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HomeMy WebLinkAbout0063 OXFORD DRIVE - Health 63 Oxford Drive _ ,. Cotuit F (� A = 021 049 I P Commonwealth of Massachusetts v Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 63 Oxford Dr. y Property Address Jake Heroian Owner Owner ,..�w s Name information is Q'I required for every Co it MA 02635 5/1/2018 ' State Zip Code Date of Inspection page, City/Town Inspection results must be submitted on this form. Inspection forms may not'be altered in any way. Please see completeness checklist at the end of the form. Important:out forms rtatforms n A. General Information" Wh fillip on the computer, 0'""' use only the tab 1. Inspector: key to move your cursor-do not Paul Martin � use the return Name of Inspector key. Cape Cod Septic Services rah Company Name 350 Main St Company Address W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 S15016 Telephone Number License Number" B. Certification i 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 base d ed on m trainin and ex erience yin the proper function.and Y 9 p p p maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs.Further..Evaluation by the Local Approving Authority - ! � 5/8/2018 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection-and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 o Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments *M 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Cityrrown State Zip-Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310.CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional-Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass: Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If-'not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank,is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . ❑ Y ❑ N ❑ ND (Explain below): a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 __ I Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M SVB'� 63 Oxford Dr.• ; Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ,r ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. . 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): El broken pipe(s)are replaced + ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑' ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑� ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR- 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts 4 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•�` 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every COtUIt MA • 02635 5/1/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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 iswithin.50 feet of a private water supply well. ❑ The system has a septic tank and,SAS and the SAS is less than 100 feet but 50.feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must :.be attached to this form. 3. Other: 1 D) System Failure criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 I Commonwealth of Massachusetts u Title 5 Official- Inspection . Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•�" 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every COtUIt MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool-or privy is Within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply Well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. l'have determined that one or more of the above failure criteria existas described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary.to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone ll of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Oxford Dr. Property Address r Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Citylrown State Zip Code _Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ 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? El ®. 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 Iand 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 breakout? ® ❑ 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. , El ® Determined in the field (if any of the fail u re.criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)]� D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 63 Oxford Dr. Property Address Jake Heroian ` Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. City/Town State' Zip Code Date of Inspection" D. System Information Description; 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2016=430gpd g ( Y g (gpd)) 2017=255gpd Detail: Note irrigation system in'use on property " Sump pump, ❑ Yes ® No Last date of occupancy: • Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Canons per day(gpd) } Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: p Date Other(describe below): General Information Pumping Records: Source.of information: No Records Was system pumped as part of the inspection? ❑ Yes ,® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection"records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.-Attach a copy of the DEP approval.` ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Oxford Dr. M Property Address Jake Heroian Owner Owner's Name information is required for every COtult MA 02635' 5/1/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 2005 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28„feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): +10, Distance from private water supply well or suction line- feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: - 18" feet Material of construction: ®concrete* ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: yearn Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Gal Sludge depth: 6-8 11 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom,of outlet tee or baffle Scum thickness - - 2-3" 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 were-dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet-invert, evidence of leakage, etc.): 1500Gal tank in`good condition. PVC tees in place. Tank at normal operating level. Covers 18" below grade. Recommend service of tank. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass '❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5••''r 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotult MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: . ❑ Yes ❑ No Date of last pumping: Date Comments.(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name »- information is required for every Cotuit MA 02635 5/1/2018- page. City/Town State Zip Code Date of Inspection D. System Information (cont.)j Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil 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.): H=10 DB-3 with 1 line in and 1 line out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 24" below grade. Pump Chamber(locate on site pl an): Pumps in working order: 0 Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): f *If pumps or alarms are not in working-order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is Cotuit MA 02635 5/1/2018 required for every ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers' number: Infiltrators ❑ . Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: El overflow cesspool number:. ' ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrators with stone in a 10'x38'Trench. No standing effluent in chambers during inspection. No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to'inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 t I Commonwealth of Massachusetts , W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form'- Not for Voluntary Assessments 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,.signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition,of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 114 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 63 Oxford Dr. Property Address P Y _ Jake Heroian r Owner Owner's Name information is Cotuit MA 02635 5/1/2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . u r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'w 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ®; Check cellar ® Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2005 If checked,.date of design plan reviewed: Date Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) _ ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data per plan on file at BOH. No water encountered at 12' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form <o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 63 Oxford Dr. Property Address Jake Heroian Owner Owner's Name information is required for every Cotuit MA 02635 5/1/2018 page. Cityrrown State Zip Code Date of Inspection. E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or-attached in separate file S t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built cards Page 1 of 2 TUWN OF BARNSTABLE LOCATION .3 0Vr—or, � _ SEWAGE#_abOSid3 VILL E C o k 4' ASSESSOR'S MAP&LOT ...�.L INSTALLER'S NAME&PHONE NO._C-p�w SEPTIC TANK CAPACrry /S 60 .. 4- CEIING FACHXff:(type)_ M F'+l gyp s tMDEROROWNER OFBEDROOMs e A CYO G�1�gy� PERMITDATE:_3layI0E__COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 9,, Fmx r Private Water Supply Well and Leaching Facility (If any wells exist" on site or within 200 feet of leaching facility) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of-leaching facility) Feet Furnished by A A a , .a A �t 8y 7y4' s 3a•S _ 35 �i..ra n 4 Q b i 1 .• http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=021049&seq=1 4/25/2018 r a c/- COMMONWEALTH OF MASSACHUSETTSI3��d' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION [31j ' Z 14005 PAR 31 PH 12 DIVISION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A r CERTIFICATION Property Address: 63 CA 7 o °:` � H `e"P ECT.10N 4l ��vL Owner's Name: F i c►' e p hl— Owner's Address: -2 ,,,� 1 o v��' 0210 Date of Inspection: — io— ps -ARCEL Name of Inspector: ease print) of r h' ,�s�� "LOT Company Name: A�1/i p— EG Mailing Address: o oX /ot Telephone Number n 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 fimction 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 1&000) The system: Passes Conditionally Passes s Further Eval ' by the Local Approving Authority, Fails Inspector's Signature: fi4 Date: The system inspector shall submit a of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing is 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. Notes and Comments 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. Page 2 of 11 3 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM { PART A CERTIFICATION(continued) Property Address: (� 0� Fo 1-d Owner. Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 21: e not found any information which indicates that any of the 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated � below.described m 310 CMIt Comments: B. 7:e nConditionally Passes: or more system components as described in the"Conditional Pass"section need to be replaced or 1ePaired. 