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HomeMy WebLinkAbout0008 TRUMAN LANE - Health F8 Truman Lane cotuit -- / A= 039-146 I - I Town of Barnstable Barnstable Regulatory Services Department MASS .19. Public Health Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 2712 June 30, 2014 Mr. &Mrs. John J Mollica John J. Mollica 8 Truman Lane Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 ' • The septic system located 8 Truman Lane, Cotuit, MA, was last inspected on 6/7/2014, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF•THE BOARD{OF HEALTH T o McKean, R.S. CHO • Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\8 Truman LN Cot Jun 2014.doc I Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2590 F ARN3TA11L 7]-� - - +-• tyy\4 rt,w$a ftc,' ;.. ��.�p�:./�raT-._. „... A' Gi✓ GC/'{m"'..i!s.��r .a ,�� LY�.� LL Logged In As: Parcel Detail Monday, June 23 2014 Parcel Lookup Parcel Info Parcel 039-146 Developer LOT 44 ID Lot Location 18 TRUMAN LANE Pri Frontage 142 R Sec oadSAMPSONS MILL ROAD Frontage 119 Village'COTUIT Fire ICOTUIT District Town sewer exists at this Road -- address No 1 Index�1742 Asbuilt Septic Scan: Interactive 039146_1 Mapes_� ` 7 Owner Info Co- Owner IMOLLICA, JOHN J&PALMINA J Owner I-�.'MOLLICA,JOHN J Streetl 18 TRUMAN LN Street2 City 1COTUIT ) State MA Zip F02635 _ _ Country Land Info __._ ........_....._ ...... ._ .......... Acres 10.48 Use ISingle Fam MDL-01 I Zoning#Rr � j Nghbd 0106 Topography Level �! Road Paved --- Utilities I Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year Roof� Ext _.._ Built 1996 _ I Struct I"able/Hip Wall jWood Shingle l Living I1926 Roof mph/F GIs/Cmp AC None___�._'_'_ max: 5 ti. Area CoverlIs Type z Style Ranch ^) Int Drywall Bed[3 Bedrooms Wall Rooms Model Residential Int Hardwood Bath 12 F � �, T Floor Rooms .01 Grade Average Heat Hot Water Total6 Rooms Type Rooms wp Stories 1 Story Heat Gas � �Found-jp rou ed Conc. e Fuel I" ation Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2590 6/23/2014 Il ✓� 1 �� , � ��� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information #t J1 1. Inspector: �� Shawn Mcelroy Name of Inspector Upper Cape Septic Services - Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 17508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by t e Local Approving Authority 6-7-14 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the.appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. d 0 t5ins•3/13 Title 5 Official Inspection rm:Subsurface Sewage Disposal System-Page 1 of 17 i,IL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts - _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vol unta ry,Assessments a �qM 8 Truman 'I_n Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ 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): ❑. broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist Which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment,: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 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 is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts = W Title 5 Official .Inspection Form 'm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town 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. 1. 1 .rj -. ❑ ® 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- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. j E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ . ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to.a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments <c�M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is Cotuit MA 62635 6-7-14 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related.to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is r equired for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 5-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �nM 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 5-2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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•3/13 Title 5 Official Inspection Forms Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: , ❑cast iron ® 40 PVC ❑ other(explain):. Distance from private water supply well or suction liner feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. s 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: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: , 1000 gal Sludge depth: 4" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 