Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0112 WAYLAND ROAD - Health
112 Wayland Road Hyannis R. 3 �. A 271 zap .r C I i a B , rl 1 1 e 9 N k O A tl I1 e TOWN OF BARNSTABLE /A LOCATION/�� �✓��L�r�•d �� SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) NO.OF BEDROOMS •3 OWNER eet 2Z PERMIT DATE: 5- -,a/ COMPLIANCE DATE: ��- Separation Distance Between the: ~® ui,(TEol e 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 I: _ 14 � - S3 aEE �/ 1r/� a,CA 4. Q© */00 No. I� YJ I Fee d THE COMMONWEALTHi OF•MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatiou for 33fgpoga1 *pgtem Cougtructiou Permit Application for a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) ❑Complete System Andividual Components Location Address or Lot No.','�/oZ d? Owner's Name,Address,and Tel.No. Assessor's Map/Parcel c47.7/ — O� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. k er7 e/7 Type of Building: �y Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building 40 C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '�.3® gpd Design flow provided 3 �® gpd Plan Date Number of sheets 7 Revision Date Title Size of Septic Tank �iJ°T � /� d'el Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ► Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date ✓` ' 7-0 IZ Application Disapproved b Date for the following reasons Permit No.7 0(Z— hs ( _ Date Issued I 'Z o 1 Z .No. l �(J I y Fee { 0400 �/ THE COMMONWEALTH1QFWikSSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF.BARNSTABLE, MASSACHUSETTS =x {'3� ZIpplication for, XDi$tlOgAr *pgtem Cron,5truction Permit � Application for a Permit to Construct( ) Repair(Y� Upgrade( ) Abandon O ❑ Complete System Individual Components i Location Address or Lot No'��oZ d0fd Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J � l /mil L E�o�i� 77 3' o)v7 �d'1//O 467" Type of Building: Dwelling No.of Bedrooms 17 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building �FZ�✓ No.of Persons Showers( ) Cafeteria(' ) Other Fixtures i Design Flow(min.required) gpd Design flow provided 1<_1147 gpd Plan Date 7 /-. Number of sheets Revision Date Title Size of Septic Tank �i l'TG' /� �' Type of S.A.S. Description of Soil c��� ®��✓� i Nature of Repairs or Alterations(Answer when applicable) i •� I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ki -accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of .. { Compliance has been issued by this Board of Health. Signed Date - � 1 Application Approved by Date ,j_�_Z p 1 Z Application Disapproved Date for the following reasons Permit No. 7 o 1Z — ( Date Issued T /Z I _/'Z o 1 Z THE COMMONWEALTH OF MASSACHUSETTS y. -BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at zx may, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,7a12- /b dated JT 21 ZOIZ . Installer 0f,w GC�OG�jL Designer et_qu 1//jam .�/jj,��0�✓ �f #bedrooms Approved design^fl\o1 .3 �O gpd The issuance of this permit shal not be co 'strued as a guarantee that the syste `will functP a de Ng d. Date O�� � ' ,. Inspector ------------ No 20 2 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS )Di5po5al *p5tem Con5truction Permit Permission is hereby granted to Construct ( ) Repair ( A-T-***Upgrade ( ) Abandon ( ) System located at /� �l'//�y.G�4/✓® Qt',p and as described in the above Application for Disposal System Construction Permit.The applicant recognizes hislher duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this Date 021 2a 1 Z Approved by 1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director MUMABLE &9,MA ` Public Health Division y 4'ArF1639. � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 50 -862- 644 Fax: 508-790-6304 Date: �7 2 � AS Sewage Permit#ion ��� Assessor's Map/Parcel x7l 3 ®/ Installer&Designer Certification Form Des i ner: � 1 WI 1 g t � �� � 't�� . Installer: Address: �'yc�t cl' ^l } Address: . 1'�Il�1gLl'�,��•,� '"�1.14�stilc.,�hu�tS On LM6�)p'.eM(.."vas issued a permit to install a (date) (installer) septic system at �W!!�,l-JA(ui c7 based on a design drawn by (ad1dress) �' ! ,�b• dated (designer) ►' I certi that the septic stem referenced above was installed certify p Y substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major 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 P- ''tions. Plan revision or certified as-built by designer to follow. Stripout (if rp- acted and the soils were found satisfactory. p`�� P,,�h M,qs� oDAVID L. can '• (Installer's Signature) 2 MASON —r 9 Na.106fi o Cof . (Designer's Signature) PLEASE RETURN TO BARNSTABLE PUBL,._ OF COMPLIANCE WILL NOT BE ISSUED UN i bL IJU p U L tits r O IVI AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsWesio ercertification fon.doc Town of Barnstable P# Departiment of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled / Time f Fee..Pd. FoilN/Suitability'Assessment for-rSevage Disposal Performed-By:1�2 1"1����(/vV�C Witnessed By: '�' 4� - LOCATION& GENERAL INFORMATION Location Address��a ����(/✓� ©2.D Oj��j4/mOXrOwner's Name Address Assessor's Map/Parcel: �'� a O Engineer's Name 44A-Ae 61i1iA_ro^' NEW CONSTRUCTION REPAIR 6� ob Telephone# . Land Use: Slopes(96) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SI{ETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Oroundwater. Standing Water in Hole: •�� _ Weeping from Pit FACe Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Deptll to soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment f. Index Well# Reading Date: index Well level Adj,tictor- Adj.Groundwater Level,, PERCOLATION TEST bate Thne Observation Hole# Time at'4" Depth of Perc ! r✓r K__ Lt Time at G' ON t ' Start Pre-soak Time @ Time(9"-G") • End Pre-soak r Rate Min./Inch G`' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data Tti 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:ISEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i ten y%-D veil D- G w DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grave OBSERVATION DEEP . N HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) j (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency. Flood Insurance Rate Map: • boundary Above 500 year flood bo d No_. Yes Y arY ---- Within 500'year boundary No ' Yes Within 100 year flood boundary No.✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv'o terial exist in all areas observed throughout the area proposed for the soil absorption system? %r If not,what is the depth ifna rally occurring per ous material? �1 Certification I certify that on tip (date)I have passed the soil evaluator examination approved by the Department of Environillental Protection and that the above analysis was perform d by me consistent with . the required training,exp tise a x eri ce described in 310 CMR 15.01�. Signature k�-- Date 2 1 2o�2 Q:\S.EPTICTERCFORM.DOC Barhstab Town of Barnstable �p SHE - ERegulatory Services Department a- BARNSTABLE�y MASS. �� Y Public Health Division �ArfD MAt a �2007 m :200 Main Street; Hyannis MA-02601 . Office: 508-862-4644 '"�*, Thomas F.Geiler,Director FAX: 508-790-6304 Thorrias A.McKean,CHO - V CERTIFIED MAIL #.7006 0810 000.0.,3524 5515 January 18, 2012 Ms. Heather Miller 41 ., Kolstar Realty Services P. O. Box 1780 { a Sandwich, MA 02563 w{ , RE; 112 Wayland Road i ORDER TO"COMPLY-WITH STATE ENVIRONMENTAL;CODE, TITLE 5, The septic system located at412'Wayland Road,Hyannis, MA,was last inspected on r. 1/5/2012, by B & B Excavation,Inc., a certified septic inspector for the State`of Massachusetts. µ The inspection,of the septic system showedythat:the-system" Fails"under the:guid'eline§ ,,,. of the 1995 TITLE:54310.CMR,15.00) due to the following • Hydraulic Overload. � j y, 4' c� x E � • System,is in:need of'rep'air You are ordered to repair or replace the septic system within sixty (60) days frorrl+tlie date you receive this notification. Failure to`re air/re" lace the,se tic s stem with the deadline eriod will result in future p p P y P ,,°enforcement action: s, a. u :PER ORDER OF THE ARD OF HEALTH Thomas McKean,R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\Town of Barnstable.doc � � ��s ��� — Ny�,ot�c o Je� lo� 1 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 forms A. Genera_ I Information ' on the computer, 7� use only the tab 1. Inspector: key to move your cursor-do not Ricky L. Wright use the return key. B & B Excavation,lnc. ,y Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S 14595 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 y � 1/5/12 Inspector's Signature Date The,system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under I the same or different conditions of use. .� t5ins•11/10 Title 5 Official Ins action Form:Subsurf a Sewa lof�7 P ge Disposal System•Pa e 1 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. Cityrrown 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 15.3.04 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is H required for every y annis MA 02601 1/5/12 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): ❑ 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): t 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 p ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt'marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage -Disposal System Page 3 of 17 P Y 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 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 Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. Citylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 ears usage d n/a 9 ( Y 9 (gP )): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2010 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 V❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required Hyannis MA 02601 1/5/12 page. City/Town 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: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool .El . Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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: 1982 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: El cast iron ® 40 PVC ❑ other(explain): >20 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection, building sewer appeared to be in good condition with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene , ❑ other(explain) r - If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 52 x52 x86 Sludge depth: 1' t5ins•11110 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 M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 19" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection, septic tank appears to be leaking water level was equal with seam on tank.There were also signs of solids on top of concrete baffel due to failed S.A.S. at one time.Staining above outlet invert. 