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HomeMy WebLinkAbout0045 OAK STREET - Health 45 OAK ST., COTUIT l A = r �I 1 } TOWN OF BARNSTABLE LOCATION. Y5— 4Z 37 SEWAGE 4 .-?3-7 VILLAGE � ,� ASSESSOR'S MAP&PARCEL Ig-J�9-y INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /5-ae LEACHING FACILITY:(type) 6�;,O (size) V..? :9 rot-BJ`X.71 NO.OF BEDROOMS OWNER�f-GLrceG� PERMIT.DATE: -a COMPLIANCE DATE: a 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 Lq � O! Oka �00 O 4 I t C_'j c F, -h No. r t ; ,t r Fee G l'o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V BLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �. ppricatiou for TigponI *pgtem Con0tructiou Vermit oil- I�q Ap ion for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) .Complete System ❑Individual Components Location Address or Lot No. ONL-- 9-r Tu t=( Owner's Name,Address;and Tel.No. `STc.%,E Assessor's MapMarcel � �2`j- bc��{ 'fs oArv. Ss- Griot-, ►.RL1 _ 2o3•�Ie2•�}g22 Installer's Name,Address,and Tel.No.;'OF-_Fot-bTT ��� Designer's Name,Address and Tel.No. 4a FmNs tl�_ b kit, ca,_ �ov1"�1 �`��g �C� 6?-1 11L& D#,14 wl/+r O2t'`H Type of Building: Dwelling No.of Bedrooms �j Lot Size ��� sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided '56! r gpd Plan Date c'L"' tt I °°a Number of sheets 2 Revision Date ►.io u i Title5&-r,:. 4 - ST. �.oTutT �h Size of_Septic Tank t t Sc Type of S.A.S. C�Ae�F�La s Description of Soil n-g �►�0 Sp�,py �.oM� _ Fes`- 2�•� �t l vl uY 3h,y o , 'LC'- 116" r e.' 1.�F�tVti SOtND . Nature c Sof Repairs or Alterations(Answer when applicable) 11P�R�e L.,o err l Tt.E y SY f.=-M epa M yEQ 0-0 O k t u �JEDR-oO K• Date last inspected: kk 2t o Agreement: The undersigned agrees to ensure the con ction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of e nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo o ealth. r Signed Date QT Application Approved by Date h(a&8 Application Disapproved by: Date for the following reasons Permit No. �� Date Issued I ; V Fee V ' THE. COMMONWEALTH-OF MASSACHUSETTS Entered in computer: P BLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Dig;P05al *p5tem Con.5truction permit Appo��• lad ,/ lieafion for a Permit to Construct .Repair( ) Upgrade( ) Abandon O Complete System ❑Individual Components Location Address or Lot No. (.r�j pt � S-r eoTu 1 Z Owner's Name,Address,and Tel.No. 57LVE Assessor's Map/Parcel1 .- 00,11 t{Gi t7 fi�c S�• u iT AQ 2a3 ��(�Z.' y�22 Installer's Name,Address,and Tel.No. �-`i t-a 1"T l n tib- Designer's Name,Address and Tel.No. SUv `d 53• -7 30'3 4,G I00-i-r ./ Qj, C-1si5-rIL_ Pu5 C1�AnE ,NG;• �L]T"r.N-- Type of Building: Dwelling No.of Bedrooms F, Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 66 1 gpd Plan Date LI It 1 ° y Number of sheets "Z Revision Date S-r, l vrui=t QJA ' z Size of.Septic Tank 1 t 4o U Type of S.A.S. Description`ofSl O—a" 'k, t � Nature of Repairs or Alterations(Answer when applicable) A* Date last inspe ted: \\ 2t Agreement' The undersigned agrees to ensure the constriction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the, nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boacd of Flealth. Signed ._� Date Application Approved by Date (p h to AO<� Application Disapproved by: Date for the following reasons Permit No. 3001 ' Date Issued (0 I /0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired ( ) Upgraded ( ) Abandoned( )by Ba�_ at 41rJ 01L 1�4. LA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ tom'�-•^• 057 dated Installer�t-tv o kj Llws� • Designer t IL4t1Uc r;,.A, #bedrooms S Approved design flow ) gpd The issuance of this pdrmit shall not be construed as a guarantee that the system wil9 flu c ionj as/designedd n Date i 7 I �) i Inspector \ �No. � '� � ,�� -.--��.-==_•_-_--=- . . . . _-._� . _. _.. , .. - _m , . . .- . ... _ , , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i,5po!6al 4pgtem Con5truction Permit Permission is hereby granted.to Construct (>C Repair ( ) Upgrade ( ) Abandon ( ) System located at OAC and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction T stt be completed within three years of the dare o'f this perrrii•t. Date tq Approved by 1 Town of Barnstable SHEIiTpw�' Regulatory Services Thomas F. Geller,Director WANSTABM 9 MAM Public Health Division ia34. �• ATEe �° Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office:.5,08-862-4644 Fax: 508490-6304 - - Installer & Designer Certification Form Date �/a2��7 L" Sewage Permit#o?G��'—o7S'7 Assessor's 1VIap\Parcel Designer ' G`r1c. �kc Installer: �� Address �. c.2 Address: 410) C was issued a permit to install a (date). (installer) septic system at �5 rlt , .t based.on a design drawn by 11 (address) dated; ( esigner) I certify that the septic s stem referenced above was installed substantially-according to y 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. r 7C I certify that the septic system referenced above was installed with major changes (i.e. greater than 16' lateraY,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. Stripout (if required) was inspected and the soils were found satisfactory. :t • (Installer's Signature) _ G-E8 S,JR. ` CrVI Designer's Signature) ffix 's Stamp Here) .