9�Zi�BL =o,oo CERTO Fl ED PLOT PLAN LOCATION �ZH oe Pj9gs SCALE DATE ... . .... EDWARD �^ PLAN REFERENCE o KEAlio �% 5A4w l/ Oil./ ALA ,ex:.. 38 y NoJ Gam, TI 1 CERTIFY THAT THE �S77ilI� /�aN�/ .✓ SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF .WHEN CONSTRUCTED. DATE �/c/Jyv .STA/VG • - Re-rl7-/o k/E72 REGISTERED LAND SURVEYOR r zwez-r Z o F Z SNEz-rs TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e 4"CAST IRON 2"MAX' OR SCHEDULE 48 12"MAX. AM • P.V.C. PIPE 4 SCHEDULE 40 PV.C.(ONLY) PIPE - MIN. LEACH • PITCH I/4"PER. PITCH 1/4"PER.FT. PIT e•a PRECAST . \—INVERT a LEACHING e EL.:!?:d� . PIT OR e'. SEPTIC TANK INVERT DIST. INVERT ? W e INVERT EL.//r4�. . . BOX EL 47. ' : _>_ EQUIV. 7� /opp. •• •, GAL. INVERT INVERT •' �1 f-~ :;�: 3/4"TO IV2� e' EL./.��. a ' . • �.. W W I E L//.•..� . EU!, 7. .; U. WASHED ''e � ;• w •;•� STONE e• �'. . DIA. PROFILE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .g�?//BZ... TIME.r7,!3o RAJ �oM G/�Fo2D BOARD OF HEALTH '.r TEST HOLE I TEST HOLE 2 GrZD2G' �7l/C; ENGINEER ELEV. . 747v. . . . ELEV. �4,.-f4.G. . DESIGN . . .DATA EZ.S•Sv - /Z.,4� NUMBER OF BEDROOMS 3 . . . . . . . . . �176-P. S TOTAL ESTIMATED FLOW . .33C . . • GALLONS/DAY Sih�D A�o" BOTTOM LEACHING AREA . . . SO.FT. /PITIC,P.D. SIDE LEACHING AREA .. . ./'S7, . . . SQ.FT./ PIT/,3S'Z.7C.RD GARBAGE DISPOSAL . �Vv. . . .(50% AREA INCREASE) S' TOTAL LEACHING AREA .?-3 .G . SQ.FT ! PERCOLATION RATE 44ZP .?7�/,?P:1-7700 MIN/INCH 2le,f- LEACHING AREA PER PERCOLATION RATE '4714�. SQ.FT/.eVp - 9a WATER ENCOUNTERED NUMBER OF LEACHING PITS p/r. W.17 1/ i� APPROVED . . . . . . . . . . . BOARD OF HEALTH � � •` �T •of S7A�►/� ®`�� AZT `SOj� I ' DATE . . . . . . . . . . AGENT OR INSPECTOR 10 OF P,rgsS Av CC //�T//►//S f'f.A$S `` F J„i� /STEP a PETITIONER ,�•8 hl i ivf LoT ' 1 i � 9a oh i P2opos��n q IIQQ � fit) /ro`7o Zo fit.. z' 1 r".5ravc S&Pne O r� 7A"r- Q A / 14'. 3 NdT�! �z�A'�Oa/3 Qi�S� dti W4*72 7?;ee,61 y/zi/8L v. =o;ao CERTIFIED PLOT PLAN LOCATION . yy,4�!Nis /yq ss SCALE . .�.y_.30 .... DATE Or PLAN REFERENCE .- t\ r 77 otV . .,,, ram.. . 9�. . . . . . . . . . . . . . . . . . . . . . . . . . .. . '-..•��•�.�..r �tov I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF .WHEN. CONSTRUCTED. DATE e iV. �%oN�v STAND• — PE?'/T//U/�/E71'Z ���-+yC � � REGISTERED LAND SURVEYOR l� y SN7' Z o F Z SNEZ�7-s TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e e 4"CAST IRON 12"'MAX ` OR SCHEDULE 40 12"MAX. f/4 P.V.C. PIPE 4"SCHEDULE 40 PV.C.(ONLY) PITCH 1/4"PER.FT PIPE - MIN. LEACH PITCH 1/4"PER.FT PITT INVERT e JGEL. /Z.P0 \INVERT INVERT p� w SEPTIC TANK EL.1/���. . . DIST. EL/�.37 �_ .INVERT BOXEL././.7.�. . .. .. GAL. INVERT S/ ►-F EL//. INVERT ww /2,3 EL.//,o�/o � LL w o• [-- OIA. fd 6.07' e . PROFILE OF ROUND WATER TABLE SEWAGE DISPOSAL SYSTEM 1� waPzfrL zj� NO SCALE SOIL LOG WITNESSED BY : DATE .g�i1/BL... TIME. �!3D L} JN G/�Fo2D BOARD OF HEALTH TEST HOLE I TEST HOLE 2 (:ZD/ZE`�('� /C, ENGINEER ELEV. . 