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0090 CAMELBACK ROAD - Health
90 cameffia �R:®ail' ©Co w/ mac Marstims Mills P !E i TOWN OF BARNSTABLE LOCATION ��� /�©. SEWAGE# VILLAGEfi4eS�V, S 1IS ASSESSOR'S MAP&PARCEL� INSTALLER'S NAME&PHONE NO.(!�440 414 . SEPTIC TANK CAPACITY d//GrU LEACHING FACILITY: (typ (size) �'i` 1 .3 J)( Z, 1 . NO.OF BEDROOMS OWNER Ar PERMIT DATE: COMPLIANCE DATE: a �' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet .Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of-leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY l p C o - Fee No. (tl! THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: 001 PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppfication for Misposar 6pstem Construction permit Application for a Permit to Construct( ) Repair$ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nl/o ?i � ;l S Owner's Name,Address,and Tel.No. Assessor's Map/parcel C� �d�— —► Installer''ss Name,Address,and Tel.No. ����� Designer's Name,Address,and Tel.No. L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date_ , J� Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C A i Date last inspected: Agreement:, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro e 1 ode and not to place ythe system in operation until a Certificate of Compliance has been issued by this Board of ed Date Application Approved by Date t Application Disapproved b Date for the following reasons Permit No. M I I - (30 Date Issued Zoo No. Fee /Oj THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Bisposal *pstem Construction Permit Application for a Permit to Construct( ) Repair/), Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N . Q ,�s Owner's Name,Address and Tel.No. A;I s, 4 4 s /"+ ..�.�GO�N �aa29' Assessor's Map/Parcel-A 4e� t�!e4ff— Installer's Name,Address,and Tel.No. ,to (_ Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)r gpd Design flow provided J,gpd f Plan Date r� 2° `� s Z614 Number of sheets / Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil J Nature of Repairs or Alterations(Answer when applicable) X-le-&tJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environxtenta�Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board offd.al Q Signei Date r Application Approved by_i Date �lo Application Disapproved;000 Date for the following reasons iPermitfNo."A164��ri i�✓�- ya .. r�> Date Issued s-( l) 7415 F 4 -� -6 - ----------- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE 7IFY,that the On-site Sewage Disposal system Constructed( ) Repaired ) Upgraded( ) Abandoned( )by (C// at 9,9 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Now 9-0 dated Installer e41Z,0l;4 A Designer #bedrooms Approved design flow /"3 0 gpd The issuance of!this permit shall not be construed as a guarantee that the system will function ads jrdesigned. erbate �{ ).2 �� Inspector �� � -- ----- - - -- --- --- -- ---- -- -- ------- - - -- - -------- ----• - - No. I I�� Fee ���do THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal *pstetn Construction Permit Permission is hereby granted to Construct( ) Repair( �)� Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi must be completed within three years of the date of this permit. Date �� cj Approved by Town of Barnstable �•►+E Regulatory Services Thomas F. Geiler,Director HAMPublic Health Division 139. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: l0 jvy Z 11 Sewage Permit#�� Assessor's Map/Parcel Installer& Designer Certification Form Designer: �r.-� Tf �`u��"J i'`T4 Installer: �4 V(- *I'(- Address: PO- Ax 713 l Address: i4i)�4' S cd# ���w►�� AV— On /'t t'G 1-4 ,A— ESL was issued a permit to install a (date) q (installer) septic system at `C based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of e septic syst )but in accordance with State & Local Regulations. Plan revision or ce ified as-builbyl designer to follow. Stripout (if require inspected and the soils w re found sa isfactory. ��AcF&i.18c, ti TERENCE o M. staPatule HAYES C No. 979 sr= (Designer's ignar) (Affix Designe'?VStamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUELT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc e Commonwealth of Massachusetts o(s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r. (; "L> 90 Camelback Rd �t u Property Address JSS realty Trust9 Owner Owner's Name W! information is MA 02648 3/14/19 required for every Marston Mills ' page. Cityrrown State Zip Code Date of Inspection r? 