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Home My WebLink About0063 POPLAR DRIVE - Health k,C63Poplar Drive erville P 121 044 f a m y i No. Fee ��t�, THE COMMONWtALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSAC.HUSETTS Yes ftplitation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair OE) Upgrade( ) Abandon( ) ❑Complete System aidividual Components Oe ti Address or Lot No; wner's Name,Address,and Tel. o. $ © A7 pi �;tve; si�-i-✓� Iles ` e�ar� R _,d�,..nessor's Map/Parcel I a i �3 yp kq� Dom%y-� O �I �2 Installer's Nay Address,and Tel.No.50Ff—775-8"7710 Des' ner's Name,Address,and Tel.No.ors 364—OSMq fin^ K�?I©i Sw• S 2 S e ��- CC)j Bc h ® &c»c 1091, 'Tjhi 0-n 1 ' rd e Sam,, .o►c ,, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A)9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 330 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 aw L Type of S.A.S. ti ^ Can Description of Soil Nature of Repairs or Alterations(Answer when applicable)T(-1(&+oL_Q 0 1 , -VA-eS Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r S' t- Date F"2 a �' Application Approved by Date —p 17 Application Disapproved by Date for the following reasons Permit No. 2-w-cl —. 7-r— Date Issued —a� i .,. �..-i`m�4.r..r...s.•«-_'.. wA...a.i.,,.S..rvircr ,wFti..�.„;,�irv�,F.��-...,:,�Mi�t• - ti,.y�, , ^x Fee No r `s 00, THE COMMONWEALTH OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppflcation for Misposai 6pstettt Construction Vermit Application for a Permit to Construct( ) Repair()0 Upgrade( ) Abandon( ) ❑Complete System Q,Individual Components LocatingAddress or Lot No; Owner's Name,Address,and Tel.]. -D . V •O(�7 t'©p) c —Dc'1ve, pS+�trV1 Ile.. &erarO ;,Uo rre f-1�M5ico` Assessor'sMap/Parcel 1 a i 44 (03 T('a (ax- Tnck V-e. 05<.c',1i \t p Installer's Name,Address,and Tel.No.50&-775-8' 7�(,a Designer's Name,Address,and Tel.No.S0S-736q w 08'9f4 Sa, S R_ S e-T4,C YO &N 1 O C en4e tir J e )1 e ` rd e, S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(09 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3P gpd Design flow provided fl gpd a Plan I Date Number of sheets Revision Date Title / r ` - Size of Septic Tank )fillu p w@ s?,ti, Type of S.A.S. �1 +� 4 f 1, C ho n f-r Description of Soil Nature of Repairs or Alterations(Answer when applicable) O S _�.Y �e� 1 , (� Ctz e,Q•� S J 5� At LIE 31C `f s Date last inspected: v Agreement: C` The undersigned agrees totensure the construction and maintena ce of the afore described on-site sewage disposal system in accordance with the provisions of Title of the'Envii•onmental Code an&.not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. t S' • 11 Date ." Application Approved by T� V Date -p 0) Application Disapproved by ' Date for the following reasons Permit No. q el -1 7�r Date Issued -(j`^ THE COMMONWEALTH OF MASSACHUSETTS Arms'�\--C'I �t BARNSTABLE,MASSACHUSETTS V Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired QC Upgraded( ) Abandoned( )by_- WM IiFL �•(��j.l(�� S e��(� at G b �0(��(�� DQ,. V e Q__ has been constructed in accordance with the prov'sio)njs off Title 5 and the fo Dispfio al System Construction Permit No. r)dy -?7 I,.dated EI?��o e Installer/ )-A � 2 Designer #bedrooms v r Approved desig flow 3 U ,. gpd The issuance of this p''rrm�ittssh'll not be construed as a guarantee that the system ill function/as designee 0 u Date /„!I) Inspector , //� -.!fin / ii r r No. -2 ri, 0 - 7 r Fee THE COMMONWEALTH OF MASSACHUSETTS �5 PUBLIC HEALTH DIVISION'-BARNSTABLE,MASSACHUSETTS bisposal Opstem (Construction i9efmit Permission is hereby granted to Construct( ) Repair Ix. X Upgrade( ) Abandon( ) --- System located at )Pn 2`GLfZ. D(6 4'e Q S+ck J + 1 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction , 'ust be completed within three years of the date of,this pe/it. / Date / �JG y Approved by ti 61 -BA 9 ........ o giflatory Servicei- Ti� Ire or:_,:� --omas Gefaer,,-D BARNSTAT" • ..-WASS..... Ilealth-DWA6w was McKean,Director- -Stteet,_ffY*nhjs;.�MA 01:02 266-Mil'n 6 Offide-_-'50&8624644- Fax: 508490:e6304 .. .. -.4 Installer:& Cerfifitatioh Forin...- er ........... W., 4 essor..s ap el: Date: gr-7-5L Sewage-PertnW-_ ----- --------- AInstaller tUN�esigner: Address:- Az :. le�Q,.-.:Addr-es**s:* _TIJ__:. W -a to-install On- -was issueda permit (date)..... Q" septic system at base- on-a--design drawnby (address _ � .A dated .. (designer) substantially;adcor g 0-- that.the septic:s��tem 16fced above was installed certify . ' �dd.-- the designwhich may include-minor' --approved changes such--asat i relocation of thedistribution box.and/or'septic tank::: initalled-MI I certify that the septic�system.referenced above was.. III MaJOT changes greate r than 10' lateral relocation of the SAS.--or.-any y6ifical telotation of any componen of the septic:system):but in accordan ce`witlf*8tdk�:&Ibcd Regulations: certified as-built by designer to-follow. OF Iqq DAVE - (Installer's Signature) D. COUGMNOWR No 1093 NITARN p Here) -PUM (Designer's.Signature) (Affix-Desigffg PLEASE RETURN TO -IBARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE.:- OF'— T COMPLIANCE WILL NOT-BE.ISSUED" BOTH THIS-FORM AND AS-BUILT CARD: ARE.- REUIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE t�� • � ' LOCATION ops ;�, JA Xk, ' SEWAGE# VILLAGE & ASSESSOR'S.MAP&PARCEL:� ! INSTALLER'S NAME&PHONE NO. J"y�4y /lv#3L1 SEPTIC TANK CAPACITY L LEACHING FACILITY. (type) (size) NO.OF BEDROOMS �3. OWNER PERMIT.DATE: �'— - �^a�' COMPLIANCE DATE: ,� o i. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of aching Facility Feet t' Private Water Supply Well and Leaching Facility(If any w lls exist on .ri r site or within 200 feet of leaching facility) Feet Edge,of Wetland and Leaching Facility(If any wetlands e st within t -� a ,1360 feet of leaching facility) Feet ' FURNISHED BY I � �� FW �7� � •� �. � ��; �, t-_ a Q � N ,ham � c+a` � s � � . � . `-` i e � _ - r �' �h - - � - - k' p TOWN OF BARNSTABLE LATION t9� 1 o p�� 'r• SEWAGE # VI1�L= �E O4lVt�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY UOO GA) LEACHING FACII:ITY: (type) (size) O tf0 N0.OF BEDROOMS, BUILDER OR OWNER I S- 1Jf0 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by R3 w s o0 , F I C I 0 u1 Postage $ 601 Certified Fee o a ru Postark (� O Return Receipt Fee HCL p (Endorsement Required) m CL Restricted Delivery Fee tI CD 0 (Endorsement Required) cc c(3 Total Postage&Fees rq Sent To�— CO QA��1L_ rS t�l 3`treet,Apt No.; or PO Box No. �¢r --------- ------- --------------------------- City,State,ZIP+ L,,// / V1 :•r rr. i Certified Mail Provides: o A mailing receipt - I n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". is If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 SECTIONCOMPLETE"'HIS SENDER: COMPLETE THIS SECTION .ELIVERY ■ Complete items 1,2,and 3.Also complete A Signa X Rem 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee SO that we call return the card to you. B. Received by( ' ted Na e) C. D to of Delivery ■ Attach this card to the back of the mallpiece, �2�' or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from m 1? ❑Yes If YES,enter delivery address below: ❑No 106fl . ViMS� h (,3 Rpldr OS1-V V I I I C j WA A OZ(/SS 3. Cice Typefied Aail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number d (Transfer from servicelabs/) 7 0,U6 18 3 0': PS Form 3811,Februery 2004 Domestic Return Receipt 10259e-02TM-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • i I1 Town of Barnstable 'Health Division 200 Main Street T�T�cannis4MA_02F.(ll�..�.- } I I �I�iflIl�E�lltll'��til!-l.it'IE�i!!1lE6!!'!!!il3itlllPEl1�!lE41l14� OF tFif Tp� Town of Barnstable btftd Barnstable Regulatory Services Department edcaC#v 4 = IIARtVSfAIBM Public Health Division 1639 prF°M'�A 200 Main Street, Hyannis MA 0260.1 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#70081830000205009793 8/18/2009 Joanne Armstrong 63 Poplar Drive Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 63 Poplar Drive was last inspected on April 23 2009,by David Coughanowr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER O ER OF T E BO OF HEALTH omas McKean, R.S., I Agent of the Board of Health Iy Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 April 23, 2009 required for p every page. City/Town State Zip Code Date of Inspection f' 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. ImpoWhen filling A. General Information When filling out 314 �4 zj forms on the - computer,use 1. Inspector: only the tab key to move your David D. Coughanowr, IRS cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name r� 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 1328 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 Z .Fails ❑ Needs Further Evaluation by the Local.Approving Authority r S April p 3, 2009 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions of the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M °V 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 every page. CitylTown 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Poplar Drive M Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 Aril 23, 2009 required for p every page. Cityfrown State Zip Code Date of Inspection B. Certification,(cont.) B) System ConditionaIly.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 El 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 Aril 23 2009 required for p + every page. Cityrrown 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 'h 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 °wM 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 . every page. Cityrrown 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. ❑ E 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 ❑' El Area— IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 every page. Cityrrown 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 El ® 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): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a- no plan 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 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 Aril 23, 2009 required for P every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No current Last date of occupancy: Date 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 f 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 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): Septic tank and leach pit 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 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age unknown—system is assumed to have been installed at time of dwelling's construction in 1976 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: ' feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): ` Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: n.d. 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: Sludge depth: l5ins-09/08. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank not evaluated. Tank should be pumped dry at time of system repair and examined for adequate capacity and structural integrity if it is to be reused 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 April 23, 2009 required for P every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•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 ,M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23 2009 every page. City/Town 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 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.): 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 W Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Poplar Drive M Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 April 23 2009 required for p , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ leaching chambers number: ❑ 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.): A hole was dug into leaching pit stone and effluent contact staining was observed in the stone