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0041 OST.-W.BARN. RD - Health
41 Ost, — W. Barn Road Osterville A =1120"= 001 — 017 0 a a i a v THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH !.'.`�_................OF.........3."'... S,F'� LO .Apure#ion for Disposal Works Toostrurtioo Errant Application is hereby made for a Permit to Construct (Jk-) or Repair ( ) an Individual Sewage Disposal System at: ISTS•/E/tv1I- GI• -jlreZ,vS!%7/I- �C►�, / . ................_-• .... ---........ .......... ------.._...-------------------------- --.......------------........------•--------• ----•----•----------......Location.Address or Lot No. r - :. - kr�.......................... ... 1 �. ��ner sd� Address a Installer Address QType of Building // Size Lot_��� .-_,_J_K1----_.Sq. feet Dwelling—No. of Bedrooms............................................................................Expansion Attic (N ) Garbage Grinder (A/) Other—Type T e of Building ............... No. of ersons.....____._..........._..... Showers — Cafeteria a m g P ( ) ( ) 0.' Other fi 3 t es --------------- --------------- - d W Design Flow.................. .....................gallons per person per day. Total daily flow......... ... .........................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-----........... Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.-___--_� '.........: _.......4........... .................... Date.._.§/.Z`� ....._.__._.. ,al Test Pit No. 1---- ."Z---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------------------------ •----- --------------------•---•-..................---•-•-----••--•-••-•-------•---•-••-•--•-------...----•-•-------•-•---•-------••----------••-------••--- O �- -� FuM SnwJ Description of Soil--------•-•- ....--•••-•-•-----•••-------------•-•--•-•--•-•---•-•--•---••-•---------------•------•-•---------••-•-------......-------•---------•-•----------. W U ---•-----•••-------------•••--•--•-•••••--•------•-...-••--•--•----------•-•---•-•-••---------------._...•--•--------••.._...---•-•......-------•-••................................................... ---•--------------------------------------------•-------------------•-••-••-•----•--••-•---•------•------•-••-•---------•---------•---••••---•--•---•---•---•-•--••••--•-•----•-•-••--•----•-••-•---.--- UNature of Repairs or Alterations—Answer when applicable.....................______________________________•----_-_-___--_-_____-_-_----_-_-_--__-----. Agreement: The undersigned agrees to install the aforedescribed I vidual Sewage Disposal System in accordance with the provisions of'T T .i; p S of the State Sanitary od Th ndersigned further agrees not to place the system in operation until a Certificate of Compliance has e i u d by board of e . Signed ......-E . -----•. -•-J6 ..... 1 Date ApplicationApproved By--••-•••-• ... -•------------•---•--------•---------------- ------- \ D ate Application Disapproved for the following reasons---------------••----•-•---------------------•--------------------------------------------------•-•----•-----•--- ..•••--•---•--•-•---•-•--•-•••••••----•--------•--•----••-•-----••-•-----...----•-•----------------•..................•••-••--•----•-•--•---••----------•--•------------•-•-......•---••---•-..........._ p Date PermitNo.----fit ::. •---------------•----------- Issued_....................................................... R s No........................ ...I....._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { ----.....dt�.