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Home My WebLink About0120 POINT ISABELLA ROAD - Health 20 POINT ISABELLA ROAD, COTUIT A= 074 005 - -I i 1 t Y kj F I � f� commonwealth of`Massachusetts `` Executive Office'of. Environmental Affairs `J Department of 2 199 9nv1ronmental Protection rya WIIIIam F:Weld Trudy Coxe t> , ,EOEA > r q . �!t swewy S David B.Struhs ;.. 7 Qornrninioner X,.,i,>t z ! .,11 'Ile - t, ti,}e tr, SUBSURFACE,SEWAGE DISPOSAL"SYSTEM INSPECTION.FORM f t+ - PART A t CERTIFICATION a0 Property Address: O"t tlksc.� {� �A`Cv� t Address of Owner: kr to w �Sp�1 J 4 Date of Inspection: Name o ns ecto Jf (If different)' „Ir.z,-,� GIB/cJ..e;'° V�T�✓t'�-a wf Company Name, Address and Telephone Number ti tt r-as Y t. D •J '�-rZ— Y,-•1L 0'y s* CERTIFICATION STATEMENT ,I certif)�that I have personally inspected the sewage disposal'system at this address and that the information reported below is true;accurate andRf complete as of the time of inspection. The inspection was performed based on my training and experience.,in the proper function and maintenance.of on-site sewage disposal systems., The system: �.'} r> t , .��>1t F + iF �� , IF- �s,, r + •. - _ �. ', + is ->. �`{� ,`ks.� rta7? �_ asses < stk 3k b't + plr Xa Y{ =is s' di to `si g V Conditionally Passes , _ Needs Further Evaluation By the.Local Approving Authority J f x t FaklS,3.Ss'"'.,t�k F,vI _ L•��'—.F•2 g "�tti i k XY"tr 1 "1e�� ,vx�Anspector's Signature: \ t b a Da e 1 a Iq n i rq- P aF Y�r'- +� � The'System Inspector shall submit a copy.of this inspection report to the Approving Authority within thirty l30)days of completing this r4 ' � .z. tnspection;j:f{lhe:system is,a shared syste{n,or,has..a design flow of 10,000 gpd:or greater, the inspecto}and 4he system to #ner is all subm t # ' r the`report to the appropriate,.regional office of the Department'oi.Environmental Protection.a{� F f x The oaginal should be sent tv me system owrier,ana copies sent to the buyer, it applicable and the appro�mg au',hori,� aa`i. _h ` +a .:? tom" ff "Sry � .x ,d.�,�r�"'r ta •'� _ 0,14 Cl{'tt'i si,t'i t X% t' u 5� # SUMMARY: INSPECTION. y-�T t' 4!. x. ,y�t,• :a r ;.I i� r {.{w;;t Rti4. cX d et?2.L I�} 1 "",;btr•TM t+ ",{, X �':: t. ,.j" t *i.r. } s Check Ax f §. n kw s3, lxs L tt. `� Y'rfk n • B;C,or D;,?,X� � 44i il 11 , }. r) , T1,11d1, { , ! . s iz. a Pisan fs F, '. *t;*T AP SYSTEMTASSES 'j, lL'{:) a` r4»st`}r,, 1. +`s'*,y 6?,"�;k:!1 tatj t t ; '"'.`,a,; .,, 'et.,s it a' a,.,,;� t,.,.,., F ;.�T'�s r a'ti.l ro t'' Ya °"- {,,, ,. .r'k '�uj� L �sh,�E•:r{�r�:.� . ,s I have not found any information which indicates that the system violates any of the failure criteria as defined m 310 CMRt15 303 nF� r"Any failure criteria not•evaluated are indicated below. rx, T BJ,SYSTEM CONDITIONALLY PASSES �.. x p tkt, n�{ f !' �,. i�i7i. .:f`F4 !�'.atr3'. e?.{"j.'*,i`2'}r{S 2l wik.i'_T -i.�t4 Nrt r'.�,t t�. Yr,, yay•a� '•;,X tylo�lhe `� ,,.;-r*�'t{$ r:';'#,4 i�='�!�r3:~riNt4,.�awrafi a�9*s�t�'Y' �1 ,4: ,tea Oner,more System 4ojnponents need to be replaced or repaired ,The'system, upon icompletron of the replacement or,repai, 4,, a'i.s.;- " 4 '- �; Passes'inspection M � '� r PI Vz 'picate yes, no or not;determtned,(Y,�N, orrND)+ Describe,basis,of determination in all instances ,If not determined explainAwhy�rtot,,y , rt s" s UK The'septic tank s.metal,uacked,structurally unsound, showssubstantial infiltration or exfiltrationl r�tank'failure is °z ' '{` +im inent,tThe s stem,,wilf s.inspection if the existing septic tank is replaced with a conf4_rmmg,,septtc tank;as '' .t d ¢ iX ..T Y Pas ,y.,k# ;i,.k t ;rt ttY �ys1.�1r�r� k. �,fv„t t �'h roved the Board of Health.. + , aPP by AN#Y' 74ry�,��Tl 's' .E _.��, '�, .�'^�'�k�t5'�,F�,�i�r1�'s• i�c`Yp(revised 6/15/95) ' vs' X , s t o r r • ,:. :,` ';� ,. ., ter,Street • Boston,Massachusetts 02108 • FAX(611)558-1049 • ;Telephone(617)292-5500 �tk One P n y } t ,o �•Tk �xra.}y i -- ..�I Printed or,Recycled Pape!�� . p Y6 ++ t4 Yrrr� I'• YL +'� • � �� f 'F 0 i `. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, Y } �y vh PART A e ,k a , + CERTIFICATION (continued) . G} a .t r=T°f y , -'.N� Ne ` Property Address: 12.4 r"Owner• 3. n: Date of Inspection: pit B)SYSTEM CONDITIONALLY PASSES (continued) "�' r,z i) }N ? ' 'it yr. +s w . Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed „ pipe(s) or due to a broken,`settled or uneven distribution boz= The system will pass inspection d(with approval of the f. ,• . 5 Board of Health):, CO fS4,!.t;: � NLCVG y .gyp t x r t; broken pipe(s)are replaced a►t 3c•�o� S�'`' e— ' r ' . r obstruction is removed distribution box is levelled or replaced The s stem required pumping more than four times a.year,due to.broken or obstructed pipes) The system will pass xr?f�4 �r Y p p g ' inspection if{with approval of the Board of Health): . broken pipe(s)are replaced 8r 1 ' 5 t tr MR x f 44 obstruction is removed•. �fk t{t,a'!§ ' i :t ,4 #J 3�' �l - „ t .t-+;4t;i '.:ay E + -i'; -.fn Iins• jr .4.f e t.,iIF{ t + s i 9 � n4 a 7 t5i4'�� .y !� �cuf Y,?{IPp" 1 ,'}it.� rs. i 5i r.. Y-"rr ,'r+F IS4 � 'ii'`}f t. Y `• ,' :s#i :a 41 t i.�$ 7r�,�.3'iSa" r3' '1# 1 r !4� ' fi n t ir�'�r >" j ° °� ^'1X i°r 43d�d3t'i i t3 + fin . �� rtC� FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH �� r y ,di 4t� � ` Conditions exist which.require further evaluation by.the Board of Health in order to determine if the system is failing to protect thet ?4 � public health, safety and the environment. d 3n 'S F rya; § #t 't:{i 4 + 5'., 5''s�I z"P' t Y c� �r i8'%y t .f� aP. ci '..SYSTEM WILL PASS UNLESS,BOARD OF:HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ��'' w i s sue. *i v,�WHICH Wlll PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT jr ti z f4A I'Ay r i 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 y � r ikt> kxir a}�( 11 41t3t, s=. ai.aP SU 55iyf +t 5rt`` F4i;!+7.p i #r;p # ...fit a ? ;tC r! ;s'• +Firr?i' #?}J �ti ,a.fif n J2 3p s2� Yt�Y 7 ��°e}i'�tl�'4!i` li��> Ir,.!*;ip` rt r�.-„r) � '..y ;+ ,- � - r ,s i X �� Z) ,w SYSTEM WILL FAII'UNLESS,.THE BOARD. HEALTH (AND'PUBLIC WATER SUPPLIER,'IF APPROPRIATO) DETERMINESvTHAT r t �,, . � THE SYSTEM IS FUNCTIONING rIN A MAN NER'-'THAT PROTECT THE PUBLIC HEALTH AND SAFETY. k � � ' t ., fy ,. " f i, xt r' t rLt; H l i•:. . ; E<' t! • a k :!1 s d g 4 t 3 35.; +#l {4 a s'g 7a , EN�'IR01A1ENT ,�i yy f ° s. Nit s. „ t „M1 p: A ThP wctem,na�a sepuc.tanK ano so�i ausorpuun system anu is within i00 fuel to a Su 40CE Wowi Sup}Ni��yOgrytrlbtJ��a��1 t0 a ' ''�"' 'v3 tY p'ri'�d, ._; , x.: . rr i:�tF.c'4, t; r , e'y+, ii;s }. "�a ^,.t fin.,'30 r y{c�,'s , surface-water supply # �h> r The systent hay a septic tank and soil absorption system And£.is''within a Zone I of a public water sup'plwel,` ` •' .h' t # �k.R3'ts ,, -1 1 t ; ' ;The syslem;has a sepucaank and soil absorption system and.is within'50 feet of a private water supply well � R K ' • f The sysie.ni has a septic tank and:soil absorption system and is less than 100 feet but 50 feet or more,from a pr vatezwate , supply well, unless a well water,analysis for coliform bacteria and volatile orgamc'compounds indicates thaw: hewell �� • nitrate nitro en.is.' %ual to or.less than;5 ,: ,free from.pollution from that Wility;and the presence of ammonia mtrogen.and n ra g +eq .