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0051 BISCAYNE DRIVE - Health
51 Biscayne Dr., Marston Mills %� - A=012-013-012 4. Commonwealth of-Massachusetts Title 5-Offidalw' Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary.Assessments. .1 S c. yNC inn- Property Address DIDErAAALL Owner Owner's Name information is required for every page. City/Town State - Zip Code Date of Inspection Inspection-results.must be submitted on this-form. Inspection forms may not be altered in any.. way:Please-see.completeness.checklist at the end of the form. Important:n utfoms n A.-'General:Informa#ion. filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not /�`',//. the return �N>7rLSay. 'use /— use Name of I pector A�lj'n-1'i. �SC_GAV�11�i-t �I Company Name b Company Address Lem. r Cityrrown State p Code G Soy 3 -o S.� l 3 Z �l Telep rrone Number License.Number C: d, B. Certification I certify that 1 have personally inspected the-sewage disposal system at this address and that thg information.reported below is true;accurate and complete as of:the time of the inspection:The.aWspe& n was-.performed based:on my training and experience in the proper function and maintenance b--on sib - -.sewage disposal systems. I am a DEP approved system inspector pursuant to Stction:15340 of- Title 5(310 CMR 45.000):The system: rn f . Passes . El Conditionally Passes. ❑ Fails Needs further Evaluation by.the Loca[Approving Authority Inspector's Signature Date The system inspector shall submit a.copy-of.this inspection report-to the Approving Authority(Board of.Health or DEP)within-30 days-of completing this-inspection.:lf 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 DER The original:should be sent to-the system owner and copies sent to the buyer,:if applicable, and the approving authority. ****This report only-describes.conditions:at1he time of inspection and under the.conditions of:use. at that time:This inspection does not address how the system will perform in the future under the same or-different conditions.of-use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Dispo ial System•Page 1 of 17 I - Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address n is 17LN 6�I�JU ( 0,6 Owner Owner's Name �j (�information is iA S� J1 /) P4 iG 7 required for every L�'� /(S / l page. Crown tate Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments OR Property Address Dis-rrJv13n c/l I ly,l D 6 Owner Owner's Name information is r ,�J42sT�� M , j required for every ,`�, , i 'I) page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): j ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further'Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water b ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y` 5L. 13,scx Y,..x D/L Property Address iU�C�vJ��l G� r ,NI LDS Owner Owner's Name information is RAILS-1 / required for every /'�AILS � 9I IS MA_ OZ& 9 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system ❑ s em has a septic tank and SAS and the SAS is less h Y p 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ © Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ [N Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ [X Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 5� 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.] ❑ EW The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ E the system is within 200 feet of a tributary to a surface drinking water supply ❑ Q the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"'yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �6J 91sc w'< DM Property Address Q Owner 1)1 01\1)m T'F'E.0 fJAG(L Owner's Name information is �,,^ required for every IA M MZTN Its t—►n 0ZL K S j�`B -j1 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ [f Pumping information was provided by the owner, occupant, or Board of Health ❑ d 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? d ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) od ❑ Was the facility or dwelling inspected for signs of sewage back up? Wr ❑ Was the site inspected for signs of break out? [f ❑ 