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. i 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 exfilbwon or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as a *A metal septic tank will pass inspection if it is approved lry the Board of Health. indicating that the tank is less than 20 years old sound,not leaking and'if a Certificate of Compliance ND explain: _ Observation of sewage backup or break out or high static water level in the distribution box due to broken or octed pipe(s)or due to a broken,approval of oard of Health): settled or uneven distribution box System will pass inspection if(with broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system pass pecti �Pumping more than 4 times a year due to broken or obstructed pipe(s).The system will on if( approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: } Page 3 of 11 OFFICIAL INSPECTION,FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION(continued) Property Address• f Owner: C :,moo Date of Inspection: C• Fu r 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(l)(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 2. System will fail ad y unless the Board of Health(an d d 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 tnbutary 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 wafer 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 flee from pollution from that facility and the presence of ammonia nitrogen and nitrate mtrogen is equal to or less than 5 pit,prMded that no other failure criteria are triggered.A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ' ON FORM PART A CERTIFICATION(continued) Property Address: C \ ";5✓� Owner: Date of Inspection: 3—/0—q D. System Failure Criteria applicable to all systems: You must indicate`dyes"or"no"to each of the following for all inspections: Yes Backup of sewage into facility or system component due to overloaded or clogged Discharge or ponding of effluent to the surface of the ground or surface waters due to anooverloaded or /clogged SAS or cesspool, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or Z'Cesspool din cesspool is less than 6"below invert or available volume is less than% flow — Required pumping more than 4 times in the last year NOT due to clogged or obstructed ems).Number /of times pumped _ ✓— zany portion of the SAS,cesspool or privy is below high ground water elevation. [�/ portion of cesspool or privy is within 100 feet of a surface water supply water Ply pply or tributary to a surface portion of a cesspool or privy is within a Zone 1 of a public well. _ j portionof a cesspool or privy is within 50 feet of a privatewater supply well, Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a supply well with no acceptable water private 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)The system fails.I have determined that one or more of the above failure criteria e ' described in 310 CMR 15.303,therefore the m The system owner should contact xi t e Health to determine what will be the Board of necessary to correct the failure. E. Large Systems: To be considered a large system the system most serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either`dyes"or"no"to each of the following: (The followin 'teria apply to large systems in addition to the criteria above) yes no _ 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 MIf you have ered"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 significant threat under Section E or faded-under Section D shall_ any large system considered a system in_acc0rdance-with-310L-CMR. 15.304.The system owner should contact the a -the appropriate regional office of the Department, t Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM ` PART B g' CHECKLIST Property Address: OX Fv/'d g 9 � Owner: C ,Pr✓'�o Date of Inspection: Check if the following have been done.You must indicate es"or"no"as to each of the following. Yes o g information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks — — system received normal flows in the previous two week period _ Have large volumes of seater beenintroducedto 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 for , � signs of sewage badsup Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site Were of the es er the septic tank files uncovered,opened,and the interior of the tank inspected for the condition I tees,material of�dimensions of liquid,nth of shy and depth of scam Was maintenance of the�n3'oar(aad occupants if different from owner)provided with information on the proper s uface sewage disposmlyftms. The size and location of the Soil Absorption System(SAS)on the site has been determined Y�o based on EExistinginformation.For example,a plan at the Board of Health Determined in the field(if any of the failure criteria is unacceptable)[310 CMR 15.302 3 re>ated to Part C is at issue approximation of distance ( Xb)l Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART C SYSTEM I"DRMATION Property Address: J Owner. C purr Date of Inspection: F RESIDENTI�►L LOW CONDMONS Number of bedrooms(design):- Number of bedrooms(actuww DESIGN flow based on-310 CA R 15.203(for example: 110 gpd.x+I.of bedrooms); Number of current residems: T, Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system or no)� [if yes separate inspection required] Laundry system inspected(yes or no)•_ Seasonal use: (yes or no): D Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): O/ Last date of occupancy: C- 'W l/'eil COMMERCIALUDUSTRIAL Type of establishment ; Design flow(based on 310 CMR 15.203): m3d Basis of design flow(seatsfpersons/sgft etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: i(�✓ Was system pumped as part of the inspecti es or no): If yes,volume pmnped .