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 28" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. P 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•3/13 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 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Truman Ln Property Address P Y John Mollica Owner Owner's Name information is Cotuit MA 02635 6-7-14 e uire r d for every ry City(rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in workingorder: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* i Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form fill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was filled with water into riser at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of'scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit , MA 02635 6-7-14 page. City/Town 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 40 r� * ' '' - F . f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slo ❑ e P ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of,Health -explain: ® Checked with local excavators, installers- (attach documentation) G ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 8 Truman Ln Property Address John Mollica Owner Owner's Name information is required for every Cotuit MA 02635 6-7-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: p V Shawn Mcelroy Name of Inspector Upper Cape Septic Services , Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification d certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by a Local Approving Authority 5-29-14 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to,the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Lz t5ins•3/13 Title 5 Off cial InspectI. Sbsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form T ' o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. r B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced' ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ' ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times�a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the'Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health- , ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of'a,bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 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 is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility.or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town 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 cesspod or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No I ❑ ❑ the system is within 400 feet of a surface'drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•1113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 General Patton Dr Property Address Charles & Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection 1 C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of El ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan atithe Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts R F Title 5 Official Inspection Form ,b o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail 4Kea Sump pump? r ❑ Yes ® No 5-2014 Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gPa) 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 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;MgO 15 General Patton Dr Property Address Charles & Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 ' Commonwealth of Massachusetts F Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) Approximate age of all components, date installed (if known) and source of information: 1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. 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: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C M 15 General Patton.Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 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 20" Scum thickness 1" @ Outlet Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official InspectionForm !