� � �. Z 1' . i- 't T 2• ! -F n + t i i i!+�i 'Yin ��0 # f ppm 4 ! i ?Z!4:.:"! 1 Y ^ s v ;I� • J1'lf' i#t Fk��- . S� 3 'DJSYSTEM FAILS 1t +,q5 y AA .have determined that the system violates-one or more of the following failure criteria as defined to 310 CMRf15r303�Thkebasts � Ii determined R-5..t{ r i f, pi 41, t. - ., for this defermrnation is identified bellow. The Board of Health'"should be"contaaed to determine what w Il beyxnecessary tocorrect . '#'r s,'� krutr�.1 � �} y. 1SfjyyeJ,,j�`iyplNor. ,...�y^' :,may: k+'#4�`..t_r9a 7e u. y ':[i 1.. .1:•�I..�?f+ '�� .�'�': p#• 1 Backu of sews a into facility or s stem component due to an'overloaded or clogged SAS or3cesspool n, � . P Sd 3 i tf ,k�ii- �..` ii"t�.� �� .� � a•:: ri t'"i � ! . ^.�r9# tt t rroV" (� a° 3charge oifrMvriding of effluent to`the surface of'the`ground or surfacelwaters due,to an overloaded°or clogged SAS or �, �y,-.� '� 5r r+4q✓ ,cz,{,:, CESSpool -%j; r f r .:'fix `'k"-"° r `:xa 3'� '' Z .' f ,` sa da` `Mplx i ''Mr ;-... - t• !4 ��,{ < • a P'.` �. br,� , ..tt,Trg Fn°(. ,tx ,�, ice.. Y7;g ��"x{ � �T ° "� �" y ; ,14 ,..•�� - r..:t,Fyri.;:,ibT iiv ss§7 o'ffij� ::.{ tC �f'✓rVi '� k x4 j�°';ai��Ai�#�,`jyyj'.,'��#;'yr _ .'•f _p - .. -.�. • � - .� e`�d"i. ia�,..'.k"=f'f.''.i.�� 'h:�.�. �r�..... S , r sra i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t ar 5 =Y PART A ; � CERTIFICATION (continued) I Property Address:• �� O�tKTZSeb� � c. WV 1�� Owner:, of Inspection: �D}SYSTEM FAILS(continued): bra \ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool r � Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/3 day flow. 5$Y Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipets). , r , � `'r✓ f � .. r.Email S Number of times pumped a n x r d aA Any portion of the Soil Absorption System, cesspool or privy is below the high.groundwater.elevation ' An onion of a cess ool or ri is within 100 feet of a surface water supply or tributary to a surface'water su I ti v i �y Y P P P �'Y PP Y �Y PP Y '' r a, a f s t{ t s "� Any portion of a cesspool or privy is within a Zone I of a public well. t Any portion of a cesspool or privy is within 50 feet of a private water supply well i . r a z in r Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a`private water supply welI" I � „.acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analy�sisIf�or is19 , * r es s coliform bacteria, volatile organic compounds, ammonia nitrogen.and nitrate nitrogen. LARGE SYSTEM.FAILS: � , The following criteria apply.to large systems in addition to the criteria above: .a� 7g�,,s.. a� y{`( t;r, �;s � ' � ". :" .� '- -$;�•ra��s-. z"a . r \ The design flow of system is 10,000 gpd or greater (Large System) and the,system is a significant threat to;public health ands safety , .and the environment because one or more of the following conditions exist: lt,S`S ..< rt.., KN the system is within 400 feet of a surface drinking water supply Mr system �s within 200 feet of tributary to a surface drinkin `water supply ) .rY. g •� � .£' ''�:rk r .1 :�,;c 4 r 3F "a", 4, ,. P � the system is located in,a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA) or a mapped Zone Il;of a F? . - r"1'� 'S 17...�h " ..,r t"; 1. s° .. .i '" kF'' ublic water su wellf ` s a n c' py z` 'ns lc tr hs ,P PpY l �riM',+i� S':.«x"•e a:):t The owner oroperator of.any such system shall bring the.system and facility into full compliance with the groundwater treatment program _ .. - - - 4 f ^ r + {t �U {requirements of 314 CMR.'S 00 and 6 00, Please consult the local regional office of the Department for.further informati3ion ��' � . ��'jTrA. �'#'k%4 1''' c +. ar +�},• r Syr ra„sesy. ¢ _•zr.-, 'Y �r ix s .�i 'ft' x f 3 ? �; ,. � �t .57r%tb �r �� ter,, 2 .w �' - .s' r _ - : '`+�''��" � "�S� � ;��1Y�••s y rix£'rF Szh -.rt+• 'Fs 1',� r �y.�f l�N\ 3d Sax' ww t�s` 3 ' ,yx u AV �<f } .d` '2• 6.r, - + �'`'S` p tg z Y '_d. .r 'r \l 4.• - , ,.r+vF ,9F ! r' "'' �. ' v � 1. ' J F k• �4 � *f' ty a. -'c•,'7 xs ' x 5IFMr - � 'IMP F ,',' 'mot, w•r. ' .r?�::�r., ,.. v �°�'.,.., b. y s. ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A 4 f i. .w .PART B sir CHECKLIST `k + s 4. 021 Property'Address: 1 a0 �NTSe � CDi u T M :. Owner t Date of,lnspedlon: •f4y Check if the following have been done: ✓Pumping information was requested of the owner, occupant, and Board of Health.Vn 's :✓None of the system components have been pumped for at least two weeks and the system has-been receiving normal flow"rates, .n� during that period. Large volumes, of water have not been introduced into the system recently or as part of this Inspection ✓As built plans have been obtained and examined. Note if they are not.available with N/A. 01 ,4y4 We facility or dwelling was inspected for signs of sewage back-up' p I MA, �� The system does not receive non-sanitary.or industrial waste flow ��`�7N ' A '�-...:.• - i =r*�' k'# 1kT t '34# t Ar3,� t. .t4s �% t ' The site was inspected for signs of.breakout, �� '� •, , All system components,,excluding the Soil Absorption.System, have been located on the site.. �� -•!`�t u- .i. �'r •. - �", i ,. e ��' �� ! , � f�r�t,. r s .•.�i�?'� 'i�. . 3 aS ,CYz Yseptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or � � 'tees, material of construction, dimensions, depth of liquid, depth of sludge depth of scum. ' v } t 7 i Iyz ?` t�'fhe size and location of the So il•Absorption System on the site has been determined based on existing information or �qitr ;;x approxlmated by non-intrusive methods. x • the fatut,� G• 'r a ,a o cupa. , if differ en! from o„•ner, were provided with information on the proper maintenance of Sub• 4'�Surface Disposal System � �x°r j?Amow+ C��` 7+a`si�'`�� .. '. - - #?', � .. � :�. •� **.r,y. vp+ rt5,�'AE'�, �y{ "�,�s-�P�^''r'�'"* +. Y +r 4, Y f��'�r*t f§,�..•''r �.%�,, y:,{ - r , 'pis � y'r'� s' -x �3�� Nn, 4'#t r'�� '! �, tFc.!>'.•d'.# .+. sh°vra ,' tf'S'' *n .;6... a,• ',S y r v`' `�'' �, #�Y ,f p� Mea a � r"m`�%:,..$ �`.,� `�, �a* f� �'' '•"�, y��,.. �{,r i' 'fit� 3'f! � q' r N°' 4 IM �y ..j`' ' k /*..''' i .4}x� •n, p.'.T •w '� _ y '`v 4 "m%'i ��1j^'"N` $y d•rr�Y fc r�Sr^ �:�FIe, 9 ,� Yy .•::r f ? ? "h 5} +�_ f yfi +% Y GAF ° ,'1,y,� X;,�^ ' ': d ' r�'•„>� .F�t? y. � ty f .. _:�' .��f t ZSv i"5,� ,�Yr a P" �"' .. +z."..�-. h �N; %�a�+ %e r.-,•t -v- _ ^' a r dry r�' �,�`ti. �i•n ,}-�V t�'��• a� 'Y`' f«. :�i� § 3 .,�'a -�i..' a,^'.f,r • n.2 ,+` t#�"'" � ,.t s�*� `, `t9'a: "3 •YF '2.f 4 SC� g �fzevSse0�0/15/95l « t € 4' � o � �g3�u �� f '}P•yc'�N �; 1 �,• J e.s '1,6`•'+' r °F '�',� fy `% �� fx. �•F w.y,3, s¢a r';,,��,•*� . e l� r' .3..5'� ., 1. %• � .