and overlying soils. Effluent was observed welling up into the hole. Cesspools (cesspool must be.pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer - Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655 April 23, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 63 Poplar Drive Property Address Joanne Armstrong Owner Owner's Name information is Osterville MA 02655 Aril 23 2009 required for p �. every page. City/Town 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 El drawing attached separately LEACH SEPTIC PIT TANK EXISTING DNELLIN,G . . ' El 3 , Z J . NOT TO SCALE 3 I ROPLAR D R I VE t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.;Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Poplar Drive G^M Property Address Joanne Armstrong Owner Owner's Name information is required for Osterville MA 02655, April 23, 2009 every page. City/Town 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: 25 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: Previous inspection report ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Previous inspection report shows property is over 25 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next 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 63 Poplar Drive Property Address Joanne Armstrong Owner Owners Name information is required for Ostery P ille MA 02655 April 23, 2009 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file. l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �00°I - �L-7S '3 - us Max, New 5(ruvkfao ckl MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MAC DOUGALL SURVEY HALL NOT ASSUME LIABILITY FOR ANY OTHER USE). \�� 9 G\�G; � R�50 00• N \ rA\ \ LOT 40 �j 6tfA "i• ,I b � I ed 1, ♦ u LA I. G -. — LOT 39 s�vo o»e 91 75 3p 0 LOT. 41 i I CERTIFY THAT THIS MORTGAGE INSPECTION PLAN WAS PREPARED DI ACOORIMCE WITH 260 CMR SECTION&05 OF THE MASSACHUSEM RULES&REOIRATIOM FOR THE i PRACiCE OF LAND SURVE016 THE BLALDING SHOWN IS NOT AFFECTED BY A SPECIAL FLOC HAZARD AREA AND DOES_CONFUN TO THE LOCAL ZMNO BY-LAYI6 IN EFFECT AT THE 709 OF CONS1RiMON WITH RESPECT TO SEIBACIC REQll is OR IS EXWPT FRW VIOLARON.EIFOR LENT ACTION UNDER 1�SACHUSE TS SAL LAWS CHAPTER 40A SECTION 7.RUMU LACED DEED SUBECT TO AND WITH THE SEHERT OF ALL RIGWM RI6II75 OF Y,EA RESERVATIONS I R£STR3Ci=OF RECORD.F ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT TOWN: BARNSTABLE (OSTERVILLE) DATE: 07/17/09 APPLICANTS: FRANK A_ & JEAN DEPTOLA , CERTIFY T : JOHN W►_ KENNEY SCALE: 1"=30' woFr� a TITLE REF: 16838/334 PLAN REF: 212/153 MacDougall Surveying �® EOINAF3D FLOOD ZONE: "C" & Associates a A. ` COMMUNITY PANEL- P.O. Box 2428 u STONIe..= 250001-0016—D Mashpee, Ma. 02649 n No.289 DATED: 07/02/92 4a ♦PF '° CURRENT ZONING: "RC' p�• (508)4i9-1086 4 �s fax. (508)419-1087 j L o - email: macdougallsurvey 4 JOB# 10514 ftomcast.net ! I k I I I r ��— T LOG DATE OF TEST: AUGUST 19. 2009 UGH � � O T I TEST- � ( _ I�,J, APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 1 L_ f WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12642 1 TEST T PIT T 1 NO GROUNDWATER ENCOUNTERED I I J I I 1 1 1 PARENT MATERIAL: PROGLACIAL OUTWASH —j PERC AT 52 in 2 MIN/INCH. IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL)_ _ MOTTLING _ 52.60 P 0-4 O WOOD LOAM 10 -YR 3%3 NONE FRIABLE 4-5 E LOAMY SAND 10 YR 5/2 NONE FRIABLE { 5-8 A LOAMY SAND 10 YR 4/4 NONEf FRIABLE c 8-36 B LOAMY SAND 10 -YR 5/6 NONE LOOSE 49.60`-:;`�; 36-138 C _.. MEDIUM SAND 10_,Y_ R_5/4 NONE LOOSE , I� 41:10 TEST} T T NO GROUNDWATER ENCOUNTERED I I 1 I PARENT MATERIAL: PROGLACIAL OUTWASH s 2 MIN/INCH IN C SOILS I ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL, OTHER (INCHES) •HORIZON TEXTURE - (MUNSELL) - ' 'MOTTLING •� 52.50 0-3 0 WOOD LOAM -10 YR-3/2 NONE FRIABLE 3-5 E LOAMY SAND 10 YR 5/1 NONE FRIABLE 5-6 A LOAMY SAND 10 YR 4/4 NONE FRIABLE 1 � 8-34 B LOAMY SAND 10 YR 4/6 ' NONE LOOSE 49.67 34-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 41.50 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other` Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. nsi to I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No_✓ Yeses Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally.occurring pervious material exist in.allrareas observed throughout the Area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification NC/ I certify that o n (date)I have passed the soil evaluator examination approved by the De aitment of Environmental Protection and that the above analysis,was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature G�"''" ID S( g Date Q:ISEPTICVERCFORM.DOC Town of Barnstable P# Department of Regulatory Services _ suwareate. : Public Health Division Date tJ(y l� , 26d 9 � t6.59 �� 200 Main Street,Hyannis MA 02601 iOlFD MA't w Date Scheduled a Time Fee Pd. 1410 r Soil Suitability Assessment for Sewage Disposal Performed By: P V t) �.J -. LV�fG F �1�'� Witnessedr By: ! ,✓ Gam„ �G' LOCATION & GENERAL INFORMATION Location Address 63 T Poke �_d, q Owner's Name C / ` P � I ,(� Address Assessor's Map/Parcel: 2,I / 0 jf ei-v. lee ►/l�� Engineer's Name O&VI D 1,. (®U6 f;,10011JP, �S NEW V C'CO NSTRUCTION REPAIR Telephone# S0� �6�" Q� 24 Land Use:—Re-5�d e fi+i ct es s Slo a - ii�j/, P ( ) 1 Surface Stonese- Distances from: Open Water Body L V U ft Possible Wet_Area ft Drinking Water Well 6D ft Drainage Way S6 4 ft Property Line "' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i r� GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARNSTABLE ` ® / GIS DEPARTMENT RECORDS. t T® t INDICATED GW 18.00 INDEX WELL SDW-253 /9��P 1 } ZONE C READING DATE DULY. 2009 READING 49.2 �\ ADJUSTMENT 4.5 ADJUSTED GW 22.5 Parent material(geologic) 7 R�D 6 4�t i ft ©L)TV45� Depth to Bedrock U�0 ji e Depth to Groundwater. Standing Water in Hole: Weeping from Pit Eltca Estimated Seasonal High Groundwater Sep al�g✓e DETtRMINATION FOR SEASONAL HIGH WATER.TABLE Method Used: See v)�)0 v Q Depth Observed