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HomeMy WebLinkAbout0099 CARLISLE DRIVE - Health 99 Carlisle Drive - A= 122 - 142 Osterville ` Bk 26581 P:9332 �46373 DEED RESTRICTION The Barnstable Board of Health requires that the following restriction; that the dwelling be restricted to two (2) bedrooms as defined by the Massachusetts Department of Environmental Protection and interpreted by the Barnstable Board of Health due to the need for a mandated Title V Deed Restriction for septic systems that have a capacity of 220 gallons per day, be placed on the property at: 99 Carlisle Drive, Osterville, Massachusetts, Map 122, Parcel 142, as currently owned by Catherine F and Margaret A Haggerty, 99 Carlisle Drive, Osterville, MA 02655, as property referenced in the Barnstable Registry of Deeds as Book 6224, Page 318. 1,C / and, / as the owners/executors oft 6 pr perty/trustee referenced above acknowl dge the deed restriction(s) being placed on the property. Owners/Executor S' tur U Date The person named above: ( ,' r� acknowledges the foregoing instrument to be his ree t and deed, efo e. otary Public My Commission Expires: / t /G�/1- a , 0/ 64M JANEWILLIAMSVia, Notary PublicCommonwealth of Massacfl uset#S � �MyComrnissionFxpiresMarch2,2018 L Bk 26581 Pg 333 #46373 DEED RESTRICTION The Barnstable Board of Health requires that the following restriction; that the dwelling be restricted to two (2) bedrooms as defined by the Massachusetts Department of Environmental Protection and interpreted by the Barnstable Board of Health due to the need for a mandated Title V Deed Restriction for septic systems that have a capacity of 220 gallons per day, be placed on the property at: 99 Carlisle Drive, Osterville, Massachusetts, Map 122, Parcel 142, as currently owned by Catherine F and Margaret A Haggerty, 99 Carlisle Drive, Osterville, MA 02655, as property referenced in the Barnstable Registry of Deeds as Book 6224, Page 318. a d,l and, ! 'f M64R& &aru=was the owners/executors of tlielpro erty/trustee referenced above acknowledge the deed restriction(s) being placed on the property. g� elk ap<-r /q-, a-1 a wn s/Executor Sign e Date The person named above: r k, I;tf/ acknowledges the foregoing inst ent to be his/her fre an deed, before otary Public My Commission Expires: 1 •', ,'r e JANE WILUAMSN, iNotary Public Commonweaith of Mlassachesfittg gg,�. MYCommissionExpiresMarch2,2oja MRNSTABLE REGISTRY OF DEEDS Commonwealth of Massachusetts Title 5 Official Inspection Form al Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ./ 9 p Y ry °M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014- required for every , 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. - David B. Mason � Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 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 the Local Approving Authority • June 5, 2014 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface 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 i ,M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owners Name information is required for every Osterville MA 02655 June 5, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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 information contained in this inspection report represents the information identified at the time of inspection on June 5, 2014 at noon and does not guarentee the future operation of the system. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 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 bins•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 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 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 '/2 day flow t5ins•3/13 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 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014• 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 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 privyis within 50 feet of a private water supply well. P PP Y ❑ ® 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 ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone 11 of a public water supply well 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. d5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 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. Z ❑ 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): 220 Number of bedrooms (actual): 220 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 I t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 r - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: 2012; 32,000 gallons and 2013; 42,000 gallons. Sump pump? ❑ Yes ® No Last date of occupancy: current Date CommerciaUlndustrial 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? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'°� 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , 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: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. ,M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 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: August 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Observable components appear in adequate condition. Septic Tank(locate on site plan): Depth below grade: 2 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 Sludge depth: 3„ 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 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name required for is Osterville MA 02655 June 5 2014 required for every , 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 43" Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 3„ Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Obserbable components appear in adequate condition. 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 °M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , 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 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 page. Cityrrown 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 effluent level with 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.): No signs of solid carryover. 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5,2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 16 ❑ 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.): No signs of hydraulic failure or ponding. 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 Title 5 Official Inspection Form F~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a °M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , page. CityTTown 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.): i 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is required for every Osterville MA 02655 June 5, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below drawing attached separately t5ins•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 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: August 2012 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: groundwater contour map ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file for this address and groundwater contour map on file with town. I 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 G1M , 99 Carlisle Drive Property Address Catherine and Margaret Haggerty Owner Owner's Name information is Osterville MA 02655 June 5 2014 required for every , page. CityTTown 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 Assessing As-Built Cards Page 1 of 2 f TOWN OF BARNSTABLE LOCATION S�S�C�Ge�/,f��� .97,9, SEWAGE# VRJ AGE �S'T ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) XT ed-- </ /NLnXrk(size) S 6 y k 31�X NO.OF BEDROOMS oZ OWNER _-JVAmod`E�7`Y PERMIT DATE:< COMPLIANCE DATE: 0 Separation Distance Between the: n d �,dJe 2 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /a 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 a I [_TT I ZI 3 0 37 http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=122142&seq=2 6/13/2014 TOWN OF BARNSTABLE 4 L'OCATION SEWAGE# VILLAGE ®� ASSESSOR'S MAP&PARCEL -0 a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��J-1'Ti�G O®®� ��: .01 LEACHING FACILITY:(type) faAoo710�(size) 6-6 NO.OF BEDROOMS c � OWNER ii�1�G:��,g`y'. PERMIT DATE: �/�— Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /a 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 lol7- �P 3 , No. f `'' ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. PUBLIC HE LTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS �aapplication for ]Disposal * stem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System 2 Individual Components Location Address or Lot No. 99 C'A&Z.6�.rd,65 ,O Z— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ra i� dd'T 6�e�� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. n p 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building d::;:?44ZP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :I cT, A gpd Design flow provided ;E-11 1_7 gpd Plan Date ,3,—r 3 "f'Z Number of sheets l Revision Date Title Size of Septic Tank �X�.d'/ Oo 0®4�1ype of S.A.S. Description of Soil 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 th' and o e lth. Si d r' Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ..� Date Issued No. -Y r ' _'r._ Fee 00 " - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HE LTH DIVISION'=TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for his' Oosal 6pstrm Construction permit 1 - Application for a Permit to Construct( ) Repair VI<Upgrade( ) Abandon( ) ❑Complete System W Individual Components Location Address or Lot No. 99 pC,4 ZC/(' ,�� ,�2.� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ' IT�rJi LE�o�' �� 7��o o �• �d vE �9�Jb� 4l� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other v. Type of Building O1 ej^ No.of Persons Showers( ) Cafeteria( ) Other Fixtures �f Design Flow(min.required) ,;I oT gpd Design flow provided gpd AA Plan Date �"— /3 ",00�L Number of sheets / Revision Date Title Size of Septic Tank �.I'/��� /®� ype of S.A.S. Description of Soil i - i 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 thi -Board o e lth. z Si 'd Date plication Approved by �a 116 / ~ Date Application Disapproved by Date for the following reasons I - Permit No. �+ ) Date Issued -----..------ -- nj - THE COMMONWEALTH OF MASSACHUSETTS j BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ') Upgraded( ) Abandoned( )by ���h .� G��®6`d/� f' G � JT ec* 44, at J'�, has been cons Winacc Ewith the provisions of Title 5 and the for Disposal System Construction Permit No. at d Installer �/ L r'�C�y/r Designer d,..J-�G/� � #bedrooms Approved design flow gpd The issuance of this permit hall no be construed as a guarantee that the system wP-1`function Esg ed. i Date - Inspector i _ . ---- kx)7✓`- Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ,. Disposal 6pstem Construction 3pPrmit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( R ) System located at 99 ! /4Od Z.,x e'e' ep 4z •f'Ti $ ' 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. 1 Provided:Constructio Just b completed within three years of the date of this permit. Date J Approved by j Town of Barnstable Regulatory Services °y s� Thomas F.Geiler,Director } B :I Public Health Division �. 9e 9-yA`��' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit#o / Assessor's Map/Parcel. Installer&Designer Certification Form Designer: 1� ! Installer: l' YrtJT `'mil I� Address: �j►�'�/1 J �l Address: On was issued a pen-nit to install a (dat (installer) 1l,�(' septic system at 4� �� `'I LL- 'based on a design drawn by .�--} ,• (address) dated 'P _" (designer) 1 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. Stripout (if required) was inspected and the soils were found satisfactory. WVS� � -To CW_A_' of::. -fit-i� "VIE 1 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 u- '^tions. Plan revision or certified as-built by designer to follow. Stripout(if r, eted and the soils were found satisfactory. 0���kk 0FMgss C o=� DAVID i lit. (Install is re) MASON 1yo.1066 ISTe ( esib is Signature) PLEASE RETURN TO BARNSTABLE PUBL. _ �� J ..CIE OF COMPLIANCE WILL NOT BE ISSUED UN;xz ititb r'ORIVI AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. T114,K YOU. q',off;ce fonns'Aesignercenification foim.doc ' zvc " oF� Town of Barnstable P# 13711 gyp'' Department of Regulatory Services WWszABM Public Health Division Date \200 Main-Street,Hyannis MA 02601 . z •_l� 9 } Date Scheduled `• 3�; Time Fee Pd. . �`-1n•X Soil Suitability Assessment forSewa a,Disposal Performed B : � P',O j6'�/,�1/'O • Witnessed r t Y tnessed By: LOCATION& GENERAL INFORMATION Location Address ' 4062 . Owner's Namej �Y����y Address Assessor's Ma /Parcel: P Engineer's Name 0_dL,4' NEW CONSTRUCTION REPAIR y Telephone# " Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft 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) Co co '4r 7 V� Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face 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. ©rdundwater Adjustment ft. Index Well# Reading Date: Index Well level, , Adi,fhetor- Adj.Groundwater Level PERCOLATION TESL' Date Tnte..�� Observation '"" Hole# _ __ Time at 4" ..� If Depth of Perc I Time at 6" r Start Pre-soak Time @ - Time(9"-6") End Pre-soak G141 E Rate Min./Inch �...1;..t 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 firsf notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel �D DEEP OBSERVATION HOLE LOG Hole# V; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist Consistencv.% rave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. j .F' fa � e Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes VZ Within 500 year boundary Nc�Yes Within 100 year flood boundary No.— Yes Depth of Naturally Occurrim Pervious Material Does at least four feet of naturally occurring per ijaterial 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 Envir men tal Protection and that the above analysis.was performed by me consistent with . the required training, rti and x rience described in 310 CMR 15.017. Signat lo Date Q:\.SEPT10PERCFORM.DOC -19 LOCAT ,ON `� SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME R ADDRESS BUILDER . OR OWNER -A-6 u - DATE PERMIT ISSUED _i� DAT E COMPLIANCE ISSUED �� �� :, y - �,� . . � . �� ,� I� No '.............. �. Fss... �............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . �•' 21U5. A�3� Applira#ion for Diipnsal Works Toni3trurtion ramit 411 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or t No. .... �� .