� a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �7M 15 General Patton Dr , Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 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): r Depth 16low 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 15 General Patton Dr Property Address Charles & Belinda Lee Owner Owner's Name information is H required for every y annis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert ) 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.): Good condition with water at working level and stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was filled with water above the inlet invert at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth.of solids layer Depth of scum Layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City[Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection - Form Ins � p Im Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments wM 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town 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 F .� U _ - . 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts „ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town 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: 16' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 16'. 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 General Patton Dr Property Address Charles& Belinda Lee Owner Owner's Name information is required for every Hyannis MA 02601 5-29-14 page. City/Town 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 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �32- '2orl. �e e Town of Barnstable v` �r� P# / Department of Regulatory Services Public Health Division Date 1 d3f>` 200 Main Street,Hrwais MA 02601 s lED � ( . � Date Scheduled m ;fl r Time Fee Pd. Sit Suitability Assessment for Sew is os Performed By: �/� / .�OyL Witnessed By: I LOCATION& GENERAL INFORMATION Location Address �, 7Q � Owner's Name \/ON4/ ( ml 1 T.Qdstl.�J.V i9�e _ — Address t;Ors//T Assessor's Map/Parcel: /4A/0 3,� C Engineer's Name Z0,0X1_E SOC/�T�cS /70 CEO✓E.2 Fj��.D /i/.g �.,��9L� 1lTeS/ NEW CONSTRUCTION REPAIR Telephone# .SOB �6 /99 Land Use 5%A4Lt-' AV tJ/ 'Slopes(%) o O Surface Stones W40T 4946*0-1146A Distances from: Open Water Body�6d R Possible Wet Area ®O ft Drinking Water Well ft Drainage Way N A ft Property Line __,�_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) p TP-Z41 /ZZ,�S" Parent material(geologic) IC 6A4S6 SAAla Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /V�/r �- Weeping from Pit Fnee A Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: In. Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft. Index Well# __ Reading Date: Index Well Adj.fhetor_ _F= Ad).Groundwater Level PERCOLATION TEST Date'7 xltne/o:ao Ar! Observation Hole# Tlp _ Time at 9" _ e, Depth of Petc 3 6� _ Time at 6" Start Pre-soak Time @� /�0% Time(9"-6") End Pre-soak /D:� 0 Rate Min./inch 6/¢L— 5'f T •. E5S 71-1, 1 2 /ql,i/ /n/C H Site Suitability Assessment. Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you(must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTICU'ERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 7P-[ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Stnucture,Stones;Boulders. o psi- stency y6 Gravell o� 8" L011 M sye x 2- /d yi 6/ 2-f�" B /DND 40, 1" SyR s/3 2 `t-A" C Q �✓c. /o/R Ar-/3 2" C,- rof Ase 0a,0 /o DEEP OBSERVATION HOLE LOG Dole#7P-Z Depth from Soil Horizon p Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders. Consistency.%Gravel) /1$""24 " . AAa 3-y2 f ,3 U"- �. 'v C A"Cse L /o mG DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consistency.%Gravel) .DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. i Flood Insurance Rate Map: Above 500 year flood boundary No— Yes z Within 500 year boundary No Yes Within L00 year flood boundary No Yes - Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification / I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and exp ce described in 310 CMR 15.017. Signature Date d� ZD/� Q:WEPTIC�PERCFORM.DOC TOWN OF BARNSTABLE y� LOCATION a / Uln;4r 1-41V­ SEWAGE# VILLAGE (,D4 a ASSESSOR'S M/AP&PARCEL 31 INSTALLER'S NAME&PHONE NO. 6G�r✓ e SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) =;22 `5eO n0-126 (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: / COMPLIANCE DATE: Separation Distance etween the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 41 _ , a T�' 01-Ef 1STABLE ti SMAGE#k' ;LOCAMON `' VILi� E, 'Co'the ASSESSOrtS MAP�c LOx — ] 15TI �LE 'S NAPId sEP1 c 1'A l I rx: . 2(type a NO..Oki-BFDROOM S�paaraeaora lI 'itaa��c:Y3a^tv��eaa:t��a Cec Maximum Acl}u�c �GputRcfwa���'Qktile to tl�r,}�nllorrtoi Leac:hin�i�ar,ility rt --- � l iva 4 utc►5up�1y W6 ai ci t,�a� ia�g atcaltty ( iy i^�et4s uxfs . 7rer�� OW 4 qr: vlthaai�QQ feet of retaahiri fatcil ty) �. ,.:�._._._. ti ,clue:iy� VVeP aaac9 saaid Uoaaist } f 011 eet i¢y.