standing in obs.hole: in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: \. I In%Groundwater Adjustment ft. Index Well# Reading Date: Index Well level AdJ,factor Adj.Groundwater 1 oval,,, PERCOLATION TEST bate I` 11`)�ITIMo 10 A �A Observation Hole# Time at 9" i r� Depth of Perc 5 Z I h Time at 6" Start Pre-soak Time @ 1 V a l V Time(9"-6") —Lb— End Pre-soak 1 0 r 06 Rate Min./Inch 2l'11�1 Site Suitability Assessment: Site Passed_Vll—*' Site Failed: Additional Testing Needed(Y/N) Original: Public:Healtli Division Observation Hole Data To Be Completed`on Back=- ------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at feast one (1) week prior to beginning. Q:\SEPT10PERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS DEPARTMENT-OF ENVIRONMENTAL PROTECTION kip MAP `Z PARCEL . TITLE 5 LOT -- p OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 63 Poplar Drive Osterville MA 02665 MAR 2 5 2603 Owner's Name: Richard McLaughlin Owner's Address: 12 Tubwreck Drive TOWN OF BA;�NSTABLE Medfield MA 02052 HEALTH pEPT. Date of Inspection: February 22,2003 Name of Inspector: PATRICK M.O'CONNELL . Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: (508)429-1779 ' 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 15.000). The system: Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Off^ lr2Date: Z 7 O The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments System in good working order.Leaching pit has no effluent in bottom,has never had more than two feet standing in pit. ""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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: Febroary 22,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ 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"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. 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 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. 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 pipe(s)are replaced _ 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 obstructed 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 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)(6j#hat 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 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 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 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 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: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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 _X_ 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. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X 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 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.] No_(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(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. Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No _ _X Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? X_ _ 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? X_ — Were all system components,excluding the SAS,located on site _X_ _ 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? _X _ 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 no X_ _ 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:0 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no): No (if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): 2001-32,000 gal. 2002-15,000 gal=64 gpd Sump pump(yes or no): No Last date of occupancy: October,2002 COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqf,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 None Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool T 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 source of information: House built and system installed in 1976 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) _ Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 BUILDING SEWER X (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron_X_40 PVC_other(explain): Distance from private water supply well or suction line: 40' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 18" Material of construction:—X—concrete_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: 8'long x 5.2'wide(1000 gal.) Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank in good condition liquid level at bottom of outlet pipe. GREASE TRAP: No (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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 TIGHT or HOLDING TANK: No (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/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: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of inspection: February 22,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 1 6x6 (1000 gal.) leaching 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.): Leaching pit was empty at time of inspection.Has never had more than two feet of standing effluent in pit. CESSPOOLS: No (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: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:.63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection: February 22,2003 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. �15 a z3 o Page 11 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Poplar Drive,Osterville Owner: Richard McLaughlin Date of Inspection:February 22,2003 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 25 feet. Please indicate(check)all methods used to determine the high groundwater 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) X Accessed USGS database-explain: Town GIS and USGS topo maps. You most describe how you established the high ground water elevation: Town groundwater contour map shows groundwater at el. 15 property above el.40. + x { ; Commonwealth-of Massachusetts Executive Office`of Environmental Affairs - Department of Environmental Protection One Winter Street, Boston MA 02108 (61 2925500 TRUDY COXE a . Secretary ARGEO PAUL CELLUCCI a DAVID B.STRUHS t Commissioner Governor , SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM_ PART A a CERTIFICATION Property Address: 63 Poplar Drive, Osterville, MA Name of Owner: Bettie Bro h ` ' Address of Owner: Same � ? Date of Inspection: September 1, 1999 p Name of Inspector: (Please Print) . James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) - — ,0�� 9 Company Name: James M. Fordj, Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 121 "ke !