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HomeMy WebLinkAbout0440 STARBOARD LANE - Health 440 STARBOARD LANE;OSTERVILLE 1 A = 167 027.002 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln r^; Property Address EI-Fayoumy Joanne Owner Owner's Name w Information is required for Osteryille Ma 10-20-18 very page. Citylrown 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. mportanhenfillin A. inspector Information c hen filling out p � cS�/d# � 3�a-J orms on the omputer,use Douglas A Brown - nly the tab key Name of Inspector o move your D.A.Brown Inc ursor-do not Company Name se the return ey. P.o. Box 145 Company Address r� Centerville Ma 02632 City/rown State Zip Code 508-4204534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-20-18 Inspec ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts _ Title 5 Official 'Inspection Form i° Subsurface Sewage Disposal System form -Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. CityrFown State Zip Code Date of Inspection C. Inspection Summary . r Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310.CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all minimum passing requirements. This report can not predict the future performance under the same or espicially increased usage. This report is not to be used for bedroom count determination. This system is from 1986 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined"(Y, N,'ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is ° structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if.the existing tank is replaced with a complying septic,tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wV 440 Starboard Ln Property Address El-Fayoumy Joanne Owner Owners Name information is required for Osterville Ma 10-20-18 every page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due will to broken or obstructedpipe(s) or due to a broken settled or uneven distribution box. System I � Y 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 440 Starboard Ln Property Address El-Fayoumy Joanne Owner Owner's Name information is required for Osteryllle Ma 10-20-18 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary-Assessments MV 440 Starboard Ln Property Address El-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead'Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 ' Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner information is Owner's Name ' required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? . ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees; material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. El ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts p Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. Cityrrown 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: According to as- built card this system consists of a 1500 gallon septic tank, d-box, and a 600 gallon leach pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: House is vacant no water usage. Sump Pum ? ❑ Yes ❑ No P Last date of occupancy: 4 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 s r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .V� 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cAN, Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: j ® 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: 1986 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade:. feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 440 Starboard Ln Property Address El-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 per as built Sludge depth: moderate Distance from top of sludge to bottom of outlet tee or baffle Scum thickness moderate 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? scour pole Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I always recommend pumping at time of transfer and at least every 2-3 yrs there after for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 440 Starboard Ln Property Address El-Fayoumy Joanne Owner information is Owner's Name required for Osterville Ma 10-20-18 every 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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address El-Fayoumy Joanne Owner information is Owner's Name � required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: . Date Comments(condition of alarm and float switches, etc.):. Attach copy of current.pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box appears to be under the driveway with no access cover i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts (P Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osteryille Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries r number ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every 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.): The leach pit was opened and was surprisingly clean with a definate stain line at about 2 ft from bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp-doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 440 Starboard Ln Property Address El-Fayoumy Joanne Owner Owners Name information is required for Osterville Ma 10-20-18 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachuset ts (o Title 5 Official Inspection Form IA Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address ` El-Fayoumy Joanne Owner Owner's Name information is required for Osteryille Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below _ ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 440 Starboard Ln Property Address EI-Fayoumy Joanne Owner Owner's Name information is required for Osterville Ma 10-20-18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Property sits at a much higher elevation than water body near by. