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0145 OLD KINGS ROAD - Health
145 OLD KINGS ROAD, COTUIT A= 022 006 II u 1 TOWN OF BARNSTABLE ,LOCATION ('j[ Q k kA1 S I? SEWAGE# 2016 e 0 7T VILLAGE C e>T-u rF ASSESSOR'S MAP&PARCEL 0)-2`©0V INSTALLER'S NAME&PHONE NO-Sd -�'ZO' 773d t/®.S elk*j & .14 1'4O� SEPTIC TANK CAPACITY 1 p 0 0 LEACHING FACILITY.(type) — So o G L c Acan L er(size) NO.OF BEDROOMS OWNER 1) f PERMIT DATE: /Zr— COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �r �� t t 4d z--uL, 13 Ll � t' TOWN OF B STABLE CC A: ' iN k AS Q. �o � SEWAGE # VILLACM ����� ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1C IN N LEACHING FACILITY: (type) ��� (size) \CbC�ie NO.OF BEDROOMS BUILDER OR OWNER DATE:, l COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater.Table m6geffem ef 16eaehing Feeifiiy Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N ! Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .i s � t Lk5 � Z o Al s N 671 = o. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Disposal 6pstem Construction permit Application for a Permit to Construct(&,�—Repair(_,__U�`pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /S/S 01 '5'f S /ion Owner's Name,Address,and Tel.No. Assessor's Map/Parcel o22 oa(D In taller's Name,Address,and Tel.Nozro$—'/:?0—y738 Designer's Name,Address,a d Tel.No. VI.-ph 00 rf `I pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. - Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �' gpd Plan Date Number of sheets Revision Date- Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)ZVZWl� l9CO/gY�lq /D /�isr!/f 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. 'l Signed Date ,! A Application Approved by _ Date ?--{ Application Disapproved by Date for the following reasons _20 'Permit No. a d Date Issued s 9 1 N a o�� Gql :No. ti Fee THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye ti 01pplitatlon for Disposal 6pstem (Construction Permit Application for a Permit to Construct(v)- Repair Gl Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locatidn Address or Lot No. 1515- 0/d �`'i'"%1` � /�Z ni9 a Owner's Name,Address,and Tel.No. Assessor's Map/Parcel G 2 - e.a( Installer's Name,Address,and Tel.No.f 02 '=' Designer's Name,Address, d Tel.No. J �f G Jd C3 'rya 9 , P M eXt Type of Building: ? Dwelling No.of Bedrooms ! Lot Size sq.ft. Garbage Grinder( ) Other '- Type of Building No.of Persons Sliower+(( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow providedgpd Plan Date Number of sheets Revision Date Title // Size of Septic Tank r �C'' `� � � � /�Type;of,S,,A.S. f Description of Soil Nature of Repairs or Alterations(Answer wheri applicable) %I/ 1-21G7 Date last inspected: Agreement: •The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in t . 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`y this Board of Health. Signed t..0 1/!� .-: f��d'- ' Date 3- 11 r Application Approved by Date 3 Application Disapproved by Date for the following reasons Permit No. ,ICI, "` Date Issued +� ,,fire ,.. ------------------- -----`-------- - - --------------------------`----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO//CERTIFY,that the On-site Sewage Disposal system Constructed(%) Repaired( G) Upgraded( ) Abandoned( )by at /i '//J- /`/ 9C�S /� %'�'' L Ji/ has been constructed in accordance C r` with the provisions of Title 5 and the for Disposal System Construction Permit No.901�'b��dated �—( b� ( y Installer Designer ' is G//.`/' --,y f-AIC #bedrooms Approved design flow -5 3 0 gpd The issuance of this permit sh! all not be construed as a guarantee that the system will functio designed. Date z/a S��In Inspector 6"1) P /V _p � ` 77 No. Fee fl " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade Abandon( ) System located at /=>>� Ll� f�% 7 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Consttruction mu t be completed within three years of the date of this permit. Date 7 / �+ �L Approved by 7 MAR/28/2013.10 :0: 11 AM FAX No. P. 001/001 Town of Barnstable Regulatory Services Richard V. ScaII, Interi>Ra Director ibg� 165 Public Health Division �� � a Thomas McKean Director 2001IMain Street, Hyannis,MA 02601 Office- 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sevrlage Permit# 20/ •p Assessor's MapTarcel a� Designer: /VeL P_w, Installer.- Address: Address: lz.,e- rt&ris issued a permit to install a (date) (installerp ,,�� septic system at 14 190 1(1�� V6-� (0Ort based on a design drawn by �" (address) R f�i fi�4 "k �kA 5�-&YIC- dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (i£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 Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory, I certify that the system referenced above was construct a with the terms of the IAA approval letters(if applicable) l ( tallet's Signature) W 1 1 P (Designer's Signature) (Affix Designer amp Here) PLEASE RETURN TO BARN TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLYANCE WILL NOT BE ISSUED UNTM BUTH TECIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DI•VTSION. THANK YOU. Q:1Septic\Designer Certification Form Rev 8-14-13.doo i Town of Ba"I nstable- P# Department of Regulatory Services BrABEA : Public Health Division bate z 11b ,`3�y tee$ 200 Main Street,Hy#nnis MA 02601 ~rFD µytl� �7 � '• UO Date Scheduled Time Fee Pd. oil 1SuitabiliO Assess M' 'ent fior� ,Se ge isposal. Performed By: N Witnessed By: I l Je [ i LOCATION & GENERAL INFORMATION Location Address 4 O f , K-l"A ' Owner's Name .�I 1 T Anp Address Joffile Assessor's Map/P4rcel: 0 7 7� ri�vj"7°lio Engineer's Name Mr yew L)OYU NEW CONSIRU�`PON REPAIR Telephone# ��� p �j 0 Land Use Slopes(�o) %C) r; Surface Stones' Distances from: Open Water Body �`"Zoo ft Possible Wee Area ;;'2_DV ft Drinking Water Well `�ft Drainage Way 106 ft Property Lineft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes,&pere tests,locate wetlands in proximity to holes) t I W� �I d was ; Parent material(geologic) I Depth to Bedrock ' Depth to Groundwater. Standing Water in Hole:, Weeping from PI[FpCe Estimated Seasonal Y-Iigh Groundwater A D TION FOR SEASONAL HIGH WATHR TADLE Method Used: I ! in. Depth to salt mottle s: In " Depth Gibperved standing u►obs.hole: I in. prountiA a[er Adjustment Depth to weeping from side of obs.hole: _ Adj.factor__.