�F. r•# �� 't� 3 4 �°xr,w�r�„d�'�g��.*�`i�� s $S4•t^% ��eh.�4k ...-. ... ...� � 3 '4.= .^: � � -, bF .. ,, .:...� 4Y,1.,M4 , r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM j A- PART C SYSTEM INFORMATION- Property Address: I-DO1 r,T ZS�Lo�1� `^�D�c�� M ' ;` ,. . k •A 0.4 Owner. ; Ow0-6-SuYV r fiV' Date of Inspection: �. ... ,,��: {tQdtx r {s :.FLOW CONDITIONS k zfRESIDENTIAL• , � ADesign flow:? • a Ilons w {{ Number of bedrooms: y �b'4 �Y Fr} "Number of current residents: C� ' _ Y �Garbagegrinder(yes or no): $. ,', �,laundry connected to system (yes or no):.` .• ' T= Aj + �=f t�tr`Seasonal.use (yes or no): ¢) ` '"{ f s t 1t, , h ,Water meter readings; if available: Lasf date o`ccupancy: S✓ M e. -/ 5' �..�,��+r,""�.�'S�,��`r+ +:. � :;., '•%f! f a.'.'^1) 4a�A�irip,�,�C'��5�� dylx M� �:5 5.(e"'4/'}�ty��r�''�ai�`�}�i�}'`'fti>� ° ,COMMERCIAL/INDUSTRIAL Type of-establishment: V— st 4 raQesigtlow` ¢allons/day t r'x } ��•: { u any& s 'Yl ,C wer^z Grease trap present;.yes Of•n0)_`.� ., ^ y r, IndustnalfWaske Holding,Tank present:,-(yes or no) ,: 1 way - ,f Fk Non-sanitary waste discharged to the Tide S system (yes or no t Water meter readings, if available sv t y&^�•+rti'��`n a+.v,+rtsa-» u -.r..;, r.,..,....«+..-.nm,r+ ,w , ..,5 ..:' �, p�.?'+�4'r., i�x4� y,r { t ,,(.ast,date of•occupancy: f. e ,f ry ins y .,.•- ;`. _ � e ' � �'."+.'>�s�� t� OTHER:"(Describe).' ,# Last'date of occupancy: I)Ic1rr 0 tgzYsa4l�l art I t`. _e y' �F i ; C� � 3itdtk i` a"la�t� rk �53r �t 3 _; ..,.GENERAL-INFORMATION PUMPING RECORDS and source of information."�( No - 1'-4- f N ` "+- #' {�z,.7 jtk t"(7; 5£�t. S•`' ry�YNj i .y,i ,? kt 5A �i•A 51t s •_; } t. �€i�° '�i`' gs5`t. System pumped as pan of'ins coon: ( es or no)_ Ifyes;;volume pumped vallon{ �l Ra xt ygLl3` : eso fgr pumping, i FF sYE �Yw'ryFfy�trtjgp �j� �t _'S,P e�4 .✓' A*1; i'x'JE { f flf.,l 3 ,r i ♦ =! q f�+4., 1 rYl a'.,(1 �k t'i-. f 1 y:ilk �Y5' f h } �. y M 7Y d bF.D!�f�4kt'��# '�+ RX .4 .g ~� TYPESYSTEMY i, w`re � .x Se tic-tank/distribution box/soiI absorption system , .• � � � � � x ° Single cesspool"M t 7<ti r frt W i + y0yerf1OW Ce$$Po01 sx` }' tn5.�, - '�'; p"'",y 6p ..+ ,. '. i n$""+'r R '•_ ,ems z i `i'r* t x _ y a e.: � C � fit•"' � Shared`system(yes or no)'(d yes attach previous inspection records, if any) � �;».w�`,�Other(explain) • � ' ,c '� 's� W Skl(+Rj:•;r�5+ APPROXIMATE AGE all components, date instilled (if known)andsource of information: SStiS�qq' xn+k.�t.di+3 5 ' � - ': ` •� f -at u Ti tl7 J,r�,s iT �• .°uRy, .a Sewage priors detected when arrMng at the site.(yes or no)�� c.: Si:• c�' x•f�c�':� ! �,e,,�, ri, - Fyr r � r § � �yn+f y�, ;+,t iz a.'n`._., tr ��. =„ x + .s� _ � a." s i• e p�ti`_� H� 5 t..��°�i k ">r r ,.. .1:�o.�e�_'d. .�'�.� �... t � �. r^,i^.... ,�•-..ten;,:.'. . . `.`� „y~.... o t...�vr-.",��`t"',x`s.�"`r. .....x4 ' is f e'i3gS°" .r`c n t„4 All j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` )a ti s ' PART C4, SYSTEM INFORMATION (continued) r s,, , S x = Property Address: 1a Q \`n1 3 - ti iY'�+ n• ) Owner: . Date of Inspection: ka `SEPTIC TANK: V ht (locate on site plan) Is}z To ? � Depth below grade: ; Material of construction: crete_metal._FRP_other(explain) � r �,�; 5 i• s .'#.: 5'�F:�I.0 , ,S e„�;;i{8 �t� r:.S`"Gi''�;j�'R: ` Slud e de thi + Distance from top of sludge to bottom of outlet tee or baffle: k . a�,�'Scum thickness: r * sf } 4 D.istance�from top of scum to top of outlet tee or baffle: :Distance from bottom of scum to bottom of outlet tee or baffle:' .. ��'� sy._ (`. _ •;,., .t«N.w,M,. t COmtrrter is, ! ✓ 4 Mtn (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural' ° 1 WWI,integrity; evidence of leakage, etc.), r x { q i !7 VGl L' i� \wed tal �86hSa Yu tv ,fr7: �€ r �e �` ��;�+mod ,..� ,. ... ,. , .F. ,.,s.-,. ..... .. a. •-r `',"' -r">;*'°n �+r,.a�fys+T�abi�Ns� •rr�s.�F a�� r�,�'�� Y� ,ty•••.�' - •: ^?,t- } GREASE TRAP._ _ ii €- llocate.on site plan) 9�, °.`i � 4 ✓/ 9a•�A ��ta ��+Ett r�x, t #��.>;tf�r f 'a� - w,.f u,r y-d.r,+ _ *h .a tea*'�� n,w M-. .,• r�+' -S'' . k Depth below grade • � s �' �- a�;`��aa�i fry .� p� �� fvtaterial of constructions_concrete _metal _FRP._other(explain) x,� era �i r y ;gyt Dimensions e 'x"ktiSeu�m thickness:'.. , r, •k °'. i ;r .il{D'f'� S4xi t'i fi" �}:•4';}}}!` ° .yc .Y. m.,g .� is-i r y � � Distance fro 'to of scum to top of outlet tee or baffle; a ¢F _ sI ell, i�t ce from bottc+m�;sr}5m�tn hatt�m C11 (4ti!liPi tPe'or 1^ •� r c?"' z, -y . # .s•�agg,�x[ s(�`1 f£'; .4. .,r ;'�}}fitii-j.,�A�t$ g � �, � :.i A'r,'•#9 F'vt��ehs�# `gC•� ;•. , � rT it;F.,. � 4 .-t ,�`' . :;:: '�..� t _•e - � `;(recommendation for.pumping,`condition of inlet and outlet tees or baffles; depth'of ligwd level in relation to outlet invert, structural A. tegri idence of leakage etc► w� . }'e - < K ,•,+r.v',., }f�l sits 3t+2,Aaplg• •y+a'yc1'r, .:•'' . +4x rb R r ..,} �A lIOU .;2 .a "k•" i+Ya = t'4z'`q�3` 5 h •. '�l'4 � tr � _ �,1 e >'t r'f•• .✓ s P:^tid iU.h f I } l ° rt y •' `kx€rs•;p4 y+aw rt -a w.n x xn k41 �t A" #hi m ..u.. < +.:.ri.. ,r .?: '.yF.y+,F *s i�s,, a ' V Q. , 'Xsn � ",y y,.� v .`saxYrls.,'"an �f .r,r• -:'�.' +�i«..a .ei^w. •.+v.s<-. ..h,._.. _ r n a. ,i w�nio»r, -w+ .,, 3.aa :�f f3s*1..�+t,✓, '«�r'.ggq�, Tr '"e`f�sN•��et�D S°F�+, �. _ r r e 1 � a r aY-�� °�. ��,�.+�,�y� 1'�r."' `c'." ��, .. t .. �wx ..:.r. .vr .;. r Sa �+ '', t kSS X �,, Y x frry �,a.r> .m wa.,a•s+ w»v».r �FG}7 f.,C1':=} 4 �)�.b l'* 1A0,1, n4 tot yPxd,1�'f f} 'sib'} y'' '}''+• y��qt d� � '�,.• k �qt f vxk'",a a &4.t+` 04, W•d _ •^ l 7* gip,} to I �;it ,�.i'tx .ir° �r�+vtt�f 5 4sysi!`,�1-i`,',+• � sr r ". . f j IN' (TevlsOd'6/:5/85} y 3 6 ;q y"}zr� krt'� +� •r ; �i y, �+ x - •+. r �,, s is z.. : Y „- ,'ei', F t- i ,R : �IP"7 AC �i ',s t t is t $huh ..... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM , t PART C rr SYSTEM INFORMATION (continued) -Prop"Address:Address: Owner.' �/�, �� ;t :�„r, ;; _• 5 �_.. r�"y rg� >� t ° Date of Inspection: 1 k. 4-41'TIGHT OR.HOLDING TANK: ` ,, i ,a5{F=: ta ..,: (locate on site plan) Ul Depth below grade: °st':' r zra4 f''VR Material of construction: _concrete_metal _FRP_other(explain) Dimensjons' Capacltyr gallons k ' Y; 'Design flow: Rallon5/day Comments � ,lcondit*oa of inlet tee, condition of alarm and float switches, etc.) N= � Jx+.iR,:r wp' .. :.r• .r-.... �", kn�.aM •rs.,.r. a yn,A. 'w g. °7 77A+ '770 r rF s 9,KX Y.` u r F wJ•::ty. q}� "7 �y�y�r.,yjp��•r"biYj'r 1 r-F+r �•r]' '� 1 t Y�....t� •.9 i��- _ ?.. Ph. i,'ff'{Ya.' f »Y'k /�AtY. .�• y� '. DISTRIBUTION BOX: BOX: ; �� . ° } ' (locate on site plans t € ''cy�" 3 's " °'s 4 � ¢ i•ls1,.+t � , at4,.l S k''�Ii +y l 4 }a�i Depth of liquid level above outlet invert.' lJ K-w�a f enp d ¢ COmmen s,, 4 MAN x : Mote �,ei ano distributiui. e4'a:, e�;dence of so,+d. camo•.er, evidence of leakage into or out of boa, etc) ( '� � s{M :Ot�'✓` � .. i.�r •1 kh•:J �•J4s5iyr F %'�i,.i X41> �kb,C b 7 - y� N�'�s�✓ { n_?` ,• '.4. ._ _ � v r-�, S1`W«yw. •Aa9�.,.•»-.