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: [{r ❑ Existing information. For example, a plan at the Board of Health. d ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): — Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): `5`3 D t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �l 91sr,,4YJ-j6 DiL, Property Address A1;FTW/3,r-HI, Owner Owner's Name information is ,/ required for every 1nRSTr��v � 1514 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: L Does residence have a garbage grinder? ❑ Yes EU/No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes 9 No Laundry system inspected? [Er Yes ❑ No Seasonal use? ❑ Yes EV No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes 9 No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 'Y / &!;C"QYrI�G �n PropeAGFzffi,8Ae-IC Address , Ni CDY Owner Owner's Name information is required for every M A page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` Jul SISLgY S ®2 Property Address , l Owner - bItir'tc* AC H �N 1 U) Owner's Name information is ` J /� c required for every fM iAIR rs tsln) ►"`1��� A y U Ll 8 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 9- Z3 - Sq Were sewage odors detected when arriving at the site? ❑ Yes Rr No Building Sewer(locate on site plan): Depth below grade: Z--5 feet Material of construction: ❑ cast iron N�40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): PVC dips Ilum 7rA Pt (-L)lTl-1 PV L j 1 N 60 CP&P J-r AT cT f IVSy-TofT1 W, Septic Tank(locate on site plan): t Depth below grade: feet Material of construction: 04oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: l9 t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Da Property Address Owner Owner's Name "It f'- h Z information is A�i� mitts /�W required for every $ (9 page. City/Town Late Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Z" fl Distance from top of scum to top of outlet tee or baffle q ,► Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? MBASU" C.L Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): JSSPC l C_ 1 to W k- 1 Iy(S' At* CKnNA`C` CAOSAS r_k 1�, A Np 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 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address pis X&,g -I , Ill Owner Owner's Name required information � %IlS page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` �l �31SC,�1 ANC D& Property Address Owner Own t' Name information is required for every M Y` MIA '[ 73 page. City/Town State Zip Code Daespection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert _ Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �� I is c4 V.4 DM Property Address 0,r--FV tj6Ae-N _ N . lz Owner Owner's Name information is ) required for every WIay�tA►1`S dZl9 Q +' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: [se leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): E Ipp== C�sp -To lr' tr6 ?tl' . (.t�+�1�c� �Eva Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` �J $iscs YA& Da Propert Address 1 L ; Owner Owner's Name information is ► / � 1 �w / )9 required for every ra �tA�"l•5��'r`� /"11 I'S Q� page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y' SI tg�SGA DNS U1L Property Address D►�Tr�N I;AG Iy i 1M Owner Owner's Name information is p ' �� �'! required for every I`1 �� M`J� c.Q y v page. City/Town tate Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately A Al ►� At A3 Z9V p 4 A Qt 2 G� x ,g vl 9 h s b� t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -C C On . Property Address DISTi-, -A A raL r N 10-6 Owner Owner's Name information is required for every �A page. City own State Zip Code Date of Inspection D. System Information (cont.) Site Exam: d Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: feet Zo+ 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: oG�` �kL�y7�1i�1�w) l�VO1L•k tN A!?�►,, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments &SCAYI-6 Va Property Address p1sTFr-..