HomeMy WebLinkAbout0049 PARKER ROAD - Health E
ker
Road
ville P
138
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE:OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENTOF ENVIRONMENTAL: PROTECTION
RECEIVES
,BAN.,O 8. ZQ03
TOWN OF BARNSTABLE
_ 1 TITLES HEALTH DEPT ' ..,,
OFFICIAL INSPECTIONIFORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:49 Parker 'Rd_
nGtervi 1 1 P', _MA" 0 2 655 1 1
Owner's Name: Martin Ta-MpLe8 MAP
Owner's Address:
PARCEL
Date of inspection: %/}— �-...o ') . .LOT - - ---
Name of Inspector:(please print) William F_ . Robinson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address:-PO'
Box 1089
Centetville',' MA .,
Telephone Number: (_508) 775-8776
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 the inspection.The inspection was performed based on my
training and ex,perience,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 15.600) The system: . .
4,1fa-sses _
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: - v Date: oPl4.2p?-"
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatthlor.
DEP)within 30 days of completing this inspection.If the system is a shared system or bas 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.
Notes and Comments
****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.
Title 5 Inspection Form 6/15/2000 page 1
t
Page 2 of l l t
OFFICIAL INSPE.CTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM.INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 49 Parker Rd.
Osterville MA 02655
Owner. Lempres
Date of]nspection:/1J ��"�
Inspection Summary.,Check A,B,C,D or E/ALWAYS complete`all of Section D
A.��ew`Passes:
any of the
des
1 have not found any inform criteria
which indicates `evaluated areailure utdicatedebelow Bribed in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failurecriteria no
Comments._ ..� qAiaf
.:T�JtiJw'i
• c�= , ; as '
B. Sy tem Conditionally Passes:
or
ne or more system components as described in the"Conditional Pass'section need to be replaced 11
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer s,no or not determined(Y,N,ND)in the for the following statements;If"not determined"please
explain.
c e septic tank is metal and over 20 years old•or the septic tank(whether metal or not)is structurally
uns d,exhibits substantial infiltration or exfiltration or tank failrire is imminent System will pass inspection if the
e . ting 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.
N explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
Ob
obs cted
Ob pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
appr val of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND exp ain:
e system required pumping more than 4 dunes a year due to broken or obstructed pipe(s)•The system will
pass ins ection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND ex l in:
Page 3 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART-
CERTIFICATION(continued)
Property Address: 4 9 Parker Rd.
Osterville, MA 02655
Owner: Lempres
Date of Inspection:to—OA-0 �---
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 fai ' g to protect public health,safety or the environment.
1. System will pass unless Board of Health determines m'accordance with 310 CM1115.303(1)(b),that the--
ystem.is not functioning in a manner which will protect public health,safety.and the environment:
L.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.;
2. Sy tem will fail unless the-Board of Health(and Public Water Supplier,if any)determines that the
system is,funct'ioning 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
sur ace water supply or.tributary to'a surface water supply: n
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.,
The system has aseptic 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.front a
pr vate water supply well".Method used to determine distance
• This system passes if the well water analysis,performed at-a DEP certified laboratory,for colifotm
acteria and volatile organic compounds indicates that the well is free from pollution from that facility and:
e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
ailure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSET MEENTS
S YSTEM.INSPECTION
SUBSURFACE SEWAGE DISPOSAL-PART A
CERTIFICATION(co:
nt in ued
)
Property Address: 49 Parker Rd. ,
Osterville MA 0265
Owner. Lempres
Date of Inspection: �� s
D. System Failure Criteria applicable to all systems:.
Yo must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component d to overloaded
o the surface of th gror surface waters d e to an overloaded or
Discharge or ponding of effluent te .4.ground or.s # ,
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 thin 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 well.