� Adj.flroundwater level Index Well# Reading Date: Index Well lev6I i -- PERCOLATION TEST Date '>Clnte Observation ` I Timeat9" r" ---- -- Hole# t Time•at 6" ' ' Depth of Pere - t.b Time(9"41) — Start Pre-soak Time-0 b -- End Pre-soak Rate MinJlnch _ Site Failed; Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed Original:.Public k.?r;iith Division Observation Hole Data To Be Completed on Back— ***If percola>yibn testis to be cond,.,icted within 100) of wetland,you must first notify the rior to beginning. Barnstable C41iservation Division at least one (1)week p DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,To Gravel (i1/� toll, Ig Ty DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.3o Gravel - \, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I 1\ I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No—7z Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s aterial exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification I certify that on 16 W (date)I have passed the soil evaluator examination approved by the Department Enviro mental Protection and that the above analysis was performed by me consistent with the required trai 'ng! xpertise exper'ence described in 3,10 CMR 15.017. / /� ✓ — � Signature l/ D ate �-o 1 4 Q\SEPTIC�PERCFORM.DOC ' COti1�40�«EALTH.OF-N1kSSACHtSETTS- EXECL•TIVE OFFICE'OF ENNIRON-IE 'TALaAFF:4IRS - DEPART`I T OF•VEN IRON�IE\TAL PROTECTION �. ONE Vl'1N7ER STREET. BOSTON. MA 02105 E1 i :S_•E:4( `' •� -4t 1 / r4t's ice= !a i '! t V1 ILLJAM F.'nEt D M�?Zd�'1 "irI'i+i74 t-, �'�.!J � V'5 o`J1;iw e•JfJ'.va'.fft i�) .iSnrJ JI i:� ti }.� •t.p-.�r•�_:f TRt.`D i•C�1�2 G9vRrrC',Y" :J !: ;; "i i L'Cs c n i._w F1"?ate e E .KC3C E;°cSGti;II ICJ r: tiny r ►s..a n i ay w SG� • ' w •:s 1 tt; r�j ARGi:O PAL1 CELLL'CCl ' -'`t=► o •-�E� -=';;`°��o � c3 DA%M B S„ • Ls.Govern SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Conur.issiar: PART A L-`CERTIFICATIOh IT!`•31.� C °is` o� } i,�.ti ;t-t zaV p .Jrst!,kJ6u. ��A���T Property Address, �S"Q�►�-�r�S° ► vt\ Address'of Owner r Date of Inspection: `���-y1"u n � . x ' [=H a 3 rgif :t eient) r:'t �qq�;_ � �Y►°<,° rf ,Name of Inspector NrC� .�Q - � tr ice• - 11`E �:C 1 am a DEP ap roved system`inspector4pur cant to Set:ion 1a.3a0Hof'Title 5`Q10 'C1NR U.0001 Company Name: I a a yr'r"?-7 8" r► Mailing Address: 'P o l3o;t e_371F 4.4 ':'H AcAl.0 H -S 0.0--C4-q Telephone Number. r5-G-74-1 Lc.��•- �� O r /� { ^ 113 �.dt\{✓ art .T $ ,..1�*s mr .'�.4 ,'. f ,yT r,l t:r}v{ .J;..t 1,Jr•.t i r,CERTIFICATIOti STATEMENT � 4,, m I cer.,tt that I have pe•icna11% ,aspeeed the sewage d:s-,gsat syste;-at this ad..ress`�nd tha:�the'irtforr auoh readrted be, is true. accurate and comole!e as o:the't,me or rnspec: -.•o The mspec::on r,as pe'icrmed bases on, trairiiiig'ani: ezperieice•in"the Fr„pe! fu iris- and mal nance o�on•stie sew°aee d,sposa systems ,The svite•t•: '1 ..,•.-•., 94 '1•�..4 a 4� 1 H :;I—. »W +3✓�' � •":: i 39 t-s- •� <• ` ,p. CI A �.„�. v C�:� � �:aN Passes _ Concitto-:ail. Passes • "' "tt :� RL' '. °".fit J'" r;rpcu i �i ,a*Jr ,.; ?:a',Sb.� 52w�>�,;°9�' i II %eec; Furthe• Eva!uatsor+ By the Local Aprro.tnj Autnor,n F ..i tm1"ri if a 1 .1 _ a c' w'lt'S .e�i`t �'K R �'r•'� : '.t .<7 t •'�J;� r YrJe•,e tom, a�� ?�qq 'g: III Inspector's Signat r Y Oate. _ , ` '_ 9� r. Me Svs:e°- Insze o• sha" submit a cop%. of this inspection rezcr, to the Ap„raving Auther,n' within thi .. (30 ef cnraplering th's,v inspection. It the s�ae•a s a share. syste;n p• ha a:cepgn Qow o: 10 000 g=d or greater, the ,nspe:or and.the system owner sf-o% ►bsubmit u t .M ti .' .. . the re, se, to the nvopriate res,onal o::,ce of the�De,a-mer+t o: En"renmenta' Frbte• ter.�The or,g.na! shoulC be se°t te�theiyste^n ovine- and copies s-•i:to the buyer ii applicable. and ap.. o g author,n ` " ` �•' 'r yin . ._ ... .., i. ._..�.a a• ? .. ., .. n zea+. i 4-.i,. N•J riF 4''�: n.aSq ..tin ,r y.r. a+Yi; .�:°� . ,»., r- a.,a r r ,...x. .. -.,r. r,^( r ,'� y t >r"4 9'Fj 44„f yr t � Y"x ....r,t�., r .q - i•. `} _ rs "�d r':`° I►ySPEC'TIOti SUMM,kRY . Check ,A .« .. .,. ! l I •# . F 3 tr4-l'`e t :" k t :b tw'•'.,1 ?}ry S ...,� iw.. '- �.^;a:r";.:,1 .s: ;r.. s :�l.!.•.r.l ;.«� S+», S ': � t M' r a's `'.c r, . r ...� I _;Aj�SYSTEM P1155E5 ,x 4 i»P ' ti- ' e Afi �°# Y !J t :t• ��y. se 9 �Y Y' ,.,a i{ r• ,y r°'Y... .°J- `rv.- .d Jr .. 1 :. ! d J"'r :_.` ,= . -4 t, .lYe4,a lr t'i 'r°._•tca+a$L�#�,'k-};}�F, •w,�, •.«TR;..,.-... .es.s.:..,v. ..�:.t.r.c"' a v�f .'lt a. ;`.H,ar�;•t•s t+�'J`+� :. n- ?:e� I have not found any information which indicates that the system violates any of the failure c.iteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicate—d below. . Y3'HT0 z: COMMENTS: .61-sySTEM"COpizDITION/1LLY PASSESs'.M�,. One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The systern, use completion of the'repiacement 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 instan es. If'not determined',explain why not. _ The septic tank is metal,•unless the owner or ape-2ior has provided the�system'tnspec:or with a copy of a•Certifiicate of Compliance (attachedt indicating that the tank was installed within twenty (201 years prior to the'date of the inspection; c the septic tank, whether or not metal, is cracked. struauralty unsound, shows substantial infiltration'or eAltratton.- or tan failure is imminent. The system will pass inspe^.ion if the existing septic tank is realaced.with a conforming septic tank as approved by the Board of health. r ' .� , s' '�3! bay >r q,st�ti SUBSURFACE.SEWACE DISPOSAL SYStTEM.INSSPECTiON FORM � '►� CERTIFICATION (continued) / � ' ate,a. n+ �, - .. `7 „a "+,.� / a �•- Property A .1 l € kM� { ` S b Owner: . ., ' 3Cten> 'Y�`~ ;"t� L� A:� E•.1�, a��'1 G�w�.+�i :3 t� �"�•��4IYI'fi( �ft f =s' �fx,s,}��'�• Date of Inspection: . a � B1 SYSTEM CONDITIONALLY PASSES Ico nun,, .�, Sewage backup-or•breakout,or high Static water level observed in the distn'button box is due to broken or�obs;rutte�• r pipe or,due to a'broken. Sealed or uneven distribution box. The system will pass inspection d.twlth approval of the .-, °_:M S Board of HealthJ.