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HomeMy WebLinkAbout0105 SETH GOODSPEED'S WAY - Health 1OS Seth Goodspeed Way 'A= 122-087 r- f Dec' 16 2019 18:20 HP Fax page 1 laa- ©gam Commonwealth of Massachusetts z - Title 5 Official Inspection Form J_J Subsurface Sewage Disposal System Form Not for Voluntary Assessments - 105 Seth Goodspeed Road r Property Address cue Valerie Finlay& Matthew Dupuy t Owner Owner's Name r information is required for every Osterville MA 02655 12-10-19 page. City/Town state Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. 0oll,tu+rppft,� Im When A. Inspector Information �yG filling out out forms N _ o: on the computer, a�: JAMES use only the tab James D.Sears key to move your Name of Inspector cursor-do not Capewide Enterprises use the return key. Company Name 5 INS? o`��• 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1• ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails. 12-11-19 . pector 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15insp.doc•rev.7128f2018 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 1 of 18 Dec 16 2019 18:20 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owners Name required on Is every Osteryille required fl4A 02655 12-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and 20 chamber's. 2) System Conditionally Passes:- One or more system components as described in the'Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined" (Y, N, NO)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 ❑ NO (Explain below): IM 15insp.41oc-rev.71M201 8 Title 5 Official Inspection Fomr Subsurface Sewage Disposal System-Page 2 of 18 Dec 16 2019 1820 HP Fax page 3 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L� 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Du u Owner Owners Name information is required for every Osterville MA 02655 12-10-19 page. City(Town state Zip Code Date of Inspection C. Inspection Summary (cost.) 2) System Conditionally Passes(cunt.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ' ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 15insp.doc-my.7/26/2018 Tdle 5 dffidal Inspedion Form:Subsurface sewage Disposal System-Page 3 of 18 Dec 16 2019 18,20 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay& Matthew Du`puy Owner Owner's Name information is required for every Osterville MA 02655 12-10-19 page. City/Town state Zip Code Date of Inspection C. Inspection Summary (cost.) ❑ 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 b. System will fail unless the Board rd of Health and Public Water Supplier,� pP r if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within . 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and.the SAS is within"50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. - c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/28/2018 Title 5 Gfficial Inspection Form:Subsurface Sevvege Disposal System-Page 4 of 18 , Dec 16 2019 1820 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 �,. 105 Seth Goodspeed Road "� Propery Address Valerie Finlay&Matthew Dupuy Owner Owners Name information is required for every Osterville MA 02655 12-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in usaiiiint is less than 6" below invert or available volume is less than 1/2 day flow AEACl//N4: ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of.the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this forma ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IW PA)or a mapped Zone II of a public water supply well t5lnsp.doc-rev.7/26/2018 Tide 5 Official InspedAon Form:Subsurface Sewage Disposal System•Page 5 of 18 Dec 16 2019 1820 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owner's Name information is required for every Osterville MA 02655 12-10-19 page. CltylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered 'yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® 0 Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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)) t5insp.doc-rev.712612018 Title 5 Official Inspection Form:subsurface sewage oisposal system-Page a of 18 Dec 16 2019 1820 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form r� Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay& Matthew Dupuy Owner Owners Name information is required for every 0sterville MA 02655 12-10-19 page. Cityfrown state Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: 100 Gal. Tank D Box and 20 chamber's. 