->BA4 Owner Owner's Name information is M� �, S n oy�_ r�,9 required for every 1`�Y� `"�.y 7 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist CY Inspection Summary:A, B, C, D, or E checked [� Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater L�1 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file . i t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE ZIppiicat ion, for Vern Constructionpermit Application is ray made fo ermit to Construct ( � Alter ( ), or Repair ( )an individual Well at: Location VAddress Assessors Map and Parcel 0w-- a Address ------ ---- — -- -----------—------—----- ----- ----- ----------- Installer — Driller Address Type of Building - t Dwelling �� C 1 ----- Other - Type of Building---- ------ No. of Persons-- ------- ------ �s � Type of Well ----- Capacity------------------------- Purpose of Well--- Q Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Priv Well P ote on Regulation - The undersigned further agrees not to place the well in operation un 1 a e c e .of m ante has n issued by he Bo of Health. Signed — — 10 �—— date — Application Approved By ° /0,- r date — Application Disapproved for the following rea ------------ -------------- date— Permit No. — Issued-- - ---------- date- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS T CERTIFY That the Indiviclual e pn ,rutted ( ), Altered ( ), or Repaired ( ) by- - - 'Lt�- ,- ------ - - -- - - -- ----- -- i ® Ins ller at- has been installed in accordance with the provisions of the Tou6n of Barnstable Board of H�ealt P 'vate Well Protection Regulation as described in the application for Well Construction Permit No - ated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- - Inspector------------------ ------------ _ - No.------ -- --�D Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Vell Con5tructionperutit J A lica ion is hereby made f r e to Constr ct Alter or Repair an individual Well at: PP Y ( o). ( ), ( ) V Location'—'Address Assessors Map and Parcel Address Installer — Driller Address Type of Building Dwelling��- -�Q_� 1 Other - Typf,„o` Building--=- - ------ No. of Persons-----------------______ Type of<Well � 5� C-------- Capacity- Purpose of Well- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Priv Well ote 'ion Regulation - The undersigned further agrees not to place the well in operation u 1 a e ac to Af 'om iance has een issued he BW of Health. by1 . Signed '_— -- ate.-- — ,�c O Application Approved By-5t�' -- - - -� y ! date Application Disapproved for the following rea ---- - ------ -_ P ----i — ------------ / — _-_—i q_da date --- erm t No. Issued Vv/ ee BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS T CERTI That the Individual e• n rutted ( ), Altered ( ), or Repaired ( ) by 1V 1. sCAAw _ at— has been installed in accordance with the provisions of the T of Barnstable Boa of Healt P 'vate Well Protection Regulation as described in the application for Well Construction Permit No. --- - Dated---- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- Inspector------------------ ---------- rBOARD OF HEALTH TOWN OF BARNSTABLE l� lveYi Con5truct ion Permit No. Fee- - S�IUIV I'S OKU Permission is hereby granted �---- ------------- to Constru ( ), r ( r Repair ( an In ivid al Well No. � .� �� ® /}� -------------- Street as sho n th�pplication for We Construction Permit �� �- _ No.- — Dat d ! --- .---------------- v Boar of Healt+ { DATE O sc; TOWN OF BARNSTABLE v LOCATION T (q �LNC/>/L, SEWAGE # - 3— PILLAGE /lit AIZ Sr6dJ /y!i 11� � ASSESSOR'S MAP & LOT CINSTALLER'S NAME & PHONE NO. KrT I)(211G®n Nl SEPTIC TANK CAPACITY QLLEACHING FACILITY:(type) �l` `� (size) J( dv NO. OF BEDROOMS 3 RIVATE WELL R PUBLIC WATER BUILDER OR OWNER 6Ae to OtUak ON ,Oxp DATE PERMIT ISSUED: 1 f 23/7 7 DATE COMPLIANCE ISSUED: 62 - 7 — 9' 7 VARIANCE GRANTED: Yes No ✓ y ® j i s Fmc 7- THE COMMONWEALTH OF MASSACHUSETTS t BOAR® OF HEALTH Applira#iou for R,5pasal Works Cnowi rt ivit Vantit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ca' n Add ss or Lot o Owner Address ---..............................5i5i &..........................---- ------.....-----.......------........_. Installer Address' ��11 2 d Type of Building Size Lot------':1_.