` Describe observations; M14 k z pipets)are re tacd ._. bro e y ? �Zolglfl SDAla b �t ob�strudti=7is removed , ' . ..; distribut,ori'tsox'is levelled or trepiaced .._-- i as 1.. � _• The system reguirea pumping lmore tlui};four times a year due to broke or obstrucred,pipe.W.•The system w•,�pa_cc _ •f Hearth •� t.• �- .�. .� <� r .. tnsoection it twith•approval of the! Board o l � } x 'broken pipes, arc re lace^ a , r9t ��'.a. �..r'rAC ,#?,r;.- ....Y - Y ;'" �45/yW4rxr o3strua,or ,s removed # y r}.4xo }.. t t t�"' d i��ti";'•, x�'�.,e i,t«'�t�''� *y a �„ 7 Y i SIn�Csa _�" aw "5 'trva *Fw * >c+.fk£ '�+nt&',u;' ' � - ���4'•4'°"""�..'"'�^``_�_'".��'°"tp.`_�+s ':� ,r.� � ,•X...h�:d��Q�y:..r..aa...: �,+ ...�,.w. 'x�i�w7f� �:1�lLd�:F•a v.. Cj FURTHER Eti'ALUA7101`IS RE'QUIRED"BY THE BOARD OF HEALTH' ". " ---�° w`~ �` rt{ss Fn;�r3s „ s�'i 3'" 'a`Y`4• tMt1W`�•R C3 4C3"'t .;--• - Conditions exist y►hich rewire furthe•evaluation by the Board of Hal in order to de-ermine if the syste•n is failing•to prote« the public health, sate~ and the environrnenG ::t p. ,o & « Y?t;# ..'"-: `•"•".,�•.s, - n• ." .. - ::s.c. *!s�3,".",.'F / « "g1.af:1 t°? 9!TS:7y '¢x u .��sa.; 's,2 ;•,s� , ........ ..' ! •,c a 1) SYSTEM WiLL PASS U'vLESS BOARD OF HEALTH DETERMINES/THAT THE SYSTEM iS NO?F(tiCTiONING IN A fr{Ai�NEA WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cess000l or pri%% is within 50 fee' of a surface. water arx>>,a,�,.,;•� +:t.. f;r•4"I'- �nr''s> ';+; .Y .9 e'14t'«''y' >q ' y`i �'iP�Y� _ Cesspoo! or prn- is v:'ith,n 50 fee: o:i bordring vegetate weaand or a snit rrursh. -�• . 2) SYSTEM WILL FAIL UNLESS THE BOARD OF..HEALTH (AND PUBLIC WATER SUPPLIER,-IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCT164% 6•lk! ABM -i THAT, ROTECTS-THE PUBLIC•-HEALTH'AND,SAFEi`Y AND THE ENVIRONMENT: Gw �lik-..r.:..�.� 6'y :•7.e7 tom..e`.:'';''.i:''�.rt Ti.'`i�..f �';«•'•ai..e.''t, ^.'".('r�'i'^`"A. '": i"_3.:.�I ,..�y..e.•, y •.� .. . .A , .�, a JG._.,,.. ..Y' -r•,„:� ;� .t.•. ? ,. t' "33•.•«K'�. a 9ti� •'""•r:. '3""r y`Ss. r,. ;...,•s r« 1 <n it ,. _. •.,g .. o- M The•sv s,ern has aseptic tank and soil lbsorpucn system tSJIS, and the S.A< is�within 100 fee, to �'stirface w�ief supply ar t-.j .91LD-3 a jY.r_,:,ai=< a:,: .`YJ. _•(..:`S ,,,,.."`.'- t -!;' 3 s ... `WS "� i ..t3 r"1.,.-.. F �, ,:..:;93. µw 9 «, ? "" '""�` tri< itibUlan IO a SURaCe water SUp01y. � a:^it... gy..�.��^� t :. i�< , s ,tr : t < .m... , ns _ The system has a septic tank and saii`absorption system and the SAS is'within a'Zane I of a'pubiic v►�ter,supn v well.. The stun has a septic tank and soil'abso Lion s stem and the SAS is within 50 fee, of a private waler supply well. _ The system has a septic tank and s i1 absorption system, acid the SAS is less thar.'`100 fee.but 50 fee. or more from`i lit rm . %,a and volatile organic cam unds indicates tha rivate water Sup ly well, uniess we.l water analysis for co o bace. a rg po P p Ys the well is free from pollution fr m that facility and the presence of ammonia nitrogen and nitrate nitrogen is equai to or less than s ppm, method u to determine disunce (approximation not valid) ' - i1' .� Z,'x• i Is � i,�a i e Y. ,�°J's :.}t�. .•�• � tmi't. ,F'•" td !a , 59.1't .r to t�f 7}F&SC •,•,� 3) OTHER wr.?: ._s «..r,� >a »� ,sxeal :fir} ;or, 41141;r 1. ,'. g t • ^ o 1 F 3...a. r R wG fa = -F Yn i h ty% H,� o M v C"� .r.Xe Cs�.ti,.`0.'Yx' � ti:b,;�{%1`�:,�«.;� ;S1To c. �'i:?; ..fa ..m S.9 i��!'i',°.�„'j11'.f'"J Si.u9,�.�t�"t,.4..'�fa '�i'1'�+';.�.a� ri IivN 1« 4: ;{ '4 .`al7fia-)a Pi;ti;'ss!a"1f$Sa�. •«r M , �4 7� '.,�'e°°�11Pis�s.1,.T �.�v k'�• iY ,�'. ..k��1�9�:•}t�A�t.! i~1S�g,�>:s`•'H'.,!'p:,:�i7 f� a*�.tTn� �!,'ii�'+,J .�iu`«�7 i,�.`��� ,.b 6'.'2*:EiI�T.v.w.vt�1',`.�1,.��i «�.�q�,:v�5'ek�e%I{. 4,io ��(40v�fS rtiw, lyy�"Ssk !e.i ��•t,"a'3.3a'd E..erY'13 .t;:'iG?Yit�'SS�p`-�,..Y'ud'i��'".�Xi�w "4�9k1.4 Pcs:`,�';'?.t�,3 e�.wYQtlJ i.sl�ki"t, q�n ic.l'1,:�`1tt�f`.�e•�•�"�: o ... sw•; i "M t,.4 ' i t. "'.-v i „ t .Ol 1 eF r kt,'�iati� "r�. oa�pigr 7�' 1�� � � n�! l���lr 3 ���, .�. ,�,s . � �• ,4-4 "i`S3lr-.lt�3 ."f0 no' r11r'{i �5. ,fe? } s niL ,b'-tour;: yr ;—m a <• irij.°,'.'w ,t�stl2c. �.' i��'wil .c`C,"w'."'` icS2', f�l, r";��.'sS.•":a: • 4: :.� i' � F su ? � .:"{ :`S '�`rC! "" p"'"i' $r9 g. ' ". $�{`�•'s9 t�'1' n 7 rleigs i .r t {, s:, 1 i :s�a. i z ili r ,t Stu. trwirted 0�t.• , -t ,. .�'i".ITS�:•:�j J1��,'� �3!'1? 'ri� �'?�k�t�;fi�'a •;.ri :27 ! , Page 3 oL F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM PART A / .... '- (;{. - r"•"Ni t+w. ;�-:. -y Y,A # 1 sv'"7 7 i 2 ",'S .;.••'r hi ,3 7 +,. CERTIFICATION (contrnu`edJ Property Addross: _ Owner: ; Date of Inspection: D) -SYSTEM FAILS .• .. }: w ;r E TKO., , You must indicate_either 'Yes` or "No- as to each'of the following S> sr cst Y t ' 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 10 303, The oasts for this determination is identified below. The Board of Health should be contacted to determine what will be necessan to Correa the failure. M zt t�lit,;' �!to n�r� `t{ s"=t> ;o `t,3y' ..; Ty ,,+n, Yes No " Backup of sewage into facihr)•,orsystem�component due to an overloaded or cl gged SAS or cesspool. �t C*:r3 ;iDischarge or pci in o'effluent to the surface of the ground or surface ware due to an overloaded or clogged SAS or a n fli.as x �. �3":.:,,°i �3 it,'Sc. F4: .�.rr. 'i� a �=' 'I• esspool. , u'?,:-t tl:,:l:tu�;t";?sGi:.'-3.-'.l "'.r. 4•r«: ..{{s.., «. i•fr' �t e /a i +. �v' . »...... ;fo-C, S:a:ic houid levei in the distnbition boa above outlet invert due to an.'ov rloaded or clogged AS or Cesspool. >rl ;`? .al ;f:�.►iL ic`. T; ! � 'lal;:.. It :'.;r; •/7, +.1 s r 't' r ;k. �.,•� .. K' It utd depth in cesspool is less than 6" below invert or available volui a is less than'1%2`da�°r1ov., d p F p r;:-- jrsi:{ _ 6 g:•�vr =c:.r �r t ::.:J.�. ,.E t;::ck. '�;•.. �7r Reduired pumping more than 4 times in the last year-NOT due C to gged'or obstriiC;ed pipes '' -• ,,�'�...... Number o;times pumped — "-Vu4: -€, f.w^t : ., ?. �w 3• .7.. .��' "s:t_.7f� ..!Za. . y� Any portion o**the Soil Absorption System, cesspool or privy is below the high groundwate• eievatto . Am ort:on o:a cesspool rn� is w,ahir,100 test of a su '�water su ply or tributar to a surface water supply. /'ryA p P _P.