Any,portion of a cesspool or privy is within 50 feet of a pnvate.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 coli for m bacteria and volatile organic compounds
indicates that the well is free from pollution from that fpaonia
pilityro tided that no other faof ilure criteria
nitrogen and nitrate nitrogen is equal to or less than 5 m,p
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)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 a considered a large system the system must serve.a facility with a design now o[10,000 gpd to I5,000
gPd-
You ust indicate either"yes"or"no"to each of the following:
(The ollowing criteria apply to large systems in addition to the criteria above)
yes o
_ the system is within 400 feet of a surface drinking Water Supply
_ the system is within 200 feet of a tributary to a sm face drinking water supply
_ the system is located in a nitrogen sensitive area(lnterim Wellhead Protection Area—IWPA)or a mapped
Zone Il 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
y or of any large system considered a
"yes"in Section D above the large system has failed.The c"cr ar operator
signi scant threat under Section E or failed under Section D shall upgrade
the system the stepain tic ordance with 310 CMR
15.3 4.The system owner should contact the appropriateregional office
4
Page 5 of 1 l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE`DISPOSAL SYSTEk INSPECTION FORM°�"
'PART B ,
CHECKLIST`.'
4
Property Address: 49 parker -Rd.
Osterville, MA 02655
.. s
Owner: Lempres
Date of Inspection:•/0—„,;t 0 a—
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes NJ
_ _ 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
1�/ Have large volumes of water been introduced to the system recently or as part of this inspection T;
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
__iz/ _ 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?
_ V 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:.
Yes fExisting
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(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 49 Parker Rd.
Osterville, MA 02655
Lem res
Owner: p .... _ ..., ._:. ,
Date of Inspection: �--
FLOW CONDITIONS
RESIDENTIAL. ,
Number of bedrooms(design):., Number of bedrooms(actual): �.
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 6710
Number of current residents:-- �
Does residence have a garbage grinder(yes or no): ,Lv
Is laundry on a separate sewage system(yes or rio):.A [if yes separate inspection required]
Laundry system inspected(yes or no):�16`
Seasonal use:(yes or no):�,
Water meter readings,if av lable(last 2 years usage(gpd)): ' 01 =88,0 0 0 'qa1
Sump pump(yes or no):,mod ' 0 0-1 3 4, 0 0 0 g a l
Last date of occupancy:
COMM CIAL/INDU RIAL
Type of es blishmenr.
Design flo (based on 310 CMR 15.203): gpd
Ba is of det
flow(seats/persons/sgft,etc.):
Grease trapsent(yes or no):_ -
Industrial w ste holding tank present(yes or no):_
Non-rani waste discharged to the Title 5 system(yes or no) _
Water mete readings,if available:
Last date o occupancy/use:
OTHER escribe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): L4-0
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYP F SYSTEM
eptic 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)
_Tight tank Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and sow a of information:
S 2-
Were sewage odors detected when arriving at the site(yes or no): 0
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM=NOTFOR_VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORME
PART C ,..
SYSTEM INFORMATION(continued) a
Property Address: 49 Parker Rd.
Osterville. MA 02655
Owner: Lempres
Date of Inspection:
BUI DING SEWER(locate on site plan)
Depth elow grade
Mated is of construction cast iron _40 PVC< ._other(explain):
_ n
Distan a from private water supply well or suction line:
Co nts(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK-
(locate on site plan)
Depth below grade: lv t�
Material of construction: /concrete_metal fiberglass__polyethylene",,
—other(explain) ,.
If tank is metal list age:_ Is age confirmed-by med•by a Certificate of Compliance(yes or.no):_(attach a cooy of
certificate) , t
Dimensions• .4i Q `#" 1 6
Sludge depth: t� .
Distance from top of sludge to bottom of outlet tee or baffle: _
Scum thickness: / t
Distance from top of scum to top of outlet tee or baffle: d a
Distance from bottom of scum to bottom of utlet tee or baffle:l
How were dimensions determined: D Lam' -VIA, w 1�
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels. '
as relatpdut_o�outlet invert,evidence of.leakage etc.):
GREASE TRAP:—(loeate on site plan)
Depth below grade:—
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
I
1 7
Page 8 of i l
OFFICIAL INSPECTION FORM-NOT FORNO EM INS ECTION FOR1Vi ASSESSMENTS
SUBSURFACE SEWAGE DISPp�T`'CYST
SYSTEM'-INFORMATION(continued) r
Address: ^19 Park
c�r 1�
Property n4 i 1 1 P� teA 02655
Owner:
Date of Inspection: /
TANK-- (tank must be pumped at time of inspection)(locate on site plan)
TIGHT or HOLD
Depth below grade: fiber lass olyethylene other(explain)
Material of constructio
concrete in g -- -P
Dimensions: allons _..