� .. 64rr 0l.rn.6-�------------------------------ -C. 2�., ...LQO.--.. �,���ls.,l� ..�.�. Owner ress Install r Address U Type of Building Size Lot... �__Q.>.L...�� .Sq. feet Dwelling—No. of Bedrooms................o� ..........._...._.....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures ...................................................... Design Flow............................................gallons per person per day. Total daily flow_..-?-310..........................gallons. 9 Septic Tank—Liquid capacityl!W__gallons Length................ Width................ Diameter________--___-- Depth................ Disposal Trench—No..................... Width.................. Total Length........... Total leaching area....................sq. ft. _._ .Total leaching area.... . ........s ft. � Seepage Pit No..._...__/.-..._.__._ Diameter.�a...."/® Depth below inlet.___._______.._ g q. Z Other Distribution box ( ) Dosing to '~ Percolation Test Results Performed b .......... .. .. _ Date. _ ._.. a y i � ,� ----_-- ,.a Test Pit No. 14t.lKFZMOinutes per inch Depth of Test Pit.................... Depth to ground water--___-_____-_-___--_:_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil...................................................................................................................................... x �., ------------------- -----------...----------------------------------------------------------------------------- ---------------------------------------------------------------------------- w UNature 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 iITIL 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 boaW of health. Signed------ � - . ................................. �? Aoe Application Approved By............ Date Application Disapproved for the following reasons:----•----------•--.._..---•---•-----------------------------•------------------------.......------------••--•-. ..................................•---.....------••----------•••-•-•.......--•--------.........---------•--••-•--------•---------------------------------------------•------•------------•-•----------•- Date Permit No.....:g Y ... Issued....................................................... Date h No........�r.... ........ Fss...�44............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - {d.{,d1.............OF.......... ,/• �6� •% 1.� . Appliration for Dispoii al Works Tongtrnrtion jhrmit . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: !! (� r /' .....�r.A! .�._...... �ipL ..E:. ......: f15,11.ue..----•-.07ma:u11 464 , si.................................................... Location-Address rL..t No. . . . .-- Own er flress MW u � .. ...................................... .......... � z Installer Address .�. '- U YP g e� j P.>,' q. feet Type of Building Size Lot.__ ._.._`___. Dwelling—No. of Bedrooms----------------X---------.---.........Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T ype of Buildin g ............................ No. of persons...........:................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•---•--•---•-------••-----•------•••......--•----•••••-------- W Design Flow............................................gallons per person per day. Total daily flow----- .........................gallons. WSeptic Tank—Liquid capacityl OQ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width............_...... Total Length........._.__ Total leaching area..........._.......sq. ft. � �Seepage Pit No.....__._ Diameter- "/®.._. Depth below inlet... _ Total leaching ._.... ---------- �-------• - P �• g area..-• sq. ft. z Other Distribution box ( ) Dosing to aPercolation Test Results Performed by......... .. Date.. Test Pit No. 14F 44fthinutes per inch Depth of Test Pit.................... Depth to groun water........................ (rq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pi .......................... ----------•----•-----.........--•-•-•-•-•----................•-----••............._.......••-----•-•......----•........-----••-•-- 0 Description of Soil......................................................................................................................................................................... x x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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:TT``: 5 of the State Sanitary Code—The undersigned further-agrees not to place the system in operation until a Certificate of Compliance has been iss d by the board f health. Signed...... .... .-•-. .- -•------------ �/te �`- ��`'r V Application Approved By............. --1 . Date Application Disapproved for the f ollowing reasons---------------••-•------•--------•---------------------•------•-------------------------...