+,� *�w+w�.in=.':� ,I`"A�st,;,�P1' a U IP CF AMBER ",I!; Al141 i, f t,;1,q `?rla? q� A n'ri vrr .o t «.e ,.p, ! t�.r . t .•�. . fin �s f G*r'3 y},� ? y (locate on Slte plan), I .�.,,,;7fY.4•t,aeF.{;r, •ar. s• + ti w,. w..c•,.rv, r - e..v�,..d tr+ �^.;^.r ..,ew n's;,.n Ad rJ°�y,S�„.F+ x T ^i. ^°9r ''a,s 2�, U'`F!r+i 'k°'�*2c�,r�1,y'�dstF3z+ � �` ..; ,�' 1 `M k01b+1 FKwsr i*,' �TPae.t AMrep°yJ°MkrAi. fr mps inorkmg order(yes or no) Fo. riytt'�5 *^-i}r 3.i.` } ��. •' .Ys �� , �, $v{r"fT �neeote eondttlon of pump chamber, condition of pumps and.appurtenances, - 1 t � .1a. <'"'�,# •,c.:.+�s"S' ,fr+*yi.�, r �cx 4Af ., t'a t ;t7 off" - oft" lA7,777777 r�•p, !{trt 'f'N ��i4� •9rwn..Mwa.+ra..++.r ..t,rw .=syr ..��v a,.<.;x•.t� n•..�y:�, r! ,,.-..14, „t.,r ,.,w' �r u�^n a d .n+.t .w..•�r a..»�r+v� `sac +•«.•.R.we7 vvyMtra.�,�aus�ia,�,� y M19iM ae 19 _pqp a t`N*es ,Vk AMA � x `S+c�equ`�ycd�sptW�� ;�� yw i3 A A y f t F£�.. �' +� � �46:�yp'� '��'t »�'Ts ?�.,�,vw'•E-�Y' (;evicted,9115/95) c, £ 7 `�n��r�i�rat s �'t b s 3 ° ��,r S •e e: ,' � � s. � S� "-s k'{�.�� K� "'�,k: 'C� G ,s` £ `�•'L 3 h `i yf,.`'7 - 6: n.,,.r +ilw6.$;x'''. .`' k sw,`ny ¢M, 'r �'^''`'+ ^, 'a',•. ' rr•'$ Y r x ,.� r.s'.. r {l`t 'l `',s'.�`Ya ,.hx k4�� a�t' ,.F' "a =k `1 1: ° r .t r� s •+rid*"^ r `IW ' s `9 o? h. Y .k• lj f `bIY"�i".�.+C{'kg ,x a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'f' PART C u .� SYSTEM INFORMATION (continued) , t f { {',. r .:Property Address: 1-�LO-Poktil'i'ZS Owner �� Date of Inspectioq: �� • ... 10 ice(Ji : 4 g � SOIL:ABSORPTION SYSTEM,(SAS): y.. (locate on site plan, it possible; excavation not required, but may be approximated by non-intrusive methods) y ;i if not determined to be present, explain: ,e t fPlj' 4 F � C . - w T... - .a .. v. _... r -.. ..e.s.+•i ��' �•,.g�k4{"N"Y � Le Saf y xr.W J .gt w ya �+f3srn xr� ' e leaching pits, number:° „��; .leaching chambers, number:_ f�' , i eaching galleries, number. leaching trenches, number,length: Y leaching fields, number,dimensions:. x An 'overflow cesspool, number: fhy,vy ' � �t Com. a"isi (note condition of soil, signs of hydraulic failure, level of ponding, conditiio/n.of vegetation,etc) k;e eau 6 ra' r' s.7t'�M1c tw.•„za.,,.....s «n.+r. ;h•� - ,-,� a' ,,�a+� x,a` Y T G d5R N .- ,),:.^V.* 4 ''�'' 1,. { Ary k •.y MW � �� 1_ L,� 'r �' wK'{Lh�M CESSPOOLS '(locate on site plan) yy y t s,- -,A co, •Number and.'con(iguration ,t ` Oepth•top`of'"liquid to inlet.invert:. _. � ' ` z ,� °t TDepth'of solids layer �.` Dimensions of cesspool: RZ � •� Matenah of construction: 3 +1r .f •r:s1-� ....k-}...._ .o. .F4s,t l a+,J,�,... a,...: n 3�S�ki { " �!�iit es nrs � ,{ip i s+..Xi f'J 3 7 /� M rir_'J3�� .,�it,3r t �� 1 d�eataon of:ground��ate ' • ��' k i�,� '�' �' "�''inflow'(cesspool must be pumped.as part of inspectioN• �� s�"¢`l �' f >rt�°��i. �;rr ��°, � `"M .4r.;<•.t..4--.aW ., `;:..;�{'ni.•,s,.,:....aa..r�.,,�: � -.., J«, - t',: se..;;:f 3s .w" �'�'�$,'.fa§e.�N� 'sv;' 4x Cyomments�(�note condition of soil, signs of hydraulic'falure, level of pondmg, condition of vegetation, f �P� 5.�•`t1 �) 'tK�Gt'•If_ 34t•... .�,, � - •k V�+�Ga f..•*;':9� �i5f'q �y� c�� -{. ift vi ^"tiT� %� �' '9rt Y+n'�,'!•„}�A. ..[....., 4 _ ., � '. . ., : � ' vffa.' .. _ . g.V.T': }l'�'�{+4 y"kteg� U`S •r . s ✓< t �'ti7� �S ,��, ,♦ �' xy a �Yd�;X�� at fv�,fir �4 llocawon site plan)✓ .' s { o yt},,fi e sx' ,, �,.sr ,, � , , � S: r ,>:•;' d I d 5`P �1.r,fl hyl ty +" J'sC}�i fi �y $�5ey�vy,Y� as l { + 4 !� "�•4 F.1,^n" H ;. S•` r"4"r�d� `•.aF°�°'"tF *�3 5 ,t :tNaterials of construction.`�`�`•�* '^~`�^� � � � �' '"Dimensions ' ''+ �•'• .-t»aa,y+Ke'x r�'.ee ,t 6 s- 3.x' .r,F.+i..:,., .:..y. +rh »vv 4-.ar r+b i ..."4.+`r�' it�iF t "•tr"`ems, ..Y, - s r G s'S"+ r v+ solids:'�. ....�.�,�»„ -��+�> .• .�...,.-,..��. ,�� ,� ��,..��7�� ; 'Co me (note condition of soil,signs'of hydraulic failure; level of ponding, condition of vegetatton,wetG) e e.x..5 �. '- , c-m'�4;:,e. .a.ly;� �.,xanX��.�M'��.i ti?s. � i J",�"ti .•�S f+aS•"•�- •s c"� H�q�#`"}4�^'�s4'J.t.},�, 'rya'�'��+r r� 1��.x�"ygt.,�{:�a"7+ ✓C .4 ,� ; .. .. y, Y i � :.`�•�'�+`"�,.�xes-• t�' .-€'a"if ."+��'Q + b K +e`i',5 6 4. { 8 f !:i` •d ' - `t W J k{.i'^*,ti {.k;�}9�3 � i s'fqv r� F. z to "x 4 Yh"�,S - ^V ��it +� r �� +t 'G /:i � : � d �,# a� � s °fix.�i� 4,X• t}, ..1�h^'�` �� . Sp 3 5 '' ilsevieed B/15/95) ,`, B`, �' •` , - x,� �'�`��£�� '`' J `.,. ;, i a p M ch1Y e+ou3 }t . �"°i�fi'• -s .4 =�s s 4 •# �� 0�'t'�F�'+i+ �.� ` �, `:•� k d k .§.,;§ Y f"`� yf,°�,�,t (2'r..N r��1�,'�� {y�(� ��`"" ," � •;�•! - e+ � '� h 1. r q Y ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 7 PART C SYSTEM INFORMATION (continued) ` c�, 4 v P.roperty'Address: i—C)o V01 tiT-�S�b Date of Inspection: may'i�� V `/W - ..�,• '4 �� i.'t` SKETCH OF SEWAGE DISPOSAL SYSTEM 'jIrclude ties to at least two permanent references landmarks or benchmarks { t locate all wells within 100W-4- f��'�-tf y Yid'; a:. � �-:q stt3 .•t •+ c k:, � .� a' t �F N r U - r +� 41.q. Y1t�q"7'S�t�4j�y,'� ''•.�''' i ♦ .' `_ � - �,� t.`�•'E3�.5 v ��$�,y� la.�t �t ` �•� • / ��Sr✓`j/.�L1�2JL c7Q7�� 1' �� i � ��r��4r� X, �'^.�� e'* � •+.r. f 1•t at ;�tG'��-�>��5 z ! .'{.dl' . N r k�tr e fy�"yaY�n��w-��i- .... 3�,�,,��av✓r-�¢,3.;.,>�.},. _. - « �+ •�*��hi i�'.. J � ��'' �.r rr' �j� s . WIN yt.',(� �"'�t`..k. t,� -M% � .�, ..A,<�. ., ; � .fit rc.. e },`,".`s •r^ �; ��,�� - 70 My2s'a at,F�4.'• q, kStK } •qt } t'.. �Y`v�I C1I'S+IiG�/ U�L'�� ,. ..i�t..".'n. r 3=-TUP t 7? "fit � -�/• n i � .�, ;., 1 .,' f . r 3 q3 4 :X *ry. ram�.. •L' r, 3 {;? �F b X 1't f ci �.• i i tK .ifiv"r?5X i 3� St" �, y„s ., .t! s .w f n t ' - •� 7 4 k �'. b ^tk4h i Y �' ♦' tt - t' }2' P� i !x- '�i�3' h 'tl.+•a 9 s y n r' ,� s ok K't ,{Am., tt t r f ., d� ,�, �.§. n ' ,`; t �., a��,,yr'S5� •.ey :a-2'A 7 mr 'Ai"`,� G P v 4 k 1 x W4� f 8 �� , �� .. t r +a� � r_ -:.r�i''kE'`9'd. x;i •#s' �'"ahT`' {•y, -�"},�,�x'6��` � �r '�^T�'p-�'�rqa��•� ,�, � ,�t ,. �'�f` �^ ' t rn rn � V r ,�''y , 7. •.,�.` S } Nr,s i t G,1.�� dyd 4 i DEPTHfTQ GROUNDWATER } ' " ��" ; ,�,I>,��' to� �.' .��.•��V� ��•„��+ Nk��V--~v7Y�� is u Trite a Depth to groundwater " V feet s �_ � r,� � � method of determination`or approximation: !4 Y'w�-5 € M .,t4G:tk4f ��J ` '« .rt r "4 t v •„•,• •v F•` "+�i' •....+-..'AR - rFplAt'��':gq};'"�.$�, k"�z„ >`•.,�u P,iF'': s t e ... �`tae F• S' '3'tb't,a 5p�,.'Y• 44 4 5 f xakae'yMM•.'�ie$'�aR�«',yf+"1•ia.�'��•+ �d".. `.z A 'r"hg. �c ?+, -s" r' 'f3D '%" �,� �'•kEu{ �}�' E"��s, M"q y�1 t�'T� ylsav�sed 8/15/95)' " 9 ua W e r k 11 >a• � t �'� '� � '. # r; �� at'� yr�>a %��r „z �� „ •"� i FW— ,._ "• t ''. -'t .v .3 r..'Y'. '•'+.'"r.'�tza+ s- ,yt ex' F RE a F§1 '� �A,. e r l z�fa r¢ z � V?'4t a s •�� r�i X'i5 � F f, - - - t � ' YSt�k y,�,,kY'�'�. "t�� 3£.. lb Commonwealth of MassachusettsCV Executive Office of Environmental Affairs F /P�cf� F Department of - Fe 8 Environmental Protection ° 199s Q111-k-' 4b Wllllam F.Weld Goamor + \ Trudy Coxed Secretary,EOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A i1 CERTIFICATION n Property Address: -i fj ?