�f : Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (ND) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures . W Design Flow........................ ..___.._.._..••__gallons per person per day. Total daily flow...................33M.............gallons. 9 Septic Tank—Liquid capacity.j. ..gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length----_............... Total leaching area....................sq. ft. Seepage Pit No-_----------------- Diameter-------------------- Depth below inlet.................... Total leaching area. .__..__.._----sq. ft. Z Other Distribution box ( ) Dosing tank p� c�. a Percolation Test Result i� Performed by.... :�___ZI- 1��..��.... ........... .... 'Date......... -v- _._._____. nn a Test Pit No. 1_____..._! ___minutes per inch DA of Test Pit.." ....... Depth to ground water----Ar7)L?_____- fi, Test Pit No. 2................minutes per inch Depth of Test Pit------.............. Depth to ground water........................ 0 Description of Soil............6. ...............:73P .._ W -•---------------------------------•----•-----•--------•----------------------------.._.....------------••---•--------•--•-•••-•--------•-------------•-----•--------•--------------------...-----••---- VNature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................-................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i:s.T y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certincate of Compliance has been issued by the board of health. Si ned_...._.(:eA' _0. ...0.�,P_7 W_-ve!).................... --- `�� ate Application Approved By..........i .,.�w ------------------------------------ ----------- Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ -------------------------------------•---••-------------...------------------------....---•-•-----------------•••....._.._..----------------••-----------•--------------•-----------•--••-----.._.....-- Date / ..Permit No.------ -�•-'-� ��------------------ Issued_....................................................... Date No.... 60-_3.3 .' Fps...... 2 5.._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....•...-- ----- /'..0.() ..OF......... �J r .. J5........................ ApplirFation for Diopotiaal Works Tonotrnrtion Funfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at oca n Address or Lot No. .� _.Al) ...... ' -- .. -Z .= . . `. 27Z IZ114 C........................... Ow er Address ----------------------------- -: .. Installer Address ,�,++ d Type of Building Size Lot------- _1,11 _3.Sq. feet Dwelling—No. of Bedrooms___-wr''..................................Expansion Attic .(<Vb) Garbage Grinder (IV ` 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ....._. Dessign Flow...........................1 ._ ggallons per person per day. Total daily flow............................................gallons. W Disposal Trench—No..................... Width_....____._..___.... Total Length.................... Total leaching area....................sq. ft. Gd Septic Tank—Liquid ca acit ._.. �..gallons Length................ Width................ Diameter---------------- Depth____._.._....__ x Seepage Pit No---_--------------- Diameter-__-____-___-___.._. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) rw '-' Percolation Test Result Performed b 4t''�_ . �'-(� r/ r _ me_1� . _ Y .*••-- Date �a Test Pit No. 1_._.___..W___minutes per inch Dei of Test Pit.__.____ ___ Depth to ground water.... 1 ��...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------•- .............................................................................................................. Descriptionof Soil............ - •----- .. . k> t -•-- . ---------••-•----••------•••-----••-••-----•-•-•................. W •---------------------------•--•--.....------...-•--•-------------.....-•-•-•--•-•----•--------•----------•-•-------------------••---•--•------....----•--------------•---•......--•••-•-••-•----•-.... UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..........................................................•............................