� w a. pY _ s_ - .,a s +. 'ay cF rt s, �;4;,r•' -. r.EsfA tilt: �. o:.Any.portion,of,a cesspoo''or pnv\ is Mithir. a•Zone I or a public well yr / 1 .ta^Ua iC3 fi3LY®Fj •nn PtsR�;� "dti:.:�?`. ,-:r^Jti�t� :�4'?1 ,:•,.e ;7 .'y^ � .S t` 'z(�,r"! ,Lai-9 s. L'„i.,w: Am pe�•o- o:a cesspool or privy is within 50 feet of a:private water supply well •� ''' •:.�r.:.i 1..t�F. �'£L:�� � P E...., $'eC ttI ^t..t.,, }J:.f �- Any pbrtOr. of a cesspool:or prig- is less than_100 i t but g►eater than a0 te--, trom atpr�ate v'ate�'supp V well with no , acceptable water qualir, analvsis. li the well has"b�n analyzed to be accea:abte anach cop. of well voter analysis for t coliform bacteria volatile organic compounds, am onia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS # you must indicate either `Yes` or 'No` as to each of the follow' -- g The iolioN:rg criteria app;% to Large in addit n to the criteria above: The systern serves a facilin with a design flow of 0,000 gpd'or greater (Large System; and the s\•stem is a significant threat to public heath and safes and the environment use one or more of the following conditions exist. z Yes No . the system is within 400 feet of surface drinking water supply '' ...... the system is within 200 feel of a tributary to a surface drinking water supply the system is located in a itrogen sensitive area(Interim Wellhead Protection Area IWPA) or a mapped Zone II`of a% public water supply wel The owner or operator of any such syste shall bring the system and facility into full compliance with the groundwatertreatment_program reqMR.S.00 and.6. Please consult the local regional office of the Department for_.further.informatiocv- u,remen,,.ol 314 C - ijt31 trwi,.d 0�/25/9;y t a Page 3 of 10 P a .n a .C, .0 1i -'-Y V a:)A-',RL.j9° Sl.'BSL'RFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST: PropertN Address: Owner. ` 3 Milt Y :, Date of Inspection:q( ��[ ss� i °E�e(it s s � }t� CT: F tit%' Z°9`f l$i ;ta FAA •"1. y ., 'f ,y 3;`L1CTr +1 '�S'iiL�.'�."�14._�'�lr�.ia ,'.x.f"'vE:,:'}li4,F["t.i.il��'w'Wa e,"�,'�::ro�3-:�:7 '3:. ..Ii+.C'."� 'flie�iF'.,'�•t:, �.'r"�t?.Vfi :•r:i .':A L^`�+� 'r-.e, .tir?!`y.�. 41 (`::Z:SCsf:i'."I3?:'n.�: ,.F,'{i`(;8. Check if the following have been'don-e: You tinust indicate either "Yes'or"No` as to each of the following: �Q rr �93 /�4•i(K tS.µ• b Y) ^9" d^ »l Pumping tnformanon was provided by thei owner occupant or Boar"d of Health f .�ti•1 x '+f' F e. "'"`°"�. t o ,w T.v s _F. / s,. 2 f c .. ,c - + 9. .. :t .:r::i:�' �,a +ag, ,s+- 3, '^_�j Ft. ts.;.s r}z.,z. '' rl-m tz. + .a .I Ff'# l ..t tS 1r . . None of the system components have been pumped for at least two'w%eks and the sys"rein has been receiving normal flow races ' during that period. Large volumes of water have not been introduced into the system recently or as,part of-this inspection ,�3 .i •v 'C: -7.-,,:,,,.J •-F; hM1.3a•Li �':ram E Gli.ni`;, f.+gV,^:i )iSi. a Jc; ' 40d osf@.d .,:t 4 if Pi _ -tort: plans have been co:amed and examined., Note if they are not available with f,.', aQ e%, f•'c,.6: a.).t( f .tiff u!,vz, zvs } ut4'B V:YI :aoi°,I �':,� .�anj ��"l; zB s� . The iac:li. of d.•e!ling+was yinspected foesign o sewage bacic ups} :r� fs:ot _ The system does not receive non-sanitary'or industrial waste flow. ---- L1'tw-wt "'` ' ' "1c""="" The site %%as inspecte Gd 3,,s.. , : ?sl' .ir. '•`. 'y"4" t tC=;�'.,, � °3.s ''? n�'',74'."s::« ,.. vf`•7 ,. .•:J ::k,cj a't..1 _ "for signs o►breakout. - 4 - `t- All sv ter'r'. co^iponent excluding the Sotl Aosorption''System have been located on"the 3ue.x _ The septic tank rranhoies Nere uncoyere�'operiid 'and the inter\-of the`seaiic tank was inspected•ior condition of n_ _ banies or tees. materia' o'construction. dimensions, depth of liquid,depth of sludge,depth of scum. t;9.:k :.., •a ,i5'r _'(e1fS,:1`.rv• :::':� '✓. tilt: . .^f e..�.°, °' '^i.: _z. .s :^1 .:.a., :�. ,".r. n,.. e The size and location of the Soil Absorption System on the.site has been determined based on Uc"1 iFii�+ .r +.£':.•``�l�1^rjjS,n ,1S! -7 t•• Yttt P ,( y to �, r ,- (r S !t{ ,. _.-... n o\.ne tano occupants i nere di -i from oNneri were provided with mtorrnauon on the proper maintenance o The tac rr ..n,,� n.: rC`i a -3 F( :y y ,3 Itn tg , atf. ., f� N •rl- ... Sub-Sunace Disposal S.sterr » , <i: ^' ?. ;'' 4_, `i.. ti: ..�f ors...I 7• S a. Existing iniormation. Ex Plan at 6.0 H. Determined in the field :i: am t of the failure criteria related to Pan C is at issue approximation of distance i5 unacceotabie 115.302:3itbil 000,,Ij.`3a ,r_,t 'Ya,?gb `rri t ,..•.,.._.... . , .. f2t.,:,F' 'Art 1!ll�•-•'�.� �; i"•PfL, �w� ;4 i'�.'t+:Y `.3'".:tYY ',L �'f'9','f c;' .,�-✓'i�• „ !..sl:?r'i. :,'°t-! �'°!' `y�•a. .'ni si: � tlx`.R..�sxa t:'�:'� ..,.._. !'t Ls',•�:.•. 1:Ye i? .,..1:. ..li >x N < 1.,utfC<.. a baa'r.::': 1..3 � 1i1 i4 'gC4ed. q.'r y`t:ft{'fl't5.:""•.' �i'.s'!'ti/�tr� ar;llrfa '°'r..c l........}�' ,..5..r•,if-�'?.ti `.;#':°'.1"su uwlhle,�'?PI£:*!x fl., :" 3t1 b,.e %�: :._1:1;..��t1 r3 "?',.:t`iv'' ..:•. _M.,..,, " gk°•r ut tt^•I:.. 1+t,;sf 'i L•.a� .. '• _ 1..as ii tt;rF{ef�. 1 it -'.'c;.yYi....-�"YS °li.., ,tva' .,... .. ....-r� l.a. :� si li.iet iris � ".�F•�i'�, 4��2`.� sWr�; i.,r"�-K;v . .:U3 tf'":. �.. .r c Jt;✓ 1(� '.A:^� S:lr,0fa .I .: ri4 I.J7{ c)(ijf 5,' ?1 .yY {'�. �. .: ;,s•.ri '...',:: ii;rv.»% ..i IY .,il'1..Inn..Li T::F i e SUBSURFACE SEWAGE,,DISPOSAL SYSTEM INSPECTION FORM PART C 0 1 T 3S EJW U2 LMO Property Address- Owner: Date of Ihspection: w 'WF7r ,, ..�� ' FLOW CONDITIONS RESIDENTIAL "Q Design ilo%% 74'90 c.p.d.Ibedroom`for S.,\S Number of bedrooms 03 Xt a.; ',t.'- a . t �o tt,z,,to Number o'current resldents•_?1 j( Garbage g•::der (yes or no?:_,&� Laundry co-^ected to system lees or no! i Seasonal"use-tves'or 1 i "'01c Tr} rt i tmrt :1„ a}w,4 ne'i Water meter readings, if a�atlable (last two year usaee`lgpd}. ` r cyta� Wit? Sump Pump (ves or t , .. ..`, !`"!'3 "k"i,;ii+rr'=e ,iw:;4't J�, - 9r Fr .y.i.tee t1:7't;•'�iti»F",'�,xt"t..� Lai- dare of occupants, COMMERCPAL'I-ND USTRIAL: Type of establishment t' ivo -- Design f}o%%- ¢a!ronsida% Grease tip present Ives or no_ F _ Z Indus:rta! Waste Bolding Tani present. Fees or no_+`t�*` ':on-santtan.