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water 2017-48,000GaIs meter readings,if available{last 2 years usage(gpd)): 2018-49,000Gal's Deta il: 4 Sump pump? ❑ Yes ® No NA K Last date of occupancy: Date t5insp.doc-rev.712612018 Title 5 OfOaal Inspection Fore Subsurface Sewage Disposal System•Page 7 of 18 Dec 16 '2019 1821 HP Fax page 8 Commonwealth of Massachusetts ,.v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owners Name information is required for every Osterville MA 02655 12-10-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.M., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, If available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev,7/25/2018 Title 5 Olfidel Inspection Form:Subsuface Savage Disposal system•page a or 18 Dec 16 2019 18:21 HP Fax page 9 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owners Name information is required for every Osterville MA 02655 12-10-19 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2012 -265. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: et3-r 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.): Pipeing is 4" PVC SCH -40. t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 I Dec 16 2019 18:21 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Crooner's Name information is requiredairedfor every Osterville MA 02655 12-10-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 2" Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge 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 at working level. Tank at 18" below grade. Inlet cover at 2" below grade wloutlet cover cemet walk. In and outlet tee's. No sign of leakage or over loading. i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Dec 16 2019 1821 HP Fax page 11 Commonwealth of Massachusetts Title 5 official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t, 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owners Name information is required for every Osterville MA 02655 12-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade, feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain), Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Dale Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene yl ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc-rev.nzenom Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 11 of 18 Dec 16 2019 18:21 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owner's Name information is required for every Osterville MA 02655 12-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.):. D Box is H -20-20"x24"-40"below grade w/cover at 15" Box is clean and solid w/four line's out. No sign of over loading or solid carry over. 15insp•ooc•rev,7/26/20IS Tide 5 Official Inspection Form:Subsurface Sewage DlsDosel system-Page 12 of 18 Dec 16 2019 18:21 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road `r Property Address Valerie Finlay&Matthew Dupuy Owner Owner's Name information is required for every 0sterville MA 02655 12-10-19 page. City(Town State Zlp Code Date of Inspection D. System Information (cunt.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Sol{Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 20 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7262018 Title 5 Ofricial Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Dec 16 2019 18:22 HP Fax page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay& Matthew Dupuy Owner Owner's Name information is required for very Osterville MA 02655 12-10-19 e page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): Leaching is 20 Biodiffuser's. Ck D Box and camera out line's, No sign of over loading-solid carry over or holding water. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): . Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): T 15insp.doc rev.7/25=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Dec 116 2019 1822 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay 8 Matthew Dupuy Owner Owner's Name information Is required for every Osterville MA 02655 12-10-19 per. Cityrrown State Zp Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tSinsp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Dec 16 2019 1822 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Dupuy Owner Owner's Name information Is required for every Ostervllle MA 02655 12-10.19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14, Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below . ❑ drawing attached separately Lj �} a :-.3% I Wrisp.doc•rev.W26J2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f Dec 16 2019 18:22 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Seth Goodspeed Road `1 Property Address Valerie Finlay& Matthew Dupuy Owner Owner's Name information is required for every Osterville MA 02655 12-10-19 page. CityfTown State Zip Code Date of Inspection D. System Information (cost.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high round water: 10'-6" P 9 9 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: 8-9-12 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design Plan 8-9-12 no G.W..Bottom of chamber's at 5'below grade. Bottom of chamber's at 5'-6"above T H Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•row.