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HomeMy WebLinkAbout0027 NORTH BAY ROAD - Health (2) 17 Ngrtl •'B_ ay"Road 0 terville P A 072 . 022 r I i c r Commonwealth of Massachusetts (}�o"t 0 aa- I1P Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form Not for Voluntary Assessments 27 North Bay Rd v Property Address r Owner Burkhead = information is Owner's Name / required for osteryille ✓ Ma 8-3-2020 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 A. Inspector Information L. 4 forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 Citylrown State Zip Code 508-420-4534 S14297 /Hh°0 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 8-3-2020 ff at re 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 regional 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �m l Title 5 Official Inspection form r 41� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 27 North Bay Rd Property Address owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all passing requirements. This report can not predict the future performance under the same or increased usage. 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 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 P Y ►Y 27 North Bay Rd Property Address owner Burkhead information is Owner's Name required.for Osterville Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 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 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 FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): The m required i❑ e system equ ed 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 J , Commonwealth of Massachusetts �. lig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma , 8-3-2020 every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water f' ❑ 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 N ❑ ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -� 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every 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 cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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 CA. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts I9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityfrown 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 all 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) [310 CMR 15.302(5)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): . 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: System consists of a 2000 gallon H-20 septic tank H-20 d-box andH-20 flowdiffusers in a 12x56 ft area. 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 ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: system not designed for usae with a garbage disposal Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �d ,F Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: pumped at time of inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 2000 gallons tank size How was quantity pumped determined? Reason for pumping: maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L v 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. City/Town 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: 3-28-05 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): f t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �m 1p Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osteryille Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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: 2000 gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 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 was functioning properly at time of inspection and was pumped at time of inspection for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �. lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown 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.): 8. 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 El polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown 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): 0„ Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box was level with speed levels. slight scum layer. I �h t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i cam, Commonwealth of Massachusetts �. �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owners Name required for Osterville Ma 8-3-2020 every 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: ® leaching galleries number: 6 flow diffusers ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ►� ��p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4� 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): A flow diffuser was opened and was functioning with wet soils in the bottom and darkish soils but no signs of failure or surcharge at time of inspection. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts 1 IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown 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.): f t5insp.doc•rev.7/26/2018 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont) 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 cam, Commonwealth of Massachusetts ►ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 8-2020 If checked, date of design plan reviewed: Date Date ❑ Observed'site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: design plan 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 System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 North Bay Rd Property Address Owner Burkhead information is Owner's Name required for Osterville Ma 8-3-2020 every 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 I I i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 I t TOWN,OF BARNSTAB JLE, LOCATION �Id�� � ) �l� SEWAGE # 4 MY-S,38 E» a VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. 