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TTRI-F^ the provisions of 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. j Signed =.... J g � t ��Date - , -� Application Approved BY - *-� �`-- gyp...... ---------- Date Application Disapproved for the following reasons:--- ........................................................................................................... ---•--------------••------....•--------•-----•-•------••-----•---•-----------.._......-----••---------...._.....-••------------•••-----•--•-••••••--------•-------------•-•--••------•---•-•-•••--•----•- Date Permit No...... .. 7--=•-�-�--�-------------------1:. - Issued_....................................................... Date {' A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ...�.. ..�Lh/........OF.... 3 , .� ................ Tatif iratr of TompliFanrr THIS IS TO CERTIFY, Thal,the Individual Sewage Disposal System constructed ' '"�) or Repaired'or ( } bY------�=•-_ ..... ---------------------------------------- at has been installed in accordance with the provisions of Ti TiE j of The State Sanitary Code as described.in the application for Disposal Works Construction Permit ............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCT16N SATISFACTORY. \'� DATE.................ta..�._..../. ............... Inspector----------------- -----1..1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH iOF... ... ............................ ....................... I�T O. ..._..--•-------- ••- FEE -......-•--- Dioposal Workii Tonstnnrtion rranit Permission is hereby granted...... _. :.._.._ '`& r.6. to Cons ruct (X) or Repair 4 ) an Individual Sewage Disposal System 3 at No j Street / /��7 as shown on the application for Disposal Works Construction Permit N }t_ Date-_____ _ �.1. _ w%_........... .�� ..h � - Board of Health DATE. �^� �� -7'-•------------ - FORM 1255~HOBS & WARREN INC., PUBLISHERS �� Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address f D� a�Z -;&l.S C'A City/Town Al!q-2!LS7-6 N_S G.S.Quadrangle Map Grid Location X Owner 42Lrn42&14 3 Ccr-g2 U. Address �2 '�Q ✓� /e O a 4,3 T_ WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water-bearing Rock Other n Water-bearing Zones ,-f Method Drilled 7)Q e,- 1) From To 2) From To Date Drilled o ' 3) From To -- 4) From To r CASING Depth to Bedrock Length Diameter Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface V6 Sand: fine❑ medium❑ coarseK Date measured S7-/ 9-ff 7 Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# /O length 3 from la 0 to l03 Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot4t length from to Chemical ❑ Biological Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To ✓ ✓f 3 S DRILLER FirmM&j U411 q , o Address %— o� \ CityME Registration No. Operator's Signature ease print tirmly I T_OMER COPY isnn-2 sa.nsa7i Log' Number: 7163 Bottle # E890 Date: Sept. 23, 1987 BAR'NSTA)BLE COUNTY HEALTH.AND ENVIRONMEENTAL DEPARTMENT sa SUPERIOR COURT HOUSE v BARNSTABLE. MASSACHUSETTS 02630 AsS DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 Ext. 337 Client: Greenbriar Development Collector: F. Clifford Mailing Address: P. 0. Box 510 -Affiliation: well driller Centerville. MA 02632 Time & Date of Collection: 9/2.1/87 11:00 a.m. Telephone: Type of Supply: well Sample Location: Lot 24 B'iscayne Drive Well Depth: 63' Marstons Mills, MA Date of Analysis: 9/2.1/87 3:05 p.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H 5.2 Conductivity (micromhos/cm) 104 500.0 Iron ( m) 0.1 0.3 Nitrate-Nitro en ( m) 0.5 10.0 Sodium m) 9 20.0. I .