+e/`.. .............OF........... . ..... . ;. ApplirFatiou for Elisposai Workii Towitrurtioaa 'phrutit Application is hereby made for a Permit to Construct O or Repair ( } an Individual, Sewage Disposal System at: 1,- 4r 41 Q�S ..�F�'t,tv�CtC` ze* ......... _ _.......... .......... •..................................... ........................................... :- /.. Location-Ad ress or La,_No. � �.._...... ...... .d ------ ----------- x....s .._...... ------------ ------ ------------------ wner Address Installer Address d Type of Building Size Lot............................Sq. feet )-, Dwelling—No. of Bedrooms...........................................Expansion Attic (A ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a1 Other fixt es ...................... W Design Flow.............._................ gallons per person per day. Total daily flow_............_............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—'_`To..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) i.... �.� Percolation Test Results Performed by........................................................................... Date.---��-�-1 �-�--------•--- Test Pit No. 1___---- minutes per inch Depth of Test Pit___-I.�._....... Depth to ground water.... "__�-___----. G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-__---_-__----..-.. a ----------------------------------•---------------•-------•-------•-------•---•-------------•...--•-•--------•----•........................................ 0 Description of Soil......E O-F U 5/"n1n U ------•---------.........................................--------•-------------------•----•- UW -----------•-------------- ............................................................................................................................................................................. Nature of Repairs or Alterations—Answer when applicable............................................................................................... •------------------------------------------------------------------------------•----•-•---------------------------------------------•------•------------------------------...-----------............--•- Agreement: The undersigned agrees to install the aforedescribed I hvidual Sewage Disposal System in accordance with f'lT rl�•� the provisions of '� LE 5 of the State Sanitary, od - Th ndersigned furti:er agrees not to place the system in operation until a Certificate of Compliance has beep i su�d by l e board of ie h. R 2 Signed = .-`...a � ----- •------•---------•--------- •..... ------- _.. r^ Date Application Approved BY - ...........-•................................•--- ....._.. Date Application Disapproved for the following reasons:----•--------------------------•-----------------------------•---•--------------•---------------•----•---.....-- ....................................•--•--•-------•-----•.........--••-•--•--••-------------•••-•-----------•----•-•--•---•-----•-•--•••-•--------•---•-----------------•---•--------.................. Date PermitNo.--- :.= •--------------------------- Issued----------------------------------------------........- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........--••-.......I...................... QT rfif iratr of Toutpliattre THIS IS TO CERTIFY, That the I Lividual Sewage Disposal System constructed (,X') or Repaired ( ) ----•--••---•------------•------------•--------------------------------- has been installed in accordance with the provisions of LITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ __- :-yy........... dated........................................:....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................