7.8 SS t SEPTIC TANK CAPACITY OLS �� ♦ l LEACHIIYG FACILITY: (typlpe) 41u�g (size) NO.OF BEDROOMS O \ BUILDER OR OWNER - C'At.\ P&,+-,A Zk:A,��A�t PERMITDATE: C I` �L COMPLIANCE DATE: 3-c28 Separation Distance Between the:' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility' Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet �577- �. .e �� s r ' aoclal CP �. L �.`' ag, TOWN OF BARNSTABLE L`OCAVON C SEWAGE CO--T-38 VILLAGE �S't"e^��`�(e''��� -- ASSESSOR'S MAP &LOT , INSTALLER'S NAME&PHONE N0.��, h�c �r. � - Lk d-1-8.2r)tof SEPTIC TANK CAPACITY a,0®o LEACHING FACILITY: (type) Ot.S :> (size) NO. OF BEDROOMS O BUILDER OR OWNER Z-' GAt-\ PERMTTDATE: I I- - COMPLIANCE DATE: Of L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o � o a ,b 0 a rt 9L) X, TOWN OE BARNS ABLE F f �CA � LOCATION '' SEWAGE # VILLAGE ASSESSOR'S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Q (size) E06 6 NO.OF BEDROOMS BUILDER OR OWNER ,'PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 77 BA O 0 gc 33 gD b5 6 TOWN E BARNSTABLE L ATJON o�' /�cl 1� SEWAGE 00"/ V LLAv1~ ®� t emu. `t�� ASSESSOR'S MAP & LOT o� INSTALLER'S NAME&PHONE NO.�, F1c�eQt l,s�-- � SEPTIC TANK CAPACITY c-Q,©D06f4I. O r/ LEACHING FACILITY: (type) P usJa 2S -- (size) . NO.OF BEDROOMS =%3UII.DER OR OWNER .�? C Ahti f�Acti r` �r� EAQJ i PERMI'TI�ATE: /f--e?-O r�`�CO.MPLIAI`iCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by . P . P VM i No. v - Fee v 4Q2 --' THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS tir Z(ppYication for M!5pogal Opgtem Con0ruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ElIndividual Components L/ oC d r� o a—P �V 3 Owner's Name,Address V d Tel.No. � —~, 6 Assessor's ap/Parcel /a9, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.N w 4�-1),� /Y�eC_A tL I s �a_� gag B �- rdLf� 4' hpZ/^(Sect 9') pi N- J`­r (:,.s rev 1 Lc Type of Building: Dwelling` No.of Bedrooms b Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type 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 Environmenta e-and not to place the system in operation un ' a rtifi- cate of Compliance has been issue 7j this BoarcLal a lth. Signed Date�� D Application Approved by Date Application Disapproved for the following re ns Permit No. 'P Date Issued Vlik �Jjjj_. , , Fee 3 , Entered in computer: (/ a f COMMONWEALTH OF MASSACHUSETTS' p ' - Yes PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLES MASSACHUSETTS ZIPPfication for Mig o a' l *pfitem Cohgtruction.,Permit 6 j'Z Application for a Permit to Construct( )Repair(� )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lo lion Address of Lot o. � N L)F__TJ) /3 A 7i 1D, Owner's Name,Address and Tel.No. Assessor's ap/Pa[cel `� /�a` 3r, t_0 1_ •& � LI )l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Srwcr, /Wc/ilL S'T poi uQT 9AV_E'9 Nye DL�G L g ND S-r 03]4EQ_vl l LC s sa 9 Type of Building: Dwelling No.of Bedrooms b Lot Size t�0 sq.ft. Garbage,.Gnnder( ) Other Type of Building No.of Persons Shovers( ) Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow {' gallons. Plan Date Number of sheets Revision Date Title �^ Size of Septic Tank Type of S.A.S. Description of Soil } Nature of Repairs or Alterations(Answer when applicable) Date last inspected: b Agreement: l.. The undersigned agrees to ensure the construction and maintenance of the afore described on-site`sewage disposal system e in accordance with.the provisions of Title 5 of the Environment �C de and not to place the system in operation un nl a ertifi- cate of Compliance has been issueds•y this Boar tHealth. Signe Date/' Application Approved by Lja _ r U11 I Date 0 Application Disapproved for the following rq�ons Permit No. // Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired (K ) Upgraded( ) Abandoned( )by 1 ( at o 1 _V has been constructed in accordance with the provisions of Title 5 and the for Disp4 System Construction Pe No. dated C «� .,Installer � t ,—_ Desig ner The issuance of this permit shall not be construed as a guarantee that t e sys�eml' ion as designed. Date 3,Aa je-:, Inspector �--"� 03 Fee A0_6*9 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migooal *pgtem Construction Permit a Permission is hereby ranted to(Construct�L )R pa' )U de( )Abandon(-� System located at ' i � and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mu tt be(ompl6ted within three years of the date of rr] pelmd / Date:_ Approved by TOWN OF BARNSTABLE, LOCATION SEWAGE # �MLf �3 VILLAGE CAS ASSESSOR'S MAP & LOT 17 �d INSTALLER'S NAME&PHONE NO. �_��C0.�`•`� ``- Lab SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �OLS �' ��fulZ� (size) NO.OF BEDROOMS ` ( BUILDER OR OWNER PERMITDATE: f (`& O COMPLIANCE DATE: .1_'2 8-C l Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site.or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300.feet of leaching facility) Furnished by I i r - C L34 D ao _ p C b k 0 o a ® a i Town of Barnstable " Regulatory Services Thomas F.Geiler,Director KAM z►st�srasr� . Public Health Division Ec rya+' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 3 2a ew-C Sewage Permit# ZOOM— 63F' Assessor's Map\Parcel t1o2 Designer: 5*Vyw" A (A i 1z�. Installer: a-C-cj L c Address: %sck r i Address: ' �o np On )VO U- 11UCf�CCAt,rL 6' was issued a permit to install a (date) (installer) septic system at 27 Ncrkk Y&3 4?