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HomeMy WebLinkAbout0050 JENNIFER LANE - Health �,5 "Lan 0 r,Jerinfer"La Hyannis A 271168 �i f — 6 � o I ° r i ° o ° Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l� 50 Jennifer Lane Go. Property Address wps Wakeby Development Owner Owner's Name information is required for eve y every an H nis MA 02601 9/28/17 a� 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 farms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Richard T. Johnson use the return Name of Inspector key. D&J Environmental Services �y Company Name P.O.Box1439 Company Address Plymouth __ _____ MA _ 02362_ City/Town State Zip Code _ 508-735-8740 S113545 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the ocal Approving Authority 9/28/17 Ins or's Signature AV Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the - -. report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to-the buyer, if applicable;and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 11 °95`� V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments h 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. City(rown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane _ Property Address Wakeby Development _ Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. Citylfown State Zip Code Date of Inspection B. Certification (cost.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): I ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within'50*feet of a bordering vegetated wetland or a salt marsh (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Jennifer Lane _ Property Address Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/23/17 page. City/Town 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: El The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet-invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is H annis MA 02601 9/28/17 required for every y 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is.considered a.significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane _ Property Address Wakeby Development Owner Owner's Name information is Hyannis MA 02601 9/28/17 required for every y page. Citylrown 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 I ' ❑ ® 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? ❑ Z 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? Z ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was.the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3------ Number of bedrooms (actual): . 3--- — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD 15ins-3/13 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 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 ` Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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•3/13 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 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. Cityfrown State Zip Code Date of Inspection D. System Information(cont.) , Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes Z No If yes, volume pumped:- gallons How was quantity pumped determined? — -- -- Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Inhovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts - r Title 5 Official 'Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,-date-installed (if known) and source of information: 1998 Were sewage odors detected'when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints structurally sound, no signs of leakage . Septic Tank(locate on site plan): , Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Septic Tank Covers to grade. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal Sludge depth: 2" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 , Commonwealth of Massachusetts Title 5 official ' Inspection Form " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development ' Owner Owners Name information is Hyannis MA 02601 9/28/17 required for every H y • page. Cityrrown 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 33" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? Field measurement/Mfg. Specs. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Sanitary Tees in good working condition, tank structurally sound, no evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal. '.