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 scum of to to of outlet tee or baffle P Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 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 �M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. Cityrrowri 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): e, 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. Cityfrown 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 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.): At time of inspection liquid level in d-box was equal with outlet. D-box showed signs of deterioration and solid 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): At time of inspection leaching was dry, however showed sign od staining above invert Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert A Depth of solids layer Depth'of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 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 M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 �3 0__3> A 3 f 4if':- , F t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 r ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Wayland Rd. M Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated d >10epth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand augered hole threw pit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 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 M 112 Wayland Rd. Property Address Acwen Loan Services Owner Owner's Name information is required for every Hyannis MA 02601 1/5/12 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 h 1 Z1 .o COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF EN'VIRONKZNTAL PROTE`CTIODT` TITLE S t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM FORM_ PART CERTIFICATION ' Property Address: F E B 1 5 2005 Owner's Name: TOVm Ui 3A rVSTABLE Owner's Address: HEALTH DEPT. Date of Inspection: q n✓1 i - ^ O 6�/ '� ' __�`l t , specto leaseprint / ' �oJ r� �S v/�" I-. CE! _ 'Z O 1_ Name of In r. OT � Y Company Name: E Vi O , 7^ r C � Mailing Address: O oX / Telephone Number. Sod CERTIFICATION STATEME}vT I certit'y that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete ase�fthe _ofthe. T training and experience in the proper function and maintenance of on site se ��d sn my approved system inspector to Section i3.340�Tide 54310�MR 1�disposal systems.I am a DEP . � �• system. Passes Conditionally Passes Needs Further Evaluation by the Local Fails Approving Authority Inspector's Signature: c _ ' 0 ' Date: The system inspector shall DEP)within 30 days of con �P3' s °rts°sheApQrnnngb (Boar d of Health or inspector and the mapectr systemis a shared system or has a design flow of 10,000 $pd or Seater,the' j3'�m,=mer.sLall subshe�epaR�o.the DEP.The original should be sent to the system owner and copies sent authority. to the buyer,if applicable,and the approving Notes and Comments """This report only describes conditions at the time of ins time.This inspection does n pection and under the conditions of use at that conditions of use, err Page 2 of 11 O''FICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE RiSPOSAL SVSTEM E%PECT PART A IONFORM CERTIFICATION(conm Property Add: 1 V0 I-A h �� Owner: Date of brspe on: 'nsPecbion Summary: Check A^--C,0•or Z/A.LWAy6 to'mplebe ag_ofSec4jona A. Stem passes: I have not found any information which indicates that�,y of the failure 15.303 or in 310 C va 15.304�sL AW4xitexiscriteria descnbed in 310 CMR uatedawejadicaW below. Comments: IL Sy Conditionally pan"; One or more system components as descn'bed in the"Conditional repa ured.The system,upon coy efthe�aocmeat or »section need to be replaced or 'as-aPP by 1he-Bmda(HeaW win nass Answer yes,no or not deterexplain. mined(y,N,ND)in the the following " statements.If not determines Please The septic tank is metal and over 20 years old*or the unwind,exhibits substantial ion ar sic tank(`�' .metal or not)is existing tank is replaced with a complying septic a fades is imp.Sys will if the *`�metal sic tank will psi� AnAlf't approved by�Board of Health. indicating that the tank is less than 20 years old is��, 'not a�if acute of Compliance ND explain: Observation Of sewage backup or break out or hi obstruc l of Board or due to a,blolmn,seed or unev+ert g►static w level in the distr�i on box due broken or ted to card of Health): �ibutioaSystem will pass insPection if(with b7o=PiPe(s)are replaced obstruction is removed &%fibution box is leveled Of replaced ND explain: Pass The. red Pumping more than 4 on if(withtimes a year due toroken or approval of-the Board of Health): obstructed P`Pe(s)•The system will broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFF1'CIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE RjSPOSAL&VSTEM DWWMN i PART A CERTIFICATION(continued) Property Address: /6i,o. a,� Owner. Date of C ib r Evaluation is Rapired by the Board of Health: Cond" exist:which is farhng to protect public �n the Board of Health in order to determine if the system 1• System will Pass unless Board of Health determines in accordance with 310 system is not functioning in CMR iS,303(1)(b)that the and Me env f2 Cesspool or privy is within 50 feet of a surface water . — Cesspool or privy is within 30 freq of a `bM*"MTeget8t0d wetwd er a Bait marsh 2. System will fail unless the Board of Health(and Public