&.X�(�wskr }{arbors based on a design drawn by - - - - (address) S icr%1c%% A. L43, lsu, r P� dated 3/2P I zm S (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. STE?HEN s^y G At1YN cm o WILSON y (Installer's Signature) No.30218 ' /S SS�QRIAL E� (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 DMSION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Town of Barnstable � Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MS 'Wayne Miller,M.D. October 26, 2004 Mr. Stephen Wilson, P.E. Baxter, Nye, and Holmgren, Inc. 812 Main Street Osterville, MA 02655 RE: Variance for Septic System Construction at(27_ orth-Bay_Road, Oyster Harbors ' A=72=22-- - Dear Mr. Wilson, You are granted variances on behalf of your clients, J. Gary Burkhead and Dawn Burkhead, to construct a replacement onsite sewage disposal system at, 27 North Bay Road, Oyster Harbors. The variances granted are as follows: PART VIII SECTION 1.00: To install a soil absorption system 85 feet away from a coastal bank, in lieu of the one-hundred (100) feet minimum separation distance required. PART VIII SECTION 1.00: To install a septic tank 60 feet away from a coastal bank, in lieu of the one-hundred (100) feet minimum separation distance required. These variances are granted with the following condition: The septic system shall be installed in strict accordance with the revised engineered plans dated September 21, 2004 (with an error date of 10/28/04 as typed below the engineer's seal). These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system. Sincer ly yours, Wayne eer, Wb. Q:NarianceGrantedW ilsonTwoV ariances DATE: i Q. FEE SS.QO •.sAUVgTABIE,.' , y MASS. bMA'Ib�� REC. BY Town of Barnstable SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM f r-3 LOCATION ' �C=� Property Address: 21 No ktn (3or L..j . Q,g;rr Nat-bars Assessor's Map and Parcel Number: W? I Z', FIL-1 Z Z Size of Lot: Yy 9p 7 S.F` ti ) Wetlands Within 300 Ft. Yes K Business Name: c�E No Subdivision Name: *J CO APPLICANT'S NAME: :1. Gar•. 'Bur A= e L k kJ Phone n � v�7 Did the owner of the property authorize you to represent him or her? Yes X No rn PROPERTY OWNER'S NAME CONTACT PERSON Name: 5. Ger.. 53urkkc.&..P Name:Stephe.% A. hJ.lso" Ho I m,%v.c h Address: 71.. AVc 6 CA, L..P p.a. 130% a6l q Address: 812- fe6 w% Sbrrcl i3d 1I.e.6,. Spa, .T. t 1 e Zo dsrlcru 1(a ,y"A cr26sS Phone: Phone: /3 VARIANCE FROM REGULATION(List Reg) REASON FOR VARIANCE(May attach if more space needed) Ps.-4- Vill I.e O RC%QLd.W- ¢met.hk rLI 2j .1L.N 4..61,2U.e lr fr-6N.. l0o Fsslr- S-J-6 ftk IN'As hom NATURE OF WORK House Addition It House Renovation% Repair of Failed Septic System 0 Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Files\OLK3\VARIREQ.DOC y ! Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals [same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman MAIL-IN REQUESTS NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Please mail the completed variance application form to the address below. Also include four copies of engineering plans, house plans, authorization letter, etc (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $85.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED REQUESTS Our fax number is (508)790-6304. Please fax a completed application form. Also, you must mail the required $85.00 fee. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-list below): Checklist Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals [same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) a, r� .= GEE). _ Zs _ •IL - a Ap 19 Vtr LIOAr— ` 9 a y � 9 p 10 seo J20C- (� . e 38-1 OILMLAND So MET .. 1-CS'>CTorgl 39 p I.Oq OMpNO a� I•Zo \ 445 `o VP� " I.oOAC /.. Abutters Map Scale 1" 200' BAXTER, NYE & HOLMGREN, INC. Registered Professional Engineers and Land Surveyors I Abutters List Ma Parcel Owner&Address _.p 72 21 C.W. Zadel,Jr. c/o Mykrolis 129 Concord Road,Bldg. #2 Billerica, MA 01821 72 20-2 Oyster Harbors Club,Inc. P.O. Box 2067 Osterville,MA 02655 72 23-2 J. M. Baker 70 Beacon Street Boston,MA 02108 72 26 R. P. Callahan 345 Seaspray Ave. Palm Beach,FL 33480 72 27 R. T. Horan P. O. Box 2046 Oyster Harbors,MA 02655 #2003-055 F September 21", 2004 Board of Health Town Offices 200 Main Street Hyannis,Massachusetts 02601 Re: 27 North Bay Road, Oyster Harbors Members of the Board, This letter is to inform you that I have authorized Stephen A. Wilson, P.E. to represent me for the variances being requested at the above noted location. Sincerely, Gary Burkhead z c PO tl N —i Co r" Cn t- 47- rn #2003-055 BurkheadBOHLetter.doc r 'uWn off' ttrnstiibleI( t (P uelrnr(ntent,of 1'Ie;hlih;Snfety;rind, Envlrontueti(nl Scrr'Iccs. yo+VIA Public, Health Division Da(c 61 �e J(i7 Mnin Street,I lynmils MA 02601 S nArwnMAntF = ��F e. Mtn a DoIe Scheduled ol-c.�i�i �- .Z5 2fy®3 'flnie (©:oo Fee l'd._ T N(� 002. Soil Sidtabclity Assessincl't.fors.ovage .Dispo,srr 7r<<. Performed Dy- Skcac 5o'n Witnessed Uy; . ..LJ �J Z \� Z. r� yy`` � �(�``!! ((�� �a� �r r) A r �Jt (�1 rll�1 UJI � Loudon Address. 2 7 f�e✓�J( �e� fzC . bwmcr's Nnmc J,.G, 12ur4ka'a-0. CD� N l¢V1 „ Qyslz.- r'{c♦r�(oor9 Z? t3 : r's. e,, rz p Address1'4 fn Q ZJ I. l�SSCSSUr'S Mnp/l'nrccl:. i!Y1.ep '7Z.� 0t,.1 L -2Z:' § i�.nghrcer's Mane .S. hvn �i, r �sr-ter_ �.Q J .. �.. 