�8T � � PLEASE RETURN TO"BARNSTABLE PUB SION. : CERTIFICATE OF COMPLIANCE; WILL 1NOT BE ISSUED UN BOTH THIS FORM :AND AS- BUILT CARD ARE RECEIVED'BY THE'BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepti6besigner Certification Forin Rev 03-09-06.doc 27+.coa 1 TW41c3- I "W11a310 =� o o o •� r`. u El CD I o z Ia, g r i m g l � x =I ! a 3 ;., v Fes., .. s / o i I , T � CP qj a !-41 £'d 9VL9-9ti9 909 L iIouo8 ana}S e9c:L L 90 ZZ Ue Town of Barnstable P# Department of Regulatory Services Public Health Division Date t� 200 Main Street,Hyannis MA 02601 �p MIx Date Scheduled 60 Time G/ Fee Pd. ,Soil Suitability Assessment for age Disposal 7 Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address tjIG p A,-I, ST. Owner's Name STEM-b N L-6C_o fL-" y - Address Zo�S'+ t G Assessor's Map/Paroel: d t ,j t -1-too 4 Engineer's Name d Cl t� t n� NL• � 55 EW CONSTRUCTION REPAIR Telephone# 4-P5$3 3 73 0 3 -' Land Use IStO a'Ti A i_ Slopes Surface Stones Distances from: Open Water Body Ido ft Possible Wet Area Its E- ft Drinking Water Well Drainage Way ft Property Line - - ft Other ft SKETCH:(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 Groundwater. Standing Water in Hole: NO n Weeping from Pit FaceO Estimated Seasonal High Groundwater Rel o c✓ /'0 /a DETERMINATION FOR SEASONAL HIGH WATER TABLE ' Method Used: Depth Observed standing in obs.hole: __— in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. -----_index Well#--- Reading Date: - Index Well level,,,,,,-..� AdJ,factor Adj.flroundwater Level , PERCOLATION TEST mute a e Time Observation Hole# / Time at 9" - n Depth of Perc / Time at 6" Start Pre-soak Time @ p1�' oAM 'lime(9"-6") - End Pre-soak Rate MinJlnch / Site Suitability Assessment: Site Passed t/ 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG \Bole# a Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co i tenc ravel ,r r � Q �� h e M Y`Q 7j 23v l� E DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil-, , Other C� Surface(in.) (USDA) _(Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0 .K Z 7/3 � }ij !I DEEP OBSERVATION HOLE LOG Hole# L Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten ,r Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes 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 pervious material exist in all areas observed throughout the. area proposed for the soil absorption system? A t If not,what is the depth of naturally occurring pe ious material? Certification I certify that on (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 . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Q\SEPTICIPERCFORM.DOC Commonwealth�.of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000. Inspection forms may not be altered in any way. A. Certification 0/9-' _ Important. -T When filling out 1. Property Information: forms on the 45 Oak St computer,use , Cotuit, MA 02635 only the tab key Property Address to move your Edward C. Dawson cursor-do not use the return Owner's Name key. 45 Oak St Owner's Address ' Cotuit MA' : 02635=, -, City/Town State Zip Code; Date of Inspection: 11/21/06 Date 2. Inspector: Mike Hudson `=- = ';3 Name of Inspector a.j Septic-wiz Environmental Services CD r Company Name C7� —.31 Midway Dr Company Address E,enterville MA 02632 City/Town State Zip Code 508-367-5669 Telephone Number Certification Statement: 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 ❑ANee s,Further valuation by the Local Approving Authority /� 11/27/06 Ins ectoes SidnAute 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. 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M yvey`e A. Certification (cont.) _ i 45 Oak St Property Address Cotuit MA 02635 Cityrrown State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: { System Conditionall Passes: Y Y ❑ 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 45 Oak St Property Address Cotuit MA 02635 Cityrrown State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 45 Oak St Property Address Cotuit MA 02635 City/Town State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection t C) Further Evaluation is Required by the Board of Health (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 and volatile organic compounds indicates that the well is free from pollution from that facility 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: r 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage'Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 45 Oak St Property Address Cotuit MA 02635 Cityrrown State ZipCode Dawson 11/21/06 Owner's Name Date of Inspection 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 El than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ®, Any portion of the SAS, cesspool or privy is below high 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] Yes No ❑ E 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. 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 45 Oak St Property Address Cotuit MA 02635 City/Town State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection t f E) Large Systems: To be considered a large system the system must serve a facility with a fl 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. 