� Telephone Number: (508)862-9400 • ' ''" cek CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate' and complete as of the time of inspection. The inspection was,performed based'on my training and experience in the proper function and maintenance of on-site sewage disposal systems:The.system: ✓ Passes Conditionally Passes _ t Needs Further Evaluation By the Local Approving Authority ails i ` Se temher 6,,1999' Inspector's Signature' ''•- .. Date: � a The System Inspector shall submit a copyof this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days„ of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable;and the approving authority, s NOTES AND COMMENTS , - revised 9/2/98' Page 1ofII Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 r - INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. ,SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass.. � • Indicate yes,w no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass.inspection if(with approval of the Board of Health) broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE:DISPOSALiSYSTEM INSPECTION FORM_ PART A CERTIFICATION '(continued) Property Address: 63 Poplar Drive, Osterville,MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD_ OF HEALTH: Conditions exist which require further evaluation by the Board of Health in bider to determine if the system is failing to protect the public health, safety and the environment. <, 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYSTEM IS NOT FUNCTIONING.IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND " SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. r 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC.HEALTH AND SAFETY AND. THE ENVIRONMENT: M The system has a septic tank'and soil absorption system(SAS)and-the.SAS.is within 100 feet to a surface water supply or•� tributary to a surface water.supply: _ _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a pubhc,water supply well. _ The system has a septic tank and soil absorption system and the SAS is`within50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than,100 feet but 50 feet or more from a private water supply well,unless a well'water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the preience of armnonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not'valid)'. . ' 3) OTHER _ revised 9/.2/98 Page 3oftt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 D. SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: _ I have determined that one or more of the following failure conditions exist as described in 310 CMR.15.303. The.basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct.the failure. Yes No Backup of sewage into facility or system component due to an 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 '/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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a 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. n of a cesspool' or riv is within 50 feet of a private water supply well. An portion privy p PP Y _ Y Po portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a rivate water supply well with no An g P — — Y p° P� P Y , been analyzed to be acceptable, attach co of well water analysis for water quality analysis. If the well has Y acceptable q y y Y P PY coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No within 400 feet of a surface drinking supply the system is g water pp — — Y 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 The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B . CHECKLIST Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 ,. r Check if the following have beengdone: You must indicate either:••"Yes"'or.."No" as to each:of the following r ;• , _ '" �� Yes No ✓ _ Pumping information was provided by the owner,occupant, or Board of Health ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes*of water have not been introduced into the system recently or as part of this inspection. i ✓ _ As built plans have been obtained and examined. Note if they are not available withsN/A.�,',. ✓ The facility or dwelling was inspected for signs of sewage back-up., ' ✓ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. a - ✓ _ All system components, excluding the Soil Absorption System,have been located on the site F ✓ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,:dimensions,depth of liquid;depth of;sludge;:depth of scum The size and location of the Soil Absorption System on the site has been determined based on: ✓ _ Existing information. For example, Plan at B.O.H.' ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)]. . 5 ✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. k • r revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 1 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No ; If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last two year's usage(gpd): 1998-30 000 izals.; 1997-27,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flow 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped on Oct 30197-per Treatment Plant System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)_and source of information: 1976-per as built card. Sewage odors detected when arriving at the site: (yes or no) No Pa e6of 11 revised 9/2/98 g i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM INFORMATION (continued) Property Address: 63 Poplar Drive, Osterville, MA • - + i+'' a Owner: Bettie Brophy r° Date of Inspection: September 1, 1999 i =v :.' stjr.,, BUILDING SEWER:SEWER: (Locate on site plan) '�.t ,r• ..r.. Depth below grade: Material of construction: _cast iron _40 PVC '_other(explain)'. Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) _ % Depth below grade: 16" _ - Material of construction: ✓concrete metal _Fiberglass _Polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 8'6"x 4'l0"x 5' (1000 Pal.) Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: ` 30" r Scum thickness: 2"- _. ._ _. _ T - v. .,... • .�,_ S ''z Distance from top of scum to top of outlet tee or baffle 10". Distance from bottom of scum to bottom of outlet tee or baffle' 12" r How dimensions were determined:....Measuring-stick..: - _ ._ �_. ;. Comments: c - T (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural'integrity, evidence of leakage,etc.) The baffles were present The liquid level was even with the outlet invert. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal Fiberglass Polyethylene ._other-(explain)•,• -„-r, 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: F Comments: ' (recommendation for pumping,condition of inlet and outlet,tees or baffles, depth of liquid level in relation to outlet invert, structural integrity; evidence ofleakage, etc.)'. revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or 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/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER: None (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.) revised 9/2/98 Page 8oftt I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,PART C / SYSTEM"INFORMATION (continued) } Property Address: 63 Poplar Drive; Osterville, MA a Owner: Bettie Brophy Date of Inspection: September 1, 1999 t ' SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,if possible;excavation not required, location maybe approximated by non--intrusive methods) If not located,explain: fa Type: leaching pits,number: el -6'x 6' leaching chambers,number: _ leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: , overflow cesspool,number: Alternative,system: ° Name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil, condition of vegetation,etc.) The pit had 4'of water on the bottom. The bottom to jerade was 8'6". There were no sirens of failure. CESSPOOLS: None r (locate on site plan) Number and configuration: - Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: f Dimensions of cesspool: - c ` • „ Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection).! Comments: (note condition of soil, signs of hydraulic failure,level of podding,condition of vegetation, etc.) PRIVY: None . (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.) , revised'`�9/2/98 Pap 9of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 63 Poplar Drive, Osterville, MA Owner: Bettie Brophy Date of Inspection: September 1, 1999 Map: 121 Parcel. 044 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � Q a /A i - ss 19', 9 5 revised 9/2/98 Page 10of 11 IJ a h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued),, Property Address: 63 Poplar Drive, Osterville, AM Owner: Bettie Brophy ..' D f Inspection: September 1 1999 Date o nsp p . . , NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate. Deep SITE EXAM Slope Surface water . Check Cellar Shallow wells s Estimated Depth to Groundwater 38 +/- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record e Observed Site(Abutting property,:observation hole,basement sump etc.)` * Determined from local conditions ✓ Checked with local Board of Health ' Checked FEMA Maps Checked pumping records Check local excavators,installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Using the Barnstable Topographic and Water Contours maps, the maps were showing approximately 38' +/- to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the.system,.the inspection and/or this report. 5 - revised 9/2/98 Page 11of11 �F . 1 I CRAIG MEDEIROS �c ing V Tulldoking Hyannis, Mass 775-08 8 , Q � -: f� J _____-- v`� 9 , �tl"� Iy ' __ � S j . . (e`,, /�' it f �� r „� r, t! • r, No..q- ........../y =--- Ficim./d.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O,f HEALTH I r^,4,-1..... .......OF............ ... -........... ----......... - - Appliration -for DID uiittl Varks Towi#rurtion Vrrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at,. I OIT.,i/10 �J ........................st�.1.�/3A!'r.IS .............................................. ......••• • . /.............................................................. � Location-Address v or Lot No. _ Owner ' ��/ Address i Installer Address Type of Building �� /{ Size Lot?6 Z4© Sq. feet Dwelling—No. of Bedrooms...-------� -------°--"!Y-f..Expansion Attic (,,Yo) Garbage Grinder (iVO) Other—Type T e of Buildin p, yp g C�.,P_R %�No. of persons--------7----------------- Showers (Y — Cafeteria (*2�, da Other fixtures -t.. ........ ......./Yo------L'. FL4t?;!A------��,4eldl4? lVale, W Design Flow-------------------------------------------gallons per person per day. T�tal daily flow............................................gallons. WSeptic Tank—Liquid capacity `_ ...gallons Length---------------- Width...-......._..- Diameter-...........--.- Deluhfe°!-tea,4 i x Disposal Trench—,No....................:Width................. Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..�X�. ------ Diameter-..--- ---------- Depth below inlet-----7............ Total leaching area------------------sq. ft. Z Other Distribution box Dosing tank ( �) Percolation Test Results Performed bY------------------------------------------------(---- ------------------- Date------------------------------------- Test Pit No. I----------------minutes per inch Depth of "Pest Pit...fl------------ Depth to ground water..�(v9Lfi. � 2. L14 Test Pit No. 2................minutes per inch Depth of Test Pit..----.---_-------. Depth to ground water...--. ----.....:------- a .