Water Supplier,system is functioning in a moaner that Pests the Public health, and environment,ff an ce that the The system surface water has a septic tank and soil absorption ristem(SAS)and the SAS is within 100 feet of a supply or tn'batlrry 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 Oink and SAS and the SAS is within 50 feet of a private water well. has septic tank pnwate supply� used to determineand SAS and 100 feet bat 50 feet distanoe or more from a "This Mtem passes if the well water bacteria and volatile ems,performed at a DEP certified laboratory,for coliform o%Mc Qompounds mclicates tbatthe well is fm from pollution from that facility and the presence Of ammonia nitrogen and nit[ nitrogen failure criteria are triggered A copy of flue is equal t0 or less than 5 must be attached to this form provided that no other 3. .Other; Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOL SUBSURFACE SEWAGE DISPOSAL SYSTEM IN PEA ASSESSMENTS PART A ON FORM RM CERTIFICATION(cogdnued) Property Address; Owner. n G vi Date of L,aYeca�on. _ or D. System Failure Criteri4 APplicable to all systems; You ZVS indicate`yes"or`bo"to each of the following for an inspections: Yes No ./ of �into fty or system oomponM due to overloaded— — �or pending of effiuent to the surface of the oaf or clogged SAS or gged SAS or cesspool ground or surface due to an Overloaded — Static liquid level in the ended or ` 1 distribution box above outlet invert — �d due to an overloaded or clogged SAS or depth in cesspool is less than 6- below invert or available volume is less than 1 �f times Required PmVing move than 4 times in the last year NOT due to clogged or �'flow, — �portion of the SAS,cesspool orwaterel °��Pil�(s)•Number PriW is below hi Portion of cesspool or privy is within 100 feet of a or to water supply, bntary to a surface — "'A PortioPortin of a f a oe cesspool o�is within a Zone 1 of a public well. `! �y portion of a cesspool or d Or�s within 50 feet of a p supply well. sly well with no Pewater quaW less than 100 feet but greater than 50 feet from a private water performed at a DEp certitiedeal� j& MUS system pry if the well water indicates that the well is free fl oor laboratory,for coliform bacteria and volatile o a"yds' nitrogen and Pollution from that f rganic compounds Am NNW to or less than S ammonia fired.nitrate of the must be a Min,provided that oher fire cr ' Dashed to this form.] rw (YMWO)The system fr L I have described in 310 CUR 15.303 the termined that one or more of the above failure criteria exist as Health to determine what will be necessary to correct the fl.m owner should contact the gad of LargeTo considered a 1 aeft with 1 arge system the system must serve a f You must indicate either a design Now of 10,000 gpd to 1S,000 (The folio �ca or moo"to each the following: �cnterra ap*to LVVe systems in addition to the criteria above) ye no the system is within 400 feet of a surface� 1Qng n water supply the system is within 200 feet of a tn'butary to a surface dnnlring water supply tj the system is one It of a 1ocated in a nitrogen sensitive area(Interim Wellhead Protection Area— supplypublic water w� IWPA)or a mapped If you have answered»yes"to question in "yet"in Section D above the Section E the system is considered a significant s'l;�cant> under Section E or failed has failed The owner or oper�or of arty threw or answered 15.304.The system owner should contact under Section D shall q)Mde m zge system considered, �e�Qnal office of the De m'n acc with 310 CUR Page 5ofll OFFICL&L INSPECTION FORM_NOT FOR VOLUNTARY ON A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PST B FORM CHECKLIST Property Addm : Id- (�/� G� /{d Owner. G n tom- Iry J Date of o Check if the fakwin have been dune.You most inlic�te as to each of t>�folio ' Yea o information was Provided by the owner,° or Board of Health —::��Were any of the system compote Pumped out in the previous two weeks — _ Has received normal$ ows in the Previous two week period — large volumes OfWAffbeen introduced to the Were as built p�of the system ����or as part of this inspection and (If they were not note as N/A) Was the facility or dweltiig inSPe.ted for signs of sewage back up Was the site mspected for signs of break out Were all system components,excluding the SAS,looted on site Were the septic tank Of tees,material afc onstnjMc a, a����� faah meted for the cow Was the hCagy o aand and depth of scum maintenance of nt from owner)provided with information on the proper Yes/ The,*e and location of the Son Absorption System(SAS)on the site has been d based on. information.For example,a plan at the Board of Health, Determined in the feW(if >s n�ptable) p�,8;15.302(3)(b)]°f the fidhure criteria related to Pa ��Part C issue won of Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INS ASSESSMENTS C'I'ION FORM PART C SYSTEM/INFORMATION Property Addrts; go H d A'd Owner~ q A r 6 O r Date of RESIDENTIAL FLOW CONDITIONS Number of bedroom(sign): DESIGN flow based on 310 C1bIR 55.203N(ffo�of bedrooms(actual): 3 G Number of current residue: 2 ( fie: 110 x of bedroom): 33p Dom residence hue a is L%nxkY on a swvap�el' (yes or no): �b e Lau,xhy systemmeted if hvdj (yes or no):�v[if yes inspection nequ Water meter Seasonal (Yu no): /�,d I �p P�(y ):Lf/ e(last 2 years usage(gam): Last date of ocxapaacy:_C A/Y 1 COMURCIAL'MUSTJUALType of m*hsbmm.