�7r4 ----gallons—Mow was quantity pumped determined? Reason for pumping: ='C'=di bution box,soil absorption system _Single cesspool _Overflow cesspool ivy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy,of the current operation and maintenance contract(to be obtained from system owner) —Titer tank _Attach a copy of the DEP approval _Other(describe): ---------------- Approximate age of all components,date installed if �wn and source o on: a o ' — %50 Were sewage odors detected when arriving at the site(yes or no):,E2 t Page 7 of I 1 J i i OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY.ASSESSMENTS F SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C s SYSTEM INFORMATION(continued) Property Addree4�co'>� /�/Owner: OdO5 Date of Inspecti ` BUILDING SEWER jlocate 0 site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well.orsuzetion flue: Comments(on condition of joints;vntiWevidence of GaGg,.etc.): c/ SEPTIC TANK; (locate.on site Plan) Depth below grade: / Material of construction ' —concrete-_metal--fiberg}ass.��'�gYlene —other(explain) If tank is metal list.age:— Is age cam,fi by,a.Certificate of ' certificate) e x //— (yes or no):_(ate a copy of . SludV-deptfic Di UPof-agetob0ttom.ofOutlettc orba8le: Scum thicimess: 0 Distance from top of scum.to trip of outlet tee or bale: Distance from bottom of scam to bottom of outlet tee or � How were dimensions determined 0 k-- C 'P4 i 4 Comments(on pumping recommendations,inlet and outlet tee or baine condition,gructura 7fated�Invertence of lea>a �, 1' ty;liquid levels F7 yce�d •^�t. GREASE TRAP:jte on site Plan) Depth below grade:_ Material of construction: x —co>ucnete_ -- metal fiberglass_polyethylene other in):(expla Scum thiclmess: Distance from top of scum to top of outlet tee or bate: Distance from bottom of scum to bottom of outlet tee or baffie: Date of last pumping Comments(on pumping recommendations,inlet and oudet.tee or baffle concfition Strtic6al inte as related to outlet invert,evidence of l &itY,liqui �1�,etc.): d levels 3 Page 8 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FOB p PART C SYSTEM INFORMATION(continued) Property Address:. oar: Date of Inspection. TIGHT or HOLDING TANK l/ (tank must be pumped at time of' mslection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass eth lease __Wb. y other(explain): Dimensions: Cavity: �llons Design Flow: onsiday . Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last Comments(condition of alarm and float switches,etc.): DISTRIBIITION BOX: (if went mast be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER ovate 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.): f � Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE ULSpOSAL SYSTEM.INSPECTION FORM �AIlT�. SYSTEM U0XMMATI0N(;cafimw*. Property Add ,. For,) rOwner: e $ .'►�.. '� Date of hupecWr SOEL ABSORP?M:SVSTEM tSA$) _ (10caft on,skr plan;ercaawatim nw e If SAS not locatod" why: leaching PiK L �x ,� l :°f O - , overflow cesspool,number: Jaive system .Typelbarne of tom: cow'( wndition of soil,signs of hydraulic failure,level of n ' etc.): _ po ding,damp soil,condition of vegetation, fLaLl'- l�!/�r - p7 b��Oc✓ C D 1,-e ^ : CESSPOOLS: ( must.be pamped as part of insp=tionxlocate on site plan) Number and : Depth-tWofliquidto inlet invent: Depth of solids kyer Depth of sew layer_ Dimes of cesspool: Materials off: Indication of gmtuKhrzter inflow(Yen or_no).- Commas(not-muditionof soa1,*of hydramic failure;level of pon&&cones of vegetation,etc): PRICY: ocatemr site plan M Dimes - Depth of so}ids: Comm=b.(nftwn&ion of sorb signs of hy&mAc&ftr,level of po>i&g,=(Won of vet,etc), Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM MORMATION( Property Address: 6 O ✓ Ui Owner: Date of Inspection: �'/G/�P✓v"1 p SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system inching ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 1 W 1 /Vq _ o� o `^ GG , i /o �G 35 l Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6X Fo/rJ a/ Owner:. ZAO Date of Inspections SITE EXAM Slope Surface water p Check cellar Shallow wells Estimated depth to ground water 3y 9-feet �V' 311. 9 P=Ohamed )all methods used to determine the hk&gmund water elevation: ystem design plans on record-If checked,date of design plan reviewed: site(�ttnW P tY/Observatiioa hole within 150 feet of SAS) L/� with:local Board of Health-explain: 61"��O 4 Checked with local excavators,installers-(attach documentation) Accessed USGS databasen: You mast describe low you established the high ground water elevation: 110 r, o , O A h f�-_J�7� V " t k mono. � 1� (9000 - _• d�C�o.rtl �)2.i.,/e u0 l;wide •. 4S.� ' � ,.#• .rye SS-.. ���-� 94 47 ,t9�>:� .Cot 71 ��. Paotnos'eo 48Z . 3 F /0U 267 j Capei OW l pq ldyaarcu; M '02607 ' / J 4 y0/ aY .to-t 60 I ! Cot; t ,i- I , l�v$a Ce No .Scate t: ! :a I-1�.`� r,"�y• r• ..�..��, +�,�p.�.i` �„�tAa�r�£-��'��l '�'`�'.r?�'�'"'v�`;�.+�','L:4 i1� � atone ,'�rli r U.. �. �o g �aju jn COtf4 t. fit lot 0 5te��het d fi 7� (( r� �n n oa.c� ! Uw ag£fl 2QY�arid.zecoul uZ p(Q,T Gk, '47[ K�. t'�x'11G.�.t.0i'L7.�d{tOu/rL-Q•ZC on. a4 let t N t �/l'-S 9/v date: cr.> talZe RoZ"o� �eaLh ',ad e 7-2O-Ro kt. J. AcKca,a (o wate2 encowite2ed P l j,p 2 t •_/14P_!a'LtUX- i MP_f�.1 UH .. ., 7r ,y , 'N Y � � � land .���,§��`;:-M°� �,•�'-�� �,yam:;:. s, r TOWN OF BARNSTABLE LOCH HON �0 3 V u CO t SEWAGE # I d 3 VILL'ArJE Co to �' ASSESSOR'S MAP& LOT (09 a s,W►4 �zr.�. S 6 �Ya Y V a 8 INSTALLER'S NAME&PHONE NO. C � SEPTIC TANK CAPACITY . ACHING FACILITY: A P���M fb� size Y /O ,r (h'pe) � (size) ti NO.OF BEDROOMS 3 ) UILDER OR OWNER 5 o'n n Ch �1 a�a► �'fi PERMITDATE: 3Ia S COMPLIANCE DATE: -T Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 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 Tz cp 6— V 4 �. 1-7 No. dJ "—/0 3 _ Fee . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, M'ASSACHUSETTS ZIppYication for 30igpont *pgtem Conotruction Permit Application for a Permit to Construct( . )Repair(X Upgrade( )Abandon( ) Complete System .jndividual Components Location Address or Lot No.-�}(�3 pX FUtC Owner's Name,Address and Tel.No. VQ Assessor's Map/Parcel C�OTlS vr, — oRI4 MLD�ce4\40(r i SAMC Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAQ6w10E �NT6QP2�5� S�+at' �1v5�vME�vT14L S�1LS. 508-4a6-40 2$ 566--5 39-79(A, Type of Building: Dwelling No.of Bedrooms 3 Lot Size o?3 ,5 sq.ft. Garbage Grinder(Iijog Other Type of Building cyou EE No.of Persons Showers( k)'Cafeteria(✓) Other Fixtures LaiV4-TaR_V; kc%TCH'Et,� StNk , L,a"zRY Design Flow 3�0 gallons per day. Calculated daily flow gallons. Plan Date a I as I hS Number of sheets I Revision Date Title S)m Dane A s�^ S�2M oog,f (C Q Size of Septic Tank x,ts�-a ispo Go. kTyp of S.A.S. nQR c.Ti2nix)2 i 28_t011 Description of Soil 1�Q -�-cj (�\� /O'X IIE'F� 7E� Nature of Repairs or Alterations(Answer when applicable) 'Vkc4c -\so PtW. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d_bg is Board of Health. gned Date 3 Application Approve by Date Application Disapproved or t e following reasons Permit No. �`� Date Issued Z0 .. No. w i"' zap Fee /a Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a. Yes 3 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zfpprication for Migozaf *p5tem Con.5truction Permit Application for a Permit to Construct( . )Repai )Upgrade( )Abandon( ) O Complete SystetrIndividual Components r Location Address or Lot Nc.')+'(p?I OXFo2o � Owner's Name,Address and Tel.No. , � - oHnl McDtemoTr Assessor's Map/Parcel a 049 } SAME Installer's Nine,Address,and Tel.No. Designer's Name,Address and Tel.No. C_APCW 1nE ENTE2t'(Z�S� SHAY v12r�NP�ErvTral SVCS, 508-4;t 6 40 Z8 Type of Building: Dwelling No.of Bedrooms 3 Lot Sizea3,-9s sq.ft. Garbage Grinder(Pio Other Type of Building Uti1 E No.of Persons �V Showers Cafeteria(✓) Other Fixtures LAVATbKY, k,rcNE�1 S�r.1k 1 L9thsflRY Design.Flow 33 U gallons per day. Calculated daily flow 3 3 gallons. Plan Date 3 ael J.D5 Number of sheets f Revision Date "— Title C Su y Size of Septic Tank �Xt GO1 cr>k Type of S.A.S. S /NFi�TeA-rc* TP_EN64 pDescription of Soil ,�c� 3�' X io'x l'e-t^� 7E�ru Nature of Repairs or Alterations(Answer when applicable) `-�fgr Date last inspected: / / Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued-by is Board of Health. r igned Date 3 Application Approve by J Date -5 Application Disapproved for the following reasons Permit No. �' Q Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLEi MASSACHUSETTS fi Certifirate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired (IX ) Upgraded( ) Abandoned( )by ef A e P-,J; e �T e rJL,J ,"S at G 3 O X-�o r 4 4-A oi r has been constructe O in ac ordance with the prr jisions of,T�tlq and the for Disposal System Construction Permit No.Qgg5 /0 3 dated 3 �`V/0 Installer �l n7� Designer 0. The issuance of this ret s,all not be construed as a guarantee that the sys�te , 1n tton as designed. Date c� � Inspector - No. r-�. )y-j / � 3 ---------------—---—-------' Fee OO _ .. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS lwi!�ponl *pztem Construction Permit Permission is hereby rated t f ns,"- ct( N R,ai "�)Upgra(e-,(( A anoon( ) System located at 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: Con clti h must belco mpleted within three years of the`te�s rhm Date: G� Appro3ed'by t r :TOWN OF BARNSTABLE LOCATION _-&J C7 y rdri4 SEWAGE # ' O 3 VILLAGE C o k ASSESSOR'S MAP& LOT (0 9 INSTALLER'S NAME&PHONE N.O. Can W 44 SEPTIC TANK CAPACITY L. ACHING FACILITY: r l)k-M f b (size) dry /D NO.OF BEDROOMS 3 BUILDER OR OWNER tJ o1n A MC1Il.e�a► �''� PER(viITDATE: 3I o1_ [7$— COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Teer Private Water Supply Well and Leaching Facility (If any wells exist on site or within-200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Al A a 13a 5 5 i 83 38.0 8y 7�.s � S �a•5 35 �� • � A a$ •a a 3l� �g•9 y ® b f Town of Barnstable Regulatory Services Thomas F. Geiler,Director BARNSTABM 9� MAW �0� Public Health Division RFD M. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3/30/05 Designer: Shav Environmental Services, Inc. Installer: Capewide Enterprises, LLC Address: P.O. Box 627 East Falmouth Address: P.O. Box 763, MA 02536 Centerville, MA On . 3/24/05 Capewide Enterprises, LLC was issued a permit to install a (date) (installer) septic system at 63 Oxford Lane, Cotuit, MA`based on a design drawn by (address) Shay Environmental Services, Inc. dated 63/22/05 (designer) YXI 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. 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. ���SH OF MASS (I staller's S nature) ��� CAR USN SHAD t in No. 11$11 ' (Designer's Signature) (Affix A Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form l 06/22/2015 01 :07 FAX fJ004/005 ,r �+.�_ 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM S ,hereby certify that the engineered plan signed by me dated N as J C5 , concerning the property located at - C e ©X�Cs —0�is� meets all of the, following criteria: 6 This failed system is connected to a residential dwelling only. There are no commercial or business,uses associated with the.dwelling. • The soil is.classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed 0 There are no variances requested or needed. • The bottom of the proposed leaching facility will_bc located no less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following.