---- -"------------------------------------------"---"-•--•-•--•----•---------•-•---•---------.--•-----------•--•---------•-----------•--------------.----- 0 Description of Soil...... '1CAIV----- ` s! c y 3" � 'Af 44'1x ��. .5'�- db '� . l U �----�'-T ...... P-- ------j6T - ---o ------------ ------------------------------------------------=------------------ -- P=�crt. ----------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue�by th board of health. Signed------- --------------------- ...................�. 7� ----------- A lication Approved B 1C Date PPPP Y--------- .- ---••---•----•••---•-•••----•--••---••--•------•------------•-•----•---••..... ---- --------------D -e Application Disapproved for the following reasons:................................................................................................................ -••-•-•--•-----------------•------------•------------------------------------------••-------•---------...--------------------------------------------------------------------------------------------•-- � Date Permit No..... (........................................ Issued.......,�....`r��.. 7�/ Date E�.�r�=•- - _ �.__---------------- -- ----------------------- -- - - - - -- No......................... _ Figs............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OA HEALTH Appliration -for Uifipaoai Works Tutu arnrtinn Vrrmft Application is hereby made for a Permit to Construct . ) or Repair ( ) an Individual Sewage Disposal Sy tem at. `� w , ,� �� + ,c -----------------•-----u� ' " ?!¢.�r t.€ --•----•-`�---------- --------�•--� ---------.�ZAIJ --l- Location Address + or Lot No O Address a � 7 -- -•- � Installer VI A4, Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...-- .--- �,->---..��.Expansion Attic (Ao) Garbage Grinder (ry�d per, Other Type of Building .-..._..................... No. of persons X............... Showers (jr — Cafeteria (y , d W Other' fixtures:" Tk• - 2 ; •!- . t!°.- :fe. - ------------------- -------------•--•----•------- WDesign Flow.:........................................gallons per person per day. Total daily flow......__._-_-.-__._.........................gallons. WSeptic Tank—Liquid,capacity --'---..gallons Length..__----_--_--. Width................ Diameter_-----_.-------Depth........-------. xDisposal Trench—No. ................ Width._..._........-....: Total Length--------------------- Total leaching area--------------------sq. ft. Seepage Pit No j -'...... Diameter_._._...cf..`...... Depth below inlet.......'........ Total leaching area--------------_--sq. ft. Z Other Distribution box ( ,� "Dosing tank ( ` Percolation Test Results Performed by-------------------------------------------------- ... Date----------------------------- --------- p p Depth to ground water...'Yf W Vim. r ., Test Pit No. 1................minutes er inch Depth of Test Pit...�a'`.-__.-___... rZ4 Test Pit No. 2----_----------minutes per inch Depth of Test Pit.................... Depth to ground water........._......---.--., ------ — _----•----•---••-----------• ----------------- ................ •----•-•----•------•--•-------------- D Description of Soil �° 3ltt' ,t .�?t,�.k ' '�'�l'"'Q---, ��N -----j----------------------------------------------------------------------- x -------------------------------- --•••----••-•----•----•---•---•••......-••-----••---••-•---- U -------------------•-------------- W VNature of Repairs or Alterations—Answer when applicable.-..................................................................................:....:.....- ------------------------------------------------------- --•----•--•--- -------------••-••--•--•••--•-•--•••----------••-------------------------------------------....--------------....-..------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system it) operation until a Certificate of Compliance has b ,en sue by thI board of health. Signed...... fl .,.. tLc. ..................... ..� I-�P - - Date ApplicationApproved By................................................................................................... 'Date Application Disapproved for the following reasons:...................... • ..............•-•--•------------•---......--••--•--...----------.........----•-..-••-- Date :, PermitNo.--•••-•••••-•-••••••-•••-••-••......•-•-•••••••--------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ..........................................OF..................................................................................... .� `: err#ifir�#le �f f�um�ti�tnrp THIS IS TO CERTIFY, Th lthe Individ�i-1 Sew ge Disposal System constructed ( ) or Repaired ( ) by `A-k-'0"1- - } ------------- - -------- ---------------------------------------------=- Installer - at has been installed in accordance with the provisions of A./ e XI of The State Sanitary Code as describedaiin the application for Disposal Works Construction Permit No.- .........!--l_.�;•............... dated...(.z-._. 1..._.... %.: THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL-FUNCTION SATISFACTORY. ('7 DATE � �... Inspector... ...... THE COMMONWEALTH OF -MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... _� No.......................... FEE.. ................. —1ntmmtssion is hereby granted.............................................................................................................................................. to Construct`("--�'bf:Repair ( ) an Individual Sewage Disposal System atNo.......................................... ..•-•...•--•-•---••--•................................ Street as shown on the application for Disposal Works Construction W rmit N .. _._..... ...�. Dated.......................................... y�� '�!P-ram / / Board of Health _ ' 111 DATE.....--•------------------------------------------------------------------------ f FORM 1255 Hoees & WARREN. INC.. PUBLISHERS - 'Yyy ' h ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS 0 W PROFILE EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE TOP OF EL = ONE INSPECTION RISER FOR LEACHING GALLERY TO 55. WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. 