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 440 Starboard Ln Property Address El-Fayoumy Joanne Owner information is Owner's Name required for Osterville Ma 10-20-18 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 3 Commonwealth of Massachusetts ' Executive Office of Environmental. Affairs 4 Department of REcEivEO ' E P Environmental Protection eu MAR 2 4 1997 William F.Weld ININOFBARN9Wify. Cox Govertar HEALTH Argeo Paul Celluccl 1r David a B.S U.Governor n Oj 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A cc�cr�3e�se^o� CERTIFICATION Property Address: Li Lt Sl-���a a,rtr� L r;n e- ©sTe�v� e Address of Owner. Date of Inspection hP(28l \O)(kCC7 (If different) Name of Inspector. Company Name,Address and Telephone Number. CERTIFICATION STATEMENT ©s'Tcc,—- c �A-U a6 SS 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 _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: r ch 1 S) (S�� The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A,B, C,or D: A] SYSTEM PASSES: e V I have not found any information which indicates that the system violates any of the failure criteria as defined in.310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,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, 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 gonforming septic tank as approved by the Boar&of Health. R , (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(61t)556-1049 • Telephone(617)292-5500 i ice=Printed on Recycled Paper f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ( � CERTIFICATION(continued) Property Address: Date of Inspection: L ' Ink Per B]SYSTEM CONDITIONALLY PASSES(continued) 3ewage,backup-or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or.due`to.jtrroke 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The m has a septic tank and soil absorption system p rp system and 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 rgani pour indicates dicates 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR_ M PART A CERTIFICATION (continued) Property Address:- Owner. Date of Inspection: D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined 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. 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 boa 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 1/2 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet-from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 1 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: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00'and 6.00. Please consult the local regional office of the Department for further information... (revised 11/03/95) 3 v� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11S S I Owner. Ch Date of Inspection Check if the following have been done: Pumping information was requested of the owner,occupant, and 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. As built plans have been obtained and examined. Note if they are not available with N/A. VThe facility or dwelling was inspected for signs of sewage back-up. JThe system does not receive non-sanitary or industrial waste flow V The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or r tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. V The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 for SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: y y O S h�r�a A� r L Steen,A 1 e Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design JIow:_j_j0_galIons Number of bedrooms: Number of current residents: Garbage grinder(yes or no):—bW Laundry connected to system(yes or no):-Yys Seasonal use(yes or no):-Y-Ls Water meter readings,if available: NIA Last date of occupancy: I COMMERCIAL/INDUSTRIAL. Type of establishment: Design flow:_gallons/dsy 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 informations System pumped as part of inspection: (yes or no)_y S If yea,volume pumped: �56d eallons Reason for pumping: LA)A]n R►S 1�2 F.CI(I F,rC� TYPF�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) Other(explain) APPROXIMATE AGE of oll components,date installed(if]mown)and source of information: ][� y� �s 01 A miff9LL&d 1 ol11-1[8C Sewap odors detected when arriving at the site: (yes or.no) / (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: Owner. ��C�c�b CX15 Cro Date of Inspection: SEPTIC TANIi{:_/ (locate on site plan) it Depth below grade: Material of construction: Xooncrete_metal_FRP_other(explain) Dimensions: O QA Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1 all , Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping,condition of inlet and outle tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Ins nn(J F`� 's rt✓ I N S A �0 N GREASE TRAP:( (locate on site plan) Depth below grade: Material of construction:_concrete metal_FRP--other(explain) Dimensions: Scum thic>caess: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: L1 LA 6 Owner. Date of Inspection: TIGHT OR HOLDING TANK�I d (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(explain) Dimensions: Capacity: eallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: n (note if jevel and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)_ _� IS A X u n a Aivz w av PUMP CHAMBER N (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 eF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: LkL1 ii0 S 1 qr�G�ro van v 0 Owner: ��C�1(aro 13e!