-----•---•-....,..:� ...................................•---•----------•-•------•--------------------------------•------....----•--••-•-••---•--•--•---------------•-•••----•----------------••------------••-----.....--••-- Date ° C PermitNo.....='� ..................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " . ............OF..... .a.4+ . . ............................... .......:. : , TrrfifirFahe of Tuntplianr THI�j�CER FAY, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---•-- •.. .'...... -• . --------------------------------------------------------------=---------------------------------•...._......._ fInstaller at.....[. / - .... •cam. has been installed in accordance with the provisions of TI"' 5 of The State Sanitary Code as described in the ----------- dated---•--... Jc,� -7.9........... application for Disposal Works Construction Permit No.._ _ _._ �„� "'::. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........� . =l -�5.---•----•----•--------•---•------ Ins ector....... -............... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. +l.-s............OF....... No. .::... ..... FEE... ..... Disposal Worku (41m;rudion rantit Permission is hereby granted.......... to Construct ( ) or Repair ) Individual eK age Dispo System atNo... �� -~ ---------`--•---------•-•-------•----•-------------------------------•-•......--.......... Street as shown on the application for Disposal Works Construction Pe t No. ated...... '.'._.�..__.�..._.... 'f Board of ealth DATE. ------------------------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _ N S1�I�L� �L�NitIY - ct��iVt Aw 110 C•�A2TSAG.� �-tZ11JT�'�I (��?�..I�(,-�- �✓�.�Yi"r' �.t Lam( FL.ow Ito -4S = 3�b G.F�b. -.,,�I-rtc 330,E 15O % _ 4-9�, G.F O. ,�SPOSAL PIT - uSE logo GA.L:. i sp- )4 2.S = 11r-, 8VT'rOAA AQMA ,cn TOTAL. •L7ESl6Q = 42S ToT4 t_ PEWCOLQTtO Q 0,&-re • M _ - i t rA9 -� AeL vA • t -,I d;j, l t7l'LCj 'j$ fd��18 I`{r� 1 L u► , �� Ilrri,l .. Jacrnr 7JJ ir�in ri/ / 4 Q 4 IW. G,o� iP P -t� �'vlsr 8 ►s... •max �.f s�-,� ..;, 2'f z tuv. T'ArtW. G4L. LEgcla PIT WASHED )A�'� STONI Ct0 J CE-Z T t lr i Eta P LOCAriot--J 05T L:4-1..v;L-LX •.� !2 u C-M tz T 11='-; T 1-•1 AT T 14 I~_ t'UI.11.} C'1 t. t�5 Uca►�.u'J Pt-A t,...l WVJ?1=tat-1 4fC:>4e1rlPL1,(S W t'TN TWi 51DM Ll►4E Awt� SE't"t_3AG1� �.'CC��It`E��-�T� Dc= 'r'►-t�; ��"(" IPL CJA`Tt=. -,,., ( {.4.P ,° �1 � a- • B J.�7CTC.4�, t . b.1Y�., i4..1�. tZEGl5[t_.IZLD I-A,wG 5uevCYo�5 T141•55 P(-AW I 1JOT A W 05TE��/tI-LC-_ v Mr1S�i� lw!;r(?JAA(Ek.1- fjclF:i/L_�{ � *(!-IG 14r,(,JLr-> A.1�lat_l C�.hJT t.�t' f:',t:Z l.l•>C��� j'" l�r�Cc;Mt��„L Lv`r t_t w�.�..y ASSESSORS MAP : /Zz. TEST HOLE LOGS NOTES: PARCEL: FLOOD ZONE: _ t? , s "PL%G - __..__...__._-_."_.__ ._--"."_ _..._M__ __-M_-.._ S01 L EVALUATOR: ) 1) The installation shall comply with Title V and Town o oard of " WITNESS : Health Regulations. G REFERENCE: �` C� 2 The installer shall verify the location of utilities, sewer inverts and septic Z'� x}v�l -- - 1'/ - -— -- - _ DATE: ) P PERCOLATION RATE 1 , I components prior to installation and setting base elevations. ---- 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first Z ! ' + two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other At71D i P) purpose other than the proposed system installation. 1A.1 0 t 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. LOCATION MAP 8) The property owner shall.review design considerations to approve of total M design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. l i i L in leaching or cesspools shall be pumped and filled with material 9) The existing g p p p per Title V abandonment procedures. Those within the proposed SAS shall aC be removed along with contaminated soil and replaced with clean sand per I AI IN }�� AA Title V specs. V , o 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM DESIGN line_ The line is to-be sleeved as aforementioned and maintained in place. I DiW 11) If a garbage grinder exists it is to be removed and is the responsibility of the 0 owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such exists. Z BEDROOMS AT1ID GAL/DAY/BEDROOM - D GAL/DAY 13)The installer shall verify tie location, quantity and elevation of the sewer lines exiting the dwelling`prior to the installation. 1 1 , 1 SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting Title V requirements. 2 GAL/DAY x 2 DAYS - 4 "GAL USE IoDD GALLON SEPTIC TANK affeo� I i w HOT ABSORPTION SYSTEM 1 GA o D B. c`a II,, _ " tWk� �" rrf Z. SEPTIC SYSTEM SECTION 1C7 off' ADS 60 " 57,2 U� p , 0 Q 0 D I -BOXj• 1 0 0 o p SEPTIC TA K -- 1�--°----3Z C qTA It SITE AND SEWAGE PLAN LOCATION : . PREPARED FOR : ,1'1kA LbfPO&X- 64PVL P SCALE : W DAV I D B . MASON FRb DATE: 3 OIZ z DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA W DATE HEALTH AGENT W ( 508 ) 833- 2177 Z