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Dec 16 2b19 18:22 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 105 Seth Goodspeed Road Property Address Valerie Finlay&Matthew Duo u Owner Owner's Name - Information is required for every Osterville MA 02655 12-10-19 page. CityiTown State Zip Code. Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information: Complete all fields in this section. ® 13. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D.System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included r i r v o (V 6-- t6insp.doc•rev.7(26)2016 TiUe 5 Official Inspection Form:Subsurface Sewsge Disposal System•Page 16 of 18 TOWN OF BARNSTABLE LGCATION/0,57 -se,4, Cwd5, -cd r��y SEWAGE# 7O iX— 2 s VILLAGELS�a/f Ile- ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. Cr&_-rpriww, G SEPTIC TANK CAPACITY /000 G ell 1 LEACHING FACILITY-(type)a0 AXXHC.,14.10 (size) NO.OF BEDROOMS 3 OWNER P40 i k/a VaterI v- L)d t-;to f,,V PERMIT DATE: S"22 2 d ► L COMPLIANCE DATE: 'e a3 Jf 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) -4//4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ;i-A-A Feet FURNISHED BY G� p �� CWt—Cr P vt iee L L C- 61 r3-3=36 e ✓� e� No. /�' (i�v� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitatiou for Disposal bpstem Construttion permit il , Application for a Permit to Construct( ) Repair IN Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 U$ SE t 4(ao0bj;peET;SuA�,j Owner's Name,Address,and Tel.No. zcl1`llWt 020C, s VALaZi 49 r1wL4Y f3OF REALT14 TROS r Assessor's Map/Parcel a;./97 .37 V OC-yp 3-4KCI1! SCAN rL— Installer's Name,Address,and Tel.No. $02--q77_2$Zj Designer's Name,Address,and Tel.No. S012-P:7-3_Q3-7-7 C0-MWktS6-S (,cl_. r Gva tuck ZT Type of Building: Dwelling No.of Bedrooms Lot Size 2 3, J�c1 + sq.ft. Garbage Grinder( ) Other Type of Building IZGS I l>QJTtl4L__ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) () gpd Design flow provided 3 j 51 -_L- gpd Plan Date —1�—�C� �., Number of sheets Revision Date Title 1 0 Z5 6 G-714 C-,p0bSbttG5�a 1.- Laj14\( Size of Septic Tank 1,00o G�4(:� -ki Type of S.A.S. A o A RC-3�, 44— 63 I®U I FFO 7� Description of Soil A4 L-D . 5 e�� P LA4(1 Nature of Repairs or Alterations(Answer when applicable) VS C (r l 6T 10(z S lC. 'tWV_ I Loco(5,40 TV W6Xw) 1)—Dretie D.® AlaC 3441C_ 8>/0D1F v_ctX.S 10 A Pry dW IG-, 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. ed Date g Application Approved by Date / � o Z Application Disapproved by Date for the following reasons Permit No. �� Date Issued Z 7 01 Z No. ._2Z ' ZI�K Fee 0 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Disposal 6pstem Construction permit Applicatioh for a Permit to Construct( ) Repair()01 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 U$ 567c 4 C-00bSpe6S A%4 Owner's Name,Address,and Tel.No. 05-t6RV1 YANL s VA LiDe1.E rfVL4y DDF REALM TRJST Assessor's Map/Parcel ( �-:Z 97 37 OeiTLLS OLY0reNSCN 50" rLt Installer's Name,Address,and Tel.No. $D$-(�`j�_�$-77 Designer's Name,Address,and Tel.No.SOSs'a7-3-U3.7.7 0-e0GW(t)e Cc s '. -Td �tJc ItuE�C��l1la ►�-C. I GOu.[ :5- T E. E Type of Building: t Dwelling No.of Bedrooms 3 Lot Size 2 3 549 + sq.ft. Garbage Grinder Other Type of Building RCS t D&sj j 4L No.of Persons Showers( )::Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided 3 5 5:, gpd Plan Date g 1 -ol y(a.. Number of sheets Revision Date Title ( O:S S ETN w A\4 Size of Septic Tank r U 00 CT 4U-00 Type of S.A.S. 2.0 ARC-3G FFG. 1310 1EFu S&QS ;Description of Soil (M,L—)i Lai :5�.z aQ s i." 5 e_-ig: 'P.LA(J I i Nature of Repairs or Alterations(Answer when applicable) V C — o l Y_ i TV l�l E=Lc> l�-1 n1c o ;Z 3 6 k_c-_ 4-;)o 22(Q C%1rrW_r e <10 A P16ab CW FIB, , 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. / Date 8 144 -',710 1 Application Approved byT Date Zy Zfl I z Application Disapproved b�Z Date for the following reasons Permit No. �0(Z z/o Date Issued . . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by_- CA®E(1VlUE ENT8FP4.153 <.L�. at 105 S e-M 4 OST�)(Ja6as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZo►Z-2.G y dated I ZZ/ZO IZ Installer dAQ E(,J(D C- Q�i TEVJ P.(.5 5 L_C.(Z. Designer ZG tg)&I TJ Eb-,X! #bedrooms 3 Approved design flow 33 Q gpd The issuance of this permit shall of be cons ed as a guarantee that the syste wil�funct o d igned. - -"`--_Date �(��� Inspector � -- ------ ---- ----------- ------------------------ - ._ - - - - -- -- - --------------- -----------. _ ( 2 65 _ Fee /60 of THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at 105 SET(-N W pwl Os-r&P,Y lu. G- y 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:Cojastruction must be completed within three years of the date of this permit. Date �j Z 7- 17..2� t Approved by -- Town of Barnstable Regulatory Services Thomas F. Geiler,Director MAS& MAS& Public Health Division Df�oM ►�� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office 508.862.4644 Fax: 508.790.6304 Date: a'2-3'M Sewage Permit# Zeal"Z- 2t�S Assessor's Map/Pareel 122- / 87 v Installer &Designer Certification Form Designer: SC Er�g(nee:ii)S, TvnG Installer: C=a �wid� Lr►Pec ciszs LL(; Address: 2h5y C(onlperry NiLjtiu,!