�en n Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: i leaching pits, number: y X(o leaching chambers, number:_ leaching galleries, number: leaching trenches,number length: leaching fields, number,dimensions: overflow cesspool,number: Comments: (noite co dition of soil, signs of hydraulic f 'ure, level of ponding, condition vegetation etc.) W I tJ I'oN CESSPOOLS: (locate on site plan) Number and configttration: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on siie 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 11/03/95) 8 rt� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: y�-1 lO STcj a Fyn 1 j CS11" Owner. �i�h(a2� CeSery•� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1 r r 35 -01 ,i �� DEPTH TO GROUNDWATER Depth to groundwater: as�feet 1 method of determination or approximation: (revised 11/03/95) 9 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCAT1ONhq jd SMZ�"M j) LXNESEWAGE# VILLAGE ASSESSOR'S MAP 6t LOT y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYQ O LEACHING FACILITY:(type) & 9L— (size) a QL_ NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER �w BUILDER OR OWNER &- AKIN CK B IV DATE PERMIT ISSUED-6 - DATE .COMPLIANCE ISSUED- VARIANCE GRANTED: Yes No r Nj _ c' . 1. . j h4p;//www.townofbamstable.us/Assessing/HMdisplay.asp?mappai=167027002&seq=1 10/21/2018 JSESSORS MAP NO: .. I 'RRCEL NO.- �.i� No �._...�.... 3 Fmc.........5.............. f( i THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -�.+�.................0F. 21U ---------------....... Appliratiou for Bi-gpaoal Works Towitrurttuu Fautit Application is hereby made for a Permit to Construct (X4 or Repair ( ) an Individual Sewage Disposal System at: ......¢ . ----.AV' ---------------- -----I 3---A_...._...-----••-----..........--•------------._...._..........-----------•-- L ation-Add ess or Lot No. ..... wner Address .................. Installer Address Q Type of Buildin Size Lot---�� C7...Sq. feet U Dwe1linNo. of Bedrooms............................................Expansion Attic Q� ) Garbage Grinder Od `., Other e of Building .............. No. of ersons............................ Showers — Cafeteria Ga YP g -------------- P ( ) ( ) Q' Other fixtures ________ _______ 3 W Design Flow............... .........��� lions per day. Total daily flow.............................................gallons. WSeptic Tank—Liq id capacity/DOD2_gallons Length................ Width................ Diameter................ Depth._.___._..Pp x Disposal Trench-SiXo. .................... Width.................... Total Length---------j_____..__ Total leaching area_....._____.j__._._sq. ft. Seepage Pit No----------/-------- Diameter-----6........... Depth belo ililet.6............... Total leaching area..................sq. ft Z Other Distribution box ( ) Dosing tank ( ) ©f- oAJ,6 .5-41 47P.4-1—A-+,f '-• Percolation Test Results Performed by.......................................................................... Date.........................t-----------.. aTest Pit No. 1_.. .._..minutes per inch Depth of Test Pit.....I_ �._.__.. Depth to ground water_�'®_� .. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' --------------------------- O Description of Soil.....4- � n_ © '.. v�°��� U W -------------------------------------------------------------------------------------------------•-----------------------------------------------•-•--------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the of escribed I fi idual Sewage Dis osal System in accordance with the provisions of L1TL1: 51 of the State Sa • ary Code— T e undersigned furtive agrees not to place the system in operation until a Certificate of Complianc has been issu y the b rd of heal el V Da; Application Approved BY------- ......... . ....... ... ----•-. -------------C-d- ..:1: -,y Date Application Disapproved for the following re on .___- _ ..... . .... . ........ .. ........................•---_._._.___.._....._._.._._._._ ----•--•-------------------------------------------------------•-----•----•--------------....------------ Date Permit No............................ ... ... Issued....__.__..._..._ -----•- -Daze----••--••--------------------- /l Z--7, �7� 19 Nov.......... ............................. THE COMMONWEALTH OF MASSACHUSETTS Y BOARD OF HEALTH ►J.......-.... oFj..+ �.ST-�- t- Appliratinn for Disposal Works Tnntrnrtion Frrutit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: _d A2: -----1tyv c----------------- ---��r L cati Address or Lot No. rr'9 2- �� on-. .E......n�_.... ------•-- ..o.... r yr iz..................... c t' Owner Address w � . .1................................. /� /2N...' 7. / �--- Installer Address r UType of Building �/ Size Lot.. 5�.3G-.7-...Sq. feet Dwellin No. of Bedrooms............................................Expansion Attic �O ) Garbage Grinder VV) aOther-Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures _ -- - - ---- - -- W Design Flow........ .. . ...�5C�/��a11o�pcN- - -- n per day. Total daily flow.......__�>__.3.v................_._gallons. * Septic Tank—L�i�juid capacit;/OQD---_gallons Length................ Width................ Diameter................ Depth___-._......�? xDisposal Trench;&.1l o..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___-----/.._...... Diameter-___e............. Depth bel inlet._........._.... Total leaching area.a'� ....sq. ft. z Other Distribution box ( ) Dosing tank ( ) 10 o F -To NE 54. 