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments , Subsurface Sewage Disposal System Form 4+M B. Checklist 45 Oak St Property Address Cotuit MA 02635 Cityrrown State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection 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(3)(b)) 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 t , Commonwealth of Massachusetts r Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System information .45 Oak St Property Address Cotuit MA 02635 Cityrrown State Zip Code Dawson 11/21/06 Owner's Name; Date of Inspection 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 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 z Laundry system inspected? 3; ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter,readings, if available last 2 ears usage 2005-290GPD 9 ( Y 9 (gpd)): . . 2006-290GPD Sump pump? „ x ❑ Yes ® No Last date of occupancy: unknown Date N / 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: Last date of occupancy/use: Date Other(describe): 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts b Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form, M Svy`• C. System.,Information (cont.) ` 45 Oak St Property Address a Cotuit MA- 02635 City/Town State Zip Code Dawson 11/21/06 Owners Name Date of Inspection i General Information Pumping Records: ` - s. Source of information: Water Pollution Control-Barnstable Was system'pumped as part of the inspection? ❑ Yes ® No If yes;volume pumped: N/A E ' gallons How was quantity pumped determined? NIA ' N/A ` .Reason for pumping: - Type of System: i ' ® Septic tank, distribution.box, soil absorption system- • ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ` ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and El maintenance contract(to be obtained from system owner) ❑ _ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 24years old, installed 1982 via as-built and prior inspection in 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts . Title' 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 45 Oak St Property Address Cotuit MA 02635 City/Town State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection Building Sewer(locate on site plan): 25" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >50'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): -Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ® No certificate) Dimensions: 8'6"Lx4'10'Wx5'6"H - 1000 gallon Sludge depth: 4'11 (1"thickness) Distance from top of sludge to bottom of outlet tee or baffle 33" 1„ Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom Qf scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured stick w/rag, tape, floodlight 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 450ak St Property Address Cotu it MA 02635 City/Town State Zip Code Dawson 11/21/06 Owners Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank not in need of pumping at time of inspection, inlet tee in excellent condition, outlet baffle in excellent condition structurally sound, liquid levels normal at outlet invert, no evidence of leakage. Grease Trap(locate on site plan): Depth below grade:p g feet; Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): iTight 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): 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M + C. System Information (cont.) 45 Oak St Property Address Cotuit MA 02635 City/Town State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert .10, even w/outlet 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, liquid level w/invert out, no solids or carryover, no evidence of leakage into or out of d- box. f Pump Chamber(locate on site plan): r Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No y 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form { Not for Voluntary Assessments Subsurface Sewage Disposal System Form M , C. System Information (cont.) 45 Oak St Property Address Cotu it MA 02635 Cityrrown State Zip Code Dawson 11/21/06 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: (1)6'w/3' stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches A number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: E Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil dry, loamy sand, no signs of hydraulic failure, no ponding, damp soil or abnormally lush vegetation, leach pit dry at time of inspection, stain line 38" below inlet invert. 45 Oak St-T5 Inspection.doc•11/2004 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 •S Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M ' C. System Information (cont.) 45 Oak St Property Address Cotuit MA 02635 CityrFown State Zip Code Dawson 11/21/06. Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration , Depth—top of liquid to inlet invert Depth of solids layer- Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Formlug . . C. System Information (cunt.) 45 Oak St ' Property Address - Cotuit MA 02635 Cityfrown State Zip Code -Dawson 11/21/06 Owner's Ohms Bate of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks:locate all wells within 100 feet Locate where public water supply enters the building. Oak S,t ' A 1-25' B 1-32' 2-54' 2-33' 3-76' 3-54' W x 45 Oak St 1 O Cotult, MA 02635 O 1000 Gatlon H-10 Septic Tank Rear of House ' B . 