-q w i `\�� Address of Owner: ��✓ Ac�tcQ e �C�N --Date of Inspection: y, p C�TU V t (If different) Name of Inspector �c05-c,�t�Ue•.�4-S Company Name, Address and Telephone Number:)) c�G't�f4�Crvf' 1� f'``(kvt.wiS CERTIFICATION STATEMENT I"certify that I have personally inspected the sewage disposal system at this address and that the information.reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: V Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signat4��V*�___,/ Date: D `i-C'( The System Inspector shall submit a copy of this inspection report to the Approving Authority within.thirty (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 Department of Environmental Protection. The original should be sen; to :ne system owner and copies sent to the buyer, if applicable and the appro�ing authority. INSPECTION SUMMARY: Check A, B,C, or D: Al �SYST� PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, ' passes inspection. Indicate yes, no, or not,determined (Y, N,or ND). Describe basis of determination in all instances. If"not:determined';explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as . approved by the Board of Health. (revised 8/35/951 One Winter Street • Boston,Massachusetts 02108 �° FAX(617)556-1049 • Telephone(617)292.5500 �A,Printed on.Recyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) t Property Address: 4 00J l Ur Owner: JV\b/' "114NC4�'�Jo�l1 Date of Inspection; BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observedV in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. .The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box.is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the publig health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy' is within 50 feet of a bordering-vegetated wetland or a salt marsh., 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: , The SV.;Iem has a septic tanK anu soli absorptiun system anu is within i0u feet to a 'wale, supp) or tributarj to,a surface water supply. The system hay a septic tank and soil absorption system and is within a Zoned of a public water supply well, _ The system has a septic tank'and.soil absorption system and is within 50 feet of a private water supply well. The sysien-, has a septic tank and soi! absorption system and is less than 100 feet but 50 feet or more'from a private water supply well, unless a well.water analysis for coliform bacteria and volatile organic compounds indicates that the well is- free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen'-is equal to or less than 5 ppm• DI SYSTEM FAILS: I have determined that the.system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis ,T for this determination is identified below. The Board of Health should be contacted to determine.' will be necessary to correct the failure. Backup of sewage into facility or system:component due to an,overloaded or clogged SAS or cesspool., Discharge or ponding of effluent to the surface.of the ground or surface waters due to anr overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 _' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address: 190?OW I IT �5��\c>` GbTu tT Owner: Y�N.,/-rA j, Q;/r_o&v Date of Inspection: a-mil`f(0 D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. z Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT/due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption.System, cesspool or privy is below the high groundwater elevation. 3 Any portion,of a cesspool or privy is within 1.00 feet of a surface water supply or tributary to a,surface water supply.- Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is.within 50 feet of a private water supply well Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from.a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria volatile organic compounds, ammonia nitrogen en and nitrate nitrogen. EILARGE SYSTEM;FAILS: p. The following criteria apply to large systems in additionto the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and.the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking`water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA):or a mapped Zone 11 of a public water supply well! The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. r (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: (ao_?br X ll SS nw� Owner: 1(�f1✓ try� � Date of Inspection: T `—� Check if the following have been done: VPumping information was requested of the owner,occupant, and Board of Health. ✓None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during.that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have,been obtained and examined. Note if they are not available with N/A. 1The facility or dwelling was inspected for signs of sewage back-up. he system does not receive non-sanitary or industrial waste flow V fhe site was inspected for signs of breakout. %"'All system components, excluding the Soil Absorption System, have been located on the site. _the septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. `� 5he occupa-u, if d!fe.—I from owner, were provided with information on the proper maintenance of Sub Surface Disposal.System. trevised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:Address: Gffv Owner: V r A NLQ*'%Sv fV Date of Inspection- FLOW CONDITIONS RESIDENTIAL: Design flow: 6 allons Number of rooms: Number of current residents: Garbage grinder(yes or no):—H Laundry connected to system (yes or no):\/ Seasonal use (yes or no): Water meter readings, if available: i Last date of occupancy: ts>,e.'O��J COMMERCIAUINDUSTRIAL: Type of establishment:. Design flow:, aallons/day - .1' Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,.if available: Last date.of occupancy: OTHER:(Describe) Last date of occupancy GENERAL INFORMATION PUMPING RECORDS and source of information: Wig evP System pumped as pan of inspection: (yes or no)_ if yes, volume pomned: gallons Reason for pumping: Al TYPE O YSTEM - 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) Other.(explain) APPROXIMATE AGE of all components, date installed (if known) and source of,information: 7� Sewage odors detected when arriving at the site: (yes or no) - (revised 6/1.5/95) a 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: %v- Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grader tio Material of construcn: _ oncrete _metal _FRP other(explain) Dimensions: lo `z Sludge depth: I" 31+ Distance from top of sludge to bottom of outlet tee or baffle: 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: i Comments: (recommendation for pumping, condition of inlet and outl t tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) )'.V c ..