-%ante d,scna►ged to,tne T,tie`3 sys,em wes-or \dater meter readings if avarlabie 2 Las:pa:E 0: 0 ct;,2'tc. OTHER: Describe _ yx> .,:, <u Last sate of occuoanc. ' GENERAL INFORMATION PUMPING RECORDS nd source of mformatioc �'3 System pumped`as"paii inspection.`"t\•es or-no. N if yes.volume'pumped___._. .-¢aiIons'...� ---Reason for pumping TYPE OF SYSTEM n Septic tank/distribution boxrsotl absorption system. .� Single cesspool '`' n "`y Overflow cesspool Pm) gars ' ! Shared system (yes or no) (if yes,4ettach�pre ious inspection records,t if any) VA Technolo etc:Co "of' Other pY` u Ftodate'c6Ff-r ct? r' �la+at� .. •t' 4. 7; v-�.)0 14icl f"O-,t,, �yI It,„tl .vf f" e:7 ?f r t J APPROXIMATE AGE of all components, date installed (if known) and source-of information tl�u'1F�C` (M Sewage odors detected when arriving at the s}te..F. es or no) Fr ---'- ._...._r......•...-.•.�..._.... +F.--............,.w..... -...,..,..............,. ............,........__... �.......,- ,,,..._.........._... , -�.''�' s .z4 to 0rtlm lvt y (ravisad 0{/2S/9�I Page 5 of 10 , - �f���� �'a,fT:�'•9a�' .?�s�i$�� .I�.����24D.3D't,>'+da? b:1a4��if.)2@t+�.l�: , : - J T•;A9, SUBSURFACE SEWAGE DISPOSAL SYST7EM,INSPECTION FORM _. PART C SYSTEM INFORMATION (continued) -//6����. �/ - 3{.. �c'^y tj�h�ka�4•`f �i Ff/i'~e Property ddress 4 74 x a :s �9x'^a+t tlCdr:f k?i:i Owner. ." Date of Inspection ,.�10=16t0!, s 0`1 `S7 3 *,}dlr3t?wZ�f BUILDING SEWER (Locate on site plan) t. "g, ara,rtar�pl : f�rin;* 'Depth below grade ; a r Material of construction. cast iron _'40 PVC_other lexplain' ;on.d`z 3tvt t c,r ^'O,J Distance from private water supply well,or suction li .Dtameter *6Tu ty t .r'{MR '�t k'+..va3oL", ' ar y ,yyc'`� w2 .s`r � f 3' Comments: (condition'of lomts, venting, evidence of leakage:etc.) ant^ ",tsj SEPTIC TAhK: Qts (locate on site pill it Depth below grade-yN�� a la Tri ret rr a � ,J rat Material of construction, , conce _meta _Fiberglass _Polyethvlene _othertexplain +"-, et,'.W a 1,.•... ,.,; : a �ihett*ar fwi q•4t�.lO;f �a..•�Rd W .t�L�C .:I li tank is metal. hs: age _I1 Is age con::rmec o% Cen.fica:e of Compliance ('res.-No a,,.z,tFa,,, :. 'i�"° 3 " •�x pimensiorc,-1 0-P)eii� l w ... M. .,}� _ .. ____m__�., _. - - �_.__ �,-�, � � _ M,. .__ - • :� ,3_ :'x2 a. Sludge depth _ �I Disiance from top o: s:udee to bororn o-*outie: tee o• ba e 3, Scum thickness, „yam _.�_.. � ,�.' ��n... o ,s.�a Distance from top o:scum to top'o' outle: tee or ba`,e _ tl Distance iron bonorn of scurn to bottom o,outlet tee c• bar;.e How dimensions were determined NaNA C?tfr� Comments , tr °lr•"t "^ trecommendation for pumping. )condition of inlet and outlet tees or baffles. depth of liquid level in relat", o out( t invert.`siru ral integrity, evidence of leakage.- :ca ., �: 0 � . _�° . . GREASE TRAP h "•: StEt 1 `s2 tSJiJGS€}iiGb 2lxod :.Ji)i�dt tstsJti.+I bt 7t d?a (locate on site plan: toc�b'w : rtiy b w. Depth below grade: nsi;I µ Material of construction: _concrete`=metal _Fiberglass _Polyethylene _other(explain), ....._..... .f`, a _'C» "• "�.':,.. "`ti7 ,'.:,7 Y4,j.y,. :"T't,:::5 .'E7 S-ti �i:f'. ,a Z,V) "i'.iptta ha ... .«,.... ,. ... .+..t..to r «... Dimensions: - -Scum thickness:_ _....,�..,.._ �..._.•._.... ._...,.......�_..�...,. ..•_�.W.,.r.,,r....__._�w-_ . �._._.� ......_.M...• _ •.,._..�. -- Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bonom of outlet tee or baf ie: t nry;;�' f 1i; ��11��f}} ���w; �f*�:,tici^:•J� '1:�+J� ��e� ��7J5c°�te$�����-�?'2 .Date-of last•pumping: ». _Y w ...af, ,c r '; Ong `. _ -. — --- COTments P't.fcly Y 'Sv7a".ifiiS"s'5SL. --""trecommendation for pumping.--condition of inlet and outlet tees or baffles, depth-of liquid level ini relat+on�is outaet-+evert;strua�ral— integrity, evidence of leakage, etc.) (rev-sod 04/25:97) . Page 4 of %a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT10% FOR. tit _ V' PART C.' CC //�� (��j�(cl �(J� SYSTEM INFORMATI ON;(continued) 'q J V��V"'lJ {.JK. 'b i.7�t'iiS'J:tl `<"`�-2,�'Y°..r�':�r..'e%s r� �'•�,<�.I �i a , , Propert% Address: 1 i £tj 41 ( t . ONner.��� - s- .•, Date of Inspection: 1Z"�1�EJ t t .f i `; u TIGHT OR HOLDI%G TANK: •Tank must be pumped prior to or at time, of inspections (locate on site plan, ih5�Depth below grade. - ! .�'{ :c:. .. •r }{ Material of constrbction7": concrete metal—Fiberglass s_Polyeihylene-=other(ezplam)._.. _ Dimensions Capecm gallons _. t*tea F� : 5mir�>N ', Design ilov% ganons�da, s f {1 n :3{ Alarm level Alarm to %korktng orde• _ Yes. _ No Date of previous pupping Comments _ -� - c �L r urn (condition o+ inlet tee. condition or a!a•rr. and float switches. etc.) -• �� �a,�p,,,.^- e =>,?tx ^�I'rnrr '�i:tom 2i- r� �f i ; �i ..... -• f ��:7 ..iaAr '1. �3 S ,.,'S..': fv y1.:.. � .e a 'n �!^. n ,a-sra7 j'r ,.J':'� �. 't 6t�'i:>z.�f'I 'r3 "$'_., }:•=". „i, `i„_ .j(:, ...._.._.»...•�...w.�,.-...�,-.=-....�.............,.wd •L.w�c..'�c.rL:�.�—.-.-..�.:`ih: ....-r'"".�...,. '*.a.....,-...»_...;w..�`.'. .go-'...;.�,.'a•+kL:��»...+..�.........y,y"r� 'l' j�s;r�. � '"T i,"�'1'...�'.�' 4,.i+Y.,�.�.� DISTRIBUTIOVEOX:- iloca;e on site p:a- :+ Depth of liculd lee•. aoo.e outte: m.e' Comments mote le e! and dts;rt t eau-' e•T 1dence o{ solids carnover, evidence o' leakage into or out of bo !c11or. �`J �a �QU �,crj w6 , sa dVIC rL: - PUMP CHAMBER: (locate'on'site"plan.------. Pumps in working order: (Yes or No, Alarms in working order (Yes or No- Comments: (note condition of pump chamber,-condition-of pumps-and appurtenances,--etc.) - ....a.,,.,,.._.,,.•-.,-,._d..,• .,... _..,.,....r.. .. me,,..�.,........,..,.. r .._.,...-. .. ». S�.- r• _ _ III • - - ,,.. ... .��....»... �...F�h•4 3 �'"Ss+,i --... e i .o-.._......_» »-....-...-.+-..,•,.....-.. .,..t•'w'Sf w�fT �' -L7 {a_ n� ' ' - .,.. .....,_.r.ws��}!may y i,3s�1 • _a ....._... (. tzy �i wti4..;r°�"t'F•+� iwti q,4,":::tij� •y ,. '--'u .. G c'Svr"T ;) q2,t i i-"I _.,..,.._..�..�..,+........--.. - _ .....:w.4.s.+.,-. ..mod_ .�..-s-.�,.......,..._...._,_,.................,.....•..—•...»--......,..,._.,..,..,. ..... ....., ----•-r:•.a.= ^^"f/ (revised 04/29!9 ).. page*? of 10 AYr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtit ? 3T'Z?2 " SYSTEM INFORM i6N (continued) u ��{ /j���(AV`^Q�. a ..