2 D-Box Porch/Addition 3 0 6' Radius Leachpit ` w/ 3' stone 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official lnspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M C. System Information (cont.) 45 Oak St Property Address Cotuit MA .02635 ` City[Town State Zip Code Dawson 11/21/06 s Owner's Name Date of Inspection Site Exam: Sloe Z 9° 1 „ P v Surface water, Check cellar "-t-cs Shallow wells t l I A s Estimated depth to ground water: 2 -}- 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: Reviewed prior system inspection from 1999 ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: r Reviewed USGS topographic and water resource maps You must describe.how you established the high ground water elevation: Reviewed prior system inspection, reviewed elevations from USGS topographic and water resource maps as well as nearest open water elevation in relation to subject property elevation from google earth software. 45 Oak St-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 i = COITION-WEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI P DADB.;STRUHS Commissioner Governor V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO QQ PART A 9 / CERTIFICATION ! l9 J.-04k S7,' t Name of Owner r7/f//� d 'r Property Address: (S �(7 Ul'rlj �9,y 99 ? Address of Owner: C.`J O � ���qe_ Date of Inspection:3-/3_1q ` Name of Inspector:.(Please Print) 90woo C, Of/SL�EL, I am a DEP approved system inspector pursuant to Section.15.340 of Title 5(310 CMR 15.000) Company Name: WRO da /Ec Mailing Address: -1 wo'o — S�Rl�GC1Cl� G 5�3 Telephone Number: 4���3 CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Falls_ 2 /� Inspector 3 s Signatur e Date: �/3-Iggq The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of _._ completing this inspection.,af the system is a.shared;system or has�.a des.gn flow of 10,0000.9p or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 1000 6&40N SEPTIC: -rnIVK , VER y GD©D C0NDj-tVt1 , dO 50Lr OS t ado G 00 six Fir- &M� P17 �JIP '1110 Lt iur4 r` i p . revised 9/2/98 :Page Iof11 r Piiieid on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: OAK 5 %, C01T01?` Owner: Date of Inspection: 3_j 3...'Cq—I INSPECTION SUMMARY:. ipheck B,. C, _... A. SYSTEM PASSES: 1 have not found.any information which indicates that any'of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no, or not determined(Y, N,or NO). Describe basis of determination in all instances. If,"not determined", explain why not. _ The septic tank is metal;unless the owner or operator has provided the system inspector,with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20)years prior to the date of the.inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ ; 1 } _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) for due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). 1 broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced w - ;The system required pumping•:more than four-times ayear-due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)'are replaced obstruction is removed { I Ct , >i revised 9/2/98 ,Pag! zofII it ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A y— CERTIFICATION (continued) Property Address: OAK Sr C OrUI Owner: Date of Inspection:3"_13—JC' 9 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 the public health, safety and the environment. ' 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WfTH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic.tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the, presence of ammonia nitrogen and nitrate nitrogen is equal to or less ;than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER l i revised 9`/2/98 Page 3ofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: q5 OAK ST CoTU11 Owner: Iq AAAV Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will.be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile.organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: { The following criteria apply to large systems in addition to the criteria above: i The system serves a facility with a,design flow of 10,000 gpd'or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or morel.ibf the following conditions exist: Yes No f: 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) The owner or operator.;of-any such systemi;shall upgrade the system in"accordance with 310 CMR 15:304(2). Please consult the local regional office of the Department for further information.-` "' i c I. revised 9/V98 Page 4of*11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART B CHECKLIST Property Address: l��'r,`S r r �Or(I f T Owner: Date of Inspection: 2 '3_Yqq Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: r Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water,have not been introduced into the system.recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. . ,'All system components, r„��ii, tr, c,;i er,�,,.�.��Cvefwm. have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)) -a-- ---- ;The•aacilit-y-owner (and•�occupants, if different�om,.awne{).were provided..with information on,th,e_proper maintenance of SubSurface Disposal Systems. f i I 'S i 1� `' a .. I a i :,, 7. •i; i._ t .tii4 '.I' To NI r•; revised- 9/?//:98r IPag!. QrII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property AddressNq;�©,oK. �r Wiv/r Owner: Ofily 1� - Date of Inspection: ,13.-'�Gy 7 FLOW CONDITIONS ` RESIDENTIAL: Design flow: C7 g.p.d./bedr om. Number of bedrooms (design): Number of bedrooms(actuaq:.3 Total DESIGN flow 330 Number of current residents:_ Garbage grinder(yes or( :av ��n Laundry(separate system) (yes or r9I10: If yes,separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):_ > I?tc-u1iC-L� Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes of rf'y):J Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)M - . It yes.