Capacity: allons/day
Design Flow:
Alarm present(yes o no):
Alarm level:
Alarm in working order(yes or no):
Date of last pump g:
Comments(cond' ion of alarm and float switches,etc.):
r
i
DISTRIBUTION BOX: if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: m, evidence of
Depth
ofComments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any
leakage into or out of box,etc.):
PUMP CRAM ER: (locate on site plan)
Pumps in work' g order(yes or no):
Alarms in wor' ng order(yes or no):
ondition of pumps and appurtenances,etc.):
Comments(n a condition of pump chamber,c
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM,-NOT;FOR VOLUNTARY ASSESSMENTSi
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM-
-Clu : . ..
SYSTEM INFORMATION(continued)
Property Address: 49 Parker Rd.
Osterville, MA 02655
Owner: Lempres
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) 4
If SAS not located explain why:
Type
leaching pits,number:_
� 5aching chambers,number:
✓ leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/altemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
CESS OOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number d configuration:
Depth—t of liquid to inlet invert:
Depth of s lids layer:
Depth of sc m layer:
Dimension of cesspool:
Materials o construction:
Indication o groundwater inflow(yes or no):
Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensi ns:
Depth o solids:
Comm is(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 49 Parker Rd.
s ervi e, 02655
Owner: T.PmnrP.-,
Date of Inspection: Pa��
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
5; l�
1
�b
0
10
Page I I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 49 Parker. Rd.
s ervi e, MA 02655
Owner: Lempres
Date.of Inspection: i �2
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water-2 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked,date of design plan reviewed:
Observed site(abutting property/observation hole within I50 feet of SAS)
Checked with local Board of Health-explain: /s' s
Checked with local excavators,installers-(attach documentati n)
Accessed USGS database-explain:
You must describe how you established the high ground water elev tion:
P 46j s 5 6 —�
- 11
'•. ,per
-\ COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE- FFICE OF ENVIRONIVIE17AL AFFAIRS
`'=DEPARTMENT OF ENVIRONMENTAL; PROTECTION
of ° 1
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART•A
CERTIFICATION
Property Address: �9 �'pr'k�v �.� �� 40
Owner's Name: 6;&42 I cu. CAGrZih e A9M n e h
Owner's Address: g Y
Date of Inspection: /0 /2 VC-7 q00 1.
Name of Inspector: (please print) ToAn , ma 1
Company Name:, 19b," Aa h',- a-15-k e Sirup�a ' ,"�t'" !-Z'
Mailing Address .
di" D1 G y
Telephone Number: -
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 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 15.009). The system:
asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: J''O�/2"00
The system inspector shall submi a copy of this inspection report to the.Approving Authority(Board of Health or
DEP)within 30•days of completing this inspection.If the system is a shared system or has a design flow of 10,000.
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****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.
Title-5 Inspection Form 6/15/2000 page 1
Page 2 of l l
OFFICIAL INSPECTION FORM—N6iTi6R'VOI -UNTARY:ASSESSMWM,- -S ,.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEP'ION FORM
PART A
CERTIFICATION continued'
Property Address: Cl Ar Pv
Owner: PN,C d-en w."
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete aH otSe� ;l 0,,"..,,
A. System Passes:
_ I have not found any information which indicates.that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"sectic'n,need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. .
Answer yes,no or not determined(Y,N,ND)in the 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 faiha+e 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 ifla d"e'rtificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
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 pipes)are rgA4 ed
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obsti`trizted pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced .
obstruction is removed
ND explain:
2
y
Page 3 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART
CERTIFICATION;(continued)
Property Address: y9 P-04er
Ds#w!/P. a_
Owner: -sc' C�av fly'e ahr�.,tti
Date of Inspection: /O� /1—cep
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
2. System will
, t fail unless the Board of Health(and Public Water Suppler,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 ofp Sublic water supply.
_ The system has a septic tank and SAS and the SAS.ismithin 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 froni 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 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,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form,
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOTFOR VOLUNTARY ASSESSMENTS /
SUBSURFACE SEWAGE DISPOSALSYSTEM:INSPECTION:FOR1Vl
PART-A
CERTIFICATION:(continued)
Property Address: 47
Owner:
Date of Inspection: 0—%Z—e—,V ,
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 16ss than '/z 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 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-501eet from aprivate water
supply well with no acceptable water quality analysis. [This system pames,if the•well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and Noltile 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,provided that no other failure criteria '
are triggered.A copy of the.analysis must be attached to this form.],y„��,
(Yes/No)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•
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)
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(Lnterirn Wellhead Protection Area—I WPA)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 systerri;i-naaccordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Depa f&nt.