�*e.t R,�:'wr.'�'`t�,��.,17� °��� tb "��`•.�ttt ._. Property Addr ss 1 i6 ^w Owner:��•v °,a jaa ;,,�° ••�ur"� sKltJ ., •nt��.: Date of Inspection: h '!j} SOIL ABSORPTION SYSTEM (SAS): � :r3oJ� r±i- a ._., t !a -m ,c) lr'rfla ki:n a�lyi t.¢Esm tr+g r. �� :)tVA r �}/ICUGH i�`� �r�:E (locate on sue plan, ti possible;'exca. ion not required, but may be approximated by non-intrusive methodsi-- w:w•Q.;SEl ..G _� 7;ra If not determined to be present, explain: Type 6 3mt � � ^' ,* J'j � eachtng its. number. leaching chambers..n'umber' leaching galleries, number. leaching trenches.number length: leaching fields, number, d.rnension - _i................. a :Vim lt':1 I�i•� � 1'YfY� overflow cesspool, number Alternative system _ L';5dl:4 'fir- z7^o:a '0 ;::r0:J Name or TeCnn010gy Comments "_..- _..._._._.-.. _ __..___.____. ..._._..,..,..�.�.._._..._._..� -- ._..�_......_.____...._...,_..._«..__,.._..._,,........._.__._.,_..._ to e c ndition f • . g ` �i *__.p�_`�-._-_._.A - g tation'etc.t o son. s: r.s of hydraulic ta,lure, le.e' or ondin c` rid�t "of" e 13 r5 CESSPOOLS: m t �, 3 >� .r•a �s (locate on site plan e � sir r 5 '3 rM Number and coniigura:,on , Depth-top of liquid to inlet inver,, , a. ?lit? �T �_Il ?•, -, t": ': a „ '� et Depth of slmds lave mm;r:. a. d 3 :„ - �_ t , Depth of scum layer Dimensions of cesspoo: Materials of constructor. Indication of groundwater inflow !cesspool must De pumpeC as par,, of inspection "X Comments: �`•" _ M (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 'PRIVY-.'- Materials of construction: Dimensions: : Depth of solids: Comments' - — - (note condition of soil• signs of hydraulic failure, level of ponding, condition of vegetation,'etc.); io : r SUBSURFACE:SEWAGE OtSPOSAL SYSTEM. !NSPECTIO% FORM:., y .4ar PARTEC; ' SYSTEM 1%.FORMATION-,(continued Property Address: LS r 1 '�J � ' `` +�^'tj` Owner:ukv Date of In,pection, ` 3_ SKETCH OF SEWAGE DISPOSAL SYSTEM include ties to at least two permanent references landmarks or benchmarks locate all wells within 100• (Locate where public,water:,supply.comes:into house) �;,•uY-F �� t L;�}.0 �,�,<,,,� �� ,� _•s. `� �`-F x:. :{'% t fir"? "cG.IF .t��>s ,�.• "rC' ... _ ,7.��.�+'+ CP . LO :3f .,.,:`7fv •1 _ lit ,:�-rij .y 'Y to v w'..� .� J. o f �,.,. - C. ,. �^ ,� � ,�'C �i i c,. Imo"'` �•`"'�a ! ,;� .. .. _ s rg .''•€ ..l `J j+FhM +'yr.::_7 .�t i%^.r y ,M c-I.. V • �- 3 q. �153 trsvlssd 04'IS!S'1Of SUBSURFACE SEWAGE DISPOSALCSYSTEM-.INSPECTIO%`'FORM r _ PART C+ SYSTEM 4FORMATION'(666nued) i,� ids Property' ddres'�5 �Owner: Date of Inspecuon: a ' `1 146 Depth to Ground ate W2 t ,a':.. : ;:••.•fro- ^�' s+t:.y }R > Z.1 r':ar.J',ram+I Lx,:5r1lit+^��f �'�'ya'.�la�#*,M1 .1..gr?am qq 0" Please indicate all the methods used to`determine Hi&Croundw•ater.Elevation E'- .-�, '!uq -ettjtiari, tx c3.7 'w fi n� l;a';a•cii 'r !?v ;„o r Obtained from Design Plans on record 1 Observation o�Site IAb utti n8 pro perry w•robse n•ati n hole, basement sump ec.) , , k.Y1, r .. r •.. x:�«` 4a+'vfix x ' _ Determine it from local conditton� Cnec""%%ith loco' 80ard 0 nea.:r Chec; FE.�tA macs > Checl purnpiq records Checl. Iota• e�:a�a;o•s rng:alle•s C' ( n a 3.1 Ise ' =_ 'Da:a rf ` i ?tom ' 3j34 r• Descnbe in %a.r o••- v:o•cs ro- %0_ es:ao;anec the '.,,E;- Croundwate- Eievation (Must be con;ieted- I�Wtaoj iC4 1�14r'e�yc-g�-Qle'3�Qc�nTwjt-!r A-C Zaq Z- 4A& t �a ! lrw���d .�:iS'9' �P�q• 10 OC 30 7 i�'';a•, ar us •:s.7 HSE ICJ l.: C �ION� r� SEWAGE PERMIT NO. VILLAGE INSTA LL R S N E i ADDRESS amomf R OR OWN ER DATE PERMIT ISS E D DATE COMPLIANCE ISSUED -� "-- �` Q S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7v.r'`i.nl...........oF..... ...Cj2�us ......................... AppliraMin for Bigvn,a al Workii Tilnuitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _____0 LD /h/CS ���/ 7 , C07-v/ l 7 .. G o ......._-----------•--•--••----.....__•------....-•----r••••--•............................... ................................... ocation-Address or Lot No. ......................_.......... ....-- ........ .._. . •--.... Owner f Address ......................._Installer .__.... ---•-• _�___Address------------ d Type of Building Size Lot....- ____ 'a_____Sq. feet Dwelling—No. of Bedrooms.........________`____._._____________._..__Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures ----------------------------•--• . e. W Design Flow______ ___________________________gallons per person per day. Total daily flow..__ - Design WSeptic Tank—Liquid*capacity_�5o�P.gallons Length__!q_!�"_ Width.___--'`___-_!-?- Diameter________________ Depth_.4/�_. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No______ ____________ Diameter....... Depth below inlet....6_En.... Total leaching area__ oa.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by._2���... ------`J_4r-..... Date_. :__ _��-..��____-- Test Pit No. 1 m nutes per inch Depth of Test Pit..... ��._ Depth to ground waterNb ^""' W P P 74�„ p g(x Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to round water........................ G4 ........................................................ -------•••...---....._..._--•--•-•--•------- •••••••-•-•--••-------•••--•••-•.._...._--•--. --------- Description of Soil o.i= � tc% "c3=Soso, 30" �9 = �6-Zvi-?�--�!.-..'z�..._._. U �76• /7�0~ G{ !- �` .%.. L sue✓» •--------------------------•----------------•-•---•--------•-------•------••----••------.-.----------------.-..----•------------...---•------------------------------------•----•-----•--•••••-••------• 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 ii;.. . y g = g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued/by the boa of health. Q�r Signed-----------......!'-!!l._' -------- j �• � � D te, Application Approved B}U,,. ' ------ .. .- -• - --- -------------•-----------•------••------ ----- Date Application Disapproved for the following reaso ---------------------•---------------•-------------------------------------------------------------•--..._••-•-- ...........................................................