--c.volume purii'ped: '•`';;gallons___ Reason for pumping: TYOF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool, Privy I Shared system(yes or no) (if yes,attach previous inspection recbrds,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval � I Other APPROXIMATE AGE of all components, date installed(if known)and�9-66 ce,bf information:;_T )1,-u A7 Sewage odors detected vwhen arriving at the site: (yes or(9 NO , p revised 9'/2/98'' „ Page 6ofI1 I` • x . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION(continued) Property Address•9 j On K S/ COUI I Owner: Date of Inspection: _?_'C�q� BUILDING SEWERc )Locate on site plan) Depth below grade:' Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,etc.) ` SEPTIC TANK: 4 + (locate on site plan) Depth below grade: 1 14XI45 Material of construction: concrete—metal._Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: O%bl,L x Sludge depth: lNc$45 Distance from top osludge to bottom of outlet tee or baffle:12-CLIMIRS Scum thickness: C /00 SOLIDS' Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: T—I-qPC rnEfi9V2e Comments: (recommendation for pumping, conotion of inlet and outlet tees or baffles, depth of liquid level.,in relation to outlet invert, structural integrity, evidence of leakage,etc.) "MAX 15 /A/ GOo -'APE APE L! U/ CE�'EL /5 /�T (30 T?L�M OF OuTCC/- p r FLU' ac'T T GREASE TRAP: (locate on site plan). Depth below grade:_ Material of construction: concrete metal: i'(Fiberglass _Polyethylene r. other(explain) I(.1 a-c'` i�" Dimensions' Scum thickness: I 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) I { revised 9/2/98. ragoorit I' i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address:yS l9Xj ST C OT U I T Owner: NnNl1N Date of Inspection:3_13 _,qr/ TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: llocate`on site plan) Depth of liquid level above outlet invert: t � Comments: mote if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) /UO 6XIDS� 6/7)EPIPE 11V 0/UEP1PC our PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: I' (note condition of pump chamber,condition of pumps and appurtenances,etc.) i 1, I! revised .9/2/98 Page 8of11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:�S oAk ST,661`u,r Owner Date of Inspection:3_13,/Cj ; SOIL ABSORPTION SYSTEM(SAS)k (locate on site plan, if.possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: L s ix FOV. - (000 &/)LLON LEI H P17- leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number, length: _ leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, si ns of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) ►CR 00 ?N NO �l -0A L 007- F .L I QUID I //- /dt E . ' Im - CESSPOOLS:_ (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'je'ettpool_m`ust be pumpedas-part-of-inspection)- 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,,,cohditioh of vegetation,'etc!) t , revised 9/2/98 ; PBFYof11 r . i. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: L15 0414* sr cot IT Owner: HRNf}rU. Date of Inspection: 7 '3_/ j SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate sll wells within 100' (Locate where public water supply comes into house) b r F i t REAR sy ii 33, 2 V � 3 revised 9/2/98 Page 10of11 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addr�ess: (L/CJ � s f CO�f t Owner: Date of Inspection:. NRCS Report name J Soil Type_ ) Typical depth to groundwater USGS Date website visited e Observation Wells checked « Groundwater depth. Shallow Moderate Deep SITE EXAM Slope Surface water o r Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to,determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions , Checked with local Board ofhealth Y Checked FEMA Maps. Checked pumping records Checked local excavators,installers Used USGS Data. Describe how you established the High Groundwater Elevation. (Must be completed) ouNpwAt { revised 9/2/98 } Pagelt1dI 12�40y LOCATION SEWAGE PERMIT NO17, VILLAGE INSTALLER'S NAME i AD i U I L D E R OR OWNER DJVTE PERMIT. I-SSUED DATE CO- MPLIA- NCE ISSUED o � � \ � 56 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................,....................O F..........:............................--.-----------------....----....................... Appliratiun for Eliipuual Works Tumtrurtiun ranfit Application is hereby made for a Permit to Construct.( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. .... r4 't __. �? -------------------•------ s'I+ ..e ! r --....�--� .�? f1� •--�-f /, Owner Address •---... .../✓f.. .-•--•................•-•-----------............................ -------•-•---•-------- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......_..............................Expansion Attic ( ) Garbage Grinder (if/L� a Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------_--•-•--•-•--•-•--_---•. . W Design Flow......... ......................gallons per person per day. Total daily flow............S�13 ....................gallons. A4 Septic Tank—Liquid capacity. .gallons I ength................ Width................ Diameter................ Depth................ Disposal Trench 4 No. .................... Width. 