4
I
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: yq grK.or
Owner: /!H-e 0-lA7"-f`-7
Date of Inspection: &2 f 2—FAO
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
t/ 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? y y
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? ;.►,r
The size and location of the Soil Absorption System(SAS)on the site has{peen determined based on:
Yes no
✓ — 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 15302(3)(b)]
� r
Page 6 of 11
OFFICIAL INSPECTION.FORM-NOT FOR'YOLUNTARY.ASSESSMENTS ,
SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM
PART C '
SYSTEMINFORMATION ;k
Property Address: nee
S vv ! u
1
Owner: {�1v1 l� '.•`��
Date of Inspection: /D— /Z—OD
FLOW CONDITIONS
RESIDENTIAL -
Number of bedrooms(design): Number of bedrooms(actual):�L
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x It of bedrooms):,.
Number of current residents: y
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no):,L [if yes separate inspection required]
Laundry system inspected(yes or no): PS
Seasonal use: (yes or no):_61,0
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):_ c,
Last date of occupancy: ota/
COMMERCIAL/INDUSTRIAL
Type of establishment: .
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available: .
Last date of occupancy/use:
OTHER(describe): -
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): Me
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 currant operation and maintenance contract(to be
obtained from system owner)
_Tight tank —Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components,date installed(if known)and source of information ,,r;
2 y-92 '
Were sewage odors detected when arriving at the site(yes or no):ZL/_b
6
Page 7 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 11q q !�- Igal
Owner: �wR� ®—(Li4-,fe-,�e 12.ltivl.l-1
Date of Inspection: le—12—DO
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron 40 PV _other(explain):
Distance from private water supply well ors on line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade: ,?
.Material of construction: concret _metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: la,
/
Sludge depth: z''
Distance from top of sludge to bottom of outlet tee or baffle: 2 G
Scum thickness: Y
Distance from top of scum to top of outlet tee or baffle: r r
Distance from bottom of scum to bottom of outlet tee or baffle: `
How were dimensions determined., k J-u�rr
Comments(on pumping recommendations,inlet and utlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evid�eejn--ce of.leakazQe,etc.): TIC, !- /
J, 7e TL1N/� 7NhC//dH/Hc) �4��}14t./!iI'L,. SrrN�IHu� /'.r/� "d
GREASE TRAP:_(locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
p
7
n
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT.FORVOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM. FORM"
SU
Y
�'C
PAR
SYSTEM INFORMATION(continued)
e
Property Address: y9 P rb.. Ro
Owner:
Date of Inspection:
TIGHT or HOLDING TANK: (tank must be pumped at time of urspetiion)(lsatate tm site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene .other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: o" y"
Comments(note if box is level and distribution to outlets equal,any evidence of solidg carryover,any evidence of
leakage into or out of box,etc): // / I
d S l(vt / Qcl-l-e 1�v-e ! IG�Qh✓ /i u
i / ' NOre/0"'
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
r
8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continuedy;;.,
Property Address: 9 A fr Gr
Owner: l •!h t -Pe-Oi"(il
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS no a t located � Y
explain w :
P 1
LAud, Ga Sys
Type
leaching pits,number:_
leaching chambers,number:
V 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.): ,
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 or no):
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,conLidn of vegetation,etc.):
9
Page 10 of l l
OFFICIAL INSPECTION FORM—NOT,FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM
PART.:C - ,
SYSTEM INFORMATION(continued)
Property Address: 79 PaXAlr A
l
Owner: ko ehe Pfh'Hl'-' .
Date of Inspection: /(1-11-00 _
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
1q
Tit
1" 10 cavte S6 ,
2 309„
® d ,J /ov' 0,
%
«err
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C r',.►�r
SYSTEM INFORMATION(continued)
Property Address:_ �9 a✓ 41_
Owner:
Date of Inspection:
SLT.F�EXAM '
to :.�.� • .
Surface water ';-►t
Check cellar
Shallow wells
Estimated depth to ground water 23 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
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)
L,,gccessed USGS database-explain: zl-54Z &11A4,4jgc_a�4 ,, ggll •«er
You must describe how you established the:high ground water elevation:
/T,
Ul?�IMt{ �i GI YOfcf//[�� c 4 sS /:S :3,9
41
et
• 3 k .