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:When filling out forms A. Inspector Information 61 13Ce (o9 on the computer, Darrell Stone use only the tab key to move your Name of Inspector cursor-do not Cape Cod Septic Inspection use the return Company Name key. P.O. Box 1466 r Company Address Harwich MA 02645 City/Town State Zip Code elua 508-240-2500 S14995 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 er Evaluation b the Local Approving Authority 4. ® Fails 3/15/19 Insp or's Signature Date ' The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.1/26/20111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 l i Commonwealth of Massachusetts Title 5 .Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Camelback Rd . ti Property Address JSS realty Trust Owner Owner's Name information is Marston Mills MA 02648 3/14/19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:' ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2 System Conditional) Passes: y y ❑ 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 p P Y P P 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 2 of 18 Commonwealth of Massachusetts rs 1� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Camelback Rd Property Address . JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town 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 to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form '- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd `I Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4 System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts M�,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. CityrTown 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 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 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town 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 an of the system components pumped out in the previous two weeks? ❑ ® ee Y Y p p p ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c� Commonwealth of Massachusetts �n Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town State. Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example:,110 gpd x#of bedrooms): 220 Description: 2 bedroom residential dwelling Number of current residents: 3 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: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 10 Commonwealth of Massachusetts �x Title 5 official Inspection Fo' m Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town 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 i Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 15inso.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 official Inspection ,1=orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ----------c 90 Camelback Rd J Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: unknown Per BoH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 10 +/ P 9 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.): Apparent good condition 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 i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 4" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon 20" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 12" I Scum thickness 15" 2" Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle i How were dimensions determined? Sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Normal liquid level No sign of leakage Sch 40 outlet tee The septic tank is severly overdue for service Recommended maintenance pumping every 2-3 years i5insp.doc•rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 1 a c Commonwealth of Massachusetts �n Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments. 