❑ fiberglass ❑ polyethylene ❑ other(explain): • Dimensions: — ` Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 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 50 Jennifer Lane _ Property Address 1 Wakeby Development Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. Cityrrown 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.): t� t a • t Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development. Owner Owner's Name information is required for every Hyannis MA 02601 9/28/17 page. City/Town 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 011 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 level, no evidence of leakage into or out of box, no evidence of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No` Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is Hyannis MA 02601 9/28/17 required for every y page. City/Town State Zip Code Date of Inspection D. System Information'(cont.), Type: ❑ leaching pits number: ® leaching chambers number: 2 x 500 gal. i r I ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: - — ❑ innovative/alternative system iType/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of i vegetation, etc.): no evidence of hydraulic failure, no evidence of ponding, normal vegetation . 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 117 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is Hyannis MA 02601 9/28/17 required for every y ' page. City/Town 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.): 15ins-3/13 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 50 Jennifer Lane Property Address Wakeby Development _ Owner Owner's Name information is Hyannis MA 02601 9/28/17 required for every y —_ — — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below drawing attached separately - - 2 30 36 6 t5ins•3113 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 50 Jennifer Lane Property Address Wakeby Development Owner Owners Name information is required for every Hyannis MA 02601 9/28/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells . Estimated depth to high ground water: 20+ 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: 2005 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: Obtained from site observation, visual elevation, perc test data on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Jennifer Lane Property Address Wakeby Development Owner Owner's Name information is Hyannis MA 02601 9/28/17 required for every y _ _ page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E`checked -® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate.file I r r t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 s \ . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 50 Jennifer Lane — Property Address C/O Milo Realty Trust — Owner Owner's Name information is Hyannis MA 02601 December 3, 2010 required for 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: A. General Information When filling out forms on the I{ computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell — cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. — Company Name r� 189 Cammett Road — Company Address Marstons Mills MA 02648 City/Town State Zip Code 508.428.1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑- Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority . LDecember 3, 2010 'Job# 10-286 _ Ins ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and,the.approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under C�o the same or different conditions of use. 94 :z Ii i�.� 91 ,..ISins•09/08 ilie °O icial inspection Form Subsurface Sewa isposal y$te age 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane — Property Address C/O Milo Realty Trust — Owner Owner's Name information is Hyannis MA 02601 December 3, 2010 — required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was pumped as part of inspection, leaching chambers were empty at time of inspection with a high stain line at 50% capacity. — 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 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 50 Jennifer Lane — Property Address C/O Milo Realty Trust Owner Owner's Name. information is Hyannis MA 02601 December 3, 2010 required for y — 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 pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): j ❑ 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): i C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which"require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•09/08 Title 5 Official Inspection Form'Subsurface Sewage Disposal System"Page 