'I'cic phone If 'Sctig -�/Z8"S/�/ car/`�3 }g NGW CONS'I'IIUC'I'ION. RCPAIit I y 'Z CM W N. o I, I,nnd Use _Y%z (%) Snifncc Stunts O .rL Distances from: ..Upcn Wnicr.11ody Z,iPV �. II Possible Wcl Arcn R Drinking Witter\Vcll !it x, m Drninngc Wny ^II, Propel I),l,liic SKETCH! (Street nniimc,dimensions of lul,e7cncl locntlons of test hula R pere Icsls,locn(c wcllnnds in prusln111y(o holes) 4Y I y v s�`W ti "h • �'� y a^cn reiro uxuscaxo 2' ..e >. It .. Parent Ittnicrtnl(geologic) G�(_CIG1 O�1-wabti Dcpth to Ucdruck Depth to Groundwater: Stnndh g Wnler In I lul.c; Wccping from I'it Knee . Gstlmnled Sen�ontil i ligh Groundwater. .;:.: ...::..:......;;..,.. ......... Method Used, . . Depth Observed stnimJing in ohs,hole:, In, Ucjrlh In.Soil htotlIcs; Depth to weeping froili side of abs,hole:. In. Gruund.wnter Adjuslmcnl _It. .r index Wcii N _•.., .,• handing iMc:_ —.,Index W611 Ievci' ^_,^ ni1l:Tnc(or Adl,(iruu.ndivnict l,ct d 'RC. i Jl Jl�l1 ��J!S A" �1111�'• t'IIIIC/D! J 06servatioii ' Flolc N : 'I'lirmc nl 9 Ue(plh of pert Gb.Ir Time nl G" Slnrl Prc•snnk'I'inmc Q !l a, ;3.0 Time lime Mtn,/filch 2m1h 1NGti ` Site Sulinbiilty'Asscssmenl;,.Site Ptm,Ssed • •_. ,:Site I�nilcd: Addillonnl'I'csting Nccgcd(YIN) Orighm is Public llen111t bivislan 0.bservnlion Hole Dnln '1'o.13e Cnnlpieled on Dncli Copy: nppilcnnt. l `... .. . . : .' ,: . a:. ..:... . .. .... . : . ,. . . .. ... .........,.:..,...::.....:.....:.:::•:,;:...-:,;.+...,•:,..,;.y.,.;.:;;....,,.,,:s....:::.•,:::,::;::.:::::: ;;:::::>.:...::;;,s':r:;::".:.:::; ::4::'<:C:i s;:`;:�o-:i:;:::::' :::'.::c:i;:'... .:.,.:... ... ... .: ,.i:�t:i :+..;+;:i:4::;•>c+:is<•Y }•�y� ':.:.'• i:•K::;:': :.....::::':Y.:f:7i:::4'.:A;:• .:i',Y::o,;'-!... :. :::t.:::'.. i':,:Y . . : :::.:. Depth Proin Soil Ilorizon soli Texture Soll Color Soii Otlrcr Sprfflce'{in.) (USDA).' . (Munsell) Molthng (Structure,Slorics florOdcres; ,.. La'w.. . ..�'y 'tea - : /o Y 2 3 .. w i 5'I ;s: . y'r beptlr front t Solt Horizon 3oil'Texture S. Color Soil Other : .' Surface(in.) (USDA) (Munsell) ,Mottling (Stnrcture;"Stones,I3ouideres. . .: . . ... o . .: . . . . I. . . .,. . . . .. . ... . I. I. . . .. . tf t •• Depth Rom• •• Sgli Horizon S6'iCTexl6r0 Soli Wor Soil Other Surface(in.) (USDA) . (Munsell) Mottling (Structure,Sloncs,.l)nplJcres: c e '- - '.,. . .: - - - - - - 1. i i > €; .D bZt'I' O�SicI�. TON k�aL) I��G :�#c le# 1 epth from $oil k{oriz1. Solt texture SoII Color Soil Other ' . Surface(In.) (USDA) (Muitsell) Molding. .(Siruclure,_5tomes,Iloulderes, .. e . . ., .. . ►. .. .. . . i .;, Flood Licnralice Bate an ti •. . . . . 'Above M year flood boundary' 'No Yes .. . Within 500 year bqundary No Yes . . Wltlrlril00yrear•flood.b0i)6 No Yeses_ . • ) ntli of Nati!rally Qcct(1 CittE rervioi!c 1VIa1er1al . i ali.area observed tlirtiu Bout tlil . . Does at least four feet of naturally occurring pert/ ous material exist n s g .area proposed for the soil absnrptlon system? : lf:not,what is the.d,ep.tli of naturally occurring pervious oaterial?' :: . .. i^ QRt itficanon I. '' a tiet r exarn'iitation a roved ti. the,:•'" I certify that on', �I 'J� (dated I Nava passed the soil ey I o: .. pp Y bepart(nent of.Environmental Protect(On and that the above analysts was perfohried by me consistent with the required tratnuig;expprds.e and' ieperibnco described ui10 CMIZ 15:017 • ;. . , .. .,. ..... .'. .. ' : Signature., Date ___/ Q,? , !i . . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Sox 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 27 NORTH BAY RD. OSTERVILLE 0­1 —®ZZ L a—1 Name of Owner JOHN HULL a Address of Owner: SAME a Date of Inspection: 8/18/99 Name of Inspector:(Please Print)JOHN GRACI t5' �'O I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15,000) F�! 7 < Company Name: n/a Mailing Address: n/a `9l�`y9gy '1'9,9 Telephone Number: n/a `� T CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Furtheiubmit a' n By the Local Approving Authority performing at the time of the inspection.My inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:8/18/99 The System Inspector shall a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nta 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced nta The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n!a- (approximation not valid). 3) OTHER nta revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8118/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with NIA, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants;if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. 4 . ' r revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 FLOW CONDITIONS RESIDENTIAL: Design flow:J4Q g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):4 Total DESIGN flow: 44Q Number of current residents:2 Garbage grinder(yes or no):]IE;: Laundry(separate system)(yes or no): MO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: WA CO M M ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):DLO Industrial Waste Holding Tank present:(yes or no): MQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n(a Last date of occupancy: n& OTHER: (Describe) D& Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: DLA System pumped as part of inspection:(yes or no):NO If yes,volume pumped nLa- gallons Reason for pumping: nLa. TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: 1985 ' Sewage odors detected when arriving at the site:(yes or no): MO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1'6„ Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nLa Dimensions: L 10'6"H 5'7"W 5'8" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: L" 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: M How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY NOW AND THEN MAINTAINED EVERY TWO YEARS, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n& Dimensions: n& Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:i2La Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: nLa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Wa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nLa Capacity: Wa gallons Design flow: Wa gallons/day Alarm present: NO Alarm level:jila- Alarm in working order:Yes_No_: MO. Date of previous pumping: Wit Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nta DISTRIBUTION BOX: X (locate on site plan) i Depth of liquid level above outlet invert:Wa Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DID NOT