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HomeMy WebLinkAbout0278 PITCHER'S WAY - Health 278 Pitcher's Way �� ... . Hyannis A- 170 — 102 ° � o - — N ° o tl " o e B e O o � p ° a J 0 " Oct 31 ,2018 13,37 HP Fax page 1 t Commonwealth of Massachusetts Title 5 Official Ins pection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ®. 278 Pitchers Way Property Address F-+ Lynne BradField CIO Owner O T wner s Name information is required for every Hyannis MA 02601 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 MY. Please see completeness checklist at the end of the forth. ````,��NntOF rnr���7Uq Important;When A. inspector Information �5 ,'II (8q O �N`�filling out forms p 4 .' on the computer, C5G James D.Sears JAMES to use or>+y the tab �g� key to move your Name of Inspector cursor-do not '• Ca ewide Enterprises use the return :�`•'•�' O.� key. Company Name 153 Commercial Street Company Address Mashpee MA 02W CI;y/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-29-18 ;spetc�es.ftna�iure ���� 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regicnal office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 1 or 18 Oct 31 ,2018 13:37 HP Fax page 2 t Commonwealth of Massachusetts ..F)r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Wa Property Address Lynne BradField Owner Owners Name information Is required for every Hyannis MA 02601 10-25-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: The system is a 1500 Gal, Tank D Box and 12 Chamber's. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 2 of 18 Oct 31 ,2018 13:37 HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments I uw�, 278 Pitchers Way Property Address .Lynne BradField Owner Owner's Name information is required Hyannis qu ed for every �L_ MA _ _02601 10-25-1 S e. Clt own — Pa9 rr y State Zip Code Date of Inspection Pec C. Inspection Summary (cont.)p ry ( t ) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed i p pe(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): 3) 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. a. 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: tshsp.doc•rev.7/26/2018 Title 5 Oficisl inspection Forn:Subsurface Sewage Disposal System•Page 3 of 18 Oct 31 ,2018 13:37 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form i l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Properly Address Lynne BradField Owner Owners Name information is required for every Hyannis MA 02601 10-25-18 page. City/Tom State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7f2OW$ Title 5 0f8dal lnspecdon Form:Subsurface Sewage Disposal Syslem•Page 4 of 18 Oct 31 ,2018 13:37 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form r a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owner's Name information is required for every Hyannis MA 02601 10-25-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or ❑ ® Liquid depth in is less than 6"below invert or available volume is less than day flow t£AcOIG ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 C.4. 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 t5insp.doc•rev.7261208 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Oct 31 ,2018 13,37 HP Fax page 6 Commonwealth of Massachusetts r : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owner's Name information is _ required for every Hyannis MA 02601 10-25-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C•5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for 0/1 inspections: 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) 1310 CMR 15.302(5)] t5insp.doc•rev.7126/2018 Title 5 official Inspection Form:Subsurface sewage Disposal system•Page 6 of 18 Oct 31 .2018 13:38 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owners Name infonnation is required for every Hyannis MA 02601 10-25-18 page, City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design); Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 1500 Gal, Tank D Box and 12 Chamber's. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report,) ❑ Yes ❑ No 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: Date 15in3p.0c:-rev.7/26/2018 Title 5 Official inspection Form:Subsurface sewage Disposal system•page 7 of 18 r Oct 31 , 2018 13:38 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owners Name information is required for every Hyannis MA 02601 10-25-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) 2. Commercial/industrial Flow Conditions: Type of Establishment: Office Design flow(based on 310 CMR 15.203): 250 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 267 Grease trap present? ❑ Yes ® No Water treatment unit present? ❑ Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: na Last date of occupancy/use: Present Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 8 or 18 Oct 31 , 2018 13:39 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address .Lynne BradField Owner Owners Name information is required for every Hyannis MA 02601 10-25-18 page. CItyfrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 2007 Permit # 2007 -473, Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 27" 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.): Pi in is 4" PVC SCH -40. 15in3p.doc•rev.7/26MI8 Title 5 Official Inspection Fon7:Subsurfsoe Sewage Disposal System•Page 9 at f 8 Oct 31 , 2018 13:39 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owner's Name information is required for every Hyannis MA 02601 10-25-18 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) B. Septic Tank(locate on site plan): Depth below grade: 1 7" 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: 1500 Gal. Precast H-10 Sludge depth: 11. Distance from top of sludge to bottom of outlet tee or baffle NA" Scum thickness III Distance from top of scum to lop of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Asbuilt-Plan-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 at working level.Tank and covers at 17" below grade. Inlet tee w/no sign of leakage or over loading. Note: Gas line over center of outlet cover. t5lnsp.doc•rev.7/26/2018 rifle 5 01ficiel Inspection Form:Subsurface Sewage Disposal System•Page 10 at 18 Oct 31 , 2018 13:39 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 278 Pitchers Way rroperty Address Lynne BradField Owner Owner's Name information is required for every Hyannis MA 02601 _ 10-25-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7, 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): B. 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 9 ❑ polyethylene El other(explain): Dimensions.- Capacity: gallons Design Flow: gallons per day t5in3p.doc rev.7/2642010 Title 5 Oftclal Inspection Form Subsurface Disposal Sewage D' 9 tsp System•Page 11 of 16 Oct 31 . 2018 13:40 HP Fax page 12 Commonwealth of Massachusetts e Title 5 Official Inspection Form w} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 278 Pitchers Way Property Address Lynne BradField Owner Owners Name Information is required for every Hyannis MA 02601 10-25-18 Page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) 8, Tight or Holding Tank(cont.) 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 9. 