> N"e n S � GREASE TRAP:±q (locate on site plan) _ c Depth below grade: Material of construction. _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: - Distance:from top of scum to top of outlet tee or baffle; + ` Distance from bottom n, M hottnm 01 ot1!je! tee or batJve- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles; depth of liquid level.in relation to outlet invert, structural integrity, evidence of leakage, etc.) Irevised 6/ 5/95) 6 e . n 14 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: ��C3�b i si � Z 5 �-,A ` C.6 i L) Owner: Date of Inspection: TIGHT OR HOLDING TANK.- (locate on site plan) Depth below grade: Material of construction: _concrete_metal FRP—Other(explain) Dimensions: Capacity: gallons Design flow: Gallons/day Alarm level: Comments: ° (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan; Depth of liquid level.above outlet invert: Comments: ot (note if ievei and aistributic,, eyua:, e�Idence ofsulid:ca:r�u�er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: , (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 0/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property 4ddress. Owner: shy AJJ(der t-.D k'\J Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined,to be present, explain: Type: t j leaching pits, number: leaching.chambers, number:_ leaching galleries, number:�(+I41(-t3 leaching,.trenches, number,length: , .leaching fields, number, dimensions: overflow cesspool, number:_ Comments: .(note condition of soil, signs of hydraulic failure,'level of ponding, condition of vegetation,etc.) CESSPOOLS: a (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. a � inflow{cesspool must be pumped as part of.inspection) Comments:'(note condition of sod, signs of hydraulic failure, level of"ponding, condition of vegetation, etc.) PRIVY., .. . (locate on site.plan) _ r Dimensions: Materials of construction: ; Depth of solids- Co' mments:;(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.), (revised 8/15/95) 8" a r } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION (continued) Property Address: 1�-� 5�tb�� TU i Owner: (\k, &':V""Cv yv Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' l� r' DEPTH TO GROUNDWATER // No�� Depth to groundwater: J`° feetS,r e� y S O"ye method of determination or approximation: ''��-- (revised 8/15/95) 9 � ® TOWN OF BARNSTABLE LOCATION SEWAGE # 9- VILLAGE ,r T ASSESSOR'S MAP & LOT _ INSTALL.ER'S NAME & PHONE NO. / L_AL9,A SEPTIC TANK CAPACITY__,��no i LEACHING FACILITY:(type L FYS (size) /Q X 76 rk/At NO. OF BEDROOMS 7 PRIVATE WELL. OR PUBLIC WATER w,yr _ BUILDER OR OWNER 14At DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No �P i 3 w e t , r V i s' A NO... ~.Y/------- �7.. ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -- ....... ................OF..........................._.._...._...---------- ApplirFation for Biiposal 10ork.6 Gunn rurtion rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... 1Za._. ' �� .._.to........... i ,1 1Q.............................................. ocation �ress or Lot No. Owne Address `� fi.�11lr , 4�5t1 ' e �-----•---•-------- Installer Address Type of Building /0L'4'/M//(j Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............�..........................Expansion Attic (/4 Garbage Grinder Other—Type of Building No. of persons__.._n? ................ Showers — Cafeteria ()V6V Otherfixtures ............................................................. ............................................. Design Flow...............1_1 ...... allons per person per day. Total daily flow_____._____.__ . ------------ WSeptic Tank—Liquid capacity7gallons Length................ Width................ Diameter________--___.-- Depth................ x Disposal Trench—No..................... Width.....f............. Total Length.................... Total leaching area..........._......__sq. ft. Seepage Pit No........e�.:_-__-- Diameter......6---------- Depth below inlet.... .- _.- .. Total leaching area..................sq. ft. z Other Distribution box ( Dosing tank `( ) '-' Percolation Test Results Performed b At'.,qA!M.................................... Date..........- -----.. Test Pit No. I...L.,_.Vminutes per inch Depth of Test Pit../..-./ ........ Depth to ground water___ vo._IVM V? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_.•............. . ------ .. Description of Soil �`-� '� c U ------•--------------------•-------•-------•••-•••-••---...--------•--•--•---------••-------------------•-•---••-•-••--•---••••--•-••---•---------•••-•••-•--••••-•••---•--••--•••---•-••......--------- w x -------------------------------------------•----•-•••------•--------•------••••••-•-••-••••------------------------••...--••••••-----------------------------------------------•....................... 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 rovisi is of 1-11L� p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in peratio u ti� tiff o een issued by the b and of health. t A 5, Signed.._4--14fS �1 n.,.e0th.V..dt t.....---la F Dat Application Approved By--•------- ........../•--`_-1_t:?.2.'_ Date Application Disapproved for the following reasons----------------•----•--••---•-••----•----------------------...------------.= ....-•---••------•-----------•---•--_....----•--------••----------------------•-----------••-•-----•---...---._............_-----------------•-•-••-----•---•---•-•---•••-••--••---------•---•.....------ cc Date PermitNo..........O. .-... ./--------------------------- Issued.--------•--.....---------------•--•--------------•---- 1�atL 'X. ` No...(?...../...... Fx$. 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�w ApplirFatilan for Dhipa i al Works Tnnitrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . ................--.............................................................................. -'.....-----.....-------•-'•-••----••------------------._.._...---------....._._....-----------•-- Location-Address or Lot No. ......................—.......................................................................... .........._....................................................................................... owner Address w Installer Address UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------------•... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ 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..................sq. ft. Z Other Distribution box ( ) Dosing tank. ( ) 1.4 Percolation Test Results Performed by-------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.__.__._•........... Depth to ground water------------------------ f r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____•______••__•._______ a .............................................................----•---•---••..............•---------------.........--•••--------•--••-•-••'--------•------•-- 0 Description of Soil........................................................................................................................................................................ x U ••••--••••••••---•••-----••-•-•-•••••-•---••----•------------------•-----•---•-----•-•---•--•-----•-----•-••---•--•••--•----•---------••--•...