� pos y w tiand5 exist r tviGl�iaa 300 f Qt l4nclaing kuc "} " �u�rat�hr�d fay: � iisry ..,. �.....,, - Q rA o i Y � � b n Y � Y Lv� No. �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �G PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Mispo8al *pBtrm Construction Permit Application for a Permit to Construct ) Repair(I/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /A)V1 44V_ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / V4 _9�_6eQAL 11tallier' Nar►Ig�d�ess, nd Tel.No. Designer's Name,Address, d Tel.N 70 o&ef Type of Building: 25�3�G%9y Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 141W 2,, Number of sheets Revision Date Size of Septic Tank / Type of S.A.S. Description of Soil LO�—� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boqd of Heal Signed Date 7'1220bova Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued Fee THE COMMONWEALTHIOF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplicatlon for -Misposal 6pstem ConstrUctloll permit Application for a Permit to Construct ) Repair('Upgrade( ) Abandon( )1 ❑Complete System ❑Individual Components Location Address or Lot No. U/1)J i 44ty- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3 `7 V eWu -M t6eQ /M I taller' N ,��,dd nd Tel.No. Designersame,Address,ess ' N Add d Tel.N . / /G � 4�v ?�S�6-SC� v �7Do�cp�i cka y , Type of Building: � g-Z%a/99y Dwelling No.of Bedrooms 13 !Lot Size C> , sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow-(min.required) ) gpd Design flow provided 3�g _ gpd Plan Date 21 of sheets Revision Date Title Tank tic Se YP Size of Type of S.A.S. P Description of.Soil d y_, �n �p�'}✓!� ��'��� �1�/ �d-25��� / p4rj1 �5��=��LJ�1� 1 ~ Nature of Repairs or Alterations(Answer when applicable) lqeu,) 'Ty 6, -)x 4 zo AAd 545 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ki ~- accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of If' Compliance has been issued by this_B d of Heal Signed Date Application Approved by Date t Application Disapproved by Date for the following reasons Permit No. -^ Date Issued ,.. t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Di osal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by C /L• at t has been consv cted i acp rdance with the provisions of Title 5 and the or Disposal System Construction Permit No. "! d tr- Installer Designer , #bedrooms Approved design-4Ow gpd / 1 The issuan,pA of is a tt s alI not be construed as a guarantee that the system will nction as esigned. Date Inspector v r / -------------------------------------------------------------------------- ------------------------------ No. a�13 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS -MispoBal 6pstem onstrnctlon 3permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at ,n and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by Town of Barnstable Regulatory Services Richard V. l' L e, t Sca y Interim Director BMNWns� KAS Public Health Division 1639. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 I_nstaller& Designer Certification Form )Date: Sewage Permit# a2b)q.�Assessor's Map\Parcel .3 9 '.4oc, Designer: Installer: /-�/C6/i9,EG Address: /70 CLOVEiC`-'/E1,0 94111V Address: PO I11 �41Wz17W- OZ �53 6 On<� L/��U72-5 was issued a permit to install a (da ) (installer) septic system at 2216, 9/,1 1q/I/- based on a design drawn by (address) fl>OyG� 1'QS.Sod/.97zrj­ dated 2, 20/I4-1 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) _ OF M,q� ( n s ignature) o P. cJ DOYLE.,fit H No.33b69 _ q ez--- l9 F-I ST ER�� (DesigneKsSignature) (Affix 6. p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTH, BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc J/od 32!/� Ne,VE �zoh, rle Town.of Barnstable P Department of Regulatory Services t+J►twarAers, Public Health Division Date MASS, 200 Main Street,Hy nis MA 02601 Time Date Scheduled— Fee Pd. �D OD ` Sa it Al Suitability Assessment for- SJ�Zggos r r �Performed By: /�/J/ /'��QyLWitnessed Hy: LOCATION& GENERAL INFORMATION Location Address Owner's Name 8 -, O1141 i�2U12j 4 Aj 1-A1V4- -Andress m li7 ' OZ6.3, Assessor's Map/Parcel: 1,1,4 `� 14AC. /,444 Engineer's Name.T JI)XI E SOG/i9,rat 170 NEW CONSTRUCTION REPAIR ___f_ Telephone# Land Use �✓FL�'�.4 /Qtj/Slopes Surface Stones Alp Distances from: Open Water Body J-60 ft Possible Wet Area 9Q ft 'Drinking Water Well-¢ft Drainage Way N A ft Property Line ft Other ft SKETCH:TCH:(Street name,dimensions of lot,exact locations of test holes&petc tests,locate wetlands in proximity to holes) � q Q +7-? 