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.): D Box is 16"x16"-28" below w/cover at 1'. Box is clean and solid w/3 lines out. No sign of over loading or solid carry over. t5insp.doc rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem•Page 12 of 18 Oct 31 .2018 13:40 HP Fax page 13 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owners Name information Is required for every Hyannis MA 02601 10-25.18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system I Type/name of technology: 15insp.doc•rev.7/26/2016 This 5 Official Inspection Form:SuWudace Sewage Disposal system•Page 13 of 16 Oct 31. 2018 13:40 HP Fax page 14 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 278 Pitchers Way Property Address Lynne BraclField Owner Owner's Name information is required for every Hyannis MA 02601 10-25-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cant.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is 12 Infiltrators. Ck D Box and camera out lines. Leaching is clean wino sign of over loading or solid carry over. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration — Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5in5p.doc-rev.V2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Oct 31 .2018 13:40 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form kvizt�Ye Subsurface Sewage Disposal System Form Not for Voluntary Assessments 278 Pitchers Way Property Address Lynne BradField Owner Owner's Name information is required for every Hyannis MA 02601 10-25-18 page, City/Tcwn State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): I t5insp.dm-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,Page 15 of I Oct 31. 2018 13:40 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Pitchers Way Property Address _Lynne BradField Owner Owner's Name information is Hyannis MA 02601 10-25-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 14. 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 t5insp doc-rev.7/2612018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 16 of 18 Oct 31. 2018 13:41 HP Fax page 17 ��� P►-�ci�.c�s wy - I-I���nn i S l V A 1\ye•OfLV y�/\pyy LOCATION ` SEWAGE 0 a - 7373 A ®� LA ASSFSSOR'S MAP&LO i+'— 1 ) RMALUM's NAM&PHoNE Nc SEPTIC TANK CAPACITY IY06 — - LEACI@rG FACMMi(type) NO.OF BEDROOMSa4Ke 7"T'— BVILDER OROvim PamrrDA7E: JQJ ' M -.__COMPLIANCE DATE: squi+iaaDiumm Hetw+eee a= Mw6mumAdjatudGsoandvsurTabkID the BottbmefLeaehin&Facility J�_72 Fen Pt'Irtte Wuer Sappiy Well aad Learlsiog Fsc ly (If my welt cost 00 site a wi0dn 200(cet oflcaehiog facitiry) Feet Edge 0f WoLbW gad Leaching FaciGry(If any wetlands exist Void"300 fat t faeiul» Feet Fturaisbed by k4 O O S-0.1 Oct 31. 2018 13:41 HP Fax page 18 Commonwealth of Massachusetts 33 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M, 278 Pitchers Way Property Address Lynne BradField Owner Owners Name information is required for every Hyannis MA 02601 10-25-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (Cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells JV0 Estimated depth t high ground water: 12' 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: 11-11-07 Date ❑ Observed site(abutting propertylobservation 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: T.H.on Design Plan 11-11-07 12'no G.H.. Bottom of leaching around 5'below grade. Bottom of leaching at 7' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page, t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysb?m•Page 17 of 19 I Oct 31, 2018 13:41 HP Fax page 19 Commonwealth of Massachusetts o Title 5 official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments F 278 Pitchers Way Property Address Lynne BradField Owner Owners Name information is H nnis required for every ya MA 02601 10-25-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of- ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15lnsp.doc•rev.M612098 Title 3 OHidal Inspection Form:SuhsuAacs Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION A7 8.2rFt`Y1 LO r��ntd.S SEWAGE # o200 q13 VILLAGE ASSESSOR'S MAP & LOT ' INSTALLER'S NAME&PHONE NO. s cs�t� SEPTIC TANK CAPACITY 1 ©6 LEACHING FACILITY: (type) IrAkwds / 1YJ lew). (size) 9,Sns- 10.1 r/ NO.OF BEDROOMS Q4i e , BUILDER OR OWNER 1 tiiP 1 Jff'Poi4S1/'05;L PERMTTDATE: I��1`9 F COMPLIANCE DATE: I Separation Distance Between the: i. 