3 of 17 f i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane _ Property Address C/O Milo Realty Trust — Owner Owner's Name information is Hyannis MA 02601 December 3, 2010 required for y — every page. CityrTown 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface water.s 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 15ins•09108 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 w� 50 Jennifer Lane — Property Address C/O Milo Realty Trust Owner Owner's Name information is Hyannis MA 02601 December 3, 2010 required for y — every page. Cityfrown 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 t ❑ ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 - every page. Cityfrown 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 — 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 cd 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane _ Property Address C/O Milo Realty Trust Owner Owner's Name information is H annis MA 02601 December 3, 2010 required for y — every page. Cityrrown State Zip Code Date of Inspection — D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No 11/4/10 _ 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 Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — I5ins•09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 rd 17 Commonwealth. of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 50 Jennifer Lane _ Property Address C/O Milo Realty Trust — Owner Owner's Name information is Hyannis MA 02601 December 3, 2010 required for y — every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for Excessive solids _ pumping: Type of System: ® Septic tank, distribution box, soil absorption system I ❑ 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): 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary'Assessments. M 50 Jennifer Lane Property Address C/O Milo Realty Trust _ Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 _every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 1/6/06 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): _ Depth below grade: 2'feet Material of construction: ❑ cast iron ® 40 PVC' ❑ other(explain): — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal.— 12" Sludge depth: — 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ' t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address C/O Milo Realty Trust _ Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 every page. CitylTown 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 18 — Scum thickness 6 Distance from top of scum to top of outlet tee or baffle 6 — Distance from bottom of scum to bottom of outlet tee or baffle 8 How were dimensions determined? Measured — Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees were intact and clear. Tank was pumped as part of inspection. — i 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 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 cf 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments «., 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 every page. Cityrrown 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 15ins-09108 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 µ 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.).- Some solids carryover, no high stains. Liquid level was at bottom of outlet pipes. 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.): s Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins.09/00 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 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — ® leaching chambers number: Two 500 galdrywells. ❑ 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.): Leaching chambers were empty at time of inspection, observed a high stain line at 50%capacity. 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 15ins•09108 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 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owners Name information is required for Hyannis MA 02601 December 3, 2010 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.): 4 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 or 17 Commonwealth of Massachusetts - r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 50 Jennifer Lane Property Address ----------------- ----- -- C/O Milo Realty Trust Owner Owner's Name ----- --—�----------—---- information is Hyannis _MA required for y -- ----'---'----..