-............................................................................................................................................. Date PermitNo......................................................... Issued.... -----------•------- Date NO!L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ]�/.�i 5' .�` Try ......._ . ._...... OF........................... ..... . Applirtttion for Disposal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..----•---•----.....-•- - ••--• • -- --_•-•... ............................... r----- ---•-------------•-----_------------------ ocation-Address or Lot No. ..isT2c.C7-10" ��i� Mom-5 -5 ......................-----...-•••--•................:.........•---•---•-•---••---•---•-••••-.... 7?..........._......----..74...........•--._.........--•------•--•------••-•-...---•.-....-- W Id�3 Owner c�r� ?> Address .... Q57��ZViLGC-� Installer Address QType of Building Size Lot..... a'.____-Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p.I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures •---------------•-••----•--••... . W Design Flow............................................gallons per person per day. Total daily flow.....�5_..•�'�__p.._..._._._........__....._gallons. WSeptic Tank—Liquid capacity S11O5?gallons Length__��'.FT'_ Width.. Diameter Diameter................ Depth..'`' /.�.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter_.....P.Er Depth below inlet....k�T_.... Total leaching area._�:47 0 9.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by._77AM �...�=..._ ....... �_.__._�.�...... Date_P.c'.._l ....................' aTest Pit No. 14C53 "`"�m nutes per inch Depth of Test Pit.___...'?l?"_.___ Depth to ground water!( . _r.f........r�Kcta Test Pit Nro. 2...............minutes per inch Depth of Test Pit---- ..... Depth to ground water........................ f { -----------------------------------•------------------------------------------- --------- •�-•-'---- ------------------- ------- ---•-•-----•------------_----- O Description of Soil---- w 'l50/G �a Ss�'-- ---------- k --- .x 7o aao U ----• ............................... . •... ------ --•-----_-----: ---------------------------------------...•-------••--------------•------------•---••-•-••-•----••. W ---•-•••----------------------------------------•-•••--•------•----•-•-----------------•••••-----••----•--•-----•---------------••-•-•-•-•-••--•-----••---••------•••••••-•-•------••-------•.......---- UNature of Repairs or Alterations—Answer when applicable-----------------------_........................................................................ ---------------------------------------------------------------------------------------------------------•--------------------------------------------•------------------------------------------•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f'1T+-1-^ the provisions of .-7 IL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued byth boa-d of health. / Signed_.__._. l Application Approved By !�Y. (-------------••-----------••----•---•--- `t a.te. - -- ------------- Date Application Disapproved for the following reaso s:---•-•-•----•-••••-•-••---------•••-••--•-----------•-••---••••••-•-•-••-•----•-------•-•--••---•.............- ----•-._._...•--•---•--------•••••----•---••-•----••---•----••-••••••-••••••---•-•------•----•-•--••••-••---••••--•--•---•-•----•--••-••----------•---------•---•-•-•--•-----•••----•-•-•-•-•-••-•------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��r.............OF..... ..... ........................................•. �rrtif irtttr laf `f�ornt�rlittnrr THIS IS O F. That the Individual Sewage Disposal System constructed (�r Repaired ( ) b .................... = ----•----------------------------------------------------------------------- 1 Installqp at.---•-•..._c!�-!_.._ q-_-... ....... � has been installed in accordance with the provisions of,T r. r of The State Sanitary Code as described in the application for Disposal Works Construction Permit N (_ l --- .y................ dated_....____._...___________._...._.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. Inspector.. - � ..�= r,........ ._... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH N ...... ................ ,,.... ......OF..... .��... FEE..._._................ Dispuottl nr no rnrtion Vamit Permission is hereby granted.... ; - r•-••----•----------------•••-•--•-••----- to Construct t_*�) or Repair ( ) an Individua Sewage Disposal System atNo..............'�=ar...../f............. ...._ .. Street as shown on the application for Disposal Works Construction Permit No......................Dated..____.._....__.....__...._............... ---- ----- ---------------------------------------- O ) oaro�alth O/ DATE---------- ...................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS .ri r � -3 OLD /�i�vG s �2 41- .s 7 od 1- , I �l 33/ �►�C. v a et G O o S /�oT�— c°ZGNi�77o�-S tQ9s�a a.v Grp ZDA7ry l-j CERTIFIED PLOT PLAN LOCATION �o 771/T �A 5 s. . . . . . . . . ./. . . . . . . . . .I - - - - - .. . . . . SCALE/` '. . . . DATE A- /5-198/ PLAN REFERENCE e� E r1 . . . . . .. . /E-�/DoLyi✓ hS/. KELLEY CA C'/Z4't/t/�02a r � ®� I CERTIFY THAT THE �`'Q�3T�NG / vj)Q•l7p,�,/ �tsT �i SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . Atvi . s?xke4.tF . . . . . . . . WHEN CONSTRUCTED. ��9✓ �C.Sj�//-�!�/� DATE .T4�.! !S_�l�8/ ,n PETITIONER: �E�Ni� yJ�S `� REGISTERED LAND SURV R TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 7-77777 e; 4"CAST IRON 12"MAX. ' PIPE (OR � 12"MAX. F3/4 4"ORANGEBURG(OR EQUIV)EQUIV.)— MIN. PIPE- MIN. LEACH PITCH 1/4"PER..FT PITCH I/4PER.FT EAT. TNGINVERT � aEL••?8�?Z. INVERT INVERT P .SEPTIC TANK DIST. • wEL..,37r43. ELS7 Z-S. V."40 INVERT BOX FOS 80 Opd • • GAL. INVERT INVERT `� �a aI/2EL....7�. ELS'%4.Z , _ w w oEL-�7.a� e' � � Dw ' • ez'—�-{---s'DIA. -•-•� /o' DIA. PROF1 LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE p- 9� PRELIMINARY SOIL LOG WITNESSED BY : DATE �> /.g.�y80.. TIME. !�.%.a�.R?7 �A 4 C, Mve/Z,q� BOARD OF HEALTH TEST HOLE I TEST HOLE 2 7 �rs. �. zc�y I?G-- ENGINEER ELEV. . WooD427 wouo4+srr� 3o s�Q_so, s„of-So, DESIGN DATA so 3 NUMBER OF BEDROOMS r7�, MsrD Cnnr.o CoTui1'S A'""0 TOTAL ESTIMATED FLOW . . 