- Design flow(based on 310 Clem 15.203):_ Basis of design flow(seats/persor�s/ �.d Gwapresent(yes or no).— ftetc.): ding tank IndmW (yes or waters " the Title 5 sy=(yes or no): Last date of occupancy/use: OTHER(describe.): Pumping cords GENERAL�RMATION Sou Was system part W �� — ® (,✓Itie the (yes or ): R volumePwRx& v—� assoon --'�" How quantity mod? TYPE SYSTEM Mtem Single boon box,soil abso � _Overflow cesspool _Privy _Shared system(Yes or n )(if Ys attach pmgys mspechon o �e )technoloB3'•Attach a copy of JtfioWn Tight tank _Attach a�Y of the DEP approval onntract(to be —Other(describe): Approximate age of all conIP00ents,date instilled(if ) j a source of u�fornwon. O Were sewage odors detected when arriving at the site(Yes or no):�� Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C l / SYSTEM INFORMATION(cow Property Address: G �.✓b v Rct Owner. r v Date of Inspechoa; _ ®5 BUILDING SEWER(loc�on site plan) Depth below / Materials Of o Distance from private water supp Mn ly well or suction C—�(explain) Comaa rrts(on condition of' hue: venting,evidence of leakage,etc.). SEPTIC TANK: _(locate on site plan) Depth below grade: Material Ofconstruction // _cowrete metal--fiberglass_polyethylene If tank is metal certificate) list age:— Is age c09finned by a Certificate of Compliance es or (3' no) _(attach a copy of Dimensions: Di�from of sl �P / ,u to Bottom of outlet tee or baffle: Scum thickness; Distance from top of scum to top of outlet tee or baffle: How�fi�bottom Of scam to bottom of dimensions determfiw& oud tee o�bad Coninients(°u Ong recommendations,inlet and olrtl ' baffle c � to outlet inverk7i of l ,etc. tee or a co ition,structural integrity,liquid levels H.N "' ✓Ie� ). ry,e, GREASE TRAP.z—Valomte on site plan) Depth below grade: Material of construction metal ff (explain): —00ncrete oerglass_polyethylene_other 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 baffl— e: Date Mast pumping Comments(on puoi g�mmendations,inlet and outlet tee or baffle conditio as related to outlet im M evi&v=of leakage,etc.): n' gntY,fiQuid levels Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addn= l� % IUn d t2ot Owner: Date of TIGHT or HOLDING TANK;_jZ(tank must be pumped at time of inspection)(locate on site Plan) Depth below grade: Material of construction concrete metal fiberglass—polyethylene other(eaplain): Dimensions: Capacity: pallonc Design Flow t ,day Alarm 1 (yes or no): Alarm level: Alarm in working order(yam or r Date of last punting: Comments(con&ion of alarm and float switches,etc.): ------------------- DISTRIBUTION BOX: ./ (if present must be oPened)(tocate on site plan) Depth of liquid level above oudd invert: l7 0/✓"e- Commen_is(roe if box is level and dimi1i Lion to outios ��► d leakage or out of box,eta): �y eviance of solids payover,any�denm of o Sob cjr o C►'q L- PUMP CHAMBER 0ocaW on sae Pam) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition Of Pump chamber,condition of pumps and appartenancea,etc.}: I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: oL Ivv, V.d J nn ,l Owner. P��_ A ►�, Date of Inspect on: _ "7_ 0 5 SOJL ABSORPTION SYSTEM(SAS): (locate on site Plan,excavation not required) If SAS not Located explain why: 1/fig Pits,munber:1 �p �e — ��. T —. leaching cha mbeM number. x leaching galle*nuniber. leaching trenches,munber,length: leaching fief,number,dizneIIsions: overflow cesspool,mumber: innovativeWtemativesystem Typd%ame of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): % �/� a o L -s� 2 �i _ , 4e_ ' vac' ., .�.� Rio /'ce w �••G Ica,• y CESSPOOLS: oesspool mast be pumped as part of 1IISpeChOII)(lOCate OII Site plan) Number and configuration:Depth . —topof liquid to inlet invert: � . Depth of layer: Depth of scam layer: Dimensi Materials ns�cesspool: of oomstructi�: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of coMitionafvegetation,etc.): 1o(kCate on site plan) PRIVY: �(/ Materials of construct ion: Dimensions: Depth of solids: COma>ents(note wadi (w of soil,signs of hydraulic failure,level of pondh g,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cow Property Address: O� �,/ci �C,.� C1 /Q Owner: f O,Z 1, o] Date of Inspe lion: a_7 _ O SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal tD at benchmarks.Locate all wells within 100 feet.Locaate��epW*e lean �P13'enters tt emnce arks or OJC � 4-i�e A/ 62 Fage 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYS-TEM INSPECTION FORM. S PART C SYSTEM INFORMATION(contimu PnWrty Address: /- Gt 1� d � / Owner: h Oa G� Hate of Inspection; - _p SM EXAM Slope Surface water Check ceav �3 5 Shallow wells r Estimated ' �"�'�to ground water l�s f� _ � N M y r I � � i Please: (check)auo�r� useto dpler�the l end water elevation: Obtained from system design Plans on record-If chI date,.�Jrved site(abutting Pr �,� �on hole of design plat reviewed - site1-0 Checked with local Board of Health-explain; � ' 1� of SAS) 1 0 7�'` —Accessed USG innsfallers^(atbch matron) You mum hOw You establi shO the high water elevation: Ovy D or i3` OCo.�.p S O _ G 6 t 000 �0 0 0 0 '0 o (0 .0 .?I c.