�K Address: 1 J 3 Co 01 M r.✓GPI S OilZZ ZcO tZ (� ' �r!/G/�'h3�S was issued a permit to install a (date (installer) septic system at h0 3 s troodsQeeA,5 l,Ua� based on a design drawn by . (address) �G t���inee�i(1c1 ; TAG dated RL " k lye 2a�� (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. V I certify that the septic system` referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local .Regulationsg Plan revision or certified as-built by designer to follow. Stripout(if req nspected and the soils were found satisfactory. JOHN CNUI<'�.,14 y JR, l Jtll►a (In./ 'TDlle Signatur No 41607 r� esigner's Signatur (Affix esi e s mp Here) PLEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE 13ARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. r Local oejca,4e_ QeQcavot oetAe., Joffe- +o vacyftI5 snit ,I',nllir�li rmsl,I�si�nurcunil'iuWnn l'onn.doa Codnd(hOOS frpm TP�� PiTS M-Od kA 00 AC,3, 9 20{Z, Pt I.17' ( 3,00- 1,17') for 4e. maxltoo m eouer Auer {'Y�� Soil Absocet�m sys}cwi_ P pvc, uen-t uja.5 aelJeA and 41t- PStodcFFusers are- 0-'A�Q\ (� © 0 V d 4t I6� ✓� �oocQS�-ee�,QS �,cJc�/ Os��r ;lle Y�lc` Oz(�5.5- ��XcOO '^'� I August 19, 2012 Erik D. Finlay PR x 10 5 Seth Goodspeed Way. . Osterville, Ma 02655 , (508)367.8820 'To Whom it May Concern, t I am writing on behalf of the Valerie Finlay Trust[Estate,stating that 105 Seth Goodspeed Way was originally purchased as a four bedroom,cape style home-on May 15, 1986. The upstairs was finished when the house was,purchased. It was later turned into a three bedroom home with two up and one down,when we removed the wall between ,the two downstairs bedrooms. I have lived-in this house from May 15, 1986 and the house remains as is shown in the floor plan provided with this'letter.. I am r, writing this letter as the Personal Representative of the Valerie Finlay Trust/Estate. I hope to resolve this issue in a timely manner and look,forward to your reply, '.. 'Sincerely, K, d Erik D. Finlay PR } Town of Barnstable 3 P oFIME # r a y Department of Regulatory Services BARNSTABIE, r Public-,Health Division Date Z 0 MARS.. �e� 200 Main Street,Hyannis MA 02601 Date Scheduled Au5us 2 d l Z Time Fee Pd. (OO Soil Suitability Assessment for Sewage Disposal Performed By: rLCVJCW_J fiW.6c f.k, E21, CSC Witnessed By: Do/lald t7cSNnarcriS (�--5 LOCATION&GENERAL INFOR IATION Location Address /65 SeAkn (%xdgeecl13 Owner's Name Qau� w, � Ualzri a D- Rnl4 7 O5le-cv i lle A K A Address 37 P e*tte-s Bkud)SWS'-_A Y:h� L 3 1115 Assessor's Map/Parcel: pJ&e 172, earee-1 67 Engineer's Name E05ioeeC C 05 t 'TNC_ NEW CONSTRUCTION REPAIR ✓ Telephone# S��-2.-73--G 377 Land Use Sf�tSle Fa nn�ly tl4r¢14�c� Slopes(%) _ t Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way r 1t Property Line -7 1 ft Other tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) see a kva&W-4 1 Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7 12(.u �.g S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used. <7caec k Otosed'��Etah Depth Observed standing in obs.hole:., l 2 in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# — Reading Date: Index Well level — Adj.factor Adj.Groundwater Level_ PERCOLATION:.TEST bate .9 9 f 2 :.:Time Observation _ _ Hole# Time at 9" r� a Depth of Perc 32 - 50 Time at 6" Start Pre-soak Time @ 16'S A Time(9"-6") End Pre-soak II:b S A ` Rate Min./Inch Z Site Suitability Assessment: Site Passed �Q$ Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC 1 i DEEP OBSERVATION HOLE LOG Htile# }2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel $- 12 !2- 32 5 6yr -5/8 - - 32 -a(, c h-cS 2 5Y�/� DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATIM HOLE LOG .`Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole#'` Depth from Soil Horizon Soil Texture Soil Color Soil USDA Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes i Within 500 year boundary No Yes 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 all areas observed throughout the area proposed for the soil absorption system? ?e-5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on ib-27-51 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the:required training,expertis and a erience described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC LOCATION � Io � SEWAGE . PERMIT NO. 917,294 VILLAGE Ls INSTA LLEN'S NAME A. ADDRESS D U I L D E It OR OWNER �I—'s141s 2 40 MLS DATE PERMIT ISSUED i a DAT E COMPLIANCE ' ISSUED ���3 +v i ��� �� � �S_j 3 0 i o. ..........//...... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH V. ..........................................O F...................:...........................