6,4 L / A-y aPercolation Test Results Performed bY..................................................i----------------------. Date---•--------------------;...•..---•--.. a Test Pit No. 1__� ......minutes per inch Depth of Test Pit....!3_......_.. Depth to ground water'a_ r---- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•------------------ -------------------....-----•---............-----. ................---••-•-------•--•--------•--------.................---•---•----. O Description of Soil----v Z........... ......14 r.......5At�AL, I["------ w ---•-----------•--•--------------Z ''l3 f---- pQ r: s E VNature of Repairs or Alterations—Answer, when applicable_______________________________________________________________________________________________ --------•------------------------------•--••---------------•----------------------------•-•--......---•-••--•--------------------------------------------------------------------------....------------. Agreement: The undersigned agrees to install the 4wedescribed I ividual Sewage Disposal System in accordance with the provisions of ii'-t..4 5 of the State Sanitary Code— r e under igned furthe/agrees not to place the system in operation until a Certificate of Compliance has been is�e&by t e b and of healt:l( 1Signed V Date Application Approved BY ��► . ......... ............�-Q- --- _ � / / = =� Application Disapproved for the following re sons:-- , �'✓ y�!` Date -- ---------------------------------------------------------- ..............•-•---.......-•----•----•--------------•-----•-•-------------------....._..----.............. ~, ^_ .1 . - r c- ----------------------------------------------------------------- t�. 1 V�' s Date Permit No.... / --`------- f 7 Issued r 'lt�i is f�� ✓ 7 3 t' t i2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH — ..�t. ..,v.......-.........OF...... ...Ar!t.! .S.. .. ►... .L.. -------------- ----,�... �rr�if irtt#r laf fa�ant�r�t�anr�e THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed (� or Repaired ( ) bY--------------— /1 _ L- - -- c.... . 'nstaller at............ - ` •v--.._��7/ ��1���2 . ...•---- ......------------------------------------------------------------------------------------- has been installed in accordance with the provisions of "'LIEi Ij of The State Sanitary Code as described in the application for Disposal Works Construction Permit MIk?.y._�.i__Z 3.............. dated_--".�_�`:_-_z`F"__��...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. iDATE.........---•--GC---- '...........- ...S .......................... Inspector............................................................. ................ . ,---g a THE COMMONWEALTH OF MASSACHUSETTS ` BOARD O/F� HE--AyyLTH .................OF .A.`�. .1.. J..4nrl ...:....................... FEE. ... ..... Dispos nrk . Tnno#rudian rrntit Permission is hereby granted ---MI...---------- ------------------------------------------------------------------------------ to Construct ) or Re air yJ\ an Indpii,idual Sevc�a /D�yfispos d-System at No........ -•-1v-----`—••T/ ..7 ._ '0/7--/.z•:D----.._...E_C.!- .G-------------------•_•- � U-�(..-l..( ------...------------ Street �� as shown on the application for Disposal Works Construction Permit Nod______i ("�_____ ______ Dated.... ....................................� --- L _------------------ oard of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE `� Y LOCATION� ;T4, -SEWAGE # 1 �� VILLAGE ' ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. �jJ 1- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) � d!� eair (size) '0 1d - NO. OF BEDROOMS ' PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER i'I 'Aep J �K78 0 DATE PERMIT ISSUED: DATE'.CO'IPLIANCE ISSUED: VARIANCE GRANTED: Yes No J �,.,,�' , „ d �� ;.�� ; ..��- . � �� j" .�� � � i ��:� ,j� 1 /j /py�/� 71 SOIL LOG NO. I D N0. 2 i - . 2 I t s _ i f � i r < c ---- TOP OF FOUNDATION EL.: ,f�f• YYY �r t • . `� .' A `f;!''$.?. C.- f Y L. ` 1, ..__ _:..._..:...� / _. .._....___.___.... / j k : ` IN f1 —a 10 ' r IN AL ! �uD� B W% 6 ` SUMP Y 13 34 � V LIQUID LEVEL __.___ 14 I •� —�` J PERG TEST RESULTS Q 2.ELA a ( L p r ,1j. PRECAST SEPTIC TANK WITH / u ` � {, �J i PERC RATE . CAST IN PLACE INLET AND : t%` � ° } ``� ------- _- --? �.L- o, ;' WHITNESSED BY OUTLET T S PER T I T L E ..._._�..:_ �,�... __�.,, � ti� t_�=..__ BOARD Of HEALTH s SIZE : DES C:-i N L,, DATE PROFILE OE PROPOSEDSEWAGE SYSTEM eL t SYSTEM DESIGNED BY THE TOWN DF REGULATIONS AND STATE TITLE V-- FOR SUBSURFACE DISPOSAL, OF SEWAGE . - SCALE 1144= 1 ' 0 ID x I . ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. ALL PIPES SHALL BE SLOPED %4 ` PER FOOT EXCEPT FOR PX THE FIRST 2 FEET BUT OF THE 0 / 8 WHICH SHALL BE LEVEL z�g 43� r'egK DESIGN FLOW _.3.__ _ BEDROOMS AT 110 GALDAY PER 88 . _1.5�___ GALIDAY � � ' SEPTIC TANK SIZE . J � � � — � —� ! r r y G 1 S ' '.._.._._ I "'_. = ' GAL , USE GAL. W� �� GARBAGE DISPOSAL _ `.� :�.,�,, r Lt i A 1- Lt LEACHING SYSTEM : $:IF _:. 4 _ ` �`` 3 ky, 25 Al- EFFECTIVE AREA . SIDE i x_ 10 x — y BOTT �5 �_ d s TOTAL. FLOW ~_ .. __��= . ._-- ' =_ .._ W,. GARBAGE DISPOSAL TOTAL I�E 4 t D FLOW _____�.. Y 441 RESERVE FLOW_-� 4�1_.-_ _ �_ .. �_.__._Il._�. GAL/©AY44 5 45 REFERENCE PLANS r iLqz .o P ED AP ROV RY BOARD OF HEALTH D . . . . ATO PROPERTY F ' _... S/ 7 _ ' • ( J l w L_0 l o NZ t3 .. •e►1 _, *, -7 t T E PLAN AL ���``� ' ' 1.`! 1 L L 1 i.\►�. � i r— T� E !{ t''\ I`,i Amm S C r" - T •