__...-••--••---•••--•••--•-•-•---•-•----------....._-•-_.. w VNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------•----------------------------------------------------•--------------------------------•-•---------------------...-------•------......------------------------..._..........--- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with !'1T 1�1� the provis ons of 1—,.a. i of the State Sanitary Code—The undersigned further agrees not to place the system in peratio uaitil ti _e o 0 �11 a"been issued by the board of health. Signed...................................................................................... ............................... h Date Application Approved By..............�l-' tt' ... ..� �._ _- - ^=---------•-------•---•-------------- .........../ -=--'.%---- r`` .. if Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ •------------------------------------------------------------------------'•--'-----...--'--................------------......------------------.....---------------------------•--••••••••-•-•----------- Date PermitNo.........9..5". -,�.....................--'-- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......7................................OF... . . ... < .�rrtifirtttr�ivr ir" ° Una THIS IS TO CERTIFY, That the. Individual Sewage Disposal System constructed or Repaired by...................•�---�•----•---•----•-.....'-.---........._.....------------''-'-•------_...--••••.....-'-"-----•------•---.............•--.........----•-..........------•-----•-''------ �. `�.. (` •-------------------Installer---••---- Ir has been ins��hl�d' in c�ordan e t 1 o isiolb k i I T E `� Tt tate Sanitary Code as described in the application for Disposal Works Construction Permit No............. _ ____________ dated----------...................................... THE ISSUANCE OF THIS CERTIFICATE SMALL Ng77EE eoNSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ ccrr DATE.. .................................... Inspector........- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F..........,..................... ........_..................................... NO........ *, ....Le.._: / } FEE.........�i t.. �i��a��1 arrk� �nn�tr�rtuan �erutit Permission is hereby granted------------------ r' l to Construct ( ) or Repair ( ) an Individual Se&age isposal System � -•----------------------------------------•------•--- 1 / /'i f _t� -'C F - �e. 1.+�rr� Sty flk x as shown on the application for Disposal Works Construction t No... ........ ated............................. ........... -•-` Board of Heath DATE................ •-•---�� _._. .-------• , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f7oto_r,_. .__,. -_ 1 Commonwealth �'' Barnstable �,t City T,wn of Massachusetts $eBpsz�ffi Applicant Arthur W. Anderson c 39• k- - --Order of Conditions - MASSACHUSETTS WETLA PROTECTION ACT NT G.L. c. 131, § `0 TOWN OF BARNSTABLE WETLANDS PROTEC '_CI'1 B'17-T._:.AIN, Ch. 3, Article XXVII FROM: BARNSTABLE CONSE RV.-.T--0N CO3LtIISSI0N To Arthur W. Anderson Arthur & Patricia Anderson (Name of Applicant) (Name of property owner) 115 Ellis Farm Lane Address Melrose, MA. 02176 Address vame This Order is issued and delivered as follows: C by hand delivery to applicant or representative on (date) ffX by certified mail,return receipt requested on December ?1, 19 8 8 (date) U This project is located at Lot #5 (110) Point Isabella P0. , Cotuit, MA. The property is recorded at the Registry of Deeds in Barnstable Ecok 2929 Page 140 C,erfificate(if registered) The Notice of Intent for this project ryas filed on Novembe ?-, 19 8 8 ,rd e) ThF ^ublic hearing was closed en December 13 , 1988 (date; Findings Barnstable Conservation Commission h, o., r cn f /_.. the above-:efer._ c_edr+ Notce o, I t nt and plans and has held a public heariing on the project. Eas_d the inicrmaticn availab'e tc the Commission �.� ,'f Commission a' is time, e ;,as de' rmined that the area on which the proposed work Is to be done Is significant tc the icilcwing interests In accordance `iith ('he Presumptions of Significance set forth in the reguiations for eacn ,-.Pea Subject to Protection Under the Act (check as appropriate): Public water supply Flood control C Land containing sheilfisn Private water supply Stcrm damage prw n'?1cli —! IsheNes r^ Ground water supply ® Prevention of pollution Protection: of wildlife ~abitat Therefore, the Barnstable Conservation Cornrnittee hereby finds that the following conditions are necessary, in _____accordance with the Perfor•m,arce Standards set forth in the re,alations, to protect those interests checked above. The Barnstable Conservation Committee orders that all work shall be performed in accordance with said conditions -- - -and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control : _.L-CONLDITIONS -- --- -1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. This Order does not grant any property rights or anv exclusive on iiieges; it does not authorize anv injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state cr local statutes, ordinances, by-laws or regulations, 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following- appiv: gal the worst is a mair.enance d_reda_g project as provided for in the Act; or (b) the time or completion has been extended to a specified date more than three years, but less than five years, from t .e dace of issuance and both that date and the special ci.-cumstances warranting the extended time period are sec forth in this Order. 5. This Order may be extended by the issuing authority for one or more periods of ,ip to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in correction with this project shall be clean HE, containing no trash. refuse, rubbish or debris, including but not limited to lumber, bricks,plaster, wire, lath,paper. cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any of the foregoing. 7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed until all proceedings before the Department; have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located. within the chain of title of the affected property. In the case of recorded land, t.e Final Order shall also be noted in the ?eg stry's Granttor Index under the name of the owner of the lard upon which the proposed Work is to be done. In the case of registered land, the Final Order shall .,'lo be roc.ed on the Land Court Certificate of Title of the owner of the lard upon which the proposed Work 1S t0 'oe done. Tie reC0r01r g information SI all be m Q D1Ltc t0 Gh i1 r,-,1 ed LCigg_C on toe for—, at -.ie enc 0. th:s Order prior tG cc iencemenc or he 'A'OrX. 9. A Sian sl'aL, ;p djs-mavc- at the site not less Char, �.wo SOuare feet or ^.Ore than three scuare feet in size bear- mg the JrOr._ ,1 _saCl:llSettS De-oarim nent JI "7,-n ironmencai Qua c`. 