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 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 I , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 1 Commonwealth of Massachusetts j Title 5 official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Camelback Rd u Property Address JSS realty Trust Owner Owner's Name information is Marston Mills MA 02648 3/14/19 required for every page. ' City/Town State Zip Code Date of Inspection D. System Information (cont) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ; Grade to box 16" 1 outlet OK condition Normal liquid level No sign of leakage No scum Signs of failure 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �s Title 5 official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �i <% 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town 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 number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 I Commonwealth of Massachusetts r- Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is Marston Mills MA 02648 3/14/19 required for every page. City/Town State Zip Code Date of Inspection Da System Information (cont.) 11. Soil Absorption System (SAS) (coat.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1, (6x6') pit with stone Grade to pit 19" Ponding over top of the pit This leach pit is in hydraulic failure 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.): 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd u Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. Cityrrown 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.): t5insD.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd J Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i I I t Zj ZE;. Z,r...(0 3c,- 9 2y-6 3 -R w-g I ( I I 1 � 6 15insp.doc•rev.7/2612018 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 . 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 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: 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: Due to the failure of the leaching pit the ground water separation was not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 Camelback Rd Property Address JSS realty Trust Owner Owner's Name information is required for every Marston Mills MA 02648 3/14/19 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 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 Town of Barnstable Pit 15q 4a Department of Regulatory Services : BARMAB , : Public Health Division Date 3-c -19 1639.�1� 2.00 Main Street,Hyannis MA 02601 �p MJd Date Scheduled Time (% Fee Pd. l r" t' a Soil Suitability Assessment for Sew ge Disposal Performed By: Witnessed By: J• rig �� ' �' LOCATION &_GEl�TEI:ZAL INFORMAzTION � w_; - Location Address 90 Camelback Road Owner's Name John Souza - Marstons Mills _ 16 Jack Knife Point Road Address Orleans, MA 02653 Assessor'sMap/Parcel: 64/102 Engineer's Name Sweetser Engineering Robin Wilcox NEW CONSTRUCTION REPAIR X Telephone � # 508-385-6900 Land Use �`sG '� Slopes(%) �j / Surface Stones Distances from: Open Water Body /t� ft Possible Wet Area vt/ ft. Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) All t Tk 4/ Parent material(geologic) I Depth to B ock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater �DETI+� � _= A�T�O�T�F0�2'�SE�AS�ONAL�HIT'�H WRATER TABIL,E Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ `" Time(9"-6") End Pre-soak Rate Min./Inch 4 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- *If.percolat><on;testis to to conducted within 1001.of wetland,you must first notify the Barns table:Conservation Division at least one(1)week prior to begiinning. Q:\SEPTICIPERCFORM.DOC Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 7_2 I . �� ,� :� DEEP 0�3SE�RVATION HOLE LOG dole#� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) -- (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel o 7 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) M 1 � DEEP 46 vATI t`N�HOE LOG Hole# •,,. Depth'from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) If I , E i Flood;Insurance Rate Mai): Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes' Within 100 year flood boundary No -� Yes Deipthtof Naturally OccurnaL-IPervious