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 o leac ng facility) Feet Furnished by, V 14 k v0 s -��` 3-23 % �� No. 7 Fee ffv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for ;0i9;poga1 *pgtem CAnOtruction Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. Lk 7 B �t tr�h�� lu, Owner's Name,Add((((((res```"`s,and Tel.No. Assessor's Map/Parcel MyaNwis 970 'P0.6Y<rkXt 12.46 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �®� �� r 0 vin�n Dwelling No.of Bedrooms I Lot Size BCQ 3 sq.ft. Garbage Grinder ( ) Other Type of Building nNice No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided a(P I„Q gpd Plan Date Number of sheets Revision Date Title ll Size of Septic Tank ( 5V Type of S.A.S. 12 .-t C19 1,e)1A11111A1_ Description-of Soil Nature of Repairs or Alterations(Answer when applicable) i A3 S'T-A LL O F—W T i Ti—E 0 S F--_P SIC S Y Sri EAA 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 and of Health. Signed Date /o/Aa,�dy Application Approved by Date _o b � Application Disapproved by: Date for the following reasons Permit No. cb ( 7 Date Issued — ----_---- ---------s—--- — No. D.00 ' Fee (1 v V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -,,TOWN OF BARNSTABLE, MASSACHUSETTS Yes , 2pprtcation for �Oigogal *pgtem Cottgtruction i3ermit i Application for a Permit to Construct O Repair(X) Upgrade O Abandon O Ycomplete System ❑Individual Components Location Address or Lot No. ,�7 8 '�,�LhP�s �� Owner's Name,Address,and Tel.No. NyC,NW 1!S - 970 PttcVM I(OSt Assessor's Map/Parcel .2 Installer's Name,Address,and Tel.No. Designe Name,Address and Tel.No. Ao091Gs Q 13tc .1 SCg-%0-7/S ?C YfffJ N I��SOCI(,,}C'S 3 8 3Co Type of Building: f �p C, c� f�`�. 4, n . Dwelling No.of Bedrooms Lot Size (oa3 sq. ft. Garbage Grinder ( ) j y Other Type of Building e5 Mr e / No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' ( - Design Flow(min.required) 2 50 gpd Design flow provided ta(D _C( gpd Plan_Date Number of sheets Revision Date I ti .t Title_ — / 1 r I Size of Septic Tank �� Type of S.A.S. 1 �.—c 1 t1 114e'r- .7 q S���✓ Description of Soil �[ Nature of Repairs or Alterations(Answer when applicable) I E i I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in z accordance with the provisions of Title 5 of the Environmental Code and not to place tfie,systerft'in operation until a Certificate of !; Compliance has been issued Athisard of Health. `', 1,•, Signed Date r; �T —i 1. Application Approved by Date /,, �7-->I. '7 Application Disapproved by: 1 Date �r r for the followingreasons ` f Permit No. Gtti 77 Y 7 7 Date Issued l D )J oJ" �l �r c e THE COMMONWEALTH OF MASSACHUSETTS G of t BARNSTABLE, MASSACAUS -TTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (x ) Upgraded Abandoned( )byVO%aG ICA -R'Rowk) at V has been constructed in accordance with the provisions of Title 5 and the 4 Disposal:System,Construction Permit No. o -tJ-7" dated Installer�, &,S Designer AA A ssex 1,nfe� #bedrooms �T� Approved design flow 2 gpd a The issuance of this permit shall not .e c s ued a a guarantee that the system l fa ct'onfas desi ned9 j Date Inspector ✓f"./ i / J �r f / No. ���- -1 7 Fee �f'1L1 e T� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migpogat 6p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair (x ) Upgrade ( ) Abandon ( ) System located at a.?o -#mot j&Mj cl 4A V/xy N,_C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this(pe�rmit. Date /Q Approved by !' l 4n! 4 � " 'town ®f Barnstable Regulatory Services 'Thomas F. Geiler,Director Bear{\STA BLE, s!E .9 Public Health Division Dad a' 'Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# (/;�VfAssessor's Map\Parcel 'D Designer: ���.