4,ng neer`-. F e'Nur i. SE3-1 905 10. Where the v.eDai:rent OI Environmental Quaiky Engineering is requested t0 make a deter. .anion and CO issue a Sucersemd r:,Order. the Conservation Com—mission shall be a par to all agency proceedings and hear- ings before t :e Oepar:r:ent. 11. Immediateiv_ fallow Win? com-clecion. the project shall be certi^ed to be as per these conditions and pians, in w71Cu17, to c o R=szabie Conser-r Commission om fission by the orclect enaineer who shah oe iegisLereO Lin the stale or MasS. 12. L'oon certl^cation by the protect e n a i nPe the ap^lrcarc Shall torth`:.'.th request. in `, ririr?o, that a CerL�:cace oI Comcliance be issued SLacing that the work has been sausiaccon:ly compleCed. 13. Prior to any ,Jorli bein_ done at the site, all legal aciyerc z .g bills ircur. -d by the petitioner in relation to the Wetlands Tlea_rin held on this project'shail be paid., 14. This Order is issued under Article KXVII of ,he Town of Barnscabie By-Laws as wel as under Mass. G.L. C'1_ 131, sec. =0. T1<e Barnstable Corservac:on Com— fission Or ConSer•,at;on OfIlc�r ; ,ald be ^affied 70 _r're than two weeks nor less than two days prior to the coml:_encen enr. oI 'Nork. and have the authoricy m issue an Eniorcer nenL Order iS i.iie terra or iRc:;nt o, orCCr -:'e i00 Jk I{ 1 Lc :s -he auc ' nL 'acrGnSipt _? r0'.. e �� " ,.^D Oi :.:-- -- 1 - t ;r-tors car` c z of 1 16. The work shall conform to the following plans and special conditions: PLANS: Title Dated Signed and Stamped by: On File with: - -- - Plan of Barnstable Record 11/21/33 Robert A. Braman, n:E. Consewafion Commission Special Conditions (Use additional paper if necessary) 1. ) Prior to the commencement of work, General Condition number 8 shall be complied with. 2 . ) It is the responsibility of the applicant, owner and/or successor (s) to ensure that all conditions of this Order .�ar.e complied with. The project engineer and contractors are to be provided with a cope of this Order and referenced documents before the commencement of construction. 3. ) The work limit for the project shall be established as indicated on the plan of record. I 4 . ) Staked haybales shall be set at the work limit prior to the start of work at the site and maintained throughout construction. 5. ) There shall be no disturbance of this site, including cutting of vegetation beyond the work limit. 6 . ) In the absence of drywells , roof runoff shall be directed, to the extent practicable, to the catch basins lateral to the house. 7 . ) in -the a'i)senC'` of drywells, roof shingles 91_iall be of ' inert' material (i.e. wood, slate) instead of asphalt. 8. ) Pooh-dra�rdown `v at-er--snall'-be_liauled---o==:F-sit-e --Drawdown-wate-r=-s-h-all not_b-e-di-sect-ec over the oC as —17— .. � . } `she lawn east (seawarj) of the house shall be maintained in fescue rather than bluegrass (sod) . 10 . ) T-his approval is contingent upon the approval by the Board of Health of the subsurface sewage disposal system. 11. ) The drive�,7ay shall ;be constructed of pervious material within the jurisdiction of the Conservation Commission. ...................................................................................................................................................................................... (Leave Space Blank) - 12. ; The existing cesspool shall be pumped dry and filled with clean sand. - - - - - Th&- Cons ar`Tation Commission, it-s -:,-_<<ployees and -tS dgentS - - -- - - \-_�i o 1S _ she 0--der o, Cgin a C:10r, . 14 . ) Az the completion of work, or 'Ov the expiration- of the present permit, General Condition number 12 shad be complied with. i I ,I Issued By Barnstable _._._..---_---_-...------------_.----_.._.___ - - Conner-:atior. Corru:.iss,on f Signacure(s) This Order must be signed by a majority of the Conservation Commission. On this 21st day of December 19 before me personally appeared !Mark H. Robinson ro oe the person described in and who executed the foregoing instrument and acknowledged that as his,her free act and deed. L October 28 . 190 Votary Public My commission expires The applicant, the owner,any person aggrieved by this Order.any owner of land abutting the iana upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereov notifieci of their right to request the Department of Environmental Quality Engineering co issue a Superseding Order. _irovidin<, c:Ie request is made by certified mail or hand delivery to the Department within cen days from the date of issuance of this Order. A copv of the request shall at the same time be sent by certified mail or hand delivery to the Consen acion Cur=ssion and the anpucant. Demc❑ on Doned '_.!nu -,nd ::_L!?'T_it -o the Issuer of this Order "0 To Barn�ztaole C-onser:at:on Commission Pi `AC.E rzE aIDV 1c,ED "'_' a"" TIHE ORDER OF CONDITIONS FOR ,H:� JECT I: recorded land. ..he :l i':,..:_ number ."hich :'1enc..,.es this -s :j .eo _terBd �._.c_ 11/23/2020 ShowAsbuilt(1700x2800) 1✓ TOWN OF BARNSTABLE LOCATION Po Ak-n74ag:4A SEWAGE dg9-:v VILLAGE ASSESSOR'S MAP&LOT /S INSTALLER'S NAME 6 Y77•16 PHONE NO. /KZA,P/>�fTi�� _ SEPTIC TANK CAPACITY_ lnnn Gd/_S LEACHING PACILITYAtype)$ E __tsite) h X 38 NO.OP BEDROOMS _PRIVATE WELL.OR PUBLIC WATER BUILDER OR OWNER Z14? /-�GCeQ DATE PERMIT ISSUED:_ Iq-S9 DATE COLIPLIANCE ISSUED; VARIANCE GRANTED: Yes No P�PGz Ho ASE b i x- i o , - V1 q3 d I/D 9p iL https://itsgldb.town.barnstable.ma.us:8431/home/ShowAsbuilt?.mp=074005&sq=1 1/1 _,T7 7, -7� 7--7-7— 7"`__- 71 FIRST FL. EL. Z9,00 , Foundation F �$T 4=fn. . NeS (W '��FZA47:1r__ C.C:),Vr IW <q A F r__ T4! nc. Cover to Grade' I Cem. Co FINISH F 5 GRADE "EL,. 0 _�J// 1A�i j 14 10 S- -4/871'mil �.A V. Sr 1/8 1 min. 2 WA- COI�SHr-_� �STC)1,4P_ V A i'l, D "A (3 V 7 1_�_�z. 7;26 4 A A Al, ills, Tc> 1�i;? W^�� INV. EL. ' ' ,L , I. , , L I L . L 6 441 ,I, - a. 1 11 - I I -HIM SMT. 1NV. EL, I M FL. I EL. �j \B AL 0C PVC Schedule 40 A A# r->" A.-I T J% -FINP,!� H t:!� S A. OCU 1. EL. , IN% Pij* 8 Tees i1sabeliz J 5C) '0 ML 0 A I�J_J-4"10, F-L. 1440, rr 41 CE A' , 'j.''L I I I L J . A .-A < f Y "MAP 40plrr> F;7 < OM LJ S. S MI Jim !1 -C>TL1t7 F_L iO' min. lz TEST HOLE min. P-7 IZ-7 20 e aSt A�;2000 gal. 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T' k SEPTIC TA'NK ............._g an gj�,F tz C> 'A' 'LEACHING AREAt P6 r c'Ra e -min i n t f IL F-N S_ ./9 G Ottorn, a i ewoll area at d 1):ALL r_Lr_V,&p'0�4'5 Aql�_7M rec s a Sidewall orea L B tiom oreov 0 STOaCTION F-ZzU1FT1`- r--"T To er 0 f 0 0 C>W 1214NST -4 Y-A xA F FF W Use -fTH gfj�,j_4_F_y5 ith sione _;C,.,4. 12�15_ TO 7A ExIs POOL� "R"PROPOSCO H OU SE, T- AININO -MALLS AND SEP7nC S F L T W,&P;i rr- t,4T, Z�� VIT I-L REPARED FOR UR- W. ANDERSOW. P ARTH A Y H e6AS NOR "M AS 110 POIN I AbtLLA �EOAQ �COTUIT (BARN,STAE31�,E E�N T s A F ze )_:�YSTIN6i COWTOW;z T T N N N W.O. �N Mona N N SCALE: AS NOTED, 0. 8105 ip, UA , DATE:N �DRAWN PLAN N -i�3ZJ By: 0. E' rLAL :BRAMAN ENGINEERING COMPANYLTD. -701 , IVIL !ENGINEERS ,:& URVEYORS A. '258 WIN ST.: BUZZARDS: V 19TO BAYP 40 71 co EET �A SH 1 OF 1 PL S ic