Material Dtes atle�ast"four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not;what is the depth of naturally occurring pervious material? Certification I certify that'on le�r7 (date)I have passed the soil evaluator examination approved by the Department of Environmental Wotection and that the a ve analysis was performed by me consistent with the required trainin xpe and experience de d in 310 CMR 15.017. j ��Signature Date yA /-7 1 Q:\SEPTIC\PERCFORM.DOC C�% COMMONWEALTH OF 1VIASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAt DEPARTMENT OF ENVIRONMENTAL PROTECTION Z F iVl/'1 f�„/� ¢� m W l' d JUN 3 0 2004 r'ARCEL t t® fI r ~� ` TOWN OF BAKNSTAbLt HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION j Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner's Name: ALLEN DUBIN Owner's Address: 14771 ATTBORO PLACE TUSTIN CA 92780 Date of Inspection: 6/7/04 4l" Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: ^ P.O. BOX 2119 TEATICKET,MA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally P s _ Needs Further luation by the Local Approving Authority Fails Inspector's Signature: Date: 6/7/04 The system inspector shall submit a c py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 TncnPntinn Fnrm 6/1 vmno 1 l�_ Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 , CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s).or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a I Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No - X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n1a. - X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well. - X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no - X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. 4 rPage5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 Check if the following have been done.You must indicate "yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] I 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): YES Water meter readings, if available(last 2 years usage(gpd)); G 3_ ( , OC) d Sump pump(yes or no): NO Last date of occupancy: n/a C) ��C C)DU COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1991 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert;evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a !� R Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT WAS EMPTY AT TIME OF INSPECTION. STAIN LINES INDICATE PIT HAS NEVER HAD MORE THAN 2' OF LIQUID IN IT.BOTTOM IS AT 8 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a I4 I Q Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. jA Deck. � g 4 A 3 roc S AO 2 6) )l F �hL Be 3-V in Page 11 of 11 OFFICIAL INSPE CTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 CAMELBACK ROAD MARSTONS MILLS,MA 02648 Owner: ALLEN DUBIN Date of Inspection: 6/7/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. 1 11 V TOWN OF BARNSTABLE LOCATION IW31 U4137 P&O 4CV SEWAGE # ku VILLAGE ✓ /4L5-&O S �� ASSESSOR'S MAP & LOT I INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY (� LEACHING FACILITY:(type)P (size) J OU y C9 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER A� p�J 0 DATE PERMIT ISSUED: Jam— .j �i (� t � I DATE COMPLIANCE ISSUED: f VARIANCE GRANTED: Yes No /d � ��� �.,�, �� ��r C� � 7.��� � �� �o �� i N .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH 0 F..... .......... AvOration for Disposal Marks (foustrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Systems at: 4 ........ ...... .....6 Location ddrR or t 0. rx /:f.;r J05 . ..... . . ..Y... 6.. ...................T--- . ..... . .............. Mddres.s.. . ... . .0) ....... .... ...... �415W DL-1......... ..................... Installer Address Type of Building Size Lot_.9_?,?.7, .3..Sq. feet Dwelling—No. of Bedrooms__________31.. .........................Expansion Attic Garbage Grinder yp Other—Te of Buildin g gNo. of persons_._.__.._4 Showers Cafeteria Other fixtures ..gallons per person p r d Total dalily ......... ... ..................._,gal ong. Design Flow................. .f p Width-41V... Diameter________________ Depth____ ....2 9 Septic Tank—Liquid capacity/g;.Iq.gallons Length..e W 14 Disposal Trench—No ......