---......................................... ApptirFatiou for Uhipug at Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal <. System -ra j......... ......... •ocat ddress or Lot No. ...G'�( `£ T � G h��"s' ._...�R 'T /C tf�' .-•------•-•. ............................................... .... n�p Address Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............... —__...._.._..__..__..Expansion Attic ( ) Garbage Grinder 44 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fi es -------------------------------- Design Flow............. ...........................gallons per person per day. Total daily flow............. ....................gallons. WSeptic Tank—Liquid*capacity/QQ0..gallons Length-__/.......... Width................ Diameter----------------- Depth................ x Disposal Trench—No..................... Width__j..._.._._....... Total Length................ Total leaching area....................sq. ft. Seepage Pit No---_--------------- Diameter__/&........... Depth below inlet........1.......... Total leaching area..6_....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.._____..toA -___._._ J�..... Date....._---__':.A' ---------- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x �' 0 Description of Soil r. ----------------------#2---'�.1 A------------- .t�- ------ W ------------•-- -------------------------------------------------------------------------•---------•-----------------------------------•------------•---............................................... 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 TITLE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Complianc as been • ued y th oa health signedd... . ........ .................................. ------------------•--•-- -•----. .... .......... Application Approved BY / �t ------------------ Date Application Disapproved or t following reasons-----------------------•---------.•.-•------------------------------------------•--.....---..........._--•------- •----------------------------------------•--•---------------------------•---------------•-----------•--•-----....-----------••--••-•---------•----•-----••--•-•--------•-•-----•-----•-----•••---------- Date PermitNo......................................................... Issued.............................................-••-••••-- Date No. ......... FEB.............................. THE COMMONWEALTH rOF MASSACHUSETTS BOARD OF HEALTH Alle`lirttfiou for Uyvona1 Works TonuUurtion prmi# Application is:hereby made for. a'Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,r rZS or Lot No. .... . ............................1 . .�1-� ............... .....•....--- O �/ y�Ltr Address �•^ ? E a ....... ;r .........•---•.......................... •••••. _._... ... Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... ...........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................... Showers ( ) — Cafeteria ( ) Q Other es. -----------------------•--------------------•--------------- • - Design Flow.._......•.•...... ..�.t._ ......_.gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./W.gallons Length.... _'....... Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width___ ----_--__--••. Total Length_._...__.__.js�._ Total leaching area..... _. ._ sq. ft. Seepage Pit No_____________________ Diameter.../4�:.......... Depth below inlet........ _........ Total leaching area_._........�....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W �ARwi elf - ' Percolation Test Results Performed by......................................................................... Date... ......... ~......____...--._.. Test Pit No. I................minutes per inch Depth of Test"Pit-__-_:--._...._.__.. Depth.to ground water--_---_____-_:=---_-__- f=, Test Pit No. 2................minutes per inch Depth of Test Pit ... Depth to ground_water........................ C� 1�.- t k O Description of Soil..........................................' - -- ... "� ... ✓ ' - wo X0 9 x -........................... ....•--- tJ = ............................. •--•-----------------------------•--•-••------••••-------•-•---•--•-•-----------•-••-•-•--•--•--=--•----•---•------......--------------•--------------------•------------------------------------.----•- s U Nature of Repairs or Alterations—Answer when applicable___________________________________.;.::_____.._._.._..___.._._....................._..__.___... ti• Agreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with,! the provisions of TITLE 5 of the State Sa itary C de The undersigned furtt:er agrees not to place the system in operation until a Certificate of Coma'�Y has be i ed the a'rd ealth N. / f ate- - Application Approved BY ------------•-••--------------•------ -----•----- _ 7------------------ =--------------- Application Disapproved for a following reasons:. .. y. .................•--------------------------•---...