---'- — 02601 December 3, 2010 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 public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately Jennifer Lane Water Service 25 30 36 6 �.. . t ,`� Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 3, 2010 every page. CitylTown 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: 20+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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 25 and topo map shows property at el. 50. Before filing this Inspection Report, please see Report.Completeness Checklist on next page. 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. 50 Jennifer Lane Property Address C/O Milo Realty Trust Owner Owner's Name z information is required for Hyannis MA 02601 December 3, 2010 every page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B; C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 y TOWN10F BARNSTABLE LOCATION `Igrin 4r l.. n SEMMAE _T?kl Se '1VILLAGE N&It2nVN"S ASSESSOR'S N4AP&PARCEL - IN&TAbMR'S NAME..&PHONE NO. ', :�-k�J�✓I►�1� tq e-I 117J SEPTIC TANK CAPACITY I 00 LEACHING FACILITY:(type) Cs (size) S�OCt NO.OF BEDROOMS OWNER PERMIT DATE: C £-DATE:W, gL 13 I ICE 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 wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY t \ ♦ \ ♦ \ \ F / f / I, 30 25 36 6 F I TOWI`T°OF BA.rtNSTABLE OP.,rr/O/4G� LOCATION'S U Tp�f j 1 I14i'V _SEWAGE # FPS '— r e VlLJLAGE j/,;�i//�1�� ASSESSOR'S MAP & LOT. INSTALLER'S NAME&PHONE NO. W %UJk411 ►7f1\16E SEPTIC TANK CAPACITY LEACHING FACILITY: (type) `�00 C-7Ak 4-• 1 (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching.Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r. I No. C5 ✓ / I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION.-TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratton for ;Bte;po of 6pgtem Cgttgtrurtiun Vermtt Application for a Permit to Construct o/Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i �9�L t .,, ..Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer`s N e,Address,an Tel.No. Desi ame,Address and Tel.No. 1 N J.DOYLE AND_-1SSOCL4TES 2 ANTERBURY LANE EAST FALM Type of Building: 508/540-2534 Dwelling No.of Bedrooms 7, Lot Size mO,SjOsq.ft. Garbage Grinder( ) Other Tl pe of Building No.of Person Showers( ) Cafeteria( ) Other Fixtures Design Flow "_• gallons per day. Calculated daily flow 3 4 0 gallons. Plan Date d].U►d Number of sheets Revision Date 10 —f� Title--` 1— , — L Size of Septic Tank tr7 rtab o� Type of S.A.S. CAli.11l=i'�_� 12_ —�t?SFA1_ Description of Soil; !i><-t_T- (��A1_1 i ' I 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 a and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B azd of S' Date Application Approved Date %© )7 f- Application Disapproved for the following reasons Permit —1-------�©O S SIQ Date-- ---O /-------- —"�- . .. r Y? ijla 714";•4�+r{' 'i' •.�f+v, +�1::k, Z. .t x..-1�r. ^r ii*a..._ ..H '.rd THErC'OMMONWEALTH OF MASSACHUSETTS Entered in,,. t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS t Application for,!§i!5po!6a1 6p5tem Construction Permit Application for a Permit to Construct Repair(. )-Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Q ���` 1=s�� �� , Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,an Te.No Designer 3 iLHQrJsslN'1'�l:$ro1N D.-ASSOCIATES V �iGJ'�r 42 CANTERBURY LANE v EAST FALMOUTH,MASSACHUSETTS 02536 508i540-2534 Type of Building: Dwelling No.of Bedrooms `2� Lot Size 'LO sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ' 1 Design Flow `_- gallons per day. Calculated daily flow 3 gallons. Plan Date >Q•�d `t �D� Number of sheet Revision Date .,Vr ... � OCU �Title . - \ .... 'D Size of Septic Tank k 5DO G•�411.of Type of S.A.S. u �'I'=�•—tZ— % t t Description of Soil' G✓t'CrrA1.J► 11 �� 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 Certifi- 1' Cate of Compliance has been issued by this -Board o ealt . -Kc S ne Date Application Approved b Date 7o 7 Application Disapproved for the following reasons • `r a Permit No. ` 1.00s5 -f Date Issued x - ----S---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS `w Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal Systenj Constructed( ' Repai>ed�( )Upgraded( ) l Abandoned( )by 5 �b n 1�"Q �a Q \levti 1 `� at "' has been constructed in ac ordance with the provisions Title 5 and the for Disposal System Construction Permit No. 5) dated /0//� 5 Installer Designer The issuance of this permit hM not be construed'as a guarantee that the system l �Cti, �elghn�ed. . Date