2- 2 c L N0. / 4 as _ 4} °�- l M 1 ? . I /Z Z,pis 41fA1,F 011 Parent material(geologic) �`6/QRS .S4AIb Depth to Bedrock Depth to Groundwater. Standing Water in Hole: N�/� �. Weeping from Pit Noe A Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: in. Dcpth to weeping from side of obs.hole: In, Groundwater Adjustment f[. Index Well# Reading Date: Index Well level Adj.factor m Ad,l,.Groundwater Level A PERCOLATION TEST mgte7-9-1� Time /D.�oo R07 Observation Hole# Time ath" y 6/ Depth of Perc Time at 6" Start Pre-soak Time @ f��% Time(9"-6") End Pre-soak 0 /n1 Rate Min./Inch . Sry T •. ,e_Sf T/y4/1 iy7�w 1A /AIC,A/ Site Suitability Assessment: Site Passed Site Failed: - Additional Testing Needed(Y./N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTIC\PERCFORM.DOC DEEP.OESERVATION BOLE LOG Hole# T7 Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency,%Oravel) 712, Lai E fib Y� 6 i SYA Z ��3g.� C cQ 4Y�s�� DEEP OBSERVATION TOLE LOG Dole#Z�=2- Depth from. Soil Horizon Soil Texture Soil Color Soil Other r Surface(in.) (USDA) (Manse!!) Mottling (Structure,Stones,Boulders. Consistency,% ravel) yR /Z ASS, s C E� /WO G DEEP OBSEIIVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No._Jl Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)(date)I have passed the soil evaluator examination approved by the above anal sis was erformed b me consistent with . Department of Environmental Protection and that the y performed Y the required training,expertise and ex e ' nee described in�10 CMR 15. 017. D Signature �"' ate vj g �� . Q:1$EPTIC\PERCFORM.DOC ff � /=Q' TOWN OF� BARNSTABLE -.LOCATION�.o� yy U / U/y lawe SEWAGE # -7U VILLAGE 1..6 f ASSESSOR'S MAP & LOT 0 / ,INSTALLER'S NAME & PHONE NO. �mr C;s p ('i c' ��� _ 7 ` ZSEPTIC TANK CAPACITY �(.«✓ �Q/< \i LEACHING FACILITY:(type)—Pj'7- of /§EE e' (size)/( Gal NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATERQL BUILDER OR OWNER yo1W vm 1�)0. 7 //ld 1°/ 1,(101- DATE PERMIT.ISSUED: s DATE .COMPLIANCE ISSUED: • .t g VARIANCE GRANTED: Yes No t a �1 e e 4 y i No. ®.-.. 1 Fss .._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN .......................OF..............BARNSTABL......-----------.....-----...........-•---• Z ppliration for Disposal Works Tonstrur#ion Prruti# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ;1 0 LOT 44 TRUMAN LANE JOHN MOLL�ffton Address] or Lot No. ........ __...__.-•. .............. ...........•••.-- -----.................... ...... -----------------------------------•----- owner ., n A dress '�. W .... fit-! -- .. .C-e.................... Q..: 9X...../ c t . �� �c.T... ..:..d. a Installer Address Type of Building Size Lot20!.919-...........Sq. feet U Dwelling—No. of Bedroom.X .Expansion Attic (� Garbage Grinder ( ) --------------------•-----. ( ) ( ) Other—Type of Building _R-gS.................. No. of persons............................ Showers — Cafeteria a Other fixtures ...........................................•..•... . W Design Flow.......55................................gallons per person per day. Total daily flow..__._330----------- __.._______._._____gallons. WSeptic Tank—Liquid capacity..I pQ(gallons Length---g_.{..... Width...5-6..... Diameter................ Depth.....A........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No....:ONE........ Diameter....I0!......... Depth below inlet-6............... Total leaching area?. ..........sq. ft. Z Other Distribution box ( X Dosing tank $ ) Date......5-.10 90 ~' Percolation Test Results Performed by.......:.......CO... ..................................................... t' �.._________._____... Test Pit No. l._..__ ._...minutes per inch Depth of Test pit... Depth to ground water....N�.............. Test Pit No. 2................minutes per inch ,Depth of Test Pit.................... Depth to ground water........................ .......-•••--••---.........••-•-•................••----••---••--...---•......-•••--•------••--------......................................................... 0 Description of Soil........................................................................................................................................................................ W 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 TI TAU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o ealIn th. Signed_... .-•--•• ............................... ........................... -••....q0at % Application Approved By. ®---- - =. Application Disapproved for the following re s:---••------•....