-------------•-------------------...----•---•-•-------......•-----•----•-----••-------••----•--•--------••-•--•••----•-•--••••---••-•••----•••------- Date PermitNo......................................................... IssuecL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...........................................I.......................... f9rdifira of Tontpliatta TTII C Y, That th w Se D• osal Sys m constructed ( ) or Repaired ( ) by...................... . ....� _... . -- ......._ .-. . Instal er at.....................................................................................-------------- 1.11• ------•-••--••••••---•------•------•--......--.. has been installed in accordance with the provisions of TI: 5A/,the State Sanitary G6 //a in the application for Disposal Works Construction Permit No......................................... dated_--------_.___ ......_._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEWI VNI FU CTION SATISFACTORY. e DATE....: /.........--•.................••--•.....--•-•-----.. Inspector........_. .----- ....•----••••------••--•----••-----••--..............-•--:...... THE COMMONWEALTH OF MASSACHUSETTS- ��� BOARD OF HEALTH ..........................................OF..................................................................................... No......................... FEE........................ Permiss' s' re ranted...... .......� .. _ __. _ .__............ ................................................ to Const ct or e+ it ( ual sp " stem atNo...................•----......•-•••......•--•-••••••----•--•--•--•.................... --. •-•-----------••------•-•-•-••......•--•••-••-•-. Street l as shown on the application for Disposal Works Construction Permit No............ . .......................................... --• `.... ------------------------------.........•...... •�6� and Health - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS A o.� �kV �`���` y�� a .5. fin. J - i p� T.O.F. EL.=-63.0'+- 4"SCHEDULE 40 PVC MIN. SLOPE 1 %[NISH GRADE OVER D-BOX= 60.7'± FINISHED GRADE OVER BIODIFFUSERS= 60.7- - 61.0- I GENERAL NOTES PROVIDE EXTENSION RISER INSPECTION PORT WITH SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 3"OF 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE F.G. (ONE PER OUTER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= - 62.1'± OVER TANK EL. 62.0'± 5- DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9" 9"MIN. PVC SEWER PIPE 36"MAX. 36"MAX. TOP OF SAS B.O. 58.43- 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. 6' 3- 3"DROP MAX 3" 9" , L 25'± PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2"DROP MIN MIN.SLOPE @ 1% JOINTS (TYP.) A=- ft A; __7 ELEVATION = 58.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A [3 69" 101, 4" PVC IN FROM 1.33' r10.7 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF " PV 1 14" \\-*59.2'± SEPTIC TANK • 4"PVC OUT TO (TYP.) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. (TYP) q_901 in CONTRACTOR TO PROVIDE LEACHING FACILITY 0.90, 10.75 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12" 16-1 of 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. I �.L \_OUTLET TEE 58.40 MIN. 58.0 57.10' (laid flat) -2.875'(34.5-)_� SHALL VERIFY SIZE 48" VERIFY CONDITION OF 58.23 (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 5.0' EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH IREQ'D TANK NECESSARY COMPACTED BASE 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 50.50' BIODIFFUSERS (END VIEW) 62.00' ESTABLISHED ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS PROFILE INC.)ROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY INFILTRATOR SYSTEMS, THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING 07- TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 13714 APPROPRIATE AUTHORITY. tl INSPECTOR: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS II EVALUATOR: Michael Pimentel, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE II C.S.E.APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DATE: August 9,2012 • TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ELEV TOP 61.00' MATERIAL IN AREA BENEATH AND FOR 5i FT. ON ALL SIDES OF LEACHING FACILITY. •EXISTING LEACHING PIT TO BE PUMPED, FILLED ZONE 2 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLA Y, WITH CLEAN COARSE SAND&ABANDONED WITH WATER= <50.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN MAP 122 PERC RATE <2 min./inch MAP 122 PARCEL86 EXISTING 1,000 GALLON SEPTIC TANK DEPTH OF PERC 32"-50" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. TO BE UTILIZED IN THIS DESIGN 16. PROPOSED PROJECT IS LOCATED WITHIN: PARCEL83 W TEXTURAL CLASS: 1 ASSESSOR'S MAP 122 0 PARCEL 87 S89024'10"W < a- 0 r -Y-X- 150.00 OWNER OF RECORD: PAUL W. &VALERIE D. FINLAY X-X-X-X-X-X-X-X-x on _X_X_X_X_X_X_X_X_:X z co LOCUS 1 61.00' TRUSTEES OF BDF REALTY TRUST 0 "all Fill ADDRESS: 37 NETTLES BLVD X) z A M 0 60.33' JENSEW­j 8" Loamy Sand N BEACH, FL 34957 G) MAP 122 M :5 C7�7 1 OYr 3/1 FEMA FLOOD ZONE C > X1 0 a- 0 12" 60.00' PARCEL n COMMUNITY PANEL# 250001 0015 C MAP 122 z -0 23,569 S.F.