EXPOSE PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wit revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number: 2-1000 GALLON LEACH PIT leaching chambers,number: jiLa leaching galleries,number: ._nta leaching trenches,number,length: n& leaching fields,number,dimensions: nLa overflow cesspool,number: nLa Alternative system: n(a Name of Technology: -n!a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY THE PIT HAVE NOT HAD MORE THAN 1'OF WATER IN IT CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: n& Depth of solids layer: Wa Depth of scum layer. n/a Dimensions of cesspool: Wa Materials of construction: nLa Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)• D& PRIVY: _ (locate on site plan) Materials of construction:n(a Dimensions:nLa Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wit revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a a r s Q a 0 CAE C o p AA 3 4 A6 33 _ AD A k 61 . revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 NORTH BAY RD.OSTERVILLE Owner: JOHN HULL Date of Inspection:8/18199 NRCS Report name: nLa Soil Type: Wa Typical depth to groundwater: nLa USGS Date website visited: nLa „. Observation Wells checked: 11LS2 Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data o Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2198 Page 11 of 11 11-06-1997 03: 19PM CENT DST F I REDEPT 5087902385 P.02 MaKe application to local Lire Department Fire Department retains original application and issues duplicate as Permit. v-ZZ a/`GC�!//_,!//lZE7'1GG iOVi/1�?i`/PA�.1LG`2Q� ✓V0aX�/ • LJ'l/XP ✓ 7�P/uP/I'G�iO�i ' ,���� / / APPLICATION and PERMIT I Fee: for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions f o M.G.L. Chapter 148, Section 38A 527 CMR 9.00 application is hereby mad e by IF-Me • - 2 Tank Owner Name (please print) John Hull X uro rr ap yar9 r m x Address 27 North: Bay Road, Osterville, MA 02655 Sneer CAY $rwe MP • Advanced Environmental Advanced Environmental Company Name Co. or Individual P.O. Box 472, S. Dennis, MA Address Address Prin( P/i�f Signature(if applying for permit) Signature (if applying for permit) CI eertifled Other C:, IFCI Certified - LSP# Other Tank LocatioP 27 North Bay Road, Osterville MA 02655 Scam Addmss C-7Y Tank Capacity(gallons) 1,000 Substance Last Stored #2 Fuel Oil Tank Dimensions(diameter x length) Remarks: Firm transporting waste Advanced Environmental State Lic. # MAV5083856100 Hazardous waste mandesj E.P.A.# Approved tank disposal,card J.G. Grant Tank yard# 03501 Type of inert gas Tank yard address Readville, MA Centerville 01920 City or Town FDID# Permit# Date of issue November 6, 1997 Date of expiration November 20, 1997 Dig safe approval number. 974005976 Dig Safe Toll i=ree Tel. Number-800-322-4844 Signature/Title of Officer granting permit :a*. After removal(s) send Form FP-29OR signed by Local Fire Dept.to UST Regulatory Complianc:. Unit, One Ashburton Place, Room 1310, Boston, MA 021 08-1 61 8. TOTAL P.02 1p� a L O C A'T ION• ;.•s7�' SEWAGE PERMIT NO. VILLAGE Ile- IN STA LLER'S NAME jA� ADDRESS Lj R U I L D E R OR OWNER /� •c3�f c rr0 DATE PERMIT ISSUED �--- DATE COMPLIANCE ISSUED �-; - - 5 . � �". 9 ,,\� �� .. ��� 6 No.....9 3-_SS`3 ��- -�` �' Fxs.....1.� ............ may, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....--........ . .._._.................OF.............................................----.......----.....----........---....._---- Apparation for Uiipuitt1 orki Tonotrnrttnn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... .SrP' ................................................... L c ions ress or Lot ..........'fir.•°' A...............Y""'!-� •---•----••--•-•--.........--•---•--•--..... .�.... G�••&=--. y,L�ee:!r.__.. 3�:'�.�!.'. --.Q dR7.�.....---••--••--- f -� Owrger Addres a ......... .........._ r..' '' Installer Address d Type of Building Size Lot..._,14 ..00....Sq. feet U Dwelling—No. of Bedrooms..___._...._Y.•_______________•___•_._--__-_Expansion Attic ( ) Garbage Grinder (-f Other—Type of Building ............................ No. of persons...___............... Showers ( ) — Cafeteria ( ) a Other fixtures ......... ` : ..__... .................................................•......... W Design Flow........�r�.I> .....................gallons per person per day. Total daily flow__........ _. ... 40....................gallons. WSeptic Tank—Liquid capacity/] Ilons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. xSeepage Pit No...,Z...._..__._ Diameter........6....... Depth below inlet............... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- --------•---------...............-----....•-••••••••.......••-•-- Date........................................ Test Pit No. 1................minutes 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........................................................................................................................................................................ U --------------------------- - W ..-----•-------------------------•---------------------------------------•.... Y--• VNature 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 iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ' operation until a Certificate of Compliance has beer-1,"suea by the board-of he lth. �a - c� -7 p^ Signed � .. { f --- ----•----------_---- Date i Application Approved BY ..... �����i� - _�- - Date Application Disapproved for the following reasons:........................................................................................... ................... -----------------------------------•-•---••-•---•--••------...........-----...---•---------•------------•..........._.....-------------------•---...