� �i Installer: � C� A"O. . Address: � �/�f / Address: �� • �! / �- . ,Glr�ozd�z On/Q -A72 d 7 �DYr�S Awe,"., was issued a permit to install a (date) V (installer) i septic system at 2,79 � rla based on a design drawn by (address) ��/k /GZ�7z dated /,0 (designer)' 1/ 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. 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. I�j%kOF AW yN L. rn - (Inst- er' Signature o VON HONE o ✓. 9 gN1TA0P (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO. BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc r± DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon; SPil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Strucre,Stones,Boulders. Cons stenc % ravel f0 Y L 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) (OYAA1v � G - ® L 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. onsistenc ra el ` Flood Insurance Rate Man: N Above 500 year flood boundary No_ Yes .✓__ Within 500 year boundary No Z Yes within 100 year flood boundary No/ Yes " Death of Natuld'allv Occurring Pervious Material o Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed fbr the soil absorption system? T �, If not,what is the depth of naturally occurring pervious material? Celt ication 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 train' ,expertise and experience described in 310 CMR 15.017. Signature Date M-07 0-7 Q:\SEPTIC\PERCMRM.DOC � p t7 Town of Barnstable P# 1 Department of.Regulatory Services e.t= Public Health Division Date �0 KAM 200 Main Street,Hyannis MA 02601 Date Scheduled b l I e) - ' Time Fee Pd.�v $oil Suitability Assessment for Sewa e =sp Performed By:_ �� " ' Witnessed By: � �`% T . r - LOCATION & GENERAL INFORMATION Location Address .,2 7 85 P I+ t e(-S W c-,\f {; GN Ay N"1$ Owner's Name �jN we%oe(� ; Address ,/,I Assessor's Map/Porcel: .6�0 1 l Engineer's Name �C7 U Tele hone �r(7�'��� f raj NEW CONSTRU"ON REPAIR P Land Use Slopes(go) Surface Stones Distances from: ripen Water Body Possible Wec Area `�� ft Drinking Water ft Well Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . a �+ O Parent material(geologic)jr-1 I "�""�d Depth to Bedrock `� 1 Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face i7O"` — I CU. a)I > Estimated Seasonal Ttigh Groundwater S / D0,TERUMTION FOR SEASONAL HIGH WATER TABLEAol Method Used: .. � in. Depth to Sa11 mg 03',� in. — Depth C1b�erved tanding;in obs.hole: _ 4 in. Groundwater A,�pttttent ft Depth to weeping from side of o .hole: A .faetor - Adj.Groundwater vel Index Well# /�-a] Reading Date 7lndex Well level d� PERCOLATION TEST Date " Observation / Time at 9" Bole# . r Time at 6" --- n� Depth of Pere lime(9"41 Start Pre-soak Time.@ lo, � End Pre-soak � Rate Min./Inch / Site Suitability Asse ssment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) . —t Original: Public He;ilth Division Observation Hole Data To Be Completed on Back-------- ***If percolafiion test is to be conducted within 100' of wetland,you must first notify the Barnstable Con'servation Division at least one(1)week prior to beginning. Q:XS EPTICIPERCF�RM.DOC -a YOU WISH TO OPEN A BUSINESS? For Your, Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Mom, , DATE: Fill in please: APPLICANT'S YOUR NAME/S: K�„n�,r (�« Cc.r(Ji�1�c.✓ ` BUSINESS YOU HOME ADDRESS: 1 \cA1CPv cc,c0 r i(c3 r_ .