53.25 D-BOX MAXI ALL PIPE O BE SCHEDULET 0 PVC �3" DROP � 1/8 AND inTO/f PI 8D1TOfPI CH AT -FLOW LINE II ii 50.25 10-- 14' rr 48" GAS�� PRECAST BAFFLE DRYWELL 6 in BOTTOM OF 51.20 +- STONEI LEACHING EXISTING BASE EXISTING 49.63 LEACHING GALLERY EXISTING 49.80 GALLERY EXISTING 1000 GALLON 49.50 (END VIEW) 47.50 5.00 ft + SEPTIC TANK SEE DETAIL ON REVERSE EXISTING 42 FE of 5 FE 12.5 f t 6l 12 FL HIGHADJUSTE GROOUNDWA ONRL V 22.5 Corner M mo _ / II w > zco Z N m 2 0 00 U' -4 " y ' °� _ m o O� a> U) r- O � cn 3 � 0 � cl o O / + z m 0 ti I� - �y m �0 �0 O C /X OIbiM Zc � / / am, o y 85 . ' O a� 0 O O� S 11'� (A) 6 �� 1 ~ / / 3_m Z X U)-u 0 U)� L u l 0) @ / 3(n o=rmp= O D W z -� zZ,=oz m =czl ® cD m ® rN \\ w / �7 —� ��",in m � 3r Z (D w � m 0O O I- rn_ I I D m , U1 >ozm z C � , tom rn � m N� � 0ro tD rnF- 4g mgti Doz �`i >Iz> m (��N O cn= oz a a r O F M m Ocn cn m 0,z C) m z rn 0 Z Z7 o x *� cn CD (-)U) O :--,Im (f) > o o 20 S (�fl) m m X O mz"_c O C (n p rn � o zz yO 2 -I m f�l m>m 3 7 Q -q Qo < O n.l o n e �m -< Fn X rI m X -i m z m f U 3 rl rl n O (n ti cncnprnz C O rn0 O � �� rn�, �7 -i y0 Amy F OdO� dl,,�a31 N N O rn L m -0 p \y y c 3�8 SO rn�cn p A-D O X o '< -i m 3 m Q4p C Z n` rn 15�M-� �cnooc N m G� 0 (n zOX a ym o-ooO y . rnZ nyZ ' I Z o m M .y o Z m > o p �, ab� c � co y r C) t^I o �1 o m3-mrn < co � � � Z r r y � mm N (n Ulr �r l _ rnZoo� m r � ,,, � v7 n�z mop 3 0 ® �m ZO V / 7 N �� o"mmz N m -< m00 m � zo �O O� �Z � O �o 0 cn >��mo o r� cn o o (n �r o on o o��n� Z I9 w r 3; 3 mrn Oy mono rn� r= Z m z cn r o o rn c �cnz m -i r 3 z= �� O O m r rnzoccnrn A rn z O� a m� N OC Z X • rn Z o�ti7 m oMzmo OZ y -1 `z Ul ® O �J �3rnp ,(� Z D DATE OF TEST: OAUGUST 19. UGH APROVED 461 DESIGN CALCULATIONS SOIL TEST LOG WITNESSED)BY VALUATOR: DAVID SDAVID DTANOTON. HEALTH#DEPT. PERC NUMBER: 12642 DESIGN FLOW: 3 BEDROOMS X 110 .GPD = 330 GPD PARENT :EPROGLACIRALD OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT 1 PERC AT 52 in - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 52.60 SOIL ABSORBTION SYSTEM: A 24 Ft:. x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 0-4 O WOOD LOAM 10 YR 3/3 NONE FRIABLE A6ot. = t 24 x 12.5 ) = 300 sf 4-5 E LOAMY SAND 10 YR 5/2 NONE FRIABLE A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf Atot. = 446 sf 5-B A LOAMY SAND 10 YR 4/4 NONE FRIABLE Vt_ 0.74 x 446 = 330.04 GPD 49.60 B-36 B LOAMY SAND 10 YR 5/6 NONE LOOSE USE A 24 Ft. x 12.5 ft x 2 Ft GALLERY. Vt = 330.04 GPD > 330 GPO REOUIRED 36-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 41.10 TEST PIT 2 NO GROTUNDDWATER ENCMATERIAL: OUNTC ALD OUTWASH LEA CHI NG GA L L ER Y 2 MIN/INCH IN C SOILS USE SHOREY PRECAST 500 GALLON NOT TO 1000 GALLON SEPTIC THINK LEACHING DRYWELL (H-10 LOADING) SCALE DIMENSIONS AND DETAIL NOT TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER USE EXISTING H-10 UNIT SCALE (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONSTRUCTION DETAIL 52.50 SEPTIC TANK IS TO BE PUMPED DRY 0-3 O WOOD LOAM 10 YR 3/2 NONE FRIABLE DRYWELL UNIT STON AT TIME OF INSTALLATION AND IS TO 3-5 E LOAMY SAND 10 YR 5/1 NONE FRIABLE E24.0 Ft- BE EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL NEW PVC OUTLET 5-B A LOAMY SAND 10 YR 4/4 NONE FRIABLE M TEE EQUIPPED WITH A GAS BAFFLE. 49.67 8-34 B LOAMY SAND 10 YR 4/6 NONE LOOSE 4- "�4 Q- 1 in 34-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE LoIE:§::Il m TAPER 41.50 nj N t, C m� C)o m o 03 DISTRIBUTION BOX GROUNDWATER ADJUSTMENT s.5 �t 8.5 ft 8.5 ft 5 Ft EXISTING GROUNDWATER LEVEL DIMENSIONS AND DETAIL USE S/-� 08-3 H-10 24.0 Ft Ln BASED ON TOWN OF BARNSTABLE r GIS DEPARTMENT RECORDS. �m s INDICATED GW 18.00 NOT TO 12 1n 500 GALLON DRYWELL A INDEX WELL S D W-25 3 SCALE MIN DIMENSIONS AND DETAIL ZONE C READING DATE JULY. 2009 JiT� FROM c USE H-10 IAVIT INLET OUTLET COVERREADING 49.2 TANK TOINSTALL ONE INSPECTION COVER COVERRISER TO WITHIN THREESAS ADJUSTMENT 4.5 INCHES OF FINAL GRADE ADJUSTED GW 22.5 x" '"A'' "'""�A �a 3 IN DROP AND INDICATE LOCATION —► Al FLOW LINE6 in STONE BASE ON AS-BUILT PLAN FROM l0 !n = 14 TO �5 CROSS SECTION VIEW BUILDING 481n in D-BOX 51n �0 33 LIQUID GAS LEVEL BAFFLE �O O in 0 0 0 0 NOTES _ o00000 000 �0000 000�000000a o00 0 0 0 0 0 0 0 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 000 �� v J 0 VIEW � CROSS SECTION I tf�k' S 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 1021n OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES -- - - BEFORE EXCAVATING FOR SYSTEM. CROSS SECTION VIEW 5) EXISTING LEACH PIT TO BE ABANDONED IN PLACE'. :.' _ '__ _'':�+ .Ljvl�l4 2 in PEASTONE 2 in PEASTONE SEWAGE DISPOSAL SYSTEM PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES A'ND' DUSTY IN,PLACE. 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSITALLATION . OF LOW FLOW FIXTURES 28 314, To EFFEZCTIVE i41, To 26 -TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF: THE SEPTIC .TANK. =' ln -1/2��A� DEPTH 1- GRAVEL 1n vf A°# GERARD & JOANNE ARMSTRONG 81 SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING'. DO `NOT "' 63 POPLAR DRIVE OSTERVILLE. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.\•r•.. .-, _ 46 in 58 in 46 in 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO- GRADE ON °A,'LEVEL 150 in ECO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE SIX INCHES OF CRUSHED STONE HAS BEEN PLACED 'TO MINIMIZE 'UNEVEN SETTLING. FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 10) SEPARATION OF TEES IN SEPTIC TANK SHALL BE NO .LESS THAN LIQUID DEPTH. ETE-3194 I AUGUST 19. 2009 2/2 r 9 "ev e 1 17 ` K i 7� /?yia✓!J r�t^�s!i� � ��p�r��l(•i --- a.u cA.1� �� . � ii GRC �G4•!*'d I " Ie !«�I v7'«Id Ili �l p � �Y 0 's,'-T w4 � tl AW (' r V U Flrn�v 3 n x+A, s�Ps i y�A'c� /tJ U Scy • I'^I �u p ' gay)ah er � �'►N�M'c.�ip,` �`�'' Q a Al J' 6 d•