---•---•--------------•--•---•......••••--••••--•-••- Date hPermit No......................................................... Issued....................................................... Date 1- No......93-____.J5.q i �, FEB..-. ,1 .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HeALTH ............. . ....... ...............OF................-.....-............-........-----'` Appliration for Biopooal Workri Tonotrur#inn rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..OF/........ r., 1 ..err.--•, ..41.marA (Z .................., ,�................................................... L a'on/-Ad ess f�/ ` or Lot .... -�0.0-A.19........ 0 l f Y fJ• � 11••1�.._ �.C21 .t' �/-.✓.. .I'�I�;---------------- Own€r /''� Address WGe�+ls 1 e 4-eAV__s--4._. ..._ ..----•---Sr.!,S. e" Jf'[. ..................................................... Installer Address d Type of Building Size Lot----- 190V----Sq. feet V Dwelling—No. of Bedrooms... Attic ( ) Garbage Grinder pa, Other—Type of Building ............................ No. of persons._.____.,............... Showers ( ) — Cafeteria ( ) Q1Other fixtures ............................................................... W Design Flow......... ____________________gallons per person per day. Total daily flow....._... tf .....................gallons. 1:4 Septic Tank—Liquid capacity./ gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No::---, ------------- Diameter........-&...... Depth below inlet....... ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes 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........................ ODescription of Soil-----------• •.•-••••-•-••••••-•••-•••••••••••••••••.............•-••--•.....-•--•-•-•--------•--••-•••-•----•-••••••...•••-••••••••-•••••-•••.:.:,..._.----.----------- U ••-..-.-..-•••••••••-•-••••------•-•-••--•-•-••••-•-••••••-•----•••••••••••-••••••••••••••••••-••••.....••-----------------•------------•-•-=----------..._._..----•--.......`..........---••••--__-•-- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ue by the boar health., q p► Signed..-- .. ��___ --•--4��--..... - •-u --- ................ ....... -- _...-/ ••- -� •--11•-� _1 Date Application Approved B -•���=•. f ---- •- PP PP y Date Application Disapproved for the following reasons-.............................................................-................................................... ............................................................................... -•-••____••__•-_----- Date PermitNo.......................................................... Issued_.:...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................:.................................................................... (9rdifiratr of Toutplittnrle THIS IS TO CERTIFb That tfie Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................ '._ ........ ..............................--- .......... ................................................................................ at.•-•••••-•••-••••-•.Wiz.-�=•-.---.•••-•- --•---_ 7. --.....--•--- �----- ..................•--•------........-•---------•-- has been installed in accordance with the provisions of TITLE. The State SanitaryCode as described in the application for Disposal Works Construction Permit No.---.____ ... —sr_ dated .............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................!!� � 0A............... Inspector............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................O F....-..-..................- No... FEE....... ............ Diopooal Workii T. no#rttr#ion rrntif Permission is,hey granted................... 1!.._.. _ ... __...--r------------•---------------------- _-----_---_-_......... ....-.._.................... to Construct"' Rep widu ewage Disposal Syon or at No.•••••••••••••--•••••...-•••_... Street as shown on the application for Disposal Works Construction Permit No...................... i .......................................... ... __: Y --------------------------------------- B rd of Health DATE................................................................................ FORM 1255 - A. M. SULKIN, INC., BOSTON •'K U C ro N C! W 0 CvF'i��H 1 Z ami OP <3�' �V+QGE Sla✓�Y w ��C.. Q - NEW DORMER CENTER OVER DOOR BELOW _- I d 7 .1 NEW _ 5 5 0 m m N N 6 -� BATHROOM Jb n, _ 4 0 W!-. NOPEN TO BELOWLT i REVISED O. - BEDROOM#1 ' 3 BEDROOM#4 2�-7 1/2^ i- 5• 5• LOFT#2 x>: 6 - TV e7u� 7' r O - - 3 .. NEW BATH#4� - - - NEW B 7 t 2 TV CLOS � 6 15'-2' " e-s ❑. a ANTHONY o MINICHETT.I BLUE BEDROOM #2 - OO ARCHITECT,LLC OO - HALL - g VESTIBULE _ EAST NY O 6 150E STREET �. f NEW 21155'" TEL 301811 " FAX 2122307211 .- O 2 " LOFT#4 4 B P v 'i • E VA TO' ev o a r T��n � , Eo s 0 0� -16 NEI' :XIRMER '(1 n NEW DORMER BATHROOM#2 " -<a uafFo;`-o DATE ISSUE 02.20.02 SCHEMATIC PLN .. - 07.09.12 BEDRM:I.SCHEMc BATHROOM d 7 i -2- O U a O a Ao 11 D2 1 i. 0�Qg 4 15, 0 a) BEDROOM#3 f; F Ga x o LQ 5e 3 )l --a Z �D 2. u • U - - li] Et J O DATE: 2.20.02, - . SCALE: 1/4' DRAWN: JG/.•30 _ 1 PROPOSED SECOND FLOOR, FURNITURE PLAN CHECK: A7 - xn�E 1/4 = 7-O -- - JOB NO: 2002 - SHEET: . - A1 .2 o0 �N ' w z O D W' .. VIDEO �-- INTERCOM O p -F N READING f ROOM 3 - I TRAY CLG-ABV. CENTER DOOR BELOW il'-b'xIP-9' F,-/TTr�,'• z _F- 'lJUa TIJI!' t .JL (Jl�. JL JL U U U V i ^ Q .'• N - . V O T�G1 ^ Q i lAl m 4 CA 05. a < FAE DEEK I RETRACTABLE � �{ m�•^ C 1 O A 14 sl I TO NO O B I NO GRANGE I ABV. DOORS < c O N I OFEN TO Fl I LItG ; `" VIDEO C LMA&ROOM I b• 'C,7rr5 - `NYD IC F� i ® a a . JJ INrERCOK BELOW ,a �SITTR:G ROOM 20° f y.e @'..