-•------••-•-•--•-•---••---•---•----•-••------•-•-•--••-••--•--•----.....--••---•••--------•--- ----•-----------.-•••..............•......---••-......•..... .............. --Permit No.. ®.------- ..........._.._ Issued._... � ......Hate j . Fps. .. ._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ' TOWN ...............................OF.............. ..... AvOiration for BUIPsal Works Tonstrudion Vami# Application is hereby made for a Permit to Construct (k,/f or Repair ( ) an Individual Sewage Disposal System at: ,- 4 TRUMAN (2 ( � ........._LOT.......... ................. - -..... .... ...... ............ ................................................:........... aOHN MOLL idton-Address or Lot No. •---•................._......._....._.........Owner..--•--•--•-•-........................... .....------.....---•-••---•--•--•---••........--•-••.........-----....._._............:........._. W Address a ........................................................... ...............•............... ............................................•.------...---^--•---................................ Installer Address 2: UType of Building Size Lot@Qt..9 ,9...........Sq. feet 1-1 Dwelling—No. of Bedroom. ................................Expansion Attic Garbage Grinder ( ) Other—T e of Building a Other—Type g _.R.W................... No. of persons............................. Showers ( ) — Cafeteria ( ) Otherfixtures ..----------•-----------•------•--••..................._...-----••--•------._.....-----------•--•---------•---•----•--------•---.......----....... W Design Flow.......55...............................gallons per person per day. Total daily flow. gallons. WSeptic Tank—Liquid capacity..JOOCgallons Length...g.._6.... Width...5`6.... Diameter................ Depth.....4........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_-_-.--....._-------sq. ft. . Seepage Pit No NE----•--- Diameter....10J......... Depth below inlet-6............... Total leaching area266...........sq. ft. Z Other Distribution box Dosing tank (( ) '-' Percolation Test Results Performed by JACOHI �/1©Y.2 W - ..................................................... Date........ _ . _.... Test Pit No. 1-_-.-.-V�....minutes per inch Depth of Test pit...14........... Depth to ground water....NQ............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ 0 M ........................-.................................................................................................................................... Description of Soil........................................................................................................................................................................ x 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 provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of bealth. Signed ...............................CA"--,P— ........ Application Approved By. � ,/ . .®...... /.21. ....... � Application Disapproved for the following reaA s:----•-------------------------••--•--------------------------•--------••--------------..._........•---...._ - .....-•------------------------------------ --------•••-. . .......... --• ....-•-•-•------..------.....---...-•-••--------- - ••-•-•�/4f/!o ... ......Date---..._._.... ..+Permit No... .__.. --•---------•----- Issued...._ .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN..........................................OF...........BARNSTABLE.......................................... C9rdifirab of Tiant;T iatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (..-<Or Repaired ( ) by---------------------------------------------------------------------------------------•--�--------------------•-•---•----.-...-.----•----•--------.-..-------.-.- atL9` 4 .__'1'XtIlA19...LME ' ---------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TIT F 5 of h e Sanitary Coe s A. ed in the application for Disposal Works Construction Permit No._.... .Qr. .. dated----- / __ `� - �............ THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUE® AS A GU RANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH .0!!V O F.......................................................................... No.. ....a. FEE.7"-.41 0 Disposal Works Tonstrwtivit rrntit Permission ' hereby granted.............................................................................................................................................. to Constr ct ) epair Indivi a S r ge Dispo s ) "... - Street as shown on the application for Disposal �tTorks Construction Permit 0.