I U ` Inspector { ----- No. '.Fee 50 THE COMMONWEALTH OF MASSACHUSETTS I PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migozaf *p5tem Con5truction Permit Permission is hereby granted to Con+uct air( ) pgrade( )Aban o ( ) System located at -n f)l V— l00U4NA_Q_ \/G #1.01 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to i comply with Title 5 and the following local provisions or special conditions. r Provided: Construction must be completed within three years oi'',the da Qby this e Date:_ Approved Town of Barnstable Regulatory Services 11 Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862A644 Fax: 508-790-6304 Installer&Desia ner Certification Form Bate: Designer: �cTFpgdF_'.T-nrnI.F A ND A SSOC AYES Installer: 42 CANTERBURY LANE Address: EAST FALMOUTH.,MASSACHUSETTS 02636 Address: On %o-- -8�rf was issued a permit to install a (date) ( ) septic system at � o%1 10v_WL based on a design drawn by, ( dress) Z c dated (designer) - .a O v I certify that the septic system referenced above was installed substantiality according td the design, winch may include minor approved changes such as lateral re ocation-of tfe distribution box and/or septic tank. o I certify that the septic system referenced above was installed with majo, changes (i.e. greater than 10' lateral relocation of the SAS or any vertical-relocation of any component Of.the septic system)but in accordance with State&Local Regulations.-Plan revision or certified as-built by designer to follow. _ r ti _r BRUCE �.: G lc�9 cc_'s i 1 S Signature) MURPHY No. 749 9c�1STERE� (Design 's gnature) :`..l.(Affix I?esigner's Stamp Here) PLEASE RETURN TO BARNSTABLE:PU91J. .-7 �.�WF WN. ..CERTIFICATE OF COMPLIANCE WILL NOT- BE..ISSUED: O HIS"']FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTARI;EP FCC::gEAI,TH DIVISION. THANK YOU. Q:Health/SeptidDesiper Certification Form i3-G G-3 _ w 0 m 6� 0" U 7-7FS e° 0 -40 0 ` . f p G 11. o i = - Bk 20362 P9241. 7192 10-13-2� 05 a 03 _ 1 HP 21562-42.res REVISED DEED RESTRICTION WHEREAS, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, is the owner of a certain parcel of vacant land located at 50 Jennifer Lane, Barnstable (Hyannis), Barnstable County, Massachusetts (hereinafter referred to as "Premises"),. under a deed from Oliver Chisholm, et al, dated October 1, 2003, recorded in Book 18038, Page 124, and under a deed from Jeffrey Pepi, dated September 29, 2005, recorded in Book 20311, Page 20. Said land is shown as LOT 28A on a plan of land recorded in Plan Book 602, Page 84; and WHEREAS, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, as the owner of the premises, has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit from the Town of Barnstable Board of Health and to obtaining a building permit for the premises; and WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to issuing a permit for the installation of a septic system on the premises and authorizing the issuance of a building permit for the construction of a single family residence on the premises requires that the agreement for the restriction on the number of bedrooms in any house constructed on the premises be recorded with the Barnstable County Registry of Deeds. NOW, THEREFORE, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, does hereby place the following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. The premises may have o s /tTvcted upon the lot a house containing no ( the ) more than two (2) bedrooms, unless an/alternative system is approved by the Board of F: 1 . 21562-42.res Health, in which case a house containing no more than three (3) bedrooms may be constructed on said lot. This restriction shall continue in full force and effect until such time that construction of a residence with greater than two (2) bedrooms, or three (3) bedrooms if in ovative/ /("I/A") an alternative system is approved by the Board, is allowed as of right. S THIO RESTRICTION REVISES AND SUPERCEEDS THE RESTRICTION DATED SEPTEMBER 1, 20049 RECORDED IN BOOK 18997, PAGE 310, WHEREIN THE PREMISES WAS INCORRECTLY DESCRIBED AS 42 JENNIFER LANE. IN ADDITION, PARAGRAPH 1 HAS BEEN REVISED TO INCLUDE THE RI 1"jI"I innovative/ A,,T O CONSTRUCT A 3-BEDROOM RESIDENCE IF AN / l' I/ / ALTERNATIVE SYSTEM HAS BEEN APPROVED BY THE BOARD OF HEALTH. For title of M. Kempton Nickerson, see the following deeds: Book 18038, Page 124 and Book 20311, Page 20. Executed as a sealed instrument this ' day of October 