� Mitir �1.. )f�,"_ c"7�5(cz� �-- °" �} TELEPHONE # Home Telephone Number NAME OF CORPORATION: er n71<� 5' F_� SS 5 NAME OF NEW BUSINESS . TY E OF BUSINESSI . YES I OCCUPATION? NO /PARCELNUMB (AssessinADRE OBUSIN SS g) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual had been iprmed;of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has n infon!� f the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: ASSESSOR'S MAP: 290 ` SEPTIC SETBACKS: GENERAL NOTES: PARCEL: 110 LOCUS te2$ es� REFERENCE: L.C.C. 22825K l - 1. VERTICAL DATUM: Assumed 2. MUNICIPAL WATER IS AVAILABLE. Ro d FLOOD ZONE: r C Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM mod' d M/tc #250001 0008 D (7/2/92) UNLESS OTHERWISE NOTED. e/lS wa 4. ALL PRECAST UNITS TO CONFORM TO AASHTO: H-10 &2p a �f 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. co6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA est a►n Str N ENVIR. CODE(TITLE V)AND LOCAL REGULATIONS. 00 ,M I 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO LOCUS MAP N.T.S. N 33' 19, 15 CV Maximum Feasible Compliance: 15, 29' 53, CONSTRUCTION. v Title V section 15.405: 1 LEGEND: 100,16 Cj -8' variance, proposed 12'separation between ° ° ° co leach facility and foundation ( G PROPOSED CONTOUR 25' � 1�NQFSSq�, ss PROPOSED SPOT GRADE 102 o AMY , — 40 - EXISTING CONTOUR +� o VON OF10NE - 30.23'— EXISTING SPOT GRADE c `� '9 # 68 TEST PIT E S 78 40,53"E Q �9 02 1 p ® EXISTING WATER SERVICE a �104 104!56 �� E33XE WORK LIMIT LINE o ::101r84 104A x / . Lot 27 Z vuo 10265. 8,623t S.F. w Map 290 100.61 Parcel 110 r" tt�Qf"ass c V J � c 10 .11 104r24 6' x 104.04 ' ;Z. O1r92 102r99. o TEARRY .. .`.... NN #278 ' W 40 ml Polyvinyl Liner For Setback Variances TOF=104.75 WARNER y + No.38721 103.84 Top EL. 101.2, Bottom EL. 98.2 (Assumed) I n5; :.;:.Parkin �. o:. g::. (Crawl) 104.28 Full (Floor EL. 102.25) rn (Floor CT1 102.20:`.'' ;E . .1 0� 67 101.30 ) 104.1 0 �, o 1 Cfeanou 00 103..68 12' 'E' 1 2 TH-2 n� TH-f 104, . 3 ® b 51 25 m041o3r97 NOTE: This plan is to be used for septic 102r37... <.; ::::; .:; : :;..: 1��3 L, system purposes only and is not to be 1.0 a :,81 10 10, considered a property line survey. ' 102,88 SEP IC/ 120. l 0 `.o �' 104.43 M 102,42 Stockade Fence 278 PITCHER'S S WAY, BARNSTABL A f V PK/SET 101 95 Benchmark Set: l PREPARED FOR: Douglas Brown, Inc. Pump and Remove associates � Cesspool SEPTIC SYSTEM DESIGNS a n d Bolt in right-cor. bulkhead o x Don N. Weber, Tr. �y EL. 104.94(Assumed) 1o4r85 o \ t 320 Cotult Road , Sandwich,MA02563 The 278 Pitchers Trust 508.833.0041 UP 102r76 x 102.20 1 ' '-104 86 Willow Street, #6 x 102,49 SU-eAng by: Yarmouthport, MA 02675 Terry A. Warner.P.L.S. ►+mom h, MA 02645 DATE REVISED SCALE SHEET NO. Scale: 1"= 20' x 103r22 10/17 07 1' _ (fios) aa2-egos / �. 1 20 1 of 2 Provide Riser over D-box NOTE:All components to be marked with NOTE:To prevent breakout,final grade FT.OL.F. 11) to within 6"of final grade i magnetic tape or similar prior tofinal cover. of EL.99.35 to be carried out a 4.75� minimum 15'beyond edge of leach facility. F.G.EL: 103.6-104.21 F.G.EL: 104.01 F.G.EL: 104.01 �� Maintain Min.2%slope over leach facility to prevent ponding F.G.EL: 104.01 Existing EXISTING. Install risers w/covers over inlet and Clean Backfill Sand Over Filter Fabric/Min.14"for HD Loading Min. 1 Inspection Port 6"to Grade EL. 102.33 . outlet to within 6"of final grade 6.25' L=20' L=10' L=S' CP%o o Top EL. 101.2 !@S7=4.1%Y.