0............ Total Length....... .......... Total leaching area.. q. --��------s ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit--______•--__..-__-• Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---------------------------------------------------------------------------••----....__...--•-••---•.......................................................... ODescription of Soil......................................................................................................................................................................... x U ---•-•-••••••••-•--•--••-•-•••--••-•-•-•---•••-•-----•-•-•••-•••-•..............•--••----•-•--------......-----•---••••----••-•---•-••••----•--••--•-•--........-•-----•-•--------......---•--•--••-.... x ••-•-•......•----------------------•--••••...-•-•-•-------------•--•-••---••---•-•---••-------•---••-------•----••---•---------•----------- _ / V Nature of Repairs or Alterations—Answer when applicable---,,� �---.. �.r...cxtL � Agreement: , The undersigned•agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is e b e bo d o a Signed..... .................'?'�.......--•---•-•--- .......................... ! Date Application Approved By---•--•--•..... ..... --- . � — Date Application Disapproved for the following reasons:.............................................................................................................. ................•-•-•-•--•-----•-..........--------••--•••-•••-•--•••--•---•---••----•-•.......----•---••--------•-••-•----••••••--•-•- ................................... ............................ Date PermitNo......................................................... Issued....................................................... Date No......................... FEs.... ..J.........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........ ........ .................OF....................................... Appliration for Uhipooal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SystemC.v........................................................ Location-Address or No. - ? i. ....,f �1we............................................ .......... � '" Owner Address Installer Address Type of Building Size Lot............................Sq. feet U DwellingNo.-of Bedrooms ..:.. .............................Expansion Attic.;( ) ys Garbage .Grinder (/✓L� pa Other Type'of Bu>ldiig ............................ No. of persons.. Showers ( 3 ) Cafeteria ( ) Other;fixtures r ----------------------------------•• ......--• •••--- Des>gn Flow 1 ..........................gallons per person per day. Total daily flow........ Q......... ........gallons. W � r; P4 Septic flank—`Liquid capac>ty. ........gallons T�,ength................ Width__ ........_..- Diameter................,Depth ............ W Disposal Trench 4 No'..................... Width..?V.............. Total Length......� Total leaching area..a.�OP ....sq. ft. x 3 Seepage Pit No. Diameter ................. Depth below inlet.................... Total leaching area.... .'sq. ft. z Other Distribution box ( ) Dosing tank ( ) 1 Percolation Test Results � Performed by...................................................................... Da . .. gr a4 Test Pit No,, I................minutes per inch Depth of Test Pit.................... Depth. ound water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth'to ground water........................ 1�1 -';. ----------------------•-••-••••------ _....._.............................. ........................ O - L•T.Y Descriptionof Soil ..............•-•••-•--•••••-•-••-•-•-•• •--• ••-•-•-•--•-••••--•••....•-•-•--•-••---- x ........................................:."'.____._"_��:.=_° ___._.......__.............................-------------------------------._...__..__..._.._...._..___........._..__....._..-------------- W I UNature of Repairs or Alterations—Answer when applicable.............................•......_.___...........__.._.._._______._.._..................._.. 19 --------------------•--------....--------•-----•-•---------------------------------.........._....••••-•-•-••-•••-•------------•-•-•••......-•-•••••.................................................. Agreement: The undersigned agrees to install 'the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITT.:, p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is 'e b e lad o eal . Date ApplicationApproved By-••----•--•--••----•-••••-•--........-•--•-•--•........................ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------••••-•--•--••----•--••........_ Date PermitNo........................................................ Issued....................................................... Yll Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrfifirate of Tontpfiattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. t& — . ...............="........................................................................................................................... nst er at '�'�' �i�11 GL7 7 . - ......-•--•-•••• •-••••--- .. 0-2 y��,�r has been installed in accordance"'with the provisions of TITLE - o7Ae State Sanitary Code as described in the application for Disposal Works Construction Permit No.......................................•. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT.BE.CONSTRUE® AS A GUARANTEE THAT THE SYSTEM.,WILL FUNCTION S WEACTDPY,.,,w�.,.......,. DATE.. .... ...... �d 'a'•---••--•-- .Inspector - -------•------------------•--..........__..._..---•-••••....... THE COMMONWEALTH OF MASSACHUSETTS BOARD ..........................................OF........................................:............................................ No......................... FEE........................ Bisposal Workii onotrnrttion rrnti# PermissionE•s hereby granted----•---•F-�/ --------� -lww_-_----- to Construct (Pn or Repair ( ) an Individual Sewage Disposal System atNo..--•••-`gyp- ;-----•-- fir---•----- e---_.............•--------•• ----------------- as shown on the application for Disposal Works Constructae mit qe------,, ----------•------------------•----•-- ••--•----•--•-•-••••--•--•-•--•-•-----•--------•••-•---------••••---••••••••••------•-•-•-------------•- �' p `` Board of Health DATE........................ ...---......._. ............ . FORM 1255,..".HOBBS & W-kRR_EN• INC_.,.PUBLISHERS a � , r 00,00 J T 00 \O D �O f�•ay ; I O\ ry - / y 'Pely E AI_ RTC \ro- �• v `MORSE i,, No.10951 F. ZN OF M, ��� 7\ q"�.S(� F z. TE��p�'. SUS" LEGEND 6pCERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO EXISTING CONTOUR --- 0 Lor — oh.V-1 FINISHED SPOT ELEVATION FINISHED ,CONTOUR 0 n o. IN APPROVED , BOARD OF HEALTH �� ,�� .� •` , �.� �� DATE AGENT SCALE= t". 4c:7'. .DATEr t2 15 r CDREDGE ENGINEERING CO. IN CLIENT ' "^s I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. gt2'S BUILDING SHOWN ON THIS PLAN CIVIL ' LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR:BY' jk OF BARNSTAB MASS. 712 MAIN STREET CH. BY$ /N^IR- E 1 'HYANN I S, MASS. SHEET--L B OF DATE 2 E IRl;-(3. 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I , , :.­i "I " , " (F 11 .- , * �.; � . . �. � , v . 0, I , " I I I I � v MAP 018 36 / k S � N/F TREEl RIOUX, ROBERT J & PINE RIDGE SUSAN H TRS 46 K KICKERS❑N O, l ROAD (4 WIDE' �' Lj EX 13- �, `(•GENERAL NOTES: q MN �I„P ' 1 ❑ K MAIN R E E i— MAP 018 129-001 1, RECORD OWNERS: DAWSON EDWARD C, & DEB❑RA J, N/F / z8° S 3�. %BRALOWER STEVEN N WALSH, KEVIN / 42'L PROPOSEDS�'OQ• ` Z 5 KIRKW❑❑D CT. L❑CUS 21 OAK STREET �` NOTE: AEA CHI G vENT 1 Z 1 EXISTING WATER LI L ADI G O P❑TOMAC MD 20854 Q MAY NEED TO BE 18. DEED BK, 12333 PAGE 056 RELOCATED,MAINT 10' . MIN.SEPARATION EX. �+ WATER TO SEPTIC SA DRIVE COM NTS / \ PROPOSED � ' /� 44.2 D-BOX s E / , 2,, PROPERTY IS SHOWN AS LOT D ON PLAN ENTITLED 'PLAN OF LAND IN CDTUIT LOCUS NTSI I EX, / �� I' A EAwa 'BARNSTABLE MA FOR AURORE L LAWRENCE' DATED JULY 31, 1978, PLAN BOOK m u S'EVIL" G / \` \ PATIO 16.41 1 G P5Do D �^ o / 329, PAGE 30. B' 16. ,TGALLO ANK X.3 84� le TANK__ EX* GAL TANK 10.0 3, PROPERTY LINES DEPICTED HEREON ARE BASED ON FIELD SURVEY BY EXISTING MAP 018 HOUSE FP TO BE REMOVED _ SH•� '� E1-28.8 '� AND REPLACED - f GRADE, INC. IN ❑CTOBER OF 2007 AND COMPILED FROM PLANS ON .RECORD AT THE 129- 02 0 x-, WITH A 1500 CAL �' N/F 28.7' PROPOSE p TANK r,� BARNSTABLE COUNTY REGISTRY OF DEEDS, SCHMIDT ELIZA ETH M EX.i x•0' SME TR \ PEE �.,_ ` r ATED 4( ORIGIN OF BEARINGS ARE BASED ON PLAN BK 311,-PAGE 93, 230 RUSTY MAR\S�I ROAD 55.4' 51 EXISTING CONDITIONS SHOWN HEREON WERE COMPILED FROM FIELD SURVEYS / D-BOX TO BE f' REMOVED AN DISPOSED / BY EXISTING GRADE, INC, IN OCT❑BER OF 2007 AND FROM BARNSTABLE GIS• 6t ❑RIGIN OF ELEVATIONS ARE BASED ON BARNSTABLE GIS, NEW y 1 - °o � EX TREEIINE -' 128 8 7� IN REVIEW OF FEDERAL EMERGENCY MANAGEMENT AGENCY CFEMA) FEDERAL = PPIT TO UMPED -•'� N/F INSURANCE RATE MAP (FIRM) (250001-0021 D) DATED 7/2/92 FOR THE TOWN OF / AND ecCKnLLED WESLEY MEREDIT & BARSTABLE THE MAJ❑RITY OF THE SITE LIES WITHIN THE ZONE X AND A SMALL ""TM CL BRODEUR D EK PORTION (SOUTH WEST CORNER) OF THE PARCEL APPEARS TO LIE WITHIN ZONE B. MAP 018 �A 45 OAK REET 29-004 ;%� 8, PROPERTY LINE SETBACKS SHOWN ARE FROM ❑UTSIDE FACE OF HOUSE TO 1 429-0 4 POINT CLOSEST TO LOT LINE DIMENSIONED TO. 1 .0-2' AC. 9.' ALL SETBACK DIMENSIONS ARE PERPENDICULAR TO PROPERTY LINES• MAP 018 10. ALL BUILDING DIMENSIONS SHOWN ARE ❑UTSIDE FACE OF � 129-003 �-/ -� N/F / / %' 11. NO WETLAND DELINEATION WAS CONDUCTED FOR THIS SURVEY, PIR -BEN..JAMIN-E_....2,48 RUSTY MARSH ROAD 5ti�� e,.� ! 12. THE LOCATION OF UTILITIES SHOWN HEREON ARE BASED ON ABOVE GROUND STRUCTURES AND RECORD DRAWINGS• NO EXCAVATIONS WERE MADE DURING THE SURVEYS TO LOCATE BURIED UTILITIES, LOCATION (IF UNDERGROUND UTILITY/STRUCTURES MAY VARY FROM LOCATIONS SHOWN HEREON AND ADDITIONAL MAP �018 � / BURIED UTILITIES/STRUCTURES MAY EXIST, 096(005 ,/ I Nam....`....i._- ---'- =' 1J, EXISTING SEPTIC SYSTEM SHOWN GRAPHICALLY FROM TITLE 5 OFFICIAL MYRICK PAUL J. g INSPECTION FORM AS SUPPLIED BY THE OWNER, NO UNDERGROUND INVESTIGATION SANDRA M TRS ' 66°26y2 45 TOPSAU—CIRCLE _ k�l `�� "" WAS CONDUCTED, 3 - " ( ,�+ 14• SITE IS LOCATED WITHIN THE RF ZONE, RESOURCE OVERLAY DISTRICT AND AQUIFER OVERLAY DISTRiCT AS SHOWN ON 'ZONING MAP OF THE TOWN OF BARNSTABLE, MA' DATED 11/19/2002. EHG 1325 wr, �., PROJECT0. EXISTING GRADE INCORPORATED •4a ` CLIENT SEPTIC DESIGN PLAN 1325 Civil Engineers and Land Surveyors � �' ,I FOR DATE: 06 1 1 08 4e� rER�o ' o zs sb STEVE BRALOWER �� P.O. BOX 682 � 45 OAK STREET 45 OAK STREET SHEET NO. FORESTDALE, MA - 02644 CDTUIT,MA CDTUIT,MA 1 of 2 (508) 833-7303 (508)833-7305 (FAX) # DATE REVISIONS j SOIL LOG TEST HOLE - ELEV.