__X_Water sample meets the recommended limits for drinking of all above tested parameters. II. Based only on results of the parameters tested for this sample, the water is suitable. for drinking but may present the problems checked below: A. Water sample has higher than average levels. of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates The aarnstable County Health and tnvironmelftl REMARKS: Department shall not endorse any statements, interpretations or conclusions made by anyone else concerning these results without written consent. CC: Barnstable Board of Health CC: Clifford Well Drilling 117/85 Laboratory Director Explanation of Test Results - 4 A. Total Coliform.Bacteria "": Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water"supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For,this reason, it would be advisable to retest any well water that is not approved. pH pH is the measure of acidity or alkalinityof the water. On the pH scale,the number 7 is neutral,less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are generally- _, r considered unacceptable and may have a laxative effect upon users. Iron , The presence of iron in water in concentration of .3•ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a.maximum contaminant level for nitrates•at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper , Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium 1 A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking watpt,•or1contact,th,eiridoetor,to-determine-if consuming the water is advisable. Concentrations exceeding 50 ppm "indicate,jhat there m.ay.bel1 ocean,water or,roa&salt runoff water getting into the well. i il?�.,_ ;tit ft li:�•..� .. r;b: . .1 ";C;A 7:'":L'� ^.`�;i ... 0 . FT:: MIN. TOP OF FOUND EL. . 7 7 aZ :. 10 FT.' 'MIN - 9, ' CONCt�ETE 4,: . ` COVER$ f/8' . SCH - ' 40 yC PIPE MIN. PITCH PER . FT. " CA5'� 'IRON PIPE " -t2 (ORe EQUAL, N. PITCN i/4.PER, FT.: FLOW LINE EL 24 aJ MIN, EL EL; LEVEL EL. L. _ 'BOX ` � 3 ' 0:0- GALLON W. SEPTIC. TANK PR �8A SEWAGE ` D f S POSAL SYST EM PROF I. LE NOT TO SCALE .1 , - - : , , , : : 'y : r t ..,.. .. t. . . 2 ' r y k i J t • x 16 TtS.t ;�Al:�)'. �.,:Y -4 '.+•t :.\ 'sY t �t '* t � 'i`.�:� a t ��_F 5 � r _ � yt , - "��lS'"A 9 • : cy yS .y t: � '.:r f ! '_ {, F. ( tf ,�..J a--„ ?. X ,d �' .*{' {L, 1�, ...1•.1.,,� �:� J",}E ,.`� 3� 4;: :`� 1. � � ). .(� V r r.; 1 4, r .�r,> a. t � -;s'� X r ��� Lli,. i:'`f, '`,F i� fl � .T`-%'. m�Y 3- - .f:-: ��.• 1 �y �'�..y .-:..k t�;:•. r �.:�. �.> �=: :. . ";? ..: �� , uX .t. rwa k ,.�„ F: :x t.- �`" ^,• 'a'tr. �„ }. <•. i� �S-�' t. 17:..,r .. ... ,:.,.: + FI 20 FT. MIN. TOP of FOUND. SOIL TEST EL. s Z `� 10 FT. MIN. I DATE OF SOIL TEST �� ! i► >3 7 WITNESSED BY `—I iv Co I CONCRETE 4 SCH. 40 P C PIPE CLEAN SAND -T COVERS ,Y PERCOLATION RATE MIN INrk AS IN. PITCH 1/8 PER FT CONCRETE "- 1/2" WASHED OBSERVATION HOLE 1 OBSERVATION HOLE 2 4" CAST IRN PIPE 12 COVERS 2 LAYER OF £LEV. s 74. 5 ELEV.2 - (OR EQ UAI.,� MIN. 1/8 -f PITCH 1/4 PER FT STONE - FLAW LINE J_ jj� sH�r c 10 N 5 Om IF I EL= 7 MIN. I _ EL = 73. 6 =73-Z LEVEL� EL= 72. I'o 73.4 0 7Z 9 T EL. s 7Z 4 e DIS 7z• -� EL ------ e • o Q w WATER AT l3-� EL. �� �' WATER AT EL.= BOX . b z 3/a" .� GALLON WASHED STONE ` 1 • o p0 • SEPTIC TANK DESIGN CALCULATIONS o• - �`1 EL.= PRECAST LEACHING / NUMBER OF BEDROOMS s BASIN OR EQUIV. GARBAGE DISPOSAL UNIT -_.Yl._1� Z .U 6 DIAM. 0 a TOTALS �ESTIMATED �S�T IMAT E D FLOW SEWAGE DISPOSAL SYSTEM PROFILE /C o �,,�,,,� ( �/0 GAL. /8R./DAY x 3 aR.) 3 GAL /DAY NOT TO SCALE REQUIRED SEPTIC TANK CAPACITY 49`_: GAL. ACTUAL SIZE OF SEPTIC TANK /LwU GAL. !�?EG MIAJ) BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL 2 (0/. 8 LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE - / - - ) EL.=, 66L6 SIDEWALL AREA SAL./S.F BOTTOM AREA GAL./S.F. LEACHING CAPACITY ( BOTTOM+ SIOEWALL) •�� GAL LEGEND' (zx s ,4 Xsa x 6.vx zs) � _ -+ > -x sx , RESERVE LEACHING CAPACITY - 9. 7 GAL. EXISTING SPOT ELEVATION 0010 EXISTING CONTOUR — - - - 00-- --- FINAL SPOT ELEVATION ® NOTES- ` FINAL CONTOUR 0 . 1. ALL WORKMANSHIP AND MATERIALS S-HALL-CONFORM TO OE Q.E. SOIL TEST LOCATION �s TITLE 5 AND THE TOWN Of � _ 7 UTILITY POLE -(}- 2Nsrf3bl,}-RULES AND TOWN WATER W---�?