- A) Top of Ground Surface Elevation(using GIS information). B) G.W.Elevation +adjustment for high G.W. &9 _ 4.4 DIFFERENCE BETWEEN A and B 40• SIGNFD DATE: S NOTICE Based upon the above information,a repair permit will be issued for bedrooms �` maximum. No additional bedrooms are authorized in the future without engineered septic system plans. 9 AS epdc\p ercexemp.doe 06/22/2015 01 :07 FAX 005/005 v - k- Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location; C))tQ5:L� --�x\\}iE Lot No. Owner: Address: Contractor;`3ki IFOQ »CS. Address: _'�. X ; . E (� Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .................................................. ......................... .Cate .�s la I OS month/day/;ear STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: Mt►.J OA Appropriate index well.................. ............................... © Water-level range zone .---••..................„,......................,.,, STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for Index well ........... I g1ta mo th year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 28) determine water level adjustment .............................................::..... STEP 5 Estimate depth to high water by subtracting the water. level adjustment (STEP 4) from measured depth to water level at site (STEP 1) L Figure 11—Reproduelbie oompufaflon form, 15 U CATION EWAGE PERMIT NO. � .63 o FDP-p f09i u-e60 �7D al Y'iLLAGE � NSTA LLER'S NAME L ADDRESS .Oaulo ��-e.tl-emo, ap 3///-/, weSrs-r. f -loUglgS ry,A, y%/p�iP.C'U e IV /1'p R U I l D E R OR OWNER wotfh4lrj,In4- oausy dam.« DATE PERMIT ISSUED S� � F7 DATE COMPLIANCE ISSUED '� O�� �dT To �+ ! 1$00 a GAi e a _ _, 3g (�WALLS* 3 BedZZ yg e wATV- VJATM O�rav-D � . . : r l/� i J � � 1 4q - 1 S Fps. ... THE COMMONWEALTH OF 2�SSA��CHU 1 BOAR® Opp' HEALTH .................OF.../ ...�f W. bL _.....---..._.._.-..................... Appliration for Dhip a al lforkfi Tnnitrurtinn Prrutit Application is hereby made for a Permit to Construct (�Kj or Repair ( ) an Individual Sewage Disposal System at: 63 �XP�......D..�' v_. ...... T�!r.-- -Hof �� --------------------------------------------- ................__ . - ---- ......._•--_..... - cation-Address. .�...R....u..� `r � " or Lot NRo. aa, 5w � t& c� i ........_.-s......�............................................................ / Owner Address h1.R.. ..Gv4R4AT2ey� 14 Gt/CST sT �'.1)- S CIS/.� Installer Address Q Type of Building Size Lot.! -3 _ i Sq. feet Dwelling—No. of Bedrooms__.___-3_________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures -------------------------------• - Design Flow..................... ............gallons per person per day. Total daily flow---------33o__..____..______________gallons. WSeptic Tank—Liquid capacityZrp0_gallons Length/d�_��__/�._ Width..S��_... Diameter__-_-- Depth_S��_---- x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter...,l__d.___.__._. Depth below inlet....6............. Total leaching area._5FJE....sq. ft. Z Other Distribution box Dosing ank '~ Percolation Test Results Performed b .......................................LL -fir--.�G.------------------- Date_7_ _a_�.- '6_____.__._ aTest Pit No. I....=2.......minutes per inch Depth of Test Pit./�?t S___�___ Depth to ground water________________________ Test Pit No. 2....,�'----minutes per inch Depth of Test _ ___.. Depth to ground water........................ �----------------------------- -t•--•-•--------------------------------------------------•...................................... O Description of Soil-•--•---.._--1_ ---Z____-----�o�---------- ------1� /!1-?D.----s-rl.� V --------•--•--------••-••••-----------------------------•------------.._.............-----------------------••---------------•---•---------------•----------•-----------------__-----------__---- W -•------•-••---------••-••---•-•--•-•••-•--------•••-••-----•---•-•----•--•-•-•-•-•-••---•-•-•--•--------•----•------•---••--•-----------•------------•-----•-•-••---•--•-•••-•----•--•._...---•---__-- 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 iITI.� 5 of the State Sa -tary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian a as 4beqissuedy the boar of 1 �Ith. (— (� �� L5 ® , Da Application Approved By.._-•---•-•••-•••••_---- -..(! rk.. - --------• -------------------------- �-Z late Date Application Disapproved for the following reasons-----------------------------•--------------------------------------------------------------••-•---•--...-----•-- ---------------••--•-----•-••-•--•---••-••-•----------•--------•-•--•-----••------------•---------------------•----••-•-------•-•-•------------------••--••----•-•----•-•-•••--•------•--•-•----•------- Date Permit No... -------•-----•L___>�V:L)....._...... Issued....................................................... Date w = Z1 - No '...._.�:='2 ( vV l-.j-._..__._ ��,��� L /� �g Fss........�...._�...._ l , 7THE COMMONWEALTH OF MASSACHUS BOARD D OF HEALTH ..._. O F..:.._.....................................---•---------•---........._..................... Appliration for Diapos al Warks Tomitrurtion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: s Location.Address .J •• ....................... ...... �j f , or Lot NQ``� ` (/l/ �............................................ Owner f .(.:...lt''. ..?4..iYl.�.... cJllf'P�r rl. L�' <<...... ��_..� _... %c ! reds �... .i`�L i .t'i .... ..... Installer Address Type of Building Size Lot __`..I -r.Sq. feet aDwelling—No. of Bedrooms....__2..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ................................ .......................................................------•----- WDesign Flow........:............ : ..............gallons per person per day. Total daily flew........:.................................gallons. WSeptic Tank—Liquid'capacityj-{0..gallons Length%`_...1_._.. Width..: --'`..... Diameter..._:_..... Depth_................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... ........... Diameter...:...'_.__........ Depth below inlet...''.............. Total leaching area.._y...............sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by._r'`'�� ...._..`__...`..`:.. . . a ..-----•-- Date •--- --- .... a Test Pit No. I....::'_.......minutes per inch Depth of Test Pit.': '___=_.r_... Depth to ground water......_.._....... Li, Test Pit No. 2..... ?:.__..minutes per inch Depth of Test Pit.' _..' ........ Depth to ground water...._ — _.... Rai ..... ..............................._................:........................ .............. Description of Soil =---" . ........ --------------------•--••--------.... f V ...............•-•--•-------•-••------•-__....•--------------•------------•----------._....•---_....__-•------•--......................................•-----------------------------W 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 TIT?:-=. 5 of the State Sa itary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia a as be issued y pthboar of 1 tlth. D Application Approved By----------. .............. ----------------------•--- I 1196 Date Application Disapproved for the following reasons:.............................................................................................................. ----------------------------------•-------------••---••------..._•--•----..._..•-•--•--•--...•------••---•--___._.........-•--•-----••--------•-...---•-------------•-------•-•--•-----•-•-•---•-------- Date Permit No.. `"" ......1-Z-2•-)........... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t.;C, ),'� ...OF....!_.'.a.` r.Cl::=.!.:. K'. ............................................. (Irdifirate of Tontpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) by--.. :.:' '-.:__ .:'...:<.r1e_.G ._.%.f : ..:4�''._%`:..••J• `= l--`' r- - 1=` ...... 7 Installer%� ! ller at.... ...t........_ ;_I. ..............................�1 .... .F__ ........_.___'?.. _____.___.___._.^____________._...______________._____.........______................---•----•------ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Perm it V oE9`__._� __.__I._ ..... dated_....1__2J ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � n DATE...-•-----•••--••-•--- Inspector......................---..__...�.._ 1 � n ` -I _ A� u --------------------------------------------- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD—OF HEALTH No.. .....13.___ 1 FEE........................ Disposal Vorkii (1:1.ono#tr ion rrrutit .- Permission is hereby granted........ '.......`)....I<......................................'-......................`-, ' ' =--........................................'' ` , to Construct (J/) or Repair ( ) an Individual Se. a Disposal System at No .. •----------•--------- Street � N 3? I + ' /� as shown on the application for Disposal Works Construction Permit No.................. Dated......�._Z.�__...._/_..40_........ Board of )Iealth DATE............... -•'•----•..............•----•--•••---___--- FORM 1255 H01613S & WARREN, INC., PUBLISHERS i Oq� ,td ^'D l��.i,u a 40 ,�►u�e ! Gkn: Cg ;0.4 A*S7. :L'o•t 69 ►.r � � ` .Cox 7I ST ,.PaoF>osev 4$Z tin � 1SOOQ' io �`, _ ' . . ; y � • v } �s -;6 f tit W12 stone ' Pot 70 49 144i iolc 90 14ya+� Md. 02601 �_YI I � 70.coo- wale 1 - 40 bate , 8-21-86 .,o•t 60 lot 59 Ato Jite No ' 5cate , 1500. c.s.7.. �t M `.� P 1 i .-. ... ._.. . ., . ._.�, ... . ..�::.i.�'�•Vic, -- _'-j� ... Sketch. nami Of .Card in cam r : f-44. obown on a ila4 oi. ino C } and tiew4ded'4n ptan Gk, 2T p¢: S6, + twat io.m ahowri cute on an ed.da uix, Ze��a�rcTo..?w��1 T7 wT R-w-w- I C�04•�U`-�{1.}. 13�rna.�.abea:7�h Made 7-2946 No wa tew eacoc aAzed' Pete, 2 ,x i,a p et I rr 47-4 d4rtd. 1QIZC� iH Of �r`' ' 814 a a r . . . . . + ----- ------- --- VENT PIPE (0 Least 24 Inches tan)---- SECTION A -A ow��uwTWu« *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 4d PVC w/Charcoal Odor Filter ALL OUTLET PIPES FROM THE 10' min. from- PROFILE VIER' OF ADDITION TO LEACHING SYSTEM DISTRIBUTION Box SHALL BE E.,atinq Foundation 1-house to septic tank __-___ - �y - y Septic tank covers must be -D-BOX cover must be SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER �^ within 6 in. of finished grade 3" of 1/8" - 1/2" Washed Peastone I within 6 n. of finished grade 3/4" to 1 i/2 Washed Crushed Stone /-Grade over Septic Tank - 99 R(1 Grade over D-Box - 99.50 c-(,rung ..+ , Q9.50 `�' ( OUTLET KNOCKOUTS r 2 - .. PVC (CAPPED) INSPECTION PORT TO BE ` , tS.S' j - T`"'� INSTALLED AND TO BE WITHIN 6' OF GRADE 1 r OUTLET I 12- INLET . 3 HOLE H-10 3' Maximum Cover Top Load Elev =96.70 - 8' ST BOX -Top OF Syaem- Elev. -96.20 6 10' E x S T S-0.01 or Greater 2' X 2 0<t.r/Or EXIST. PIPE '~ U) 1,500 GAL. --- S- 0.01" X I`) 15 4' - SCH 40 Te 175• FROM EXIST. FOUNDATION W r SEPTIC TANK N per foot -• Depth - - --15.5 rn H-t0 r- O 20 - 10' EMective 0 th o PLAN SECTION CROSS-SECTION 5 Units 2 6.25' 30' CONCRETE FIAT FOUNDATION-- _v ° - _ - u r; 01 0.83' 10 Inches 3 3 ar n N 1 3 HOLE H-10 DISTRIBUTION BOX SYSTEM PROFILE Uri 6 n of 3/4"-1 ,/r p „ - --------37.25' compacted stone > v > 4 i'w•^ Not to Scale c c v 0 rn Effectivp Length NOT TO SCALE _.