--=--.,.-. ... Inspector................ ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF........° -7 No. � ... FEE...=•--=,2....._..... Disposal Works Towitrt iutt rani#•y Permission is hereby granted.....ar'.___. ............ .._... '. S'b to Construct or Repair ( ) an Individual Sewage Disposal System at .. . d �. ' .. .. ......................................................r ......•-•---......•.....-_- : ---------------• .I....- ----. .... .. ,, ,# �-----•-- Srreet as shown on the application for Disposal Works Construction Permit No Dated..Dated.......................................... ............................. --------------•---------....-------•--••------.......__... .r DATE.................... - -/Q--s?0..................................... Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ - TOWN OF BARNSTABLE LOCATION ql os►e-rYi llti°_ `wl trf)ahle RD SEWAGE # 2pol-637 VILLAGE_/051er ;Or- ASSESSOR'S MAP & LOT h "Ap INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I.SQD n LEACHING FACILITY: (type) aIT��l,�i�/cvc(�5 (size) 12 X2J- NO.OF BEDROOMS 3 BUILDER OR OWNER+ L 26 PERMITDATE: /�r/ COMPLIANCE DATE: 7, D 2 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 �,eFr Fro kT- L-7�L_ t3 - 41 �A N •3y to G .3GS" SD �D� TOWN OF BARNSTABLE LOCATION [o} q �5+ /f i��n5� Rd SEWAGE #-T c) 5" VILLAGE a c4t/,/, )(R ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Si SEPTIC TANK CAPACITY /(IUO LEACHING FACILITY:(type) Psi c -,sf + (size) /Gu p N.O. OF BEDROOMS PRIVATE WELL OR PUBL WA BUILDER OR OWNER Z�P-. Icy rv�f � DATE PERMIT ISSUED: I ')0 .- �!b DATE COMPLIANCE ISSUED: W VARIANCE GRANTED: Yes No /� r - A 41 QS �v�'I(s bi b3A:n 5�A-b1e '!QL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osteryllle Ma. 02655 6/11/2010 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: A. General Information When filling out forms on the computer, use 1. Inspector: ( { n t� only the tab key vvvGGG to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name tQ P.O.Box 763 Company Address Centerville Ma. 02632 0" Cityrrown State Zip Code (508)428-4028 S14454 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 , b �J 6/11/2010 s Insp ctor s Sig ature Date The system inspector shall submit a co of this inspection report to the Approving Authdril B a d Y P PY p p PP 9 �Y( 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. LAM (,, t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis sal System•bell D,7 d ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every 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: ® 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: The septic system is in porper working order at the present time. B System Conditional) Passes: Y Y ❑ 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 is f_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every 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 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•09/08 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 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every 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 privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09108 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 ,M ,•y'' 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Ostervllle Ma. 02655 6/11/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this,inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 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? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6/11/2010Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 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: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"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.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1' 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: 1500 Sludge depth: 21, t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. CitylTown 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 30" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): 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 um in p p g' Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 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 wM 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every 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 No 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 is level.Box has one outlet lateral.No evidence of solids carryover.No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.no signs of hydraulic failure.Chambers were dry at time of inspection.Stain line observed 16" below invert. 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 Lt5in. 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 every 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 3iaG � ems• xv, L—FL FronT '1 w _ 13 �10 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 15 of 17 A Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osterville Ma. 02655 6/11/2010 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: Bottom of LC 30'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report,please see Report Completeness Checklist on:4e.xt page. t5ins•09/08 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 41 Osterville W.Barnstable Rd. Property Address Richard johann Owner Owner's Name information is required for Osteryille Ma. 02655 6/11/2010 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 T Fee ��6a/ ✓ THE COMMON EALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Zigooar *pgtem Construction Vermit Application for a Permit to Construct(K )Repair( )Upgrade( )Abandon( ) XComplete System ❑Individual Components Location Address or Lot No.4( 0_&�,u;1(L (j��( ,g� Owner's Name,Address and Tel.No. 7 71— /040 Assessor's Map/Parcel qn- f J/7 5S Installer's Name,Address,and Tel.No. e Designer's Name,Address and Tel.No. 42$"—'I,3 f b,M P~ v L),&- 2xc ,CA L6g75—IQ� n 2cG _ a[/ / Alt Ynm,., 5*, ®Sdzr�alie Type of Building: Dwelling No.of Bedrooms Three- Lot Size q 3 �^ sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow //© rx,*,/ s. Calculated daily flow gallons. Plan Date M41�K5S Number of sheets tram Revision Date Title Ce.r4 Ptc4, Pie, Size of Septic Tank /0'00 Type of S.A.S. le ekc— C%ur/Xa i2')(Ss'+c 2 r/-ry/, Description of Soil p I e ct se 4M _-cs'e i lam, 64A n 1 lifts ?_`314-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 E vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedb oar Signe Date Application Approved by Dat ®I Application Disapproved for the following reasons Permit No. 2(:3yDate Issued — �J Fee THE COMMON EAL� ki M�►SSACHUSETTS Entered'incomputer: Yes "PUBLIC HEALTH DIVISION - TOWN'Of`BARNSTABLE., MASSACHUSETTS w � , ' 2ppricaction for �N!5pool *pgtem Con.5tructiori�Permit Applicati on for a Peng to Construct X )Repair( )Upgrade( )Abandon( ) 5'Complete System ❑Individual Components Location Address or Lot No.el( 05kw;1(R &P Owner's Name,Address and Tel.No. 7 7/— /OA-o "Qa�s�r�.a C3 c,�Id''•�.. Assessor's Map/Parcel aria /2v Oc /—/*7 aw- JS <tM/trdi��! _s Installer's Name,Address,and Tel.No: Designer's Name,Address and Tel.No. 428 '913 � ) Old /`�`/I!i(�C �oix4zr F �� TN.