=23.8' NOTES: DESIGN FORMULA: 1. ALL SYSTEM COMPONENTS SHALL BE INSTALLED INCOMPLIANCE WITH THE STATE SANITARY CODE DEPTH FROM ELEVATION OTHER (STRUCTURE, TITLE V AND THE TOWN OF BARNSTABLE BOARD OF HEALTH REQUIREMENTS. SYSTEM REQUIRED PROVIDED (FEET) SURFACE SOIL SOIL TEXTURE SOIL COLOR SOIL MOTTLING STONES,BOULDERS, (INCHES) HORIZON (USDA) (MUNSELL) CONSISTENCY, / GRAVEL) 2, ANY CHANGE TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND DESIGN ENGINEER, DAILY FLOW: 0'-8' 23,13' A SANDY LOAM 10 YR 2/2 NONE 3, HEAVY EQUIPMENT SHALL NOT TRAVEL OVER DISPOSAL SYSTEM DURING OR AFTER CONSTRUCTION, 5 BEDROOMS @ 110 GPD/BEDROOM 550 GPD 8'-29' 21,38' B LOAMY SAND 7.5 YR 5/6 NONE 29'-126' 13,3' C MED. SAND 10 YR 7/3 NONE 4. TIGHT JOINT (T,J.) PIPING SHALL CONSIST OF POLYVINYL CHLORIDE (PVC) PIPE, SCHEDULE 40. SEPTIC TANKS: ALL PIPES TO BE LAID ON FIRM BASE AND TO BE WATERTIGHT. ALL CONNECTIONS AND JOINTS 550 GPD x 200� SHALL BE MECHANICALLY SOUND AND TIGHT. 1,100 GAL 1,500 GAL SOIL LOG TEST HOLE - ELEV,-23,8' 5. DISTRIBUTION BOX SHALL BE WATER TESTED FOR LEVELNESS. LEACHING AREAS: DEPTH FROM OTHER (STRUCTURE, 6, NO GARBAGE GRINDER IS ALLOWED. 4 CHAMBERS @ 8.5' LONG x 4.83' WIDE SURFACE ELEVATION SOIL SOIL TEXTURE SOIL COLOR SOIL MOTTLING STONES,BOULDERS, 2' EFFECTIVE DEPTH — 4' STONE (INCHES) (FEET) HORIZON (USDA) (MUNSELL) CONSISTENCY, X GRAVEL) 7, DISTRIBUTION BOX SHALL HAVE AN INLET TEE EXTENDING TO ONE INCH ABOVE THE SIDEWALL:((12.83x2)'+(42.Ox2'))x2 219.3 SF 0'-9' 23,05' A SANDY LOAM 10 YR 2/2 NONE OUTLET INVERT ELEVATION, BOTTOM: (12.83'X42.0') 538.9 SF 9'-28' 21,47' B LOAMY SAND 7,5 YR 5/6 NONE 8. SEPTIC TANK SHALL BE EMBOSSED WITH SEAL STATING CONFORMANCE WITH ASTM C 1227-94, 758.2 SF 28'-126' 13.3' C MED, SAND 10 YR 7/3 -NONE TOTAL: 9. ALL SEPTIC SYSTEM COMPONENTS SHALL BE DESIGNED TO WITHSTAND H-20 LOADINGS. LEACHING CAPACITY: SIDEWALL: 219.3 SF x 0.74 GAL/SF 162.3 GAL 10, SEPTIC TANKS SHALL BE PROVIDED WITH AT LEAST THREE 20' DIAMETER MANHOLES WITH READILY BOTTOM: 538.9 SF x 0.74 GAL/SF 398.8 GAL PERCOLATION TEST BY, NICK SOUKE REMOVABLE IMPERMEABLE COVERS OF DURABLE MATERIAL. FOR, EXISTING GRADE, INC. TOTAL: 550 GAL 561.1 GAL WITNESSED BY DONALD DESMARAIS, R.S, BOH 11, BEFORE BACKFILLING THE SYSTEM THE CONTRACTOR SHALL NOTIFY THE BOARD OF HEALTH TO INSPECT, DATE, 05/23/08 PERC RATE, <2 MIN/IN IN C SOILS PERC HOLE @ DEPTH=74' (EL=17.63') NO GROUNDWATER ENCOUNTERED THREE MANHOLE COVERS. BRING A MINIMUM OF ONE N TESt 2' OF 1/8' -1/2' COVER TO WITHIN 6' OF FINISHED GRADE. BRING OTHER 1. SEPTIC TANK SHALL BE EMBOSSED WITH SEAL /DOUBLE WASHED COVERS TO WITHIN 12' OF FINISH GRADE, STATING CONFORMANCE WITH ASTM C 1227-94, 4' (TYP) 4' TYP) / PEA GRAVEL TOP OF F❑UNDATION (1) ROW OF (4) 4,83'x8,5' LEACHING CHAMBERS /// ELEV=25,5' 2. CORR❑SION RESISTANT GAS BAFFLE SHALL BE WITH MINIMUM ONE ACCESS PORT PER CHAMBER INSTALLED ON SEPTIC TANK OUTLET TEE, INVERT 0 4 3/4" TO 1-1/2" EXISTING F.G.=24,8'i VENT WITH 35" t„ G o4, o a c DOUBLE WASHED STONE & 24 0 4 a p p p 4 a PROPOSED CHARCOAL FILTER 4' PVC SEWER 2' OF 1/8'-1/2' DOUBLE WASHED PEASTONE LINE L1-4'PVC @ 2,1% TOP OF PEASTONE ELEV=21,45' 4-10,1 w INV=22,6' L2-4'PVC @ 3,1% 'PVC @ 4'-0" 10 4'-0 4 " 6' SUMP II INV. IN 1,500 GALLON 2i F.G.= 23,8't ; ' SEPTIC TANK o 22,1 3' 3' INV. OUT 4'PVC @ 2Y. TYP, TYP, 5' MINIMUM 21,85' SEPARATION o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DISTANCE o' 0 a °a L1=23.6' o 0 0 0 0 o INV, IN BOTTOM OF TRENCH FROM L2=16,3' ° ° ° ° G ° INV. IN 0 ° LEVEL FOR ENTIRE = GROUNDWATER LEVEL STABLE 6' 21,50' 20,95' 42,0' CRUSHED STONE BASE INV. OUT LENGTH 17,4' 21,33' BOTTOM OF BOTTOM OF 3' MIN. r------I 19,0' TRENCH 18,95' 3/4' - 1-1/2 DOUBLE TRENCH 18.95' MAINTAIN 10.0 TYPICAL LEACHING CHAMBER I I I I I 1120" MIN USE CONCRETE PRODUCT, INC, 1500 GAL WASHED CRUSHED STONE RESERVE CROSS-SECTION ��� '�/ NO TO SCALE 6' MIN, ( T ) �2' MIN, CORROSION RESISTANT GAS BAFFLE BY TUFTITE OR APPROVED EQUAL 10, MIN, MIN. TYPICAL SEPTIC SYSTEM PROFILE � l EHG PWJECT NO.1328 tl El .� ; EXISTING GRADE INCORPORATED �? `;. SCALE CLIENT SEPTIC DESIGN PLAN 1325 Civil Engineers and Land Surveyors iF, tl FOR GnrE 06 11 08 g y VIL STEVE BRALOWER P.O. BOX 682i 4"` FORESTDALE, MA — 02644 �;®,� � ® �'_� 45 OAK STREET 45 OAK STREET SHEET N0. (508) 833-7303 (508)833-7305 (FAX) ' tnT�R d # DATE REVISIONS COTUIT,MA COTUIT,MA 2 OF 2 4 -.AL ' , I 1 .� 30'-D" 11'-8 1/2" 14'-0" 4'-3 1/2" 2641DH 2641DH 3D68 , _ 2641DH 2641DH _ W N O co ti q q .N Q 00 E = DINING SCREEN PORCH o d N O x 11'-9" c N I O to *a io of U X r -. - 101068 5468 - = LL 0 .� .� m V 0 m 75 J CL CD ,M =O 0 V c. G - co m O = 'a m !VZD C cl) KITCHEN/LIVING ROOM iv o cc t O 3 29'-4"x 11'-9" - o 0tm V in t6 M O m W) 0 N BR/�LOWER EXISTING CONDITIONS 2640DH 2640DH - FIRST FLOOR 13'-2" O OFFICS0 - 5-3"x 1 T-V BATH p- 9, .,x.T_1" ENTRY o _ 2641DH - 2641DH 2641DH MASTER BDRM bo �--' 12'-11"x 1T-5" U) "X 2 W o L 7 _O c /L� - 264ODH 2640DH W LIVING AREA 1158 sgft 13'-6" N 43'-2" 0 ED m ao Z C3 CI J &5 Y co W U -ru • t x Ica I NW j P a. Rye vn . � `i Z , � 'sR -'7F_• ..,'ten'a� - _� Q. } ... _ O_ i - y 14-4 � - jF Q s aTa.�v - Can' c 1' 77 ol f f � WE 3 r. LA 7° . .-. `.: uu REGISTERED ARCHITECT �O S�D. 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