� EXSnN6 F PI-AGE 1340'x,1'-10° STUDY ,, ®• - NO CHANGE s. KINS a . - NEW KING ow ExlST'G GLOB. SCOTT5 BEDROOM s1 GONGEALE NEYi 2EDRG0.: TRAY CLG:ASV- s4. - - _ - .PANEL RAY CLG.ABV. O O OExISTNG SL4'c a W:nTE v na>LE. - LOFT - - NAu. - - - - - -- - FLRNITL'RE VERIFY S41NG K5 SWING W/ SLOF O 2 1 PROPOSED �Q.;/4' E 4 - EXIST'G b 3ATN m .,tee o w_ DESK Or C� s fq f / 17= DATE ISSUE . Ex15T•G, `J ) (7 C �C f� - 07.14.04 CLIENT REVUE . CLOS. - - 07-27-04 CLIENT REVIEW - - ' 4 - U ' O I 5�_ Ro�K 09-08-D4 CLIENT REVUE NEW DGZ NER oil NEW DOR�R. 3' ,_b• 09.13-04 CLIENT REVUE _ _ Wl SKYLIGI,T 09-21-04 ACCEPTED - - - 12-23-04REFERENCE • O r � WW EXISTING rJ U .. . s. L _ - W .. C 3 z - - 'EX15TG KO NOGIIANGc - - G0S. nn F, A V° S O w < A p� h ^y a Np 4 TV EXISTING Q BEDROOM-3 ' - NO CHANGE 6 F-1 1ry�-•y rD .w.l W •(/) C4 F' - DATE: 07-13-04 - i - SCALE: AS NOTED - I DW1WN: AM _! FLOO l"U NI i UI PLAN f cl�Cx stall.I/4-=I'-0' I Joe Na 11 SHEET: ' :..J_n.1.lJ•-J - Existing septic tank j` ,•. and leaching field ' i j / __I.i _`\ .T gyp; , P�'° v . -Y-z- r^✓"-•, ,,,,.. V "' r^ Existing stoop ,C, _ to be renovated <' W -a . . . Existing stoop 'B' - - s' Y-•�,; a� _..\ -� % 'ti- � � N � • to be renovated { EAsting stoop 'D' - e Existing stoop 'A' - ° / - ,' ? �� t-- b renovated,e renova to be renovated / House /` Existing stoop 'E' - i Lijj o be renovated Project Area en .- I En Nh • Ca i • ,gip' �.\� �' - . i`-';=a _ `` -.`' , . 1 � � _f\ O, 0=`.c-O. O O _ �' 4. :Q •� < r, �. p\ _ ..L,%fit ;-- `' 9. ��l!--�t� t , ♦ ,. � ,..3 fit, �"'�'`^ •_ 2 y '; . � + In �iP r 7 5 � Fro nt� ` t ya r rd setback \ � Z 77, CIJ Top of state defined coastal bankV-1 y W Ott, 100' Wetland Buffer ems 00 0 '/� - N - O _ v' O 0 h CU PERMIT _ O.� o North S 3 ET o` o O 0 30 60 Drawing Number. Graphic Scale(feet) 10/09/2015L 1 Renovated stoop 'A' enovated stoop 'B' Renovated stoo 'E' v � 4-10" 9'-5' P 3 P enovated stoop 'C' U 00 t� �.. Renovated stoop 'D' - o'EJ ❑ 1CO r: ��. j / Q 2-8 I Z 19, �— ----------------------, — ------------------------------ r- ----------------- ------ r-- ---------- I �d CO CO CU Renovated Stoop/Steps —Plan pO 1 = m SCALE - 1/8" = 1' - :• _ 3' Building wall } m `�. New bluestone paving to. replace existing brick paving , New bluestone treads to replace existing brick treads i P tctch� New fieldstone riser to 0 replace existing brick riser Adjacent paving 0 70 o 0 U, PERMIT SET o 0 DU) Existing concrete to be Drawing Number IT- 10/09/2015 Renovated Stoop/Steps Detail - Typical repaired as needed SCALE - 3/4" = 1' L2 i tq 'r 1 Z? •o t 3 2G. ,Q P. s vi N zL.$ zu l` IZAStpri TJ4r To I/ , W w¢t0 OF ;g ALAN Voyet+lz�?/J Cats fir_ 'f T i i..IANM 4• PtO-c�ci r e . 4 F3 t T i f 27 I 22 ? 24`• ZZ•7 V tS 1 � vlviW-u 2�•$ _t • 1 .n • 4 �to`'�-ram'\+/ ►� v ter BSI Ys l t -,� ,4,j 8c�c tV Gtrz z4. ►.tom `� 2 ,Z Scent. . r �{ ------------- v t2 � 10 O r Aw JoN E S ,. OF > f� F+A ..�• , ZAj� .t. f'� \_ mod.+ • ri,/ 5 'te. tom►- - 44o K-Z.. rS .....& s Z- „rc.GPZZN2tk Pt t-�Z/z I;TtAjv t t I F- 7 i 4 NORTH " BAY Variances Granted b Board of Health on October 12, 2004 6.8 LEGEND y RA4 Py EXISTING PROPOSED GOB ,ter gR�o�� sr. � P�� a I.P. LOT 14�1 o Stake do Tac Set/Found FND.OFF � O� C PK Nail Set/Found GRAND �g 0 SITE b I I o 11,387 SQ.FT. UPLAND �G�O X o Concrete Bound oRiv . -n 29,593 SQ.FT. WETLAND \�,•� ® Gas Gate ►- '17 I ( '� 40,980 SQ.FT. 0.94 ACRES = TOTAL a Electric Meter WEST BAY BENCHMARK �p ❑ Catch Basin GRAND TOP OF SPINDLE 04 Water Gate ISLAND 3 I I.F. w � 20.t #1619 EL. 11.21' �' OFF N � ® TV/Cable BOX N ' o as Telephone Riser } wj 17. 5 7j 13.4 x 1 3 Z rn RAS -0- Utility Pole A m - # 200 Contours �tiC� C. ��, I 9 7.2 71 - a Spot Grade LOCUS MAP pA r 183 , / Test Pit C.B. �' SCALE 1 25,000 o N/F 'wN M• �g49'20 E tIDSCAPEDI co 4.9 FN rn 69' 1 I o $ / GENERAL NOTES Zp4. M , X 12.0 3 O o .� lEO 19 5 15.3 5 7. 4 C4 I / / � Os ZONING DISTRICT: RF-1 p,29' C.B. 9 I I 13.4 LAWN 7 I /%// to ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH �D' ! t 2. x ° I z / / WETLAND FLAGGED BY TITLE V OF THE STATE SANITARY CODE DATED MARCH 31,1995 AP (AQUIFER PROTECTION) � � � 2,.2 _ tO 2a.7 3.5 3X \ 15.21x t 3.7 3 y I \�/�/ #RA6 D: MICHAEL BALL v ANY LOCAL RULES APPLICABLE. FRONT SETBACK = 30 SIDE do REAR SETBACK = 15 Z 4.5 .5 1 ,4. I o c 14 / % 25.4 N� 23.1 ` X 0.5 5 12.1 9.9 4 7.5 / ! OCTOBER 20, 1999 �S J / G ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING W2E g ` -� X 1$�5 ]�6.3 I 11s s.5 o , , BY DESIGNING ENGINEER `mil SLOCUS PROPERTY IS SHOWN AS: 5.6I W / O ASSESSOR'S MAP 72 - PARCEL 22 24.9 1p \ Il x It 5.9 i x�, �X 0 x De I to / / \ 0 �6.0 �ffic25.5 �, � A0 j/ # WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, CERTIFICATE OF TITLE # 133,834. :�25.s �5.9 w X \ X 23.9 O a I I I x I / / - RA7 #R � NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT LANDSCAPED N 25.4x0 0 4.3 5� qe. ,.4 (7.9 j/ #RA9 O FOR INSPECTION. 25.5 X QP X 16. - 10.0 I �- PLAN REFERENCES: _ I/ g I x 13� i• 00 ° EXISTING WATER SERVICE FROM C-O-MM WATER DEPT. FILES LOT 27 ON L.C.C. 15354-84 SH.S � TEST PIT �°�`�<UA I 4 \ OO °�� (ACCOUNT #8088-K) LOT 141 ON L.C.C. 15354 109. �25.8 I I \ 26.0 25.9 I X 5.2L8 3 I ' \\ w 0 25.3 J�L3 THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WR11TEN COMMUNITY PANEL NUMBER 250001 0018 D (7-2-92) x 26.o LAWN 26.1 < ' I ' 8.2 \ APPROVAL BY DESIGNING ENGINEER THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONES 1 3 \ I s.e C & A14 (EL. - 12') \ ` - I ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" PVC., SCH 40 26.1 1 56'X12' SERVE 25.7 EXISTING SEPTIC SYSTEM LOCATION PER OWNER PROVIDED NOTES 25.7 ; FIELD 2X 25.8 \ \ \ 13.1 LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND Ki x 2'.2 2 .1 2s.8 ` N \ \ \ x 14.2 1s�0.4 \ EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE , �` 2s.2 tAwN 0 26• \ \ 5\ ' E. , \ � ' -- #RA10 SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5, PER UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. o X 2 2s 5 27.0 �� I �,4.e o \ I \ A 310 CMR 15.255. z ,6. p 6' 2� Z d l (A 10 PLAN IS BASED ON AVAILABLE RECORD INFORMATION AND 0' MIN I+ 20' MIN BRICK / n I X ° \\ to VV �``+r I \ '� rn PLANS AND AN ON THE GROUND FIELD SURVEY BY THIS FIRM x 4 - �'�� tt tt I \ - - 2s.8 - 8 27.1 26. y // 3 \ IBM:PROJECT BENCHMARK PLAN MARK : DATUM NGVD EXISTING SEPTIC SYSTEM TO BE PUMPED AND REMOVED. 