•' 8l2 YYlorh yl-� OS�r�►i 11G Type of Building: Dwelling No.of Bedrooms -irtG Lot Size q 3 % sq.ft. Garbage Grinder Ak) Other Type of Building No. of Persons Showers( ) Cafeteria( f' Other Fixtures Design Flow //Q a„/ . Calculated daily flow 330 gallons. Plan Date ---� Number of sheets �� Revision Date %T Title Ce m Ptm- Pla A r Size of Septic Tank /SRO ke //ems Type of S.A.S. �coc�r*y C/csra/,ra /2'X SS'K 2l�i�� ' Description of.Soil I GO se m,6r -4=- so',I 19d rA,. n l G n s (F-$14.1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: i 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 E vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss b d �•`' Signe Date Application Approved by a.:Dat. O� Application Disapproved for the following reasons t ——Permit No. ——————————"'"' — Date IssuedA& THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( I<Repaired ( )Upgraded( ) Abandoned( )by yCAT£ .lvo at yl 0.57 W. 6AR 41 R b r D 5 Ire V iGC-6 has been c � c rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. l Z Installer Designer The issuance o this permit shall not be construed as a guarantee that the sys a will fu tion as deli ed. Date Inspector No. '�"E ,•�.. �� ••+'�j)--------------------------------------- Feed ` THE COMMONWEAL a OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligoal *pgtem Con!5truction Permit Permission is hereby granted to Construct( V Repair( )Upgrade( )Abandon( ) System located at _yl 05 T Gd. 8 9)eAl. /Z 1 p 0 S TER (/I -L e 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:Cons ction inust be completed within three years of the date of this rmit. Date: // () A roved b PP Y �I�1l�LE FAkI►L:� $® E PL.A I•i OW BA 4 .UGJZ.EOF Dp,I L_y Fix/ _ x.1 10 1-1 CU�,'ja1l(.�-tom SFP'T1 - TAN ' *3sp x Too ="a 6Pfl v I ci00 GAL.. Q•Pvc E PIP t:saAGt}1�.1G 5`(��K pES�N � o� €Qvi�l4c�►�iT" - - 33� GPD �' 0'►4- 5F=� SF -- Z� ,(PP UGdTw�t A1ZFA FLA14 VIt=-YV = L1=A 41W-v CMMBEe5 51t,EWALL A M 3l xl-x7-=146 SF . aT - AMEAs j WN FiNrsW Grzav� PE2ZOLATP4 2&TE G 5 Mw/iNaa 2 3 n-cax T I/$-'/Z Z01L C1�, y � � O - �.�� M Qf4S' r 0 00 0 � O a ST"o►lE STEPHEN : yG� ✓ r 33o v o 9 `r) e�Il p�`'3ToNMO O AL YN rn` cn No.30216, 1 Z� ciSTE�``���/ 4Bax-SE�1�aN DF G► AMv,�� AD irM[ e� rL OKG �Mc IN/ �'� z -"L CRAM13C 5 5a¢ 5�t� two s. , 10 (;Li5A►J bGse sAl�� ia' EL-4 C "I1 RGD ROT PLAt.I wM _ // 1�CATtotil `T ►( P- Ui4i rpmio Iq3 ScA.t_ �� &C; 7% q� L GE=n r-`f 'rpAT r4 E �v v -c.L-1►,>G_St�owN PL1 1 :. - HeaaoN ctwtPt-`t5 wrm TAFE St�.u"e A►m ,>r'TBAGiC ul?zEM6NT. OF TWr- 1-0WN OF MAP' - J 2�k; .�lt►-ro is Acrii ' LLeA.TCD wlT*41N /a SPG�J AL F lsr7D HAZAY.� ZDN E. BAXT�2- � N`f� 1 h!G G LAuD SUeVl;y�S -SW&1WSW )c _ o5 szv�L MASS. 0FFFSe•1~s . MOM Bui[.Dl066 SPbeXD ►,tPi" B>z ,4PPLJG4NT: F,S�xi�u�sy PFto�T`y- AtiStaE� 01��}�� 93 ' rl 'Zo AJF- Of - G 3 . l.00 S 4& 49 IT 14 -'\ Ek -44 1 ` of 1�i . �,c vv , + tN OF,;s c*EF,r-E ,yN Err rr 3'3216 AL 1) '130 45 Yif 7c P • !S y■'gib Y23PC SSg A C ad deck r Y E >g $ AeZ6Ete A i:BY . s u°1>' dining — �•.� ._ bedroom o 0 family b .`�' •* • kitchen n.R..,,+ c S ,. _ .rn M i t � em •.n.n m t si ® belh foyer +T ❑ n�.sW n +yl� UA n yr:v v. n vra u u• S3 '�'.0 1.'T�. ' 0 6 ge p. - W i�ge yr..W:� O N First Floor Plan A 9 s ! ( T 4 E I U) nLL uiNvpW,4ywn 7xeR'+^F=-rELLA' I d•Y a.uWJve,E-me I 9'•l'o.it.:,M�4e.vR� m o a A S�fC Y cpe WI I d A Sl� S £Y eY S A G k _ _ 3 y ----------------- ----- bedroom /J2 bedroom #1 loft beth a m 0e o� , d c hill. ur � � 6 , ' u , .,, S3 ----- -- m ! •r+.:. A c S A o �� 6 m S16 Second Floor Plan e a W € garage � 00 U) G:O Z U W N section thru garage gs .