7 r?. . . . ELEV. .. .. C. . -App SO/� 2 ps�� DESIGN DATA : NUMBER OF BEDROOMS3 MAD, s/�ivl� TOTAL ESTIMATED FLOW . .`3. .. . . . GALLONS/DAY BOTTOM LEACHING AREA .78•So . . SO.FT. /PITloV P,D, 40" • 6=96 SIDE LEACHING AREA . . .1�7.,� SQ.FT./ PITI-M.7CAj> GARBAGE DISPOSAL . .(50% AREA INCREASE) TOTAL LEACHING AREA . .1?4K. -A . . SQ.FT PERCOLATION RATE GAS . /. / nl/q MIN/INCH 16,e 'LEACHING AREA PER PERCOLATION RATE ' 71,?, SQ.FT/cep .... . .WATER ENCOUNTERED NUMBER OF LEACHING PITS 0'/45 .R/T. W1771 , . 771 APPROVED . . . . . . . . . . . BOARD OF HEALTHY • ?- ��57 �� • u' `S1D . DATE . . . . . . . . AGENT OR INSPECTOR i tiL HT Q OF EjA o� Le0 . ! GaT'�'' i �. o o 4 = La. KELLEY ^, w Nas� ( W AV A No.26100 Z; Mo�3 U EV t% TE?� / SgNRARtP PETITIONER : f�A• sT�4411/' sN T / of z Sf1 Ts J94:;l Al �40 G , ' ?Z'5T 1� �� hbG6 4 01 ' �• L3 'k t6 a,3 Lo T .1 '— — /4, 700 PliopoSLTn !J 3 47 � �• Zai �•1�� �lD� a �,.�1 ` 1 1&5w ev-c 0 / \ 9zhvG p R r V 10, oo 3 3 N�-- �Z�w�jv,v.s 13s�-sue o.v W,17-b7Z 7P3BL6, llZilBL o,00 CERTI FI EO PLOT PLAN LOCATION . . . . .. SCALE . .�. ."30 DATE :2W..119./9BS cF�'% ;, PLAN REFERENCE 8�'?'•t/G La�`''�/ Nn I I CERTIFY THAT THE �57 Jit/tr /�riNo/� ✓ SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE .A8. P&T/7—/0A/ REGISTERED LAND SURVEYt7R 1. . . .�... . .. .. ... . TOP OF FOUNDATION CONCRETE COVER s CONCRETE COVERS e 4"CAST IRON II2"MAX. 12"MAX. ' OR SCHEDULE 4b 4"SCHEDULE 40 P.V.C.(ONLY) P.V.C. PIPE PIPE - MIN. LEACH • PITCH I/4"PER. PITCH I/4"PER.FT. .' � PIT PRECAST INVERT a LEACHING EL./Z.do INVERT INVERT ! . e` PIT OR a'r SEPTIC TANK DIST. • w S'� EL.//c4ze. .. EL//.37. ' • >_ EQUIV. e INVERT BOX ' e; EL./��.7� /o4?P, .... GAL. INVERT S' v o~. '�' EL//. INVERT ww :►: 3/4"TOI1/2 S � o WASHED w STONE e bpi � � A/ '• :.: , T T ' /5 s'DIA. —*-+ r a• �'. . �--- DIA:--d 9.07' ` PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM _ _ a• `' 1C_ NO SCALE p SOIL LOG WITNESSED BY : DATE .9/?//BL... TIME. . .%3o 4xlr !'On! G/ !r-b BOARD OF HEALTH TEST HOLE I TEST HOLE 2 GsZD��'�G'�� �7t/C; ENGINEER ELEV. . 7 rp. . . . ELEV. ../4,.-�4.�. . 7/0 4VA- ► mP so/� �� �'s DESIGN DATA : NUMBER OF BEDROOMS 3 . . . . . . TOTAL ESTIMATED FLOW . .`3.3r? . . . GALLONS/DAY SAID qo�� BOTTOM LEACHING AREA 78^So. , . SO.FT. /PIT/,r P.D, �,9G SIDE LEACHING AREA , 7, . . . SO.FT./ PIT/J-P.7CAD 40" E2, o,o0 Co/a e- GARBAGE DISPOSAL . 'Y9. . ..(50% AREA INCREASE) 2 TOTAL LEACHING AREA . .Z-3•r6T-.G . . SQ.FT Igo", PERCOLATION RATE LESS .?J{/,�iy T1~/p MIN/INCH 9b� LEACHING AREA PER PERCOLATION RATE '¢714�. SO.FT/.e- ..... .WATER ENCOUNTERED NUMBER OF LEACHING. PITS GNE pFr. W17;11 . . APPROVED . . . . . . . . . . BOARD OF HEALTHY • ?- 06 S7aw� p.v 4ZG S/� I DATE j AGENT OR INSPECTOR cp (N OF PETITIONER