- ixt W E'N'R. d kt Nyh E:x+pa••r O:Gi�N4.TF� ' 4' - - SOIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4'-1 1/2' 105 INFIL(ATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN GENERAL NOTES ----'---'----------------- compacted stone EFfecttve Width ( ) OR EQUIVALENT Not to Scale NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE w o 1. Contractor is responsible for Digsafe notification _ d Bottom of Test Ode 1 Be-d-01445o m NOTE OVERALL HEIGHT OF INFILTRATOR IS 18" EFFECTIVE HEIGHT IS 10" and protection of all underground utilities and pipes. � No Goundwoter Observed O 144• / p g p p -- - - - - -- - .......... - --- - O 2. The septic tank and distribution box shall be set O level on 6„ of 3/4"- 1 1/2" stone. 3. Backfill should be clean sand or gravel with no II-- -- - - - -- ---------- - - - ---- - ------ ------- ---- stones over 3" in size. Design Calculations ��� 4. This system is subject to inspection during installation i by Carmen E. Shay - Environmental Services, Inc. PERCOLATION TEST Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gai /Day Min. per Title V) , 5. The contractor shall install this system In accordance Garbage Grinder: No with Title V of the Massachusetts state code, the approved plan Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) , and Local Regulations. Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,500 GAL. Septic Tank. C, 6. If, during installation the contractor encounters any Date of Percolation Test: MARCH 22, 2005 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch / soil conditions or site conditions that are different - Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons Test Performed B CARMEN E. SHAY R.S. C.S.E. / � from those shown on the soil to or in our design Y - / 9 9 Results Witnessed BY. WAIVER - (per Barnstable B.O.H.) Sidewail Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gallons installation must halt & immediate notification be Excavator: ShayEnvironmental Services, Inc. Providing: = 331.80 gallons LOT #60 - , I made to Carmen E Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 min./inch - 7. No vehicle or heavy shall drive over the Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, y machinery septic system unless noted as H-20 septic components. TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ' 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. ON THE ENDS. NO STONE UNDER. 00 Test Hole - 1 i 0. i 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. No- 1 W 10. All solid piping, tees & fittings shall be 4" diameter DEPTH SOILS ELEV. ��\ Schedule 40 NSF PVC pipes with water tight joints. 0 _ 99.50I ` 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy Loam Properties Within 150 Feet. 10 rR 3/1 LOT #59 `• � '� NOTE: 0"-6" A 99 00 /%i \�� �,' i THE PROPERTY LINES ARE APPROXIMATE AND COMPILED FROM THE PLAN BY ALL CAPE ENGINEERING Sandy Loom \ �, ENTITLED "PLAN OF LAND IN COTUIT, MA OF LOT 70 OXFORD DRIVE" ` DATED JULY 29, 1986, AND PLAN BOOK 271 PAGE 56 ,o rR 5/B 3 5 I - i AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 6'- W. _e 97.50 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Med-Coarse 7.25'+ P`IC THE SEPTIC SYSTEM INSTALLATION. Sand 30"-144 25 C,7/6 E;7.5o /' = • _ /` EXISTING LEACH PIT TO BE PUMPED. OUT AND Failed ;tips L _ #t' -- - // FILLED IN PLACE. Leach Pit • �?� % '' `` `51'�_ /� NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE ,l FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED OF AS PFR TLAN \BOARD OF HEALTH SPFCIFICATIONS. LOT #69 NO PROJECT BENCH MARK TEST HOLE #1 n ( 1'IJ TOP OF RETAINING WALL -- - ------ .__ _ ELEV.= 99.50 DECK. Cb ASSESSORS MAP 21 PARCEL 049 -- - --- ---- ---- - -- _. -- -.1,i 5' ; ELEV. = 100.00 (Assumed) LEGEND Perc #t ` ENCLOSED Perc Rate= <2 min./inch EXIST. 1500 gal. PORCH Groundwater Not Observed Septic Tank ADJUSTED H2O Elev. = No Adjustment Required I 104 j DENOTES PROPOSED i SPOT GRADE Tj DENOTES EXISTING LOT #71 x 104.46 SPOT GRADE \ EXISTING \ 3 BEDROOM \ PL PROPERTY LINE J i iIDUSE \ � ` � / T #ss � - 96P - PROPOSED CONTOUR t_V t -- ---- -------- -------------------- - ----- t�A 11 - -- - - ----- --- O \t� \ 1 V � t i •; /'t,, , - -- -- -- -- -97 EXISTING CONTOUR Cl) ` - 3-24• gAll. ACCESS MANHOLES j� t t T1, �fJ E'• i/- O DEEP TEST HOLE & _____ ID• _a" C � 1\ kky u a PERCOLATION TEST LOCATION v ( J)� o `_ - .- - 6 FOOT STOCKADE FENCE - t o v��01 ,oF Gs - 06 - - --- - -- -- - ---4,1 1:- SEA SHElL \`3 �I I/1 ET �D/, � ,1 / -, .. DRIVEWAI)1 INLET ` . _ / OU T , \,� 1 c F� LOT #70 '_' THE ACCESS COVERS FOR THE SEPTIC TANK, f I 1 Qi DISTRIBUTION BOX AND LEACHING COMPONENT t+� t` } Mt 21,295 Square Feel +/- P L01 PLAN SHALL BE RAISED TO WITHIN 6" OF + - • FINISHED GRADE. to 1, 85 - ---------- 98 OF PROPOSED SEPTIC SYSTEM UPGRADE STEEL REINFORCED PRECAST CONCRETE INSTALL TLIF-TITE GAS BAFFLES OR EQUALS - ON ALL OUTLET TEE ENDS `, ` ��� L 5 - "�'- , ___------96 PREPARED FOR PLAN VIEW T,al 1 M - _ _ - 3-24' REMOVABLE COVERS / t`_� I �` •�60- ---- JOHN MCDERMOTT - :. , 4- r v� -'- AT _3'_mkt•cbarmce I - / //�-) 1 L ��-//- {�'`� Ilq.ET B" min_T 2_mh. (Net to outlet s.mYr, `tY IN�T' / / t• + L - TT V 0 X F 0 R - -- �- / l rf -� TI 11 1 V INLE 70'�mh. 1 Liquid level / I - OUTLET 61 t }' r r -5' _r , C0 I UIT) MA 5' -7' E$ mN o o as ewe. LkWW depth - Y / \ f of PREPARED BY: - 10'-0: -5'•-g• 11 /// �P�> �::: R N N _ ARHEY E. ,5 HA Y CROSS SECTION END-SECTION " �GN� 04 0 20 1; S ` VIRONMENTAL SERVICES, INC. Q Foo, R I � No �a .0. BOX 627 EliTYPICAL 1500 GALLON SEPTIC TANK / X t,�° GfsTER EAST FALMOUTH, MA 02536 NOT TO SCALE / �- O sANrTAP SCALE: 1 "-20' t- " TEL/FAX : 508-539-7966 I (H- 10 LOADING) ;ALL 1 "=20' DRAWN BY: CES DATE: MARCH 22, 2005 PROJECT#SD708 FILENAME: SD708PP.DWG SHEET 1 OF 1