�. Alm W � � I • I TOWN OF BARNSTABLE LOCATION SEWAGE # WI-63 _ VII.LAGE�S1Grwi�lc ASSESSO 'S MAP& LOT 1r Zp 'l INSTALLER'S NAME&PHONE NO. v I SEPTIC TANK CAPACITY I SDG oed of LEACHING FACILITY: (type) &QL!> &1,1 cI& (size) NO. OF BEDROOMS 3 . �. BUILDER OR OWNER uI l l PERMTTDATE: ��e��26 COMPLIANCE DATE: 7A� Separation Distance Betwebn 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 k?-Fr Fronj' 13 t CGS+` I� � MD' i I yr _ _ _ ---- • , _ _. __ _ 1 Y - ,. :..` .. - , .�11:IIILrIIi�I���IIr1�eI�����IL�I1�ILIIr!IriII,�.�,I41,��I.II-�.-IIIII�.,I I.���Ik�;II�I.II-:Lr 1�I�I-II�r.,���II,I1I 1 L.,�I,lII�I1I I rIlI I II 1 r I'�.,�I.�.',.I,.L I I I 1 rrrI I�,I�.r 1r,,,r I 1.1.1 1 I.r-II-L I�-rI'I II r�II1I I..I-I.L I I I..I II I I I,I II I II IL II I I.I-�1IL IIII�I I�1 ILI I1I�rI Ii�I�III I I II I-I r1I�..I IIII'L I�-rI.I 1I.I.L I�.r I1 L 1 rLI 1 I1 L,I r I IILILI I�II II.I'L I IL II��LLII.'IL I.ILL I 1rL L I II r"I�I-IL"1 1 I,I1�4 1.I�1,�.I I I�I I,r I r I II�.IIII I.I II II I IIII I..Ir III II rII1I IrI��,.I I rII�1�L I I.�'Ir,I'��r I L�"I rI,r.1 I.Ir,I.-r II,.�..II�LI.I I--I.L.I I�.L 1I 1 L rI II��II I LII I.�I�II I.II 1 I lI'IL I1III I.I.L I-IIIIr�I I'�I1ILIr l;I IIL IL�I L.IrI II I�I.LTIr I II-I r II I�-.I�r.I III 1,L I II I.1-L�.II I�LI Io��.I�r I I I IL I II1IrII I.rII..-IL r.LL LIL L I I��.II1�I r.ILI IIL r 1r�I�1 I I�I II.I III,��L1.I".-I I I'�I III I Il I�1I�I�,L I,.I��.,.�r I�"II I II r I 11I..�I1.II,r,1.II I-r 1.rL II r ZI I.rI 1-I 1 I.I�I I�II,I I 1 I.I�I II.rL..r�I L.II�I.�II.r I,L I I�.I.�r.LI.LI.1r I.r,�.I�--I.rrII I"�III I Ir...r-I II IL�I-r L.I II.L I�II rI III:LIL I ILr,III,I�I I-II,I r�-II 1.,,III I 1.rr.�r r I II I�1IrI-rI.I Iq.LI.I LII-I I.I-�L I III�I�II I I I�II.IIII.r I�r I I.II I I-I'L I L.LL-0-I.I.I IIL'�..II L11L III''r I 1 r�L ILL I-.LI..�L.I�I-..L-.II.�-IL.L.�-_I 8 I�t 1II I I'�.I I.-5r.�.1-.L 1II1 I II��I�.I I 1r,�I.I I.I r-�-I-I 1L.-�.�II,I alv'III.L I I I�I-I I Lit I1'.I IIr r I I1-I�I I.I'.II II 1I.III�I I�1II t-I 1I 1,��I�r.I Ir"II,I-I II,I..L�-I-I�I/IL�:.I,I�I�r��I",�I II��I�0�I I�_LI I.I LI�..f II iiI"I I L IL I.-I I'II�s IL]N I�II r,.\II I,i.I�I4Ir!I1Ir L�rI"L L II IIIL-I-��.L IL II-I.I L��,rI-Il fr,I II I rIr I'IIII_I1' . : 1�r"1I I r ILI I/II 0 L0 LrrI I.-I I.I Ir ,I�,I�1.�r.I:/1 I I1�I.,�,,"�1I.II 1(lL.,II c 1.'I.II I1L.L I I�tI�II.I Lr�LiI--I I,I.IL-,I I�_I*fq1II I�L�i.I#L>>,IM 4I�r�.-._:_.I-.1L''I I I,I�iI 1 1I1 I.I1'�gL r�rI.��0',.�IIr L�I'. ")II.I r f'�:1I-I-,�r:I,�I,r��''I���'I I��-I.LI,'I;I�,_l"II.I�I j-i-1LI I.�',r.Ir,_,II,i 1'Ir�.,,LIr LI,'..I�I,,"��L,I�I LI�'L 1 I i'I�L,.r-.,r II j,:.-L�l_Ir LIr._1L4,� L�II�r IL 1 L e,'"I1�II.L I1I I I I��,"rI1�Iq'�:'I L:I1�;�.LI�I�I 7 L I'�1r��I� II��r�,L�I L.I,,1'" . III 6 I�I L IIr I IJ I-I.Ir. , < . . :: D O s to N TE MARSTONS MILLS -+ . 0 1, AL WORKMAN5H1 A D A {ALS SHALL CONFORM 0 D. 44, . L P N M TER H O T E Q E ti NtMUM OR A5 INDICATED ON PLAN TITLE 5 THE TOWN `OF � 88NI8�I�E . RULES AND' $, + �, r. > W S F0 THE S SUR ISPO A OF S G REGULATION R UB FACED S L E A E, $ LOCUS 1 o MIN, Q AND THE RE UIREMENTS OF THIS PLAN. -10 MfNtMUM - m A L COVERS TO SANITARY ;UNITS SHALL E B OUGHT;TO . 2 L B R U r> 2s ROUTE .� Ra 28 IH � . : BL .� .,� WITHIN 12 OF i=`tNISHED GRADE. : UE>v0 T.O. FOUNDATION SE MIN. icy CLEAN SAN [�t,� �, 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE f. . MASONRY f J SHALL 8E MORTARED IN PLACE. 4. L COMPONENTS OF TH A ITAR YS SHAL B CAP _BL ALESN YS- TEM L E A E 4o PVC PIPE PI7*i _ 4 sCH. _ F WI 5fi ND NG H 0 OAD NG UNLESS EY AR UNDER °`OR t 4 PER PT. MIN. PITCH 1 PER , O TH A I 1 L i L TH E N r - � MIN. . .. W(TH N t0 T. O DRIVES 0 PARKING AREAS, .H 2O-LOADING . i F F R w Y LAYER oP -- UNE .. s 8 � SHALL B USE UNDER OR 'WITHIN 10 FT. :OE DRIVES OR�/ /z E Q � 10 . , W H E , • AS Eo STON PARKING. 