(201M1 SCH 40 PVC 4"SCH 40 PVC . to, « 4"SCH 40 PVCL.101.2 Breakout Elev. ia, CAS=1.0%(1%MIN) s@S=5.6%(1.0%MIN) 40 ml. polyvinyl EL. 101.25 EL. 100.98 0 10. "Inve EL 99 87barrier for Install Gas Baffle EL. 101.15 3 EL. 100.7 0° setback variance PROPOSED DB-3 Use 12 High Capacity Infiltrators without StoneL. . . . .. .. . . .. . „. .... H-10 DISTRIBUTION BOX Clean Title V Sand 3 Rows of 4 Units set 6"apart(25'x 9.5'x 10.2") 7.54' 10.32' Bottom EL.98.2 NOTE:Contractor may substitute polyvinyl (Install PVC Inlet&Outlet Tees) LEACH FIELD LAYOUT SEPTIC SYSTEM PROFILE H-20Loading 1500 gallon septic tank in place of precast PROPOSED 1500 GALLON EL.91 EL.89.55 due to accessibility issues. Minimum 10' H-10 SEPTIC TANK 9.5' separation between tank and foundation N.T.S. Bottom TH 1 Adjusted Groundwater BeNati Me[BrI"I and property line is required. -"��a DESIGN CRITERIA n abAs"vegetative Over �Fill per Desl�Specillwtlpnv SOIL LOG :.. { •jh c6paftI�wete,Mp.,• Doctor's Office: 1 Doctor 25' EL.101.2 Top of Units ., Max 3' ± SOIL EVALUATOR: AMY VON HONE, R.S.SE#2517 (Actual Office Space: 638 S.F.) ' Soil Type: Class l INSPECTOR: DAVID STANTON,R.S., BOH EL.99.87 Design Percolation Rate: <2 min/Inch DATE OCTOBER 11,2007 5:00 PM o Bottom of Units . PERCOLATION RATE: <2 MIN/INCH TV. MIN. ER ODE 10.32' {RECOMMENDED NOT LESS THAN 6-) Daily Flow: 250 G.P.D. per Doctor Design Flow: 250 G.P.D. (Min. Required) ADDITIONAL NOTES EL�9.55 TH - 1 TH = 2 Adjusted Groundwater Garbage Grinder: No EL.104.33 EL.104.33 I A/ AV Leaching Area Required: (250)/0.74 =337.8 S.F. Sandy Loam Sandy Loam I. Contractor to confim soil suitability prior to installation. Contact BOH in the event of 9" 10YR3/2 103.58 9e 10YR3/2 103.58 varying soils from original soil test. ► Septic Tank Required: 1500 Gallon(Proposed) B B 2. Failed leach pit to be pumped and backfilled per Title V.specifications.All Use 12 High Capacity Infiltrators(H-20)with Clean Sand Fill: Sandy Loam Sandy Loam contaminated soils to be removed within 5' of proposed leach facility. Leach Field Dimensions: 25' tong x 9.5'wide x 10.2"deep 10YR5/6 10YR5/6 20" 1o2.ss 20" 102.66 Per DEP General Approval Letter: C1 C1 3. Sewer lines to be sleeved at any waterline crossings and within 10' of any septic High Capacity Infiltrator: 4.72 SF/LF for Field Configuration Coarse Sand Coarse Sand components, as needed, per Water Department requirements. High Capacity Infiltrator Unit Length = 6.25'x 4.72 SF/LF=29.5 2.5Y6/6 2.5Y6/6 . An existing Orangeburg pipe to be replaced with Sch. 40 PVC pipe back to existing SF/Unit 4 y g g Minimum 337.8 SF required/29.5 SF/Unit=12 Units Required 20%Gravel 20%Gravel cast iron or PVC pipe. 12 Units with End Caps=354.0 SF Total Provided Perc Design Flow Provided: 0.74(337.8 S.F.)= 261.9 G.P.D. @ 5. Maximum 3' of cover to be maintained over leach facility. Regrade area over leach 56"B om facility to maintain maximum cover. C p� p 278 PITCHERS WAY, BARNSTABLE, MA PER RATE: <2 MIN/IN.(C Horizon) FLOOR R [� Lr N V H 24 allons in 6:54 minutes N.T.S. PREPARED FOR: Douglas Brown, Inc. associates and 144" 92.33 144" 92.33 SEPTIC SYSTEM DESIGNS Don N. Weber, Tr. rNo Groundwater Encountered. Exam Exam c,ul M Road "4 Barstable Groundwater Contour Map:Groundwater @ 19.89 below grade(EL.84.45). Room 1 Room 2 Sandwich, The 278 Pitchers Trust 11x11 508.833.0041 11'x15' MIW-29,Zone C,September 2007,5.1 adjustment:Adj.Water @EL.89.55 86 W I I low Street, #6 i Waiting Secretary Exam ^9 Yarmouthport, MA 02675 I,Amy L.von Hone,R.S.,hereby certify that I am currently approved by the DEP pursuant to Room Room i1x11' Bath 11x10' Y2 I Room 3 Terry A. Warner.P.L.S. ' I�a22 L MA ozsaa 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been 11 x11' °^ Roae DATE REVISED SCALE SHEET NO. performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that (W8) 432-SM 10/17/07 1" = 20' 2 of 2 1 have successfully passed the Soil Evaluator's Exam on November,2004.