� C A 0 q `l V , I , t r l /•d riw z.o� p . �' c ZO iT. M/N. IY07E TA,V� OR E.4CH/1vG P/T A,rF MORE , TNoq.;/ /Z"BELOJV /O fT M/N.. :�,4ADE� fi 24'O/�1METER CONC'R.ET,E C'OYER Sj/AGL BE.BRO4ASHT TO 4S-JA l)E,��.;jy •EXTRA CA/VCRL'TC' 4"PYC PIPE' �. gLt V, GOYERS.yc7,� MI.V. P/TCN hrEAYY CA ST /.PON CO{iER Sf/.q L L !3E US EL7 _ �B•I��iQ FT /F/N OR/VEJVA Y A 2'J. MiN. CO/VC,eETE .:: irr- G .DOE CU YER CL-AN S'ANO -*"CAST N ST 2'LAYER * I P/PF P. e 3 ' MIN.P/TC/+I GAL. ° •" • .. . . . . . : Of 1/8 - 18, %4 Pc'R/?. SEPTIC TA/VX D/ST,. • ► • • • • . . `b• • WA 5HEO S7??/YE �, BGX o • e • • 8 • • • . • � ••e • ::., v� • 1 .•EFFECT/VL � • • �• 3/ 1 jjl _ DEPTH . WASJ/EO 574NE 4 7 cm) r .• . • . . . • . • J o • r ► e . • • • • • • • . P r o PRECA5 T SEEPAGE /NNGRT ELEf/AT/ONS �i r C_,1.11 C.!7 Jq�' G•'1 LJ'�A'/ s �. . • . . . . . • , 'o P/7 OR EpU/V. . L. 7-7 v /NYERT.AT df!/LD/NG S,D FT G FT. D/AM. hV4.-T .WEPT/C T.4MK �'`'t.5� FT V f T O/.4JN. C�5E&Ti4BULATION� OU71-RT SEPT/C 7*ANIA ` ff 4.3 FT E� /NL.ET O/STR/6f/T/ON BOX SECT/G/V OF GROUND W,4TEX TA9LE 0(/TLETD/37,4f,BIlT/0N BOX 93:9 1=7; /NLET LEACHING P/T 3.,2 FT .SE)MAGE 0/4SJW05A L .SYSTEM LEACHING PIT 7Ad411-AT/ON DES/G/Y G'R/TER/�l SCALE : %s" /'_a' _ D/MEN.SPON A 3 xr G/•LIENS/ON E{ 6 FT. NUJNdER.Ode 6E0R04MS GARCAGE DISPOSAL UNIT Nw SO/L LOG. TOTAL EJT/M.CTED FLOH/ 3 3 0 GAL.IDAY , SOIL TEST*/ SO/L 7l�'ST�2 SD/L TEST NUMBER QF 4eACR/N4 P/T.S_. I E-LEy, BSZ S/DFLrACHIN4 PER P/T f ------ DATE OF SOIL TEST. k .Sit PT. . � -�•--s _ O- z OoTTOM L.EgCN/NG PER P/>• �� - R.ESIJLTS h//TNESSED dY jR E • G� '`�,�-'-� 4 S4. FT. !U•�+.r'! .. PERCOLAT/ON /tR7*4ff G,C�S MIAI�/INCH TOTAL LEACH/NG •4REA �' _.iT. . t-p pso!� AEItCOLAT/ON RATE A&2 7EFit�✓ /y!!V. /NGH .QES6RYELEACN!/V6 AREA 2��5Q. FT. - Zp OF 0 A). Et��► -t9 Iv, ' L o 7 Q-fr 1/'.�E { RC18EirT l o A. `1ELU8 H u .1 t; A4(5ffSE ` No. A 29814 .Y�No.10951 p ti E��Q 4: �o�s�sr ��`%� . FL DREDGE ENG/NEER/l1/G.co ,INC o F 6�� F 7 3. 7_. 71Z A'IA/N S7' • HYgAIAI/.S. /NgSY, . :`, �,"ia-•Y�' yr I�. .NG GRO(JNtT, LN,4TCR` ENCOUNTERED CL/ENT: F o(� GRO.UAIa LVA.TE.Q AT JOB No: IRI�'`_= SKEET fL A. IL 7 Oe L., Of Mq. • -7 JOHN '��, I fl 4 -7 `\ <A� Qc ✓\1" I .LEGEND AA CERTIFIED PLOT PLAN r EXISTING SPOT ELEVATION Ox0ro, P,a,;-0�a ( EXISTING CONTOUR 0 --_ �� `,� 407 .. Y . FINISHED SPOT ELEVATION FINISHED CONTOUR 0 U n�o�sE N 4 IA! APPROVED BOARD OF HEALTH A pNo.10951¢�0 � ,�, �,�V 1 , *4 ASS40 .� ' �FSSIONA; SCALES J •'` DATE DATE AGENT AFL EDGE ENGIN££�ING CO. lNG CLIENT F'�A I CERTIFY THAT THE PROPOSED EGISTERE REGISTEftED J08. N0. BUILDING SHOWN ON THIS PLAN CIVIL LAND _ ,4 ,q.. ,. CONFORMS TO THE ZONING LAWS DR..BY __.=_. OF BARNSTAI LL , ,MASS. ENGINEER SURVEY R \1 T12 MAIN STREET J. T2. H YA N N I S, MASS. SHEET L OF �° A E AEG. LAND SURVEYOR . - - Z- c 10CATN SEWAGE PERMIT NO.k/ o Ah VILLAGE 5 INSL# L L ON,S NANI ADDRESS cl0 e01LDER OR OWNER . eO Pam! DATE PERMIT ISSUEDLV DATE 'COIMPLIANCE ISSUED �� 8�,� � 7h A �� �Z �. ' . . 82 qZ �� i �� ��� � Nof�------72------0 .............- THE COMMONWEALTH OF MASSACHUSETTS 0 BOARD OF HEALTH .271 Town OF...........DArnsta ......................I.................... .......... ......................................... Appl#atiou for Dhipoiial Works Tomitrurtion ramit Applica, 'on is hereby made for a Permit to Construct (x) or Repair an Individual Sewage Disposal System-at: ..........L 0.t_1............................ ......... Hyarmia - MA........................I.................. '/� ------ ....................... or Lot No. Location Address.• tLth...Ro.a.cls...HY.8=1s................. .q.ni.gorn Realty Trust ......7.6 ---------------------*...... Steve Lebel Address ................................................................................................. ................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..........3...............................Expansion Attic Garbage Grinder ( ) Other—Type of Building rarlah............ No. of persons............................ Showers ( 2) — Cafeteria ( ) P4Other fixtures -------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow.............515.........................gallons per person per day. Total daily flow..............3.30......................gallons. WSeptic Tank—Liquid capacit;.00.0..gillons Length ... ._._._..'.67..... Width. ....." ". Diameter________________ Depth..5- ..... 1-0. Disposal Trench No..................... Width-_....._......_._.: Total otal Length..____.__...._._.___ Total leaching area....................s q. ft. Seepage Pit No.___1---_--------- Diameter....61........... Depth below inlet...j6.1........... Total leaching area.....2......sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by....Eldredge...Engineering.......... Date..LL.V C,.ZJ............... Test Pit No. 1<....2.0'-minutes per inch Depth of Test Pit---'.1V------- Depth to ground waternone...encount Test Pit Ni ....minutes per inch Depth of Test Pit..N/&--------- Depth to ground water.._ V�jL........... H ......................................................................................................................................................... 0 Description of Soil.................Q!........2-9.........loam..&...topsoil--------------------------------------------------------------------------------- ................................................. ......me.dim yelloW---sand........................... U 7--------------------------------------------------------------------------------------- _12.......rae_d..._*.White---sand/traced...of..gi-ave.1/no...water at 121 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 TI I T E 5 of the State Sanitary Code—The undersigned further,agrees not to place the system in operation until a Certificate P�Compliance has been issued b the board of health. 