2005. OF M. Kempton Nickerson COMMONWEALTH OF MASSACHUSETTS Barnstable County On this // dayof October 2005, before me, the undersigned notary public, personally appeared M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, proved to 2 21562-42.res me through satisfactory evidence of identification, which was jPer50 jQ)Jk k nOW)? to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. Alot J. Notary Pubic Notary Public ,BEk 67. ScHU4Z COMMMeeb Of mmahaft My commission expires: /�� 1Zo�' My Conxrision Evirm Aug.11,2011 / / 3 LAW OFFICES OF ALBEIT J. SCHULZ WILLIAM CHARLES PLACE 7 PARKER ROAD OSTERVILLE, MASSACHUSETTS 02655-2034 TELEPHONE(508)428-0950 FACSIMILE(508)420-1530 ALBERT J. SCHULZ MICHAEL F. SCHULZ aschulz@schulzlawoffices.com mschulz@schulzlawoffices.com October 13, 2005 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE. Jennifer Lane Our File: 21562 Dear Sir or Madam: In connection with the applications of Daniel C. Wood for building permits for Lot 5A (41 Jennifer Lane), Lot 6 (49 Jennifer Lane) and Lot 28A (50 Jennifer Lane), I enclose copies of the following instruments: I 1. Deed Restriction for premises at 49 Jennifer Lane dated September,1, 2004, recorded in Book 18997, page 312; 2. Revised Deed Restriction for premises at 41 Jennifer Lane, dated October 7, 2005, recorded in Book 20362, Page 238; and 3. Revised Deed Restriction for premises a"f 50 Jennifer Lane; dated October 7, . 2005, recorded in Book 20362,page 241. _ " "Q— These restrictions have been reviewed and approved by Thomas McKean. If you have any questions,please do not hesitate to call me. Sincerely, c P ( Albert J. S 1z 7 AJS:cg Enclosures cc: Daniel C. Wood 4 A Bk 20362 P9241 -16F71925 10-13-2005 2156242.res REVISED DEED RESTRICTION WHEREAS, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, is the owner of a certain parcel of vacant land located at 50 Jennifer Lane, Barnstable (Hyannis), Barnstable County, Massachusetts (hereinafter referred to as "Premises"), under a deed from Oliver Chisholm, et al, dated October 1, 2003, recorded in Book 18038, Page 124, and under a deed from Jeffrey Pepi, dated September 29, 2005, recorded in Book 20311, Page 20. Said land is shown as LOT 28A on a plan of land recorded in Plan Book 602, Page 84; and WHEREAS, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, as the owner of the premises, has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit from the Town of Barnstable Board of Health and to obtaining a building permit for the premises; and WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to issuing a permit for the installation of a septic system on the premises and authorizing the issuance of a building permit for the construction of a single family residence on the premises requires that the agreement for the restriction on the number of bedrooms in any house constructed on the premises be recorded with the Barnstable County Registry of Deeds. NOW, THEREFORE, M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, does hereby place the following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. The premises may have constructed upon the lot a house containing no innovative / ("I/A") more than two (2) bedrooms, unless an/alternative system is approved by the Board of 1 , y 21562-42.res Health, in which case a house containing no more than three (3) bedrooms may be constructed on said lot. This restriction shall continue in full force and effect until such time that construction of a residence with greater than two (2) bedrooms, or three (3) bedrooms if in ovative/ /("I/A") an alternative system is approved by the Board, is allowed as of right. 5 THIX RESTRICTION REVISES AND SUPERCEEDS THE RESTRICTION DATED SEPTEMBER 1, 2004, RECORDED IN BOOK 189975 PAGE 310, WHEREIN THE PREMISES WAS INCORRECTLY DESCRIBED AS 42 JENNIFER LANE. IN ADDITION, PARAGRAPH 1 HAS.BEEN REVISED TO INCLUDE THE RIGHT „'�'O CONSTRUCT A 3-BEDROOM RESIDENCE IF AN / innovative/ / ` I�ALTERNATIVE SYSTEM HAS BEEN APPROVED BY THE BOARD OF HEALTH. For title of M. Kempton Nickerson, see the following deeds: Book 18038, Page 124 and Book 20311, Page 20. Executed as a sealed instrument this day of October 2005. �,A 1QJL- M. Kempton Nickerson COMMONWEALTH OF MASSACHUSETTS Barnstable County On this 1/t�da of October 2005, before me, the undersigned not public, Y � �'Y personally appeared M. Kempton Nickerson, a/k/a Melbourne K. Nickerson, proved to 2 ._.._......atau.,•i....._.