* Width_..._ .(.......... Total Length...............f--- Total leaching area______.F------------sq. ft. ---------- Diameter._._.__.__ Depth below inlet...... Seepage Pit No........./ -__Y----- ---------- Total leaching area.-��. _zsq. ft. Z Other Distribution box Dosing t nk ( ) Percolation Test Results Performed .... . . 4 C /N/4....... Date...... ---- T 4 Test Pit No. I................minutes per inch Depth of Test Pit__________.__.______ Depth to ground water 44 Test Pit No. 2................minutes per inch Depth of Test Pit._.____.__________._ Depth to ground waterll���� Ix ......................................... ....... 0 Description of Soil------.. ...... ....... W U ........................................................................................................................................................................................................ W ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of�hpth. . ........ .I ..... ....... ................................ D Compliance S Dee issued �n Application Approved By.. <. .. .. ................. . . ... ............................................................ ..... late<........... Application Disapproved for the following reasons:..............................................................................................................- ........................................................................................................................................................................................................ Permit No....... ...Y Date Issued_____________________ Date ---------- -------____ N L..U--7 F>cs ... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ��, '. �x `.......OF......1 , ,.�,* . r? (►-` , + _ r ... Appliration for Disposal Works Tomotrnrtinn rrnti# Application is hereby made for a Permit to Construct =(7L) or Repair ( ) an Individual Sewage Disposal System at: qq ,ram +' / ��/j j ` p�q 1 -r � i /l i111 !» I - �Ff _!f ,aq o ,v T 1. 1 J 1.%/• .� I �l/�! .........._.`»..._/.....................__..w..,-........,._........................._._.... ... ........................................- r" Location `Address .... ...... �f » or Lot.NHo. - .. Owner t' /� r!•'/7 !� --7"�Lr 4./iJ!>1 �1 .i» !'J (f`t !/ ....................». ........................................••--•-------- -------•--- -- - --- ''' + Installer Address � q �,U Type of Building �'� Size Lot__.____:___.--_____________S feet Dwelling—No. of Bedrooms.......... _ ...__.__._Expansion Attic Garbage Grinder Pk Other—Type of Building _,.:_ __Y'�._.,. No. of persons _____________ Showersyy — p �, O Cafeteria ( ) Other fixtures .................................gallons r person per day. Total daily flow______.___ ... WDesign Flow .............................g PS+ P P Y• _.. ............l�lons, J WSeptic Tank—Liquid capacityj� t_�.gallons Length... E, t Width.../Z.. '__ Diameter ._......._. Depth..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area................._sq. ft. Seepage Pit No........... ........ Diameter........... ..... Depth below inlet.._............. Total leaching area...-* .Zsq. ft. Z Other Distribution box ( _� Dosing tank '-' Percolation Test Results Performed by._..._;N '=4:___ _ �.::':� ......� -�_-•._-_ Date_•...._ ..............................� W a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..___.r_.:_,__ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... ----•-•---•------------------------•--•--------.....------......---......-----••••--------•..--•---•-----•-••-------•-•-•---••--------•----------•-•-•.--_.. O Description of Soil........ ri t .?-: --------- .l - --------- _/f - -----------------------------------•--••-- U -•-•--•................••----•••---•-•-•...•----------•---••-•-••-•...................................•-------•--•--•-----•---......•.............•... W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------•---••------------•----------•-------------------•------••-----------••------••---•-----------.....