26.5 �a 6.5 / ` \10 �'' 24.8 26.5 X Z� / .t \ ••J '00 4 N / \ SOIL LOGS DATE:9%25/2003 26. 25. O 25.9 / /- "--' 1 4 7X 13.3` 9'X Oi� �0, - P#=P 10,566 10' LAIN 26.4 x �(O�� 26.0 X 2418 \�17.6 \ �Al2.o \, 8.6 � 4� -�: .. c L - F Z O O O O 0 0 4' 12' ENG BOARD OF HEALTH AGENT: X 25.9 26.8 ( \ \ \ - O - � 2s.o s.o �, y \ \ \ \ `: j� ; _ - ', Steve Wilson P.E. Sam White s.3 2s5 o BRICK PATIO X\ 4.s \ X16.5 \ ` + `J v #RA11 . �- �ut.et�ss'" < BRICK WALL \ \ - coo = - TEST PST TEST PR D.E.P. File ME 3.3883 VENT �w � 6 „ ��ti 2.0' HIGH . \ \ 4.8 - � � G.S.E. = 25.5f NIA PERMIT EXPIRES OCTOBER 30, 2004 0 26 isTIN x 2s. 2s 2 `�, C 26.7 X25.5 \ \ ` 7� C.B. PLAN 01'' 0 PERMIT EXTENDED TO OCTOBER 30, 2007 10 .s x 2s � PTI 6. WRICK \a �. \ \ 15.1( FND. a Sandy�Laam 6. t 6 �' \ ,ss\ \ - .. PP..1CAS"!�EAG1 � �''�...��BERS 4• 10 YR 3 3 5.6 X F.7 4 ///, � \ ±��`\' S\4 2.0 � � NO SCALE i O 26.4 `\` \ \ B $ 24.0 LANDSCAPED yG� 2s.3 7.8 1 \ X ii 3.2 3 8p X 26.6 O � .6 26.3 ' /w ` Q Sandy Loam iq 26. X 1 PATIO 26.X 23.0 �2.2 9.5 14" 10 YR 413 Variance Requested. 27.0 6.4 �� ''� � � , - + \ c PART Vill; SECTION 1.00 = o `'� {, ,�, __ f ti� ACl \\ 4 -yL Medium Sand To allow a septic tank to be 60 from a coastal bank x t, t ,, ' yr w s's I ` � MANHOLE FRAME AND z 3�• Fy 132" 10 YR 6/4 I ,6.1 \ \ in lieu of 100 • "h i .,th r. I�1'T�%r f', WICJ, IV NtWJF S w , .s I �I,8., \ (IF UNDER PAVE1r1EN>7 WASHED STONE To allow a soil absorption system to be 85' from a coastal honk CATC• BASI �J'n � rasO�® 2s. 0�� y�l�' 1 15 113.4 ` 1os NO WATER ENCOt1N1ERED RATE- <2 MIN/IN in lieu of 100 F �k� �-10� UNABLE TO WAK 26.3 24.1 X 1 D.6 - X 26.8 6.8 �� 6.1 113.3 7- 9.8 (� 28.0 6.2 �17.1 *,2.,\ / 2r 7.6 24.5 I 3.5 ` Q % � 28.9 � &7 27.6 `=s' ,Y r ham -' Y� i.};�.`yi T =' � •- w: �`•r` ,>:;: �:�i� v. 00 L.C.B. %28 .7 8.6 LOT ,2�' 12' Z FND. jf8* X 27.3 14.7 � \ 24' �i�'-%u�'yr'�.�:r, ?:`�'- ;Y: ,i:yi �:.:• La�:i�; 44 907 SO.FT. 9.0 . , X 22.8 9 X�1•t»1.7 J �'.:t.F:S'iaF. :.k�!=�f: �. 1, `. .. . ,,{ F!•t:�"� 8 � 6. `�lnli"' ��tt DEPTH : •MF,?i 4 r. 1- s w it'�: . ..-' ''� ' , i r:..:C �; UfG411.G DEPTH %. i'• ••.� •-!g:•+. .,,'i�:: •'„ •`+':kii• (ai _ a•/�•t,.•�.f 220.66' 1.03 ACRES m 10.50 ` 12 .�'' �'} :,*;...,,r ,�;� .::r.r a`.r t. ':r "�';�y�'; ' ? ;''7'= A. "•i: N •�. .r.r+' .r�v.w-.'�:tia. �� - r� �,�'it!•;�rr•i;:it•-•K•.:.n:> �`:,�s'.irJ.�•.s�_i•;- 67'O1 . s• :sf'�'�•',"•>ri mot• � � �.• • l�t��:: '.+a.t�•r'ua..=L- - � f_ _ ..•�:... .f•., .52w W � \ 4.• 4. 4. N/F OYSTER HARBORS CLUB INC. C.B. BENCHMARK D. OFF 12' 27 North Bay Road N/F ELIZABETH B. COOK TOP OF C.B. EL. = 11.69' 10•6 CONCRETE LEACHING CHAMBER DETAIL (H,2 ) Oyster Harbors, Massachusetts PREPARED FOR J. Gary & Dawn Burkhead TYPICAL SYSTEM PROFILE DESIGN SCHEDULE ELEVATION Leaching Area Requirements MIS TOP OF FDN. = 28.34 -:.: Fl�+m GRADE NOT TO SCALE TOP OF EXISTING FINISHED FLOOR 28.34 6 BEDROOMS AT 110 GPD/BEDROOM = 660 GPD Septic System Design - Upgrade SEWER INVERT AT FOUNDATION 24.3 MANHOLE COVER AND FRAME ("UST M GRADE) SEWER INVERT INTO SEPTIC TANK 24.0 NO GARBAGE GRINDER SEWER INVERT OUT DI SEPTIC TANK 23.7 PERC RATE = 2 /1 MIN. / INCH (CLASS 1 ) BAXTER NYE & HOLMGREN INC. FINISHED MANHOLE COVER & FRAME SEWER INVERT INTO DISTRIBUTION BOX 23.2 � , GRADE OVER TANK 27.of FINISHED GRADE OVER D. Box = 2�of GRADE OVER MOM TRENCH - 26.5t SEWER INVERT OUT OF DISTRIBUTION BOX 23.0 LIAR = 0.74 GPD/S.F. Registered Professional �A Of ;a 3 mm. SEWER INVERT INTO LEACHING SYSTEM 22.8 Engineers and Land Surveyors t• INV. OUT-23.7' F FIRST 2 (TO BE LEVEL) y St NEON BOTTOM OF LEACHING TRENCH 2O.8 4• scH. 4o PVCSCH. then 0 2.07E 812 Main Street, Osterville,Massachusetts 02655 �^ EL 24.3'-� ° NpICAL•) '`�' t O .Ox PVC pL2' (mi ' WATER TABLE: NONE OBSERVED AT EL 14.5 MIN. LEACHING AREA OF SAS. : c 9" (min) Cover 660 GPD 0.74 GPD/S.F. - 892 S.F. MIN. Phone - 508 428-9131 Fax - 508 428-3750 •[-f O 2.07E py�C �r 6• SUMP !: r r 1 :.s. 10w CI lEES �- 4 SCH. 40 PVC 36 (max) Cover / l ;- GAS BAFFLE 1..:.-•�•:f�r rMtSTE��V1 INV. IN-24.0' f W. IN-23.2' -''�'�► ''r 1 CONNECTIONPROPOSED SYSTEM: SIDEWALL (j 12'+56')(2')(2) = 272 S.F. s'StOaAIL ti - 6, CRt►SHEo 4• pIA, PVC h ,�' = ,�;--�j- B01TOM 12' X 56' = 672 S.F. 20 0 20 40 , RONFORCED CONCRETE �� ZFO sroNE BASE--- T = i}.�-•�5;. -. ,,_ .�;:-..•... INV. OLIT-23.o' C] O O � � O TOTAL 944 S.F. 1 f %L I=- '�: � f' -M ;--, SCALE I N FEET 4. INV. M 22.8 12 .�' SCALE:1"=20' DATE: 10128103 NOTE IF AREA OVER SEPTIC SYSTEM IS UNPAVED, MANHOLE COVER do • - FRAMES ARE NOT NEEDED. ADJUST CONCRETE COVERS TO 6' 5' MIN STONE LEL 20.8 BELOW FINISHED GRADE. REV. DATE: REMARKS OWNG 2,000 GALLON SEPTIC TANK DISTRIBUTION BOX LEACHING CHAMBER LEACHING SYSTEM TO BE VENTED I �S R JCT�l1�SF�V HSEONK ACRE LOCATEDEDGE -1- 8411104 Pro Garage & Septic No Groundwater Observed O Elev. 14.5 `M Or IN RELwTpN TO THE MONUMENTS SIIOVVN AND ARE NOT LOCATED p gcol H-20 H-20 H-20 W" A SPEcuL FLOCO HAZARD AWA -2- 8123104 Rev. Septic -3- 9 21 04 arience Request N THIS PUN IS NOT TO BE RECORDED NOR IS IT 71) BE USED TO ESTABLISH PROPERTY LINES. -4- 3128105 Xistin Water Service DRAWING NUMBER 3.26- 05 0: 2003-055 surve worksht 2003-055SP4.DWG ' LMD SURVM - DATE 2003-055