�a.::ad.::rz^aim'c.4,:.`a�::.:eik�s:%';.s.:�..r..,.�__.._�..,.........a...,..,.. ... .. .,.... fn:,. s 21562-42.res me through satisfactory evidence of identification, which was )oeps npw)7 to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. AJbW J. Notary Public AEe c7. ScH[/12- N Notary PubW Commomweeft of Mmwhusft My commission expires: My Commission F.,res A411,2D11 RA 1 z01) 3 Town of Barnstable P# v L o Department of Regulatory Services Public Health Division Date IABNSTAB(E. ` v M'o• 1639. 200 Main Street,Hyannis MA 02601 �0 Date Scheduled ��L� Time Fee Pd. ±� Soil Suitability sessment foY Sewage Disposal Z ''nn,A, , C /LIG� � G✓r - J ^ 4T • Performed By: WitnessedBy: •'/� LOCATION& GENERAL INFORMATION f�j Location Address q1 J e VM-'k f- 4✓o Owner's Name _I Address Assessor's Map/Parcel: / Engineer's Name 10!/+� a-7 a- i �2 7 t/ REPAIR Telephone yaU ��s NEW CONSTRUCTION 11 Land Use t.C�pU d Slopes(%) Surface Stones �- ft Drinking Water Well ft Distances from: Open Water Body ft Possible Wet Area__ Drainage Way ft Property Line !_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to•holes) �tur 2 r 1 v 75 11 � 13sr- { JLS J � 2 3S e f\ 75. 10 i 7 S' 13'e&A(AI re2 Lrovt -e Parent material(geologic) t4 v-22 Depth to Bedrock 3�u Depth to Groundwater. Standing Water in Hole: NoIV e ' Weeping from Pit Face Estimated Seasonal High Groundwater ` DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: in. Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft: Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date " Ky Time'# Observation Time at 9" Hole# 30" Time at 6" Depth of Perc q y�3c> Time(9"-6") Start Pre-soak Time'@ qlS� /�l� W�'er �0�12 • � 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:HEALTH/WP/PERCFORM - a DEEP,OBSERVATION,HOLE LOG Hole 17—/_ l Depth.from Soil Horizon Soil Texture Soil Color Soil Other ' Surfaca on,) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. �onslstenav °laaravell..._.._�_ $mower 4yNy SA C 7C) 5�6 NO C,vw DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other 1 Surface(in.) (USDA)- (Munsell) Mottling .(Structure,Stones,Boulders. Consistency %Gravel) t� /3VvLy sg w c- .. a a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other j Surface(in.) (USDA), (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ! •Y f . 3 • I - DEEP'OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color ' Sod Structure,Stones,Boulders. (USDA) (Munsell) Mottling Surface(in.) Consistency,%Gravel) r Flood Insurance Rate Maus ZCM C i Above 500 year flood boundary No_ Yes j Within 500 year boundary No_ Yes " Within 100 year flood boundary No*— Yes De th of Natural) Occurrin 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? C If not,what is the depth of naturally occurring p rvious material? t i Certification I cent n (h•l�4�1 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with d training,expertise and experience described in 310 CMR 1.5.01)7. the require , Date Signature Q:HEAI,TH/W P/PERCFORM t s PROJ..E T .TIT v.zt � :a? b:. t l 7� _f I s, 5 �> . - ,.•rs�.. Z —...._S I�'��-oG�•- C .r t �J ,� -..—_._.... �- .Jf�Et-- .�'�:^•�. . PREPARED_ FOR - alb � 6 - ii W4; i Central Construction Company, -in 9i Steve Devlin •President pV ! 261 Blackthorn Drive•Marston Mils,MA 02648.509 420-1340 _ SCALE< J - ;' o n\ r { DATE DWG NO: U't'� i DESIGN 6GJL l• ` - ._...—._ •1 - ... ..----.. .._._.. CHECK DRAWN . JOB NO, SHEET OF Top Foundation Elev 48.0' Vi IV, 7" 'S' .hia6rb Crade II 47 t 1/8' to 1/2' llasbed Stone 9 3' Mck VMRT" 6" bW ELl�l ll V Rabb Grade El 47't ilLSER 44.35' " / Foundation Die. o Die l�+s ? ?1TITf 6 Design By others 8 5'� ItLSER El. 44.00' ' Et 41.5' Io' mia. 14'min V EL INV EL ° ° o ..m.. .� e ®®e m •. El. 41,17' INV EL INV EL 3 EL 43.37 43.17' 43.92' Below Flom Lice/- 43.6T 43.57' 8'stone, 4, 3/4' - 1 r/2" )rashea stone 0 28 +' Liquid Level 48' 4 lZ u 4 HOLE DISTRIBUTION BOX � Ka m -- 25' Duans o Pond PRECAST REINFORCE CONCRETE DISTRIBUTION BOX PROPOSED LEACH TRENCH °j �b LOCUS 1500 GALLON SEPTIC TANK Install on a level base USGS Ground Water Adjustment = 3.9' Minimum wall thickness = 2 Q ,� Minimum inside dimension = 12" USGS Adj. High Ground Water El 32.1' Outlet .inverts shall be equal to each other and at 4 ° o° Fawsetts 1500 GALLON REINFORCED CONCRETE SEPTIC TANK » q �� Pond 2 minimum below inlet invert. Bottom of Dee Observation Hole El. 35.9' Minimum Construction Materials Per 310CMR 15.226(2) p Tees shall be constructed of Schedule 40 PVC and shall extend a The distribution lines from the distribution box shall all have @a� equal inverts as determined by flooding the distribution box to L2.83 dry minimum of 6 above the flow line of the septic tank and be on the height of the distribution line .invert after all lines have _Y' the centerline of the septic tank located directly under the been sealed in place. 