--------------------- ----------•-----------------------------------.._..._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,issued by the board of health. P ` Signed.................._ _. r: -. ��, ;+'� «=v � f----• _ f.. ��. y_ - - --• -•-- --------•---Date.............. Are___f -------•--------- v Application Approved By..........:.... /r� .-• --------------•--....------•------•--•---•--•--------• —� .�,. ✓ ,,- ' Date Application Disapproved for the following reasons:-----•--------•-----••---•-•--------------------••--------------------------------•-••• •-•-••-•.._..---•••-- ...............•-•---------•----........----•---••-•-------•------------.....----........--.....----...--.-•-...---------------------------------------------------•------------------------------••-•-•- Date Permit No............ . ... ... .�� Issued ------- Date......-•--••.........--••-•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...OF........... ...h ........................................... CIertifirate of Tuntplinnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System,,constructed ( 7-or Repaired ( ) Y ,..,.. ................. --•--------------------------------------•----.........---•--------..............--•--------•---•••......••---••-•-••. Installer ................ ........................... ----- has been installed in accordance with the provisions of TI 1 LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ...._.. ......... dated----------- _._.. f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN`TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................(_.':� .............................. Inspector.............. I ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / P-19 Nol?...._ ..... _ FEE.•�: ? ..... _ y. Disposal Vorks Tonstrwtlo lerntit Permission is hereby granted.................. == -:..._. f , r' -.- ------ ---•--- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System . ' r Street as shown on the application for Disposal Works Construction Permit No:::2�._.Ei^_tf.. Dated..... :--- =_ f- i _mil .. ............ ..... ---... DATE....................... n oaB�rd of Health"'— �_.7.....----•----....... FORM 1255 A. M. SULKIN, INC., BOSTON OF OF FOUNDATION 2C FT MINIMUM FROM c ELL.AR OR CRAWL SPACE _ SOIL TEST T T 'ATE OF $OFL TEST APR' , 20 9 ELEV. 100.00 ! 10 FT, MINIMUM 'C3 F MINIMUM FROM SLAB SOIL TEST DONS. BY SWEt SER ENGINtEFzf�G +� __ ,— CLEAN SANG P 15942 WITNESSED B''� _�_�T�?��?�__,__--____ + (ASSUMED) CONCRETa_ 7INSPECTON PORT COVERS i ,_<.I ;ZAP! AND SEED SCHEDULE L 4 PVC PIPE ! n. OBSERVATION N 1 E"Ev. 1 r' MIN, PiTCN 1/8" PER FT" , LAVER OF , 18„ TO /2., PERCOLATION RATE.: ..<� �� MIN./iNCHe AT v_�� INCHES i s i t 'WASHED STONE - -r A. ! _ 2S AX. 2 FILTER FABRICI I ENT y DEPTH HOF2'� I FX URE: °CO LOR ! MOTT, (3TFIcR t3.50 1 4" CAST !RCN PIPE 88. AI _ _ -�- ,__ 9.,,.__` t h1. NOiT REQUIRED _7" Y ., .;_ r " ' EQU RED Ir_w�.,_. i iLtAM, SA4k,O R4f 1 _. --A i 1 I (OR EQUAL) MINIMUM � �_. - - -� r _ �a}._ t�-� ... ENORJCTS PI;CH ' f4 PER FT. t L W � :, � �." 47-24" �8 ;LOAMY SAND 'C'YRfsJ"4 iROOTS �. - - `."�. - LEvELERS E � 1 #E �44fl Ca ,D, l FLOW 'LINE DY LOAM //t4 _. .._.._ aAN F," , s .,,,, r--, I.,_, r+ �-,� ,_.� kd M SAND a 2.�'Y J 4 �M4'v u G— Cs WATER ENCOUNTERED 132 � ELE'w' — 87:0 - ` �_ELEV. � "£ � I0C3CimG � wCi , m ug OBSERVATIONN ELEV. LEV, U ELEV. G 2BAFFLE 1 13 00 0 0 n © _! C3 10 ° DISTRIBUTION E ° °i - u °' DEPTH HORIZ ? TEXTURE COLOR I IM0T?..; +GTHER L�- �° ELEV. _ �1---- u� LOA.'M`�` SAND, �17�R4,t NO ROOTS _ g G Pr ---T}=---- -' _ ; ('EXISTING) TO BE 'Y4A ��R 'icSTED 2 SCC wALLuN GALLE!S 'OFT , r-- ___•._ 7-24 18 :,,Ash, SA'111^ vYR6/`4 ROOTS f 4 FED : 14 ?NCHES ; 5 FEET '19 INCHES 1 dF MORE THAN ONE OUTLET � STONE =v` ,�N 2A-A," - -- r + 5 FEE 24 INCHES DALLC}N } ; T 'TO BE PLACED ON BASF) f I 13' X 25` iC 2' TRENCH FORMATION 1 z ! WELL N A i 1 .. SAID aAf �YR7/4 8 FE 34 INCHES f SEPTIC TANK /' ";" ___ '� ZONE __ 31y Nu _I _ i 5.'3 I' VEDa'UM SA. 3Y7f4 I 3/4" TO 1 1/2 CLEAN i INDEX _ '� b a� r 32 — 87,C DOUBLE WASHED STONE SOIL ASSORRTI �� - WA ER ENCOUN-`RED A I _._ � ELL; � ._w.