/ 1)0'.
• 11
w
TOWN OF BARNSTABLE
LOCATIO P,qp &ff� SEWAGE #
LEL
VILLAGE ASSE SOR'S MAP & LOT I" P87 lm
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY (C7
LEACHING FACILITY:(type) e� (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: - -`/� y�I
DATE COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
9
' O
CA
I
16 co CALtolq
. 63
�EPrrL7l�
i
Fizz M........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH conc=Z=31hpartment
,r 4�,Opp,)............OF........15A.P.),4S... .AOL---e........ ..........
- d Appliration for Bi"oiial Wo #V,81
parks Tonstrurtion rr It
Date
Application is hereby made for a Permit to Construct,��) or Repair an Individual Sewage Disposal
System at:
MA ........W..V
12AR -9 V
_q.. ....................Xe.j.......... .. ................. ......1-5.5.............................
Location-Address
�..............
..........................................ti......................... .....
0,,,,wne.r 're S
Q..........az '27--- ...4.."A
/, Address
Type of Buildin CCIV-5—/ / Size Lot---S.. D.I.I.Sq. feet
9 _k
U oms..........5.............................Expansion Attic ( )Dwelling—No. of Bedrooms.__....... Garbage Grinder
4
PL4 Other—Type of Building BAX_R.�?........... No. of persons....41.................... Showers Cafeteria
P4Other fixtures ......................................................................................................................................................
Design Flow............ ......_....... ...._gallons per personper day. Total dail fl -0 ......... I
Ww..............0.6
Liquid capacit I - .
Septic Tank 0 allons Length. .- Width5.�. .... Diameter-_--_---.---_. Dem 0
Disposal 06VAl"IN........G........ Midth....10........... Total Length......a.Q.I.... Total leaching area.AiL.4.....sq. ft.
Seepage Pit No..................... Diameter............._...... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.... jx ........... Date.....1. ...............
�_l ba.
P_a Test Pit No. I................minutes perinch Depth of Test Pit.....11........... Depth to ground water.....
Test Pit No. 2........2......minutes per inch epth of �est�:-._I'��..�.:: Depth to ground water. N.0.144N9 ! rTp� ob.... 7. ;t
0 Description of Soil.... .. ......
�4 Y---- -------- -
U ........&nv 690-
�0W .1 ............................................
............... ----------G VV------------------- -----------------------------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ed by t*. a,. of d4
Signed...... ............. ......A. .........
Application Approved By.... . ........ ..............
Application Disapproved for the following reasons:... ..................... ....................................................................................
. ........ ...... ............................................................................../--------J7-----------------------------
-, q
Permit No... .. .. . .......-------------7------------- Issued......... l 1C17 'e-------
No
� ` ,f
THE COMMONWEALTH`.OF MASSACHUSETTS
` BOARD OF HEALTH
---_.... 0 ........... OF.........5 a 7: ........................
Appliratilaat for Uh4paii al 10ork.5 Tomitratrtivat Famit
Application is hereby made for a Permit to Construct (j or Repair ( ) an Individual Sewage Disposal
System at m
Location-Address or Lot No.
.................................................................................................. -•---...---•---._._......-•-••-......------•••---•-•-•--------••--•...........--••------...•---••.
Owner Address
W
�-� •.• -•--•- -------•• ----------- --- --••----------••-•-••-••--•-••-•-••------ •--•..................................
-•------.._..-------......---
Installer Address
Type of a Building P ( ) Size Lot.-__ ► _ _Sq. feet Dwelling No. of Bedrooms._.._ .__._Ex Expansion Attic Garbage Grinder
Other—Type of Building _0A- ...... No. of persons.....OZs.................. Showers ( )`— Cafeteria
F
dOther fixtures .....................................-•-•--•----- •--•--•-•--••..... ------- ------•---- •-= ••-•----- -----
W Design Flow_..... _._ .... gallons per person er da . Total daily ow................ -6 __.__.. to s
y �
P; Septic Tank—Liqu>d,.capactty . ..__!gallons ,Length.l.�.~° _. Width ... Diameter________________ e th ..... _.
x Disposal RJAL- ....._._.G....... 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
`" Performed b . . t ".......... Date.._ '1 �- __
a Percolation Test Results yit'Aluo.f-IWJ � . - /i
Test Pit No. I......� :minutes per inch Depth of Test Pita........ Depth to ground water $ c'
W I V minutes�er �inch -Deptho e � .' ". Pt,�� r1�4J ......1 _...O '.
f=, Test Pit No. 2_____ _-_ 'J fat
�-v
Description of Soil..... P`1! ,
b d
x , '
............... .. -
V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------
----------------------------------------•--••------------•-•----•-•-•--••-•-••-••-•....--•----•-•---•-•-•••-----••--••---•------•••-•------------------------.........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
TT�=1 ^
the provisions of .T= 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
.1 Signed ........