± 0 > PARCEL82 XI < B Loamy Sand 17. DEED REFERENCE: DEED BOOK 17619, PAGE 344 M X1 W 1 OYr 5/8 CA JK C.A M z 18. PLAN REFERENCE: PLAN BOOK 311, PAGE 77 -4 0 32" 58.33' CO>{ w / cv / Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 50 56.83' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ni FOR SEPTIC SYSTEM UPGRADE. JC ENGINEEP.ING)NILL NOT ASSUME ANY LIABILITY LP _0 C Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. GAS GA�; PROPOSED DISTRIBUTION BOX' i I 6" W W 2.5Y 6/6 PROP. TOTAL 20 ARC 36HC (loose) (#3616BD) BIODIFFUSERS (H-20) 8'� c, #105 IN A FIELD CONFIGURATION EXISTING LOCUS PLAN 16" 3-BEDROOM 6 SCALE: 1" = 1000' PROPOSED INSPECTION PORT I (CPO DWELLING M WITH ACCESS BOX (TYP OF 2) TOF Se 126" 50.50' 5_ EMEND 4 63.0'± oexA f m: ! No Mottling,Weeping or Standing Observed DECK DECK G) ------ 1 0 TP 1 , DESIGN DATA TEST PIT DATA LEGEND EASEMENT LINE 61 xO 0 0 PERC NO. 13714 TP rn Donald Desmarais 50X0, EXISTING SPOT GRADE 61x0 INSPECTOR: > EVALUATOR: Michael Pimentel, EIT, CSE 50 go Benchmark BIT� DRIVEWAY M NUMBER OF BEDROOMS (DESIGN) 3 EXISTING CONTOUR GARAGE 0 M --j Spike in Tree C C.S.E.APPROVAL DATE: Oct. 1999 61 x4' M M 4 0 DESIGN FLOW 110 GAUDAY/BEDROOM PROPOSED CONTOUR r_ Elev. =62.00' rn z DATE: August 9,2012 G) M Approx. M.S.L. 61x5' TOTAL DESIGN FLOW 330 GAUDAY EXISTING OVERHEAD UTILITIES -0 Q 660 GAUDAY z "'� 61 x5' TEST PIT#: 2 z 0) > DESIGN FLOW X 200 % ELEV TOP 61.00' EXISTING CABLE LINE G) 5 0 r- 6 USE EXISTING 1,000 GALLON SEPTIC TANK 0 > - ELEV WATER <50.50' z M W W EXISTING WATER LINE > PERC RATE CD M M r_ GAS EXISTING GAS LINE m X M -0 DEPTH OF PERC Z X_ INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) z TP 49.0 51 45 TEXTURAL CLASS: 1 TEST PIT LOCATION j - m FENCE XX • S89013'30"W SWING-TIES SCALE: 1-=20' SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK 103.01 DESCRIPTION HC-1 HC-2 (TOTAL L.F. OF BIO'S)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0. 61.00' MAP 122 MAP 122 BIODIFFUSER CORNER(1) 557 40.0 (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING DAY 8' Fill 60.33' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE PARCEL58 PARCEL59 A Loamy Sand 0 PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(2) 45.2' 32.0' TOTALS: 12" 1 OYr 3/1 60.00' BIODIFFUSER CORNER(3) 60.8' 19.2' TOTAL NUMBER OF BIODIFFUSERS: 20 Q PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) TOTAL NUMBER OF COUPLINGS: 0 B Loamy Sand BIODIFFUSER CORNER(4) 69.0- 30.7' TOTAL LEACHING AREA: 480.0 1 OYr 518 HC-1 TOTAL LEACHING CAPACITY: 355.2 REV. DATE DESCRIPTION 32" 58.33' PROPOSED SEPTIC SYSTEM UPGRADE NOTE: (n EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR: o DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES Cn 0 #105 CD C.0 6 02 (1 1.51 2) "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR C Medium Sand C2 Cn EXISTING SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6 rfi 3-BEDROOM MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. (loose) LOCATED AT DWELLING TOF 63.0'± 105 SETH GOODSPEEDS WAY 0 OSTERVILLE, MA NOTES: DECK DECK 126" 50.50' SCALE: I INCH 20 FT. DATE: AUGUST 14, 2012 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC 0.2' 0 10 20 40 80 FEET SYSTEM COMPONENT. -19.3' No Mottling, Weeping or Standing Observed (4)-) -2 ------------ 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED JOHN L. PREPARED BY: RESERVED FOR BOARD OF HEALTH USE CHUP HILL JR. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. GARAGE IVIL JC ENGINEERING, INC. 3� REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH .41 07 2854 CRANBERRY HIGHWAY TEST PIT DATA. EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY SITE PLAN- 508.273.0377 DISTRICT AND THE ESTUARINE WATERSHED. SCALE: 1"=20' Drawn By: BSM I Designed By:M - - - -- CPTchecked By: JLC JOB No.2279 S/TE PL A N T YPICAL PROFIL E SCALE — I " = ?��' FL ALL &2 0 NOT W SCALE 18"STD. L T. WGT C.I. MH COVER 4"C I. PIPE 4"BIT. FIBER PIP£ 77GHT JOINTS FLOW L INE a/TLET LEVEL O O O ✓OVN _ DWELLING •� ! /O,- 14 44v,12 C.I. TEE C.I. TEE 4 5 ,7 7 .4& STANDARD PRECAST 4 4 CONCRETE GALLON 45. 5 SEPTIC TANK T D/S R18V r1OAr BOX TO BE INSTAL L ED ON LEVEL, STABLE BASE. SEPTIC TANK I LEVEL , STABLE BASE NL- I AMCEA C-4p- LCAGta 2"- 1/8" TO 1/2" WASHED ,PEASTONE 6L 40 LEACHING P/T -f ALL AROUND FREE OF IRONS, FINES AND DUST IN PLACE BASE TO BE LEVEL BRICK& MORTAR COURES 3/4" TO l-l/2" WASHED CRUSHED AS REOUIRED TO BRING STONE ALL AROUMD FREE OF COVER TO GRADE 24"C.I. MH COVER IRONS, FINES AND DUST /N PLACE. AND by I a0 FRAME v _ . tN ` j EL 47.5 4 4" - - _ _ ___ L EACHING Pl T SEC T/ON-- INLET B FLOW L/NE _ PIPE � � �� I. CONCRETE TO BE 4000 PSI 28 DAYS yT17 tlrZ�GAs i e,rI �ti —�„ 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. p GO t`1 G iD0 A �- --L �ICr� c4 TA__K_,�_ 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER i DEPTH REQUIREMENTS. 