3-3c? . . GALLONS/DAY --- 96 " -- 9` BOTTOM LEACHING AREA 7��So . . SQ.FT. /PIT SIDE LEACHING AREA . . / �`—�? . SO.FT./ PIT GARBAGE DISPOSAL 1'10 . (5O /o AREA INCREASE) TOTAL LEACHING AREA u 7 00 SQ.FT PERCOLATION RATE `3.5. Tf�/ './1Na MIN/INCH LEACHING AREA PER PERCOLATION RATE 33c?. . SQ.FT. .No .WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED BOARD OF HEALTH 4F STt.+nf any AZG S/p�5,c /5; �u,T �L 5 . . . . . . . . • DATE . . . . . THOMAS E.KELL$Y CO: AGENT OR INSPECTOR ENGINEERS—SURVEYORS 346 LONG POND DRIVE TH YARMOUTH,MASS. OF MA SVj OF MA, 02664 7HOA4A N El p a co &LCEY cn No.24260 /�/!95 5 ., , F o �. 'No 2a10. G�STEP r/� ` 1�T ® FSS�ONAL �� PETITIONER �,� APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION (!:67'Z- /7' NO. VILLAGE DATE .APPLICANT -e►1-1-V A;r0S11/ Z-: FEE ADDRESS jet //v/S TELEPHONE NO. (Non-refundable) ENGINEER " ,�� - TELEPHONE NO. 30,'--3�,6® r` DATE SCHEDULED (Applicant' s sig ture) SOIL LOG SUB-DIVISION NAME �L.1���. fl�f I f-4 DATE Dj;e- f mil, /�967e�- TIME EXPANSION AREA: YES NO _ =^, t G ENGINEER TOWN WATER SZPRIVATE WELL BOARD OF .HEALTH z.&W-- EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES 176 ; �4z, PERCOLATION RATE: LZ"35 . Z��N-%>�e,Al TEST HOLE NO: / ELEVATION: TEST HOLE NO: j ELEVATION: 2 3 m.� - ,�,�., �; 3 4 4 5 ev 5 c tT 6 S f 6 jA, 7 7 8 8 9 eve 9 10 10 11 11 4 12 12 � 13 13 14 14 15 15 16 16 / SUITABLE: FOR.-SUB-SURFACE •SEWAGE: --LEACHING FIELD LEACHING� PITS c/ LEACHING-TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT f LOCUS { COTUIT ` 145 OLD - ID KINGS RD I SCH00 ST. P\ G s l� � � PVEti�FN O c P,� O D 40_ oNs ,S� LOOP 40 rn BEACH i r7 • it + ` ., r� �000 s ' 42 LOCUS MAP - - - - � _ LOCUS INFORMATION TITLE REF: 19217/295 PARCEL 1D: MAP 022 PAR. 006 NOT IN ZONE II j FLOOD ZONE: X" 42 COMMUNITY PANEL: 25001 CO539J DATED:07/16/14 , o - SE PTIC SYSTE e ,, , 0 t PAiE� oRivEw.aY REPAIR PL'AN E>C�ST�N G LOCATED AT: UJN G _ 145 OLD - KINGS .ROAD COTUIT, MA. _ =,4u 0 1 — k, PREPARED FOR -- -- - - - DEWEY RICE P A F O 6 FEBRUARY 26, 2016 AREA 21400 sr+- ``a 1 88 1 3-F 2 �N OF10 Mqs p 2 2 - 6 AA Y f� V S �� EXIST. 1 OOO:G TP-1 N �'I14..0 i r 0 SEPTIC TANK - TP-2 Th _X 11 / ♦ O it 4X ,�. SCALE: 1'=20' MEYER & SONS, INC. `LP, #� _ _-- ,��0 LEGEND P.O. BOX 981 i BENCH MARK L ��-�- PROPOSED CONTOUR EAST SANDWICH, MA. 02537 ® ® PROPOSED SPOT GRADE PAINT SPOT ON PH: (508)360-3311 CONCRETE WALK ; -- 98 -- EXISTING CONTOUR FAX: (774)413-9468 A*8. 7 9 + 96.52 EXISTING SPOT GRADE 8.4Ri�IsrABLE cis DATUM � ` meyerandsonsincC�?gmail.com SG W— EXISTING WATER SERVICE - TEST PIT SHEET 1 OF 2 J#1809 ELEV. TOP . FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE _ FINISHED GRADE (50.0) 50.0 F.GEL: 48.9 F.G.EL: 49.8 F.G. EL: 50.3 VENT �- MAINTAIN 2% MIN SLOPE OVER LEACHING AREA D _ 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL: 46.83 STONE OR FILTER FABRIC DOUBLE WASHED STONE d 6' 4" SCH 40 PVC 101 ®®®® O ®®®® ®®®®®®®®®®® 14„ 6 © S= 1% (MIN. ®®®®®®®®®®® TEE'S ARE TO BE INV.46..08 2' E F. DEPTH ®®®®®®®®®®® Q.::4::: 4' SCH 40 PVC INV.46.33 INV.45.91 4' 2 X 8.5' 4' GAS - EXISTING OUTLET BAFFLE PROPOSED DB 3 25 �. EFFECTIVE. LENGTH = ' .I*%-. ..,, .?" . .. , :. DISTRIBUTION BOX - _ INV. 46.58 � (H20) INV. w ELEV.= 45.75 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ����� �F Mgssq� BREAKOUT OUTLET TEE AS MANUFACTURED BY _� y ELEV.= 46.75 TUF-TITE, ZABEL, OR EQUAL RE 'RM , TOP CONC. ELEV.= 46.75 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 11 ''INV. ELEV. 45.75 Now= PIPE INVERTS PRIOR TO CONSTRUCTION �O 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 'FIG/STER GRADE ON A MECHANICALLY COMPACTED SIX SgNITAR�P� BOTTOM EL.= 43.75 3.75' 5 FT. 3.75' INCH. CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 2i SEPARATION 6.25 FT. I EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED,DAMAGED, .NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE i 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 37.50 r SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P#:14959 DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: FEBRUARY 24, 2016 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ZANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 - 310 CMR 15.405 (1) (8): DAILY FLOW: 110' G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. WITNESS: DAVE STANTON, BARNSTABLE HEALTH 1) A 1.2 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 4.20 FT (MAX) BELOW GRADE VS REO'D 3 Fr. (H20/VENT PROVIDED) SEPTIC TANK: 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP- 1 Depth Elev. TP-2 Depth 330 gpd x 200% = 660 gpd, USE PROPOSED 1,500 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 50.90 A 0" 50.5 A 0" (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LEACHING AREA REQUIRED: FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LOAMY SAND LOAMY SAND 74. 10YR 3/2 tOYR 3/2 ENGINEER BEFORE CONSTRUCTION CONTINUES. 3 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 50.08 B 10" 49.68 B 10" USE TWO (2) 500 GALLON H2O PRECAST LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND LOAMY SAND STONE ON ENDS & 3.75' STONE ON SIDES: 25' L X 12.5' W X 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF IOYR 6/8 10YR 6/8 BOTTOM AREA: 25 x 12.5= 312.5 SF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. . 47.72 38 47.32 38" C C t SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE MEDIUM SAND MEDIUM SAND THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.5Y 6/4 2.5Y 6/4 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd CONSTRUCTION. 10. EXISTING LEACHPIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 37.90 156" 1 37.50 156" 1 45 OLD KINGS ROAD, COTUIT, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY <2MIIN/INCH IN "C2" SOILS AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Prepared for: Dewey Rice 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER,OBSERVED 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. } Engineering and Survey by: SCALE DRAWN MEYER&SONS,INC. N.T.S. DMM 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 981 to conduct soil evaluations and that the above analysis has.been performed by me consistent with the EAST SANDWICH,MA 02537 DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. ' � 508-362-2922 02/26/1 6 DMM 2 of 2