9 :O .. : k ---...1 ICI "�` ��,.. �- a..� O Y SN , ; LEVEL. . , /_ ,t; . 4 .s. .. LN2lRD ." / ,:WA E LEVEL` SNEO 5fO►1 NG RO { U ON BO SHALL EN R LIEACH P{T 5 I UTION 6. EFFLUENT PIPI F M DISTR B TI X TE _ 0I TR B - LOCA i0N MA ROU A ONR BOX ' THROUGH SIDEWALL OR TOP :ONLY. ENTRANCE TH GH M S Y d " WED.EXTENSi N WILL NOT BE ALLO 1 i MP C" WITH DE NO D ERMINATION HAS BEEN MADE AS TO Cd LIAN E ED Chi.GALLON 5E TIC TANK: . ET LI C N S L.. _ -RESTRICTIONS OR ZONING_REGUL.ATION5:`'OWNER APP A T HA L ,: - U O 0 W'' U H NA ON ROM APPROPRIATE A TH R TY. F " M R6 LE •r BTA 5 C DETERMI TI F THE '_ dS �L� :BOTTOM ,OF TEST.HOLE ,� OR ZO 7AL AND : RTiCAL CONTRO SEE LEVY ELDREDGE a scALE 8. H I N VE L+ , N T TO IL IL `'HIGH WATER LEVEL : OR . . PROBABLE & WAGNER FIELD NOTEBOOK - . ILI L. IIr , DESIGN N C ICUL` TIONS G A A - RET TI ON. ___�____ . , CURRENT ZONING . iNTERP A . . , n M{ ON S AC . - N. FR T ET8 K FEET 3. F 3 OF BEDROOMS_ � :NUME ER SE C I �I r ' MIN.' SIDE TBA K FEET GARE3AG DISPOSAL UNIT .�� _ . TOTAL EST{MATEQ FLd W MIN, REAR SETBACK FEET 3� 1 a 0 -GA R. D Y , BR. GAL.. ___ L. B A X _.__ DAY ( / f ) f . -A . E 111RED SEPTIC TANK CAPACITY GAL R Q Q A u ACTUAL SIZE OF SEPTIC 'TANK G L. EAC;HI EA R UI EM TS , , ,, L NG AR EQ R EN 5 SIDEWALL AREA GAL S.F. L(.3 f .t . : : :.... 1 fl C► OM" ARE A GA ; S.F. _ �:~. B TT E ,�...__ L , -. f RC AT ON T ST a� PE OL I SOIL E �.�. �N1 a .�G> --- .- . ACHING CAPACITY BOTTOM + SIDEWALL GAL. __ s 4 a s ' 3 ; 1.0 k ,; OF SOI TEST 21T U 2 2 5 +7T IC7 2 A o ! DATE L t f )( _)( ) ( f ) ( ) . e- rJ� t►.13.t3. S ca ,�£. " : L'�c,) H tt. �.{ 1/E _C G APAC TY s1 �" � � RESE,R LEA HlN C I ; � WITNESSED BY �. � , AM - ,r 3A a�-� f h1 PERCOLATION :RATE MiN. INCH Y a f I - - - . �� , l E `J +$ I O _ I-. - : . OBSERVATION HOLE 1 08SERVAT ON H LE 2 _ c�.�,1 -` EL£V. £L£V. C „� . -0.00 -0.00 f I BREAKOUT CALCULATION. " � Y` -.: , �, .. , r: r. .. - - :: C St t . : -.�L 1 r i'��.L. :.. - .... I..:' - # LEGEND. 0 c� MIz � r� . EXISTING SPOT ELEVATION 00 0 , - X P .: . _ _ , • EXISTING CONTOUR 00 c� # .� r . t : t 1- 4 i .. . : _ s iL'" 'L� . , , ...< .� �. FINAL SPOT ELEVATION 00,0 ' -� ;- �': v , . , l t_ . _ , ' f . _. FINAL CONTOUR., �._r , ECG ,3 .W .T_ t ��. Q W V. WA A7 E EV, _ .r, _ N ATER AT ELE __. TER L SOIL TEST PIT LOCATION Y TOWN wA7£R C. 1 i SEPTIC TANK C :7 , \ . I - DISTRIBUTION BOX .. : \/ : N , I WAT R LE EL ADJUSTMENT. f NG T, _ tom}, _ PRIMARY. LEAC II Pt O , tf R _ ,. _ VE LEACH{NG PIT _ � - RESER ., , - _ s l , , t , L ,� , __._ ; ,. : S Q TE WATER LEVEL , P E _ TE T A !, , a , 6 I ...� 2 W iN EX' WELL ._ . . . Fax , W R RANG ZON t4 � WAR LEVEL E E 1 � �.� .. in ,- i Its INITIAL ISSUE W _ _ - ' DEPTH TO ATER •LEVEL F R tNQEX .WELL _ N RIPTIO r o NO. D TE DESC BY �. . A - _. . __ ._ OR TNlS MONTH c I r� , . , . S]`TE PL AN & SEPTIC ICE SIG W R VEL AD US7M N: _. - � � ATE LE J E 7 ,.,.. �,, t i , C I PTH TO IGH WATER �, . 4 DE H �.,. _F _ C i ._ _ V I A : .: N LC` ' I 5' r'C1 - , �p B. S Tt S r� DT MSStiU1 , - . , H 0 II Ir F c fOR :' : : P q 0 s . : . : �. 9 ,_ _ _ 2, A i R VE OPMENTO. INC. - _ GREENBRE TEE L , L . , Vl , _ APPROVED, BOAR OF HEALTH r j p ._. w - /. _ JOB No. 1472 , SCALE, 0 . ; �, 1 4 , , o i :� ,�� II I. LI Ir IIr ILI F -.. - . .-. j : :... :. .tip... :. w. DG & AG R S4CIAfi�S C. T P N , LEVI', ELDRE E W NE AS I� "I -DATE - >jEP!A T Q� - ENNGWE I.Alll?SC9PE dlCTS U� , _, 889 WEST MAIN STREET T RVILS,E M� 02632 CEN E L III „ . , m _ .