1 OPENING WITH 4-118" 4. NUMBER OF PITS REQUIRED I v o \� z f 5 � 0 , Q OUTER DIAMETER 8 ' 1-3/4"� INS/DE DIAMETER NOTE; EXCAVATE TO ELEVATION o "2 OR LOWER AS k 1 N REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH I'24;P 2- Ike' ti(' I N ( PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE P1, fcL. 2,a r•� NA 11 \ 4 0 � � p, 6 - 6„ s �ZL �` r L 3 ��o �j 5� IMIN EFFECTIVE DIAMETER I (NOT TO EXCEED 3 TIMES EFFEC TI VE DEPTH/ I -- -L­_- WATER TABLE na v !+a >M re �j G 17' 5pyc 5 ^x o >! �4 SOIL AND f ERC. DATA GENERAL NOTES PERC. RATE 2 MIN. /I N . P - 17 GUI.}- NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. 4 0' TEST BY: �+N1• KC/A IZ�UiLK # A. k.IG) SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD PRECAST REINFORCED CONCRETE UNITS. WITNESSED BY _ J L' 14 Y J AG U I'3 ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR. EL `�� DATE ' 71 �'� MINIMUM REQUIREMENTS FOR THE S'JBSUFACE DISPOSAL OF TEST PIT N0. 1 TEST PIT NO. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977, 0' ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE �- BOARD OF HEALTH. AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE �A S BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED �i rcL35 5 OTHERWISE. DESIGN DATA BEDROOMS DISPOSAL 'J - EST. TOTAL DAILY EFF. zZo GALS. LEGEND — SEPTIC TANK GAL SIDEWALL AREA GAL-/SO. FT O x00 EXISTING GRADE BOTTOM AREA ! ' GAL./SQ. FT. SEWAGE DISPOSAL SYSTEM LEACHING REQUIRED 1 2 42':2 5 -SO FT. ZONE �G o oo� FINISHED GRADE ACTUAL LEACHING AREA SQ.FT. / FOR DOMESTIC WATER SOURCE ' Tout �c1 o. oo INVERT ELEVATION ' SMT N Gmaap 5Pl'cI✓py vi 4Y --- - - - PROPERTY LINE �`+� o' fi i�A2uhTAIf�� F M /k'516 PLAN REFERENCE ' �� fJ �` �' 7 7 X� _ - - ----- MEAN HIGH WATER ',� \ SCALE' AS INDICATED DATE N BENCH MARK DATUM Ah�7 UM D la L_ Gja, U t�JA r� A.T LoT 10 _ MARSH 6 '` WM. M WARWICK a ASSOC/AYES 1 J::-- L-O UrJ Z o k.1 fr a U - o A-2- A BOX 801 - NORTH FALMOUTH ' 44ASSACHUSE T TS 02556 SV� ASSESSORS MAP : ��•� TEST HOLE LOGS NOTES: r PARCEL:M 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH SOIL EVALUATOR:1y• 4 DATE: ( V. CS>" S PLAN, 1"5 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE: NOr� � � , / ��Ro WITNESS: BOARD OF HEALTH REGULATIONS. REFERENCE: �• 7$2.g Z�-��S '�RwaS_ 8.�•t} �'R9&GF_ 1C; 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, �q PERCOLATION RATf :' L Z Nn 1N I r)(,1,{ SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO C-L-ASS = S, 1 L LTAdZ.=0,7 N INSTALLATION. TH- 1 8.,t'pl•'%Y 0�� TH-2 �L: gyp• 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION �p './ ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE FIIG� SLOT f g "�1LU /",• WN I Gl�i.�-�--� A LORMy 4 q LORM�( 1D 4' DETERMINATION. RD VTR �� � ►�Pizt� 20 3 5AN-0 Ioy�L �� � ,► 5�,�1�n Y�- �� (o �- ' ^ 51.73 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/9 FOOT. (UNLESS l J' SPECIFIED OTHERWISE) s. mm� s ��YR6/a n �:�oyR�J LOCATION MAP �1`� 'r O M shoo ,��y( S l 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A N O z �" 57. GARBAGE DISPOSAL. -��-A n ntV,� Vw��JtuM 6) EP71C TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. rnz 27� 2• ✓�J% 11 (1)0) FILLED ry $Jt4b Ri _ C.LS w lfj tCo r-r. of PRo� t,E.�C t►SEPT SYSTEM DESIGN . SE T H GOODSP _ w�►� I So�-�- a� _���m�_,.__ EEDS .-WA Y FLOW E;,T I MATE O Rmy o-r— EDGE OF PAVEMENT 3 ZBEOROOMS AT 110 GAL/DAY/BEDROOM -44-0 GAL/DAY1.�_ 149.39 Ft - SEPTIC TANK \ c + m �G'�L/DAY. x 2 DAYS - �� GAL\ / rn k I USE 1..�GALLON SEPT I C TANK- al5TIN -RI=Pc,Az-� w�1,S0 6.A/!°h I. SE�nL, ><, ►r r-A-,.co vAm fib s: SOIL ABSORPTION SYSTEM --AIm z Avg- 4 IN Ft y I I (L_ � � T1R >L 3oSa t/nJ/M H/�2•t pr, of 5rD NE CD CD r y i 6� E�n544profsTv _ oNSgo- - 3.4 ,L.xt2.{(O'Wx1 N SIDE AREA:L34)Z ; IZ.Q, X 2. Z k 0.7y - 13G. 4,3 \ m m 30TTOM AREA: 3LI x 1 Z•I to x �1 0 7 ins 11qz. s8 c?m E IS TING m y qqO 6PD req '4- �\ D LLING ' I � I SEPTSEPTI C. SYSTEM SECTION tr , TOP\ F GARAGE SLAB EL \63,26+— N XC0 1U w/tr . 4 sp f 1 O ,� t'0 1"i✓J�S� qq roe oto 36' ly e F 6 n k ra-1e i m EX►ST1 N- V ti lVVS•41 � (,as QafFle ' C GAL b7 D-BOX W3Sd� T�}" 1 I eod 58• refT+� 1 I �N SEPTIC TANK F/lewIness� S7,!2Lass ?O �g • og �3 SmC770�J(Wrs.) L X lZ /�0 LEgGEft C,QDSS 6•117 a�� L 0 1 �' / � EX1Sr p1T � �-� -," � � � � i --------'� �� N l _ o� 'f°t5�LE ��: 49•�3 m T Z of e Dvv4 e ° I 1 S I TE AND •'S EWAGE =P LAN '/STD 2 1 ubk LOCATION : 00 D pS - Wusllc�l � >z�lU.f.' AM 105.00 Ft N N o�� cy� 48 S�•' 48 o PREPARED FOR : 6 No. 1140 62.1l0 _ 0 DARREN M. MEYER, R.S. SCALE: a SgNI TAR��`� c l�`•�� � DATE: Jo � lea -06 P.O. BOX 981 EAST SANDWICH, MA 02537 Z DATE HEALTH AGENT Ph: (508) 362-2922 i _-