34" :a•", " clean-out manhole. d m The inlet pipe elevation shall be no less than 2 nor more than 3" Invert adjustments shall be made by filling with. durable and 4 4 L.O C` T_T,S' MA.P above the Invert elevation of the outlet pipe. nondeforma ble material permanently fastened to the line or --a-] 5e" Septic, tank shall be installed level and true to grade on a level, reconstructing the lines until all inverts are of equal elevation. Number of Trenches - 1 stable base that has been mechanically compacted and on which Number of chambers - 2 6" of crushed stone has been placed to ensure stability and to prevent settling. PROPOSED LEACH TRENCH - END VIEW N.T.S. ASSESSORS DATA: Septic tank shall have a minimum cover of 9': 271 - 168 Two 20" manholes with readilyremovable impermeable covers Install Two ton Gallon Units A 48 with Four Feet of Stone at Sides and Ends of durable material shall be provided with access ports FEMA DATA ZONE "C" The outlet tee shall be equipped with gas baffle. Design Data: SUBDIVISION LOT 28A _ T RB TPl El. 46.8' TP2 - El. 47 4' � Two Bedroom - 2 X 110 gpd - Required Flaw ZONING DISTRICT-0 0 BM Top CB g OVERLAY DISTRICT` WP Elev 50.1T J 09 N No Garbage Disposal BUILDING SETBACKS: 1,10 , Organic »O„ Organic _ _ - Datum. NGVD - �. -_. ._r ,,r.,.,r.,_.��, _ . Qem vtfl/Po1ery - . .38 ._ _._ h m ._.,, _ ._ 651 _ m' = SIDE AN ep J.,... ., � ..;�r~ l r�.z��.���c�.E x_�a�� r�"_:xt ,� �Ir�epth D REAR 10' 3 „A O [25' + 25' + 12.83 + 12. 2.83] x 0 - 151 A SL IOyr 6/2 I Dyr 6/2 ( �� 2'30 , 25' x 12.83 = 320 „ SL „ Ck 5 5 l N35 471 x D. - REFERENCE PLANS:• B LS IOyr 5/6 24" B LS 10yr 5/6 24" �d88 52 / 74 - 348 GPD Total Design Flaw BOOK 293 PAGE 26 SUBDIVISION MODIFICATION PLAN LOT 28A -- 74' g ��s 0' Note. OF JENMFER LANE FOR s ems- 1 JEFFREY PEPE AND KEMPTON MOMSON 30" 20,838fsq.ft.,,--, ti`�' a A Two Bedroom Deed Restriction is Required. SCALE 1" = 60' „C„ „C„ 50 / 11 �'�� � ,... Locus. Falls Within a Water Protection Zone. DAM. 11/18/04 REV 07/25/05 Proposed-----10 o 0 1P 1 �a MED. HER 50 / 1500 GPBon Tank �' / 46 SAND -_l0yr 7/4 SAND 10yr 7/4 ° TP 2 � seato 16, w 52 �' iJ J% h o ��s r' DO BRUGE 138" �nF 138" / `'. n�lkrir Ftv >; - El 35.3' El. 35.9' <� - 73' , � t �� v3 No Water Encountered No Water Encountered fr° g• ea `, "; TE4` 521.048 / P Iq 744 � Soil Log # USGS Groundwater Adjustment: Performed By.- Bruce Murphy Zone D c, ,�, BOH Dave Stanton Well - AIW 230 N 40 8 50r i ROp05 _ , , �. a � p A� � Sit e Plan o f Lan d Date: August 10, 2004 Adjustment 3.9- El. 32.1 _ w 1 i P / 44 Pere Ra te.• C2 Min/Inch Prepared For- See Lots 4 and 5 for Water '" JJ Adjustment-Pere Date 0113%4 46- '� a.9� HO USE 50 J�'NNIF�'R LANE' GENERAL CONSTRUCTION NOTES �i _ f In 1. All the workmanshipand materials shall conform to REP P Title 5 42 �..; - �• ' Hyannis, Massachusetts and the Town of Barnstable rules and regulations for the subsurface disposal of se wage. 44 j� Scale: 1" = 30' Date: August 2, 2005 2. At least one access port over tank tees shall be accessible - -� within 6" of finish grade, with any remaining access ports brought 40 Prepared By 42 � Stephen J. Doyle and Associates to within 6" of finish grade. 42 Canterbury Lane, ,. - y E. Falmouth MA 02536 3. All components of the sanitary system shall be capable of Telephone.* 5081540-2534 withstanding H-10 loading unless they are under or within 10 ft 40 R vi s 3 c� z B Z o k of drives or parking. H--20 loading shall be used under or within a 10 ft of drives or parking unless noted Plastic equals may be GRAPHIC SCALE used in lieu of all recast units 4. The excavatorpontractor shall verify the location of all site 30 ° 15 120 utilities prior to any excavation, and shall be responsible for all matters relating to electric easements. 5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0. 02 slope. IN FEET 6. Any masonry units used to bring covers to grade shall be i inch = 30 ft mortared in place: 1 10-12-05 Revise Hse Numbers 7 Finish grade shall have a minimum slope of 0.02 ft per foot. No. I DATE DESCRIPTION