.
a1 l.. D�t
Application Approved B . .. f =.......... - ._.•: { .L �.. _. ._.
PP PP Y•-• --•-• -4'
/ 15ate
Application Disapproved for the following reasons:.. ..........................................................................................................
..------•-•---------------•-•-•----- == ---•-•......•.-•-•---- -•-•- --•---••-
1 J� -----•--------•-•-
ate
� .... -----•.Issued.......... ..-Permit No. THE ate
COMMONWEALTH OF MASSACHUSETTS
BOARD O. HEALTH
G< (/ ,I ....OF........
�a[.... ... >..:... .. ............
Trrfif iratr of ToutpliFaatrr /
PL , dual Sege Disposal System constructed ( or RepairedZZ . _by THIS i ,�i�T That rIn vtt f ----••••-••-•-•--•--•---T i 7
n P� ! i °$
taller 1 /
has been installed in accordance with the provisions of TIT/ r�5-of Tete,t Sanitary Code as described in the
application for Disposal Works Construction Permit No...._.`_9._�_,,_.._,,}} 1 dated.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................1,ti-^__):R.'4................................ Inspector.--------.YJ
_.__-------•---________
THE COMMONWEALTH OF MASSACHUSETTS
OARD O H ALT
NO..j _.__,.,__.y__ FEE.
Dispos �_ !"orkv Qlnno tan rrmi#
' �
.............Permission i ereby granted..-••---.
to ConsiSys em
a. �oredp airy a.,n In--�:rv- :.) s ---- i_ ��� - y• ..... >•- •--------------------•-----••--•-•--Isteei � Ll f ........
as shown on the application for Disposal Works Construction Permit No:____ ?fir.,------- D4,ted..........................................
.................................... .7- - -------------------------------------------------
Board of Health
DATE...............................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
DES I GN CR I T ER I A : INVERT ELEVATIONS; -
GENERAL NOTES: DESIGN FLOW: INVERT AT BUILDING: 110.00
C£ ^47- 6 BEDROOMS AT I1 O G. P. D. PER INVERT IN SEPTIC TANK; , 6
THIS PLAN IS FOR THE DESIGN AND A147 - AccEss COVERS Musr t7 C? 35
112 FIRST 2' To BEDROOM EOUAL S�6— G. P. D INVERT OUT SEPTIC TANK:� 4
CONSTRUCTION OF THE SEWAGE DISPOSAL ,5 �• ��`'�''�,,, BE WITHIN 12 of 1 Qg,05
FACIL I TY ONLY. FINISH GRADE
6E LEVEL NO GARBAGE GRINDER INVERT 1N Dlsr. aox:
-` \�,,� ,��
. �`-�' � �;� INVERT OUT DIST. BOX: 108• $$
4 PVC y — MIN. 2 OF
f 1�_ _ _ 3- - SEPTIC TANK REOU I RED; t * 103.00
2. ALL CONSTRUCTION METHODS AND scHEDUL E 40 T0 �r -- PEAsroNE I NVERT IIV 6AL�.PYS
- loq-35 , . � G�Coo G. P. D. X 150°. = 9 O 7 0
MATERIALS FOR THE SEPTIC SYSTEM OOGAL — 1 o8•$8 / p-- ----314 ' - 1112" _--_ GAL . BOTTOM OF GAU, &yaf'
SEPTIC TANK 3�� j, u DIA. WASHED SEPTIC TANK PROVIDED: 1 500 GAL ADJUSTED GROUND WATER:
SHALL CONFORM TO MASS. D. E. P. — 0 TL Er STONE
TITLE 5 AND LOCAL BOARD OF HEALTH _ (o' MIN_ D-Box -1 SIZE OF LEACHING FACILITY OBSERVED GROUND WATER; IJ OW�
REGULATIONS.