=W REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. --- 2. ALL COVERS TO SANITARY UNITS SHALL 8E BROUGHT TO 7 L 73 ` ` 1 CATCH BASIN ®) WITHIN 12" OF FINISHED GRADE . �� �, 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTiAL-LY THE SAME. FL Ev 7L 4z_ 4• ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE • _ /-� 1ti �, OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER 00 /00% RFS E p j , WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING As MAIN FRONT SETBACK Fi SHALL BE USE-D UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. Iva_ - - ` MINK REAR SETBACK ANY MASONARY UNITS USED TO BRING COVERS TO GRADE \ 1-JT 24 it) MIN SIDE SETBACK _ SHALL BE M0RTARED IN PLACE �l / '� R 40 , NO DETFRMINATION HAS BEEN MACE AS TO COMPLIANCE WITH 47 443' S F Z� / r \ 't'E� r'�T \ DEEDED CAR ZONWG REGULATIONS. OWNER /APPL(CANT IS TO 5' /o'- �7 ' 'q OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. P►T 7 VEQ 7 : AL/µ (3ViZoNTAL GariT-tZ.��.— SEE L Ew SuoaVEY �' ` `� 76 APPROVED , BOARD OF HEALTH s«ox '0 ZQ3 7_0t DATE AGENT i = PROJECT Locrrlor`: A S 8 S YS i EA4 FL A IV-Ilk 6ARAJS-rA B49 NA. -Y t Z A►POCANT ! 1P l � � Levy, Eldredge & Wagner Associates Inc. fnc net landscape Architects Pk r'>ners Land &mynrs �>S ,&U/�. T L � - )V CU 889 West Main Street 'A OF ..Oc ' Centerville Ma. 02632 a''•`' ,�46TUA1_ AE (_)1L_7- ElEvArION e, M``" £ PAUL A �\ w a/ LEVYF7 �— ACTUAL A4 S rBUILT LUC�A7-/C�1`�I NO IQ6I7 H J 9/i6/87 ° A S. L kEV/SI�JIN/ :ie / AS KJiLT /217f7 �'%ST�R �/ 4 SFF L E. W s�,� vFy ,t3oo,+c # 2/7-2 �:� R' - LOCATION MAP AmN0' /��z7 SHEET OF TOP of FOUND. 20 FT. MIN. SOIL TEST EL. = 7�z 10 FT MIN, DATE OF SOIL TEST 7 CONCRETE CLEAN SAND WITNESSED BY COVERS ,Y PERCOLATION RATE -- z. 4 SCH. 40 P C PIPE MiN. INCH MIN. PITCH i/8 PER FT. OBSERVATION CONCRETE HOLE I OBSERVATION HOLE 2 12 COVERS2" LAYER OF ELEV. 2 4 4�� CAST IRON PIPE i'� ELEY.= - (OR EQUAL, MIN. 1/8"- 1/2" WASHED PITCH 1/4 PER FT. — 1 STONE FLOW LINE z (/j/ 11 n� SOM k 7 / . J 10 r1• N EL = MIN. ?1 __ EL.= 7.3. 4- 20' EL = 72- 6 _g' LEVEL Q� EL. 72. � _ �Z � I'- G w� D I S T. EL. - T � EL o --- BOX o a o Q > WATER AT �� EL.= �� �I WATER AT EL.=o - 3/4"- 11/2" c xo° � b a , GALLON WASHED STONE � 00 ° ' � °o0 • DESIGN CALCULATIONS SEPTIC TANK , W ° EL.= 6 6 PRECAST LEACHING NUMBER OF BEDROOMS BASIN OR EQUIV. GARBAGE DISPOSAL UNIT 6 DIAM. G - TOTAL ESTIMATED FLOW SEWAGE DISPOSAL SYSTEM PROFILE ,:�- bih t _GAL,/BR./DAY x 8R.) GAL./DAY M NOT TO SCALE SolREQUIRED SEPTIC TANK CAPACITY 49�" GAL. __ - - ACTUAL SIZE OF SEPTIC TANK ::mac: GAL. k ''1%Aj) BOTTOM_ OF TEST OR USGS PROBABLE WATER TABLE EL-2 6i.6 LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE - / - / - ) EL.= NT SIDEWALL AREA L. tAL./S.F. BOTTOM AREA GAL./S.F LEACHING CAPACITY ( BOTTOM+ SIDEWALL.) 7 GAL LEGEND (z -. - /4 X s6 k 6.0 9 2.5") -f- (3 ,4 X sx sX /.0) RESERVE LEACHING CAPACITY 6-49. 7 GAL EXISTING SPOT ELEVATION OOxO EXISTING CONTOUR - -- -00- --- FINAL SPOT ELEVATION ® NOTES FINAL CONTOUR I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. SOIL TEST LOCATION TITLE 5 AND THE TOWN OF ,;-tA T j=RULES AND UTILITY POLE -�- ( \ �� 7.J - 1 __ REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE . TOWN WATER W --=W CATCH BASIN ( ®� 2• ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 7 Z \ 1 � WITHIN 12" OF FINISHED GRADE . ST, 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. FL L- V 7 � 4 E E- . ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 'rov K i4, RFC X,, -OF WITHSTANDING H 10 LOADING UNLESS THEY ARE UNDER OR rT Y 1'AuK A ' ; WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING 1' - �" ---1 — Ev eA- MIN. FRONT SETBACK `'a SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING VE 01. _ t MIN. REAR SETBACK S• ANY MASONARY UNITS USED TO BRING COVERS TO GRADE JT 24 ',_ p MIN, SIDE SETBACK SHALL BE MORTARED IN PLACE 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH «---- ►r I 47 `g43-' s F J \ �D � }� lip ` ?E .T r��'� ` � DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO EACH `x OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. L PfT ,� 7- VERT i C A��H0P-k 7-0fM L 'EE L E w Sil'/EY APPROVED : BOARD OF HEALTH CAT E AGENT PROJECTuocAT1oN, PROPOSED S l T- AND -SEPTIC S YS TEM PLAN _ =•x , V j 31SG,A YNC �R/v� S.�r?NST.4 L,�1 MA. Z. Y l APPLICANT; ����.� :� `' , Levy, Eldredge & Wagner Associates Inc. - Engineers landscape Architects Planners land Surveyors 889 West Main Street Centerville Mo. 02632 PA' F \~� ' wN I. Y da 1'1 9//G/87 �1 S LOCATION MAP roe NO. -7 SHEET OF cHEc�rc v '8 Y