911gned.................. --- ... e ApplicationApproved .. ... ...................................................................................... .... -—-------- Date ;peCt Dy the boa Approved ------------ i Application Dis Approved o he following reasons:.................................... the .......................................................................... ............................... ...... ........................................................................................................................................................... Date' PermitNo......................................................... Issued-....................................................... Date r7,20 � No. ..... .......... Fus.#_-p................_ THE COMMONWEALTH OF MASSACHUSETTS EOA RDV'OF HEALTH Town - ..... . OF.....:.:.. Ba xmo.table. AVVI a tlan for Btipu;5al 041i Tomitarnrttun VarAft Application is hereby made for a Permit to'Consfruct ( x) or Repair ( ) an Individual Sewage Disposal System at: wK ..........�Q t..#.. :•.� --....... •�-- ---•--••........: ........................I3y-a.zlnis•r---11�A------------------------r----------------- Location Address or Lot No. .. Capricorn Realty--Trilg.t ..................... 76.,..Falmauth.-Road ...H ---•----- e+. r�e. Owner Address w St Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) p`11 Other—Type of Building ..rf.knah........... No. of persons............................ Showers ( 2) — Cafeteria ( ) Q, Other fixtures •---••-•---••-•-•------••-•----- W Design Flow.............55.........................gallons per person per day. Total daily flow..............3�Q.....................gallons. 9 Septic Tank—Liquid capacit}lQQQ.gallons Length_$.:.�._.... Width..4_.10... Diameter................ Depth...5::.ag .._ W Disposal Trench—No..................... Width..... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..... ............. Diameter....6............ Depth below inlet....6�........._. Total leaching area.....266....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by-----Eldriedge...E2 Engineering Date---11-2.)r_$1.............. `_l� Test Pit No. 1.<.2:.0-minutes per inch Depth of Test Pit.....122 ....... Depth to ground water-none---enCoun-ter— N (z, Test Pit No. 2..._.. A...minutes per inch Depth of Test Pit__X/A......... Depth to ground water----2'3/a........... eQ ---•----------------------------------------•------ --.----.------------------------------------•------------------------------•------------------ ODescription of Soil 0 -...2�. 10 -•&.-• o e0. -1----------------------------•-------------------•--------•------•---------------- .................•--•--•••-•-•---•--••--• ...2.'-•• -•i•0•.•-----medium•--Y elloW--sand.-----------.......-•••••......-•••••_..... W --- -me_d. ft r at 12 ------------- ------------------------- n e ' UNature 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"TTIES of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate,-of Compliance has been issued b the board of health. %.`-..: ..- 1 f ate Application Approved,,By..�. • �' 12-�'2�' '''. ......._._ Date Application DisaPPro d f pr the following reasons:............................................................................................................... ,j Date PermitNo..................•-••-•------•--•-••................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................T.0wxM............OF............Ba M. gtA'b�i4.................................... (Irrttf iratr of Tompltanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( x) or Repaired ( ) by••••--..S.teve---Lebe.1.----•--•----------------•-•-----------------.-----. ------------------•------=----------------•-•----------------------•-----------•------•------------•-- J�1 Installer ��M1J l r ? n r at. Lot r --------------------- -------- -•-• -- _ -------------Hyann a i- p -•--------------------- has been installed in accordance with the provisions of TITLE?LE j of The State Sanitary Coda s escribed in the application for Disposal Works Construction Permit No.- ._"._ _............... dated j--/7 _. �,.-------------- ._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WIWI. FU CTION SATISFACTORY. DATE..... .�..-f' ............:.........••----....--•-••----......•. Inspector...... .....•----• -- ..................................................... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH { Tarn.......................OF............Banns.ta.ble......................................... FED P .. Nsf. ._ 2 ..... Disposal Works Tnno#ru#uan rrnttt Permission is hereby granted..........SteV{?•---L- bel--•-.---••••-•••••-•-•-------••••••••---•---.....•••.....................•••-•......•--..... . _ to Construct ) or Repair ( ) an Individual ewage Disposal System 1 at No........ t._�-���. ............. �.... --------- -� # Hy rs� a Street ,m as shown on the application for Disposal Works Construction Permit No.............. :-!Rated!_=_!�_ .......... .................................... ........per;�.:f✓ ......._..................-_................- ,Board of Health DATE........... �'...