- _ _ ated.._�_ P-0......._.. ... -------------------------------------------------------- Board of Health DATE------------•---...?=J..I. 7--Q FORM 1255 A. M. SULKIN, INC., BOSTON J -6-7, a 9 PVC 1,V,5'P,6 C 7-1P IV 'OVA 7-5* 7�0 -5��/Z- SE WA r,15, 4 AV.0 COV-r-9 710 1.V17'Hl^l 6" kv I 771Y/,A/ 3 --11V- GRADE S OF =11,11SH 6AAjoC- TP-1 MIA1, -1-/- '64,-f-J,IA c o V'rR W/7'91,V 6 ,=11%4 49R. 91-fER AIV-b CoVhR 7-0 4 5y, 14 W1 THM4 4" OF 4elAl. 6AA.De. RisER MI.A4. FlAI-1c, 9AIb cove w.4'r6 jC rl 6 H T c o Yen 1401k 36"14A-y' -AHb �12 �TrVIVJ5 i-10411-D 4."'V.64. *9� ZFCHI *40 PVC a/-, 52, 574,A16>1 -5--A/Vo/ IN V, *"' so p 1/6 '111AIV. 670 9,3 !21 1 IAI V. C-Z) 500 GAL- ,V-2P 1-6ACH EDAM S Z,0,4AII 53, 75- - It -2" '5�2 '/9 lAoO'V- 3/* ot' " C-1 = E--1 T -/-.j Y '5 ;�3 -PO IJ1546 =3 W'4jW'Fo 61eA il,!�-z-Y • '-<7 r =1 VIC-4>1 'Vf �l fiV 4 '37 "e 12 fllll T 1= Ell (p f 5 rA.64 e W1 a S O.Aol STONEI - 12 N AlIM lYMEC 17 A LOAP e4PACI- 753 5Z., 4 - l'-Z CZ 71�4 O�A�- -316> /S: -227 71� S07-rOM 011FAr TE5T P17 X- SEWA6e sYs-r6M DeTlrAl cAl- Cu41jr1o.#VS 6904IA44AI,4TElf A,107- j),6.S 04 AL Y 1`4 OW = J ,6.6Z APONS X //0 6,D-D = 330 I-CIAII-S-H 6Ro4.b blIA1. _rZ_gq'p'e el'oo, A54P411R,64 4450RP71-0^1 AREA c 0 VlC#q WIV11M 4• - - N 330 6P4 + 0. 7V- 61Solr a"MAX- 2 co DER a,,-- �Z) SOO. 6,44. Pe,6:C. C"C, I-SA CIII/Vt; CA14,W-8-ERS J-V1711 13!"j M14. CH AMBERS a,4C .2>aj18j_6 Wo4SW/F-b ff-1 r-7 cm AcW 7,,= .&C,C1,04.6 WACAle p o a a I-C- WASHED bZ = CI r--1 CIEol'�'F- -b 6 P 7'H, c -b 6-R71v: gip'`- -�49 VC, -D .9.07'7*goM 4#f4C,4 = 12 . 93 -V 29 92,0 s," ✓ .5-r4o tv e CI =1 I STONE -Ab - - -67,0 5 s 725X7 ,C,4z- C2-,45.S c2s. & Z-J�l + 7P7,41- 1lX,!5A �17/ 12 1/,ON ,D6S16AI /-5 o'::'0X I-IS,6 k I V17-,,V /A/0 619,ofA6,46,6 -01V Z) SEC 7-/10" 0 S. -9AI ',4C41C - -7 'TlqlVb Aj.47,-6�A'1Az- ,5 444 e, -S'7 7149 A/ M-- 2, /9G� SEWi�1 G E s YsT /y/ C�/ /T- /s"72 G 8E !�i.47"�. , l6h'7= 9 p L) c.a. 3, -D04461.6 Allf5,-�4 -5-T41V-6 Slloof.4,4 B� �iP 4,F 1�!!ST ,9,td./� /!�/ES. 3 9 p o 0 M-4.61r.' 7P S'\ 7p a; :eo-Vc' gall'Vz �y SyN� d -/, r.3. 99 o 0,C 4/S %- IN /4 It) Z / 7?� X, 0 7� A,00, GP 97 �-Z 1W (A Q iti /' J 1 1 (�;, ca vT q C7O,� Sh/fl.L G YEiC'/. Y Tiy� z -7-1�el-5 1V5 lWV,-5,C�7 z574 4Z> a'V 1 7' 2W4S"T�9�' " 'f ///sT. .G.G,9?/G�.�/. e �1'E- Q rP 2- 7 Mk9 S,4CA-14�1� 1-1,V6 /WlzU/ 74-9 4,oVZ -2' & ' - 'e) S� y 7h'e g � 7;4/z�; h�4 7 Z 11 77 7 A16 1;r d0-C147-,!C-!0 //A,/ A/V 4,). \97 7,3� 23,7' 1,AlaG B w >.r \ Z 0 C c4S IW4,P 2a�52�9 ' 172, , (.,q --Z .6- -�x " -, /=/A� or - - ;I -S-X,5-7ZIkl 4,'/P6AWZ),--- 1A'::1'-XA1 N N, - 1 C S2- I'A 184:��AaaO'W -044 Z- 11V6 049 s-2 7W 1-,VM�NN J. E -s-4 JORN /V, P. Zzz-JI-x 7 OOYLE,III No.33589 El GIST t A A, IV-414 *JA E: u su ol -6-3 19,9 All EL 2VPr OV'M LWA 170* V" -0 LVJyCR= Copj= r 1 48.0 GROUND EL. _ 17� ? 7' Af 4:7aii�_��­ �11 Z OR Sg I 12 PlFkr P.V C, 4 117" 40 P.V C(OJC Y) pnrH.114" P" PIMN .114 P" �ff. XA CH Pff . p AVY J= 1NAC"G. r OR -4 -4 . 0 AVtffVALVff Ap= TAW D"T ,000 a. 442 Bor EL -44 GALL ONS —7- 14 2V .1 IrAs"D smiff EL 10.00 . 79 L 38. 0 '20 11.3 L 10 L 34. 0 LOCUS-1,MAP PROFILE OF vi vj UM TA= - 'SYSTEM DISPOSAL No SCALE SOIt LbG WITNESSED B P 4NDER Y. 4 HEAL W OMCER .20 P—7600 B-4 'TAB DA TE_L_�! 0 90 NUMPER LRAW LE 0 6 618 MT Wofff MT BOLLP J. rA DVGfNED? 48,12 DESIGN DA TA. 44 ' -OF BEDROOMS __3 MBERTOTAL S 17MATID. FLOW GPD 78 BOTTOM 119ACHNe,AREA c SIDE IZACHDTG AREA-- 50. f 7: NArQ ............. ARBAGE DISPOSAL SO.V INCREASE 266 TOTAL LEACENG ARE.A FT PERCOLATION RATE < R-1 4 LATION -RATK AiISA�6 19ACHNG',AREA. �PER PERCO --- 34 - 0 YUMBER OF LEACHING PITS AW A L CULA 7701VS 1 780) C ul R 78 OPD .211' RH W2,A -470 N M TAL GPD 548 ENCOU L0 T N, W A TER 7?8D ..... ...... �WAM OF,BXU29 14 .. .... ................. ............................ .......... .......... .............. 0 'R 'm A AU GENERAL NO TES. LPE BCH 40 _PVC_- P S4 0 tj 90 7- 24-j 10 0 . ..... 0', 4.:0*-'.:�-.::--V 0 T 49 ; ...... -OF IVD _N LA OF ............ IT Box 'PU .74 ITHEW (yol No.32098 Gaff&r A" N 0 11 JAC081 No 814 4 7*46 'RAJ?A 5TA BLE '415. 1,IV PI?EPA ED Fol? EA L VA D y A,VL 'WA GE 0- P,K 'M MIN ' j OLL ?AL .4:;'p j uj4v EL RAP SCALE G HIC 0 P7 0 0 80 990 116 MA y 71 f t c h 2,0 E vf �51, �O ,RE V 5123190 _,yANKpp' S UR VE r,' CONSULTANTSL: ' 149 R0. BOX 265 :443 WO UPE R 3 ET 36608 C SftgEr Oy 'A 0 2 ONE- c z ST NS M A SS. 2648 JOH #