G ;171lt��.�'�'� 1�I/��' �,"'!'Q Nt REOU I RED; roCv O G. P. D.
PROFILE : NO TO SCAT_ #-�.p DESIGN FERC RATE = - MIN/INCH
3. ALL SEPTIC SYSTEM COMPONENTS LOCATE'D � REVISIONS:
UNDER PAVEMENT SHALL BE DESIGNED TO {t� '�� ���I R��
PRO IDEU:_9?'6ftt9YS W/ _03—'STN. N0. DATE REVISION
WITHSTAND H-20 LOADING. LC 1-16-rirL GALLEYS ! 1J SIDEWALL: �G°g' S. F. X 2•�J = G G()GPD
S�`fszA'rA . BOTTOM: 3 y d S. F. X 1, 0 0 GPD -
4. ALL SEWER PIPE SHALL BE SCHEDUI_E 40 ----- -
OR APPROVED EQUAL. TOTAL; _ (iA S. F. 9 GQ GPD
5. BEFORE CONSTRUCTION CALL "DIG-SAFE " ,x 0 SOILPIT TEST T DATA 9
l-800-322-4844 FOR L OCA T l ON OF $�66 ��O • � r� ' ' 1C�
• �! INDICATES _� INDICATES
UNDERGROUND UTILITIES. PERCOLATION OBSERVED
r TEST GROUNDWATER
6. VERTICAL DATUM IS: ,4 '//i"''c-._f ,,'; , Ry(11 OF ,�„ P•TOdA�
R. ^�r'cti ROGER
7. BENCH MARK USED: TPs
-'` wit �
3 GRND EL ►0 3
} No. 32443 ci MICHNIEWIC a C'RND EL.1SZriDi 9
+ f' �' No.30420 '
ti4 '~ .o T CIVIL 4 G. W. . NQ111 . G. W. EL.s11LNLe
8. FOR BENCH MARKS SET, SEE SITE PLAN. `�, G F_(.
•,:-,-, .�.: . _ �` N TOPSOIL.
T"e 'PP 0P05C V 'DW 9 LL)N G 1;Ct"L,NGF?S
'1 t?P•,�q 1�
A PRV )0L> 17WELL11-aG ► }l I T � 1_0 I� 0J � ' 7 S
�vti�)Gla WAS r� noL{5ut� i oc-cor.� 1�197
DA TE �aaC1�Q, SA�T�
?E PRO E SIONAL E GINEER C IL Y
5�L.-�
f�a 61-{o�.�t,.� {5 5)ZG s.� PR�FES ON LANDS EYOR _ DAB 1 � 5ti�'r'
TO ,�sG1.U37� n �L)-V0 �'� C?T)17,60A CLGI `r
Cc' EL 108.3
24
' �vM
F
`-y -
i
KA v +.l p WATto,
0 DA T E:
PrpP �' I;� TEST BY:-�,- _ N�p•E.
`V 'D 0�a�r4
x p 0 r ARAGf 1v WITNESSED BY: T.
dU ?l1 h r I - '
O "�y a� i PE.RC. RATE MINI INCH ITJ
Q.n)w0_ z - Q M 171um SA hi
rR,b>?a5F Ina F- C)dj
LEGEND
w/3 50 - EXISTING CONTOUR
.................. ,.�5 .. _ = PROPOSED CONTOUR
T' '!'0a� Rai i 50 = PROPOSED SPOT GRADE�o
p0 a b I -
Z W „) Cl 7�►•, ►� 8 - DIRECTION OF STORMAWTER
a
-A � F�UNOFF
=2 7 _.
Q
�Oi, �c�a°jQI 3 p,4q
P
v O .
�{ ► o, PLAN SHOWING THE DESIGN OF A PROPOSED
SUBSURFACE SEPTIC DISPOSAL SYSTEM
o 10 3 `�� AS3ESS�RS AP 1 ASSESSORS MAP 117, PARCEL 138
1AR L 138 OFF PARKER ROAD, BARNSTABL E, MA
6018 S.
SCALE IN = 30 ' OCTOBER 7, 1992
1 e 99-�- EAGLE SURVEYING G ENGINEERING, INC.
44 a------ 1 ROUTE 130, SANDWICH, MA
PROJECT NUMBER 92-120