�:�-�...._...--•...........................•--•---- i FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - -' ' � S .> � � � r _ � o U v� V� � , ��� w�ti� r lj i.It -77 37 r rrr - 50 fJ >c c C J c ! ` v 1\ o tt'� r U�. _ /l Le H cx. I , f Lo J GIN 'r IOHN -,- - 86 _mow' V40p. , y' Ni 29s7a Q lJ Lc=> L IL, LEGEND CERTIFIED PLOT PLAN .EXISTING SPOT ELEVATION Ox0 - �--- u; ,'rq EXISTING CONTOUR --- O --- a��.. Lp7 _ a FINISHED SPOT ELEVATION F I N I1HED CONTOUR 4 o n�oRSE APPROVED , BOARD OF HEALTH " No.10951 �FFSStTs Gis ONA1:La�\ � � f DATE AGENT SCALE, f �j :: DATES , /. l_ z fir; DREDGE E/NGIWk RIAIC CO IN CLIENT FfA-n%n I CERTIFY THAT THE PROPOSED REGISTER REGISTERED JOB NO. �2ovr_ BUILDING SHOWN ON THIS PLAN CIVIL LAND ..BY DR = CONFORMS TO THE ZONING. LAMS 'R ,.q-'�j. ENGINEER SURVEYOR OF WWRNSTA LL , 1 2.4 ASS. 712 MAIN STREET CH. BYE �rT� � ' 1 .q / N Y A N N I St, MASS. °' 1 -- ------------ ---- SHEET_._.•I OF' A E G. 'LAND SURVEYOR 20 FT. IM//V. ET �E /VOTE. /F TNER TilE SEPT/G TA DR 7_E.4CH//VG P/ ARe /"J'ORE - T.°++.9;•/ / LOK/ /O fT M/N. rRAOE� �O1A W,TER CONCRETE COVER Sj lAL L BE BROUGHT TD GRA DE. EX7 COIVCRCTE 4+PYC..P/PL t,�EAVY CA ST /RON CO{/�R SHALL 3E IJSEO M/N. P/TCN er• t LL:--V. COi/ERS �9�OFiP FT /F/N DR/VE1V.4 y p J• MiN. COnIC,�E•TE GJl.�OE CU VE.4 CLEAN SANG IRON P/PE d' M/N:P/TC�I GAL. ' e 1 • . . • . . �., e: .t4 SEPT/C TANfC o/S7. . . . . . . . e a WASHED-S7�iNE E BOX , +.. 1 • ., p • 1 ® I . I • • �' P • n v • e 1 . FFECTIVG •E • n • . DEPTH • • 1 I o 0 WASHED STONE 7 0 _A r J D• • • • I. • • • I t d ••Al !N{iG•RT ELEf/.4T/GNS / ?� L�?-r' Gi-r y a: . . . . . . . . • o P/7 OR EQu/v. F • • � _ 7 -7 /NYERT.AT., T OZ//LD/NG g.S D FT 6 FT D/AM. JNLET SEPT/C Ti4NK 4 s FT. V FT. D/A1 M. C SEE TABUL.4TIUN, 4 3 r w T F/ Ti4 l T E APT IC N K - T ou L TS t 8 4'. GROUND PV,4TER TABLE INLET D/STRt6l/T/ON BOX SECT/0N OF OdTLETD/STR/BtJT/ON BQX �'��9 FT.. - t/VLFr Lg.4cN/NG "s�iT 3,'L F T SEWA42E 0/.S.0005A 4 S YSTEM � L EACHI VG P/T TAJULAT/DN SCALE %. _ �f-O'er D/MENS,'ON A 3 FT. DES/GN CMITERM`., o/•ti.F/vs/a" 8 6 fr• NUJNBER.OF BEDROOMS 3 . , . D/HENS/aN ..C—�FT./�'tti✓•. t�v :SOIL. LOG ! GARd AGED/SPOSAL UNIT' SOIL TEST TOTAL EST/hf�rED FLOrs/ 30 GAL DAY. SOIL TEST 0/ SO/L 71=ST*,2 NUMBER OF L,e54C11/NG PITS fEtEK PATE OF SC/G. TEST S/DB 4PACH//V4 PER.-PIT Sa PT. U- Z RESULTS yV/TNESSED BY J•kE BOTTOM LEr'ICN/NG PER P/T AT P46MCOLAT/ON RAre�E/ �-�S`' Ml.VylINCH 7-07,11- LEACHING AMEA R to SQ.. FT. -r OpSotL l°L�itCOL.4(�T/O—N R.�7E 2 7 '✓ M1N.�lNGN RES6R1iEGEACN/N6 AREA 2� �S4 FT Kam= tL OF �P�1 t1 A i� IMERT. . �o c1 H j V MOFfSE n u ;IUn A °p No. 10951 wQ EL D/4E®GE ENG/NEER/NG CO /NG. �. • ' C� E� .J� cF c �. (/ ?3 712 1%4A/N ST. HYflic/N/S. Nl.9SS, NG GROUNt7'yv.4TER ENCOUNTERED• 44hcNT: Fi12,CS-0, Cl. GROUVD Yv<fTER AT EGE(/ ./OB NO:• }/ SHEET OF z. ASSESSORS MAP : ---z71-__...-------------_-PARCEL: TEST HOLE LOGS lvoTcs: Z � ,ZO/ _ ��FLOOD ZONE: Alr/t�? s} �C.tom. - ,, SOIL EVALUATo.R:_ g ), ,G �. 1) The installation shall comply with Title V and Town of )�l' �3oard of WI TNESS : -j ok-A 1 Health Regulations. REFERENCE: . /�t,./C� Gc ,2i_ G 1 `7 DATE: " 7 \ 2) The installer shall verify the location of utilities, sewer inverts and septic CnF/ _ 7GX57- FCC 8 ( / PERCOL T 1 ON RATE . /- 2i , ► components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first ` 1 --- --�� _ f 83 V two feet out of the d-box to the leaching shall be level. TH- 1 TH-2 4) This plan is not to be utilized for property line determination nor any other o DD N l b purpose other than the proposed system installation. � "'? 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. ,, (0�{svr/ ��� r 6t7 g ,✓ 7) The property is bounded by property corners and property lines. O C 8 The property owner shall review design considerations to approve of total LOCATION I ON MAP � /0 �Z �J ) p p Y g pp f 111 design flow and number of bedrooms to be considered for design. Receipt 1 ►�4 cJ' Ito 40 of payment for the plan and installation based on the plan shall be deemed �0 2W� , approval of the design flow b the owner. 4 C W/ ��� pP g Y 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. �p , .�._ �, _ ____. . _. ..______ 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if rF applicable. The proposed SAS is being installed below the water service SEPT VC SYSTEM DES I G N line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the 192 < owner to ensure such. FLOW ESTIMATE ! 12)The installer is to take caution in excavation around the gas line if such BEDROOMS AT w GAL/DAY/BEDROOM GAL/DAY 4 exists. \ 13)The installer shalLverify the location, quantity and elevation of the sewer '� 1 �'���� ✓ i \ \ �i lines exiting the dwellin*i3rior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting Title V requirements. GAL/DAY x 2 DAYS - GAL IDS 0 USE l0Ob GALLON SEPTIC TANK �OUOf"lw I , SOIL ABSORPTI N SYSTEM - J DAVID �y `c� \,• 1 Y, t ooc� 1-ro Z B. z.x 077 S IDE AREA. �C 2 ( IVAE:rl— 6 c� v �r� T�.S BOTTOM AREA: 2 X -6 017 t3 SEPTIC SYSTEM : SECTION /b-P or rauw' or H to L 0 Cj D-BOX 1000 GAL SEPTIC TANK �� ''--1 Z �l7Dlr t-4�rip y �� 6 S 1 TE AND SEWAGE PLAN o LOCATION : \ �Z W 4 L. C eoA[: �-' � I PREPARED FOR : .�►Va( tMA _ SCALE vp� CL DAV I D B . MASON QS DATE: 17 ZOIZ s DBC ENVIRONMENTAL DESIGNS u W CAST SANDWICH . MA DATE HEALTH AGENT _ ( 508 ) 833- 2I77 t