� FREE OF FINES & SILT SYSTEM+7 e� 4 Ar P! DESIGN CALCULATIONS US;S PROBABLE WATER 7AB;_E ELEV.SEWAGE DISPOSAL SYSTEM PR%E OBSERVED WATER TABLE ( � ,' , ELt V, - ______-__ NUMBER OF BEDROOMS 3 ; NOT TC SCALE BGTTOM OF ST ttOLE ELEV. - _n GARBAGE DISPOSAL UNIT_ Tr 7AL ESTIMATED `' 1Ns 11-0 GAS, *iY s) GA' ;/DAY RFOUIRE D SI:-PT T4,.v "AF 4 `f `raA.. ACTUAL SIZE O SE.PT TAN 4 ( 0 x _ . - GAL, SCCDIL LASSWICA`I1 N ._,. DESIGN PERCOLATION RA_iE % 98.27 EFFLUENT OADING RATE ..AL,/DAY/S.F. LEACHING AREA _ SO- FT (1 )'( =;EACH!N:G CAPACITY (AREA X PATES 3AM GAL' ,/DAY 477.00 k 0.74 RESERVE LEACHING CAPACITY t-A i NOTES: t _ WORKMANSHIP AND MATERIALS ~IA �'CFOI4 TG' 1,"c,R 5 AND THE 7OWN'S RULES AND REGULATIONS FOR I O T ""' t i`Sc,5,Ji'c Ali., S POSJ',AL�`�(,)F 5_Y1+Aq�G w� :. r�tS 97.72 r7 ., t� 2J,273,0 � S.f. � �Y;.. r„= '`ct t s- r- t#�'4?^tt�7A GRADFi s ,;3f"I�S BROUGHT t}la`IY DO W?THSTANC"NG — L4 ADiNG luiNLESS THE, 44E "ND ER CiR OF' 10 FT. 'OF DRI'VES, OR PARK3-NG AREAS `SHALL __ USEi"3' UNDER 10-FT, DRlk�tS OR PARKI, G W : 4-. ANY WkSONIARY ' NITS s3SEID TO F=RING C'OV RI� TF �?AOF c',.sm _ g IN 00 HAS i , +aoil- g 98,3 Y -, 1 is > y 9 . Al a { ,W GALLO \ } y -.=�,r. T.�TANK OF�vt nn jEY r .- ,< r.''tip ' rkBO" /y ff U I R CE..u' .. t `Ai fs a '` �.N ;. °'..w iS, :RKJNG DAYS) NOTICETHE FINAL INS' .✓ 98,C' r" ci pit; ;; nF a 1 ��, BOAR' 0" HEALTH V , Qz 95 PROPOSED SEPTIC DESIG4 N r 97,36 j 2 , i AD 1AU . >} MAS 0�a � � / r _ % 9840 /� a�y?y� ;'F j' r !' j a t } / n c 03 :JPT�..'�g� ,ROAD d OX 71 ".2 BACK 0 U DENNIS, MASS. cX!S'sv£, SPOT ELEVATION 00,0 / _ EXIS+"NG CONTOUR ---___J0-_1-_ � �� i j C3 DATE kY� � �1�� � SCALD FINAL SPOT ELEVATION 10 G; r I FINAL CONTOUR----- --{_�3C ---- ._ SOIL TEST LOCATION RE_ JOB NO f U li, i TY POLE -.J f Q 1 l+ry G— ITOWN WATER W' 9V5 CATCH BASIN fl' 95.3 n � GAS LINE �•., f�Q I k t'"'.�'` -�- R d. CLEAN OUT G.O, r vs�� , �v �a, f I w_ �I J CESSPOOL C; P, 19 2C? 7 S WEF ;*,R E.i`4 GINL .ham, 3`,+ 1 ,. ,. , a ,.. ,> t ...,. . . p ., . ,... _...'�. .."<� « ., .. h,c,. ... _, ,�. ,.r. ,,..-'''he`s.,-.. .�. ,. :,a. � •t a >.a.. _.. ..... Mom ... _. _S' .., .. ,.. ,. • .- '. ... .. ,.. ,.,, . ...,.. ,-.. .. , . Tii � I r _ EAIE�SA4, NOTE" r r T T ['� !r 4,, I"A t,i�,/5', S /C.�'Y I'N r ✓ 1 . 4 4E /- A I,J 7NA`� iCfM t VA sr p �j' { , E t ,, ► O P � A + I � .2. I C°I-i` ,4�.�,,, ,L.,NE".�` ti1I/t+1 MU/LJ' CIF 14 p -=ate __ f f � tl� f�' 0 @ 0 (3 (1) .2-� ij I 1 11NZ "5,5 C1 � VISE SPE '1FIP ._' } �\ t r .3, s44L lo/PE`S 70 ANC /N THE SYSTEAf SlgAf,4 BE CAST IRON OR SCHEP41LE 40 PVG. Q 0 © 0 (1) Go 4 ,444 SEP7"IC T�#N�'S, L?ISTRIBUTIpIv B� �'Ev: r� 4NP 4 E,4C,411,,/G PIT, ShrAL� 8E PESIGNE P 000 CD,j A t� �1J )CUR h' ,O WHEE"I- �a 4PING 5 o t � �•1 rnrn m � RE�oYE ~' 0 0 �11 GENE,4 7/V T,'/C INYElf T E�,Cil..4 R O11/� J ; toll ,O„ . t� 0 @ 0 0 �' 0 OA THE' PhC'F&S095 FOR A PIST,4 OF 0 (D (D 0 (9 00 T /o AlYP B. C'A ,;Flkk W1TN CLAY TFfEE �i SA/Y� ,4Ib v ,4 Vc I .SAY1.NG A P��COI,ATfCJN 4 `- -9 TYPICAL D/S'TR/BUT10111 BOX R.4 TE f3F Z MINL/TES PER INCH 0R 1,65,5 =: 7'h E Ii' BC1J #RO OF �YE.9 z,Th°MtIS7- �o /VOT ra sC,44Z- �_ _ �� _ . ., . . .. -� � TYPICAL Zf4cl-//NG P1 T �r NOTE: P15TRI50TION BOX ,4lYv All" GAO,, �? NOT TO SCgLE BE NOTIFIES W,4-'EN T,yE 5YSTC*/S!VE,4,•,�' 0 3\5ERk,4T/CN P/Td SEPTIC TANK 5Y C'OIWP,,ET101V ANU TO f'4'/C7�t' 9,4Ctr4/1,z 11V6. TyP�CA�, ► o ��A�,. SEPTIC TANS 41N4E6>S OTHEW tfY15E NOTED,ALL SYSTEW ..�f, ,4•�%` I'�`'EC'���T C7R E"QLIA�, PERCO�..AT1D,1` Fr'ATE p�_ �''k.} iIk_iG4 OBSE.i'YAT/ON BY= - AMA � �j�c?s,j NOT 7-0SC.',4�t E CD�lfPc1/b'EN77,5 S ,d .x BE ,',NST.9� 1,EO IN NO TE T41VA S RL47-I NFORCeP 7tiRQUGHO U T 4CC0VF 4N0Z W 1 TN TI T�,E Y OF THE S'T.4TE I se + i r I. BOAIf P OF 1-16-4 C,TAI kv1 TH 4-4 E C'TRIC WE4,t%4 P MliI " kYl T-1 Z4- %` 54NI T41T Y COPe A1VP ANY 40CA,�, iYU4,E5 ENGIN,5% CR: AeROW ENGINEERING INC Eh18E�G Ed� .STEE.C, ROAS 1N TOP el,- SOTT"C?.N. lNHIC'h' hfd Y ,qPPk Y CONCf�ETF" /5 4,000 P,51 TEST \' A107-z • ACC E:55 ,V4A190C.E5 T ,5E-PTIC TANK tg { '�8. r� A ND L.EACH/A/0 F'/T, TO 3,E BUILT !JP 70 E.cEY , �z C���ow /NiSH ( ,eA 2E, —' 1--IIN45H GRAPE oYE"f TANK I�; 5 vh'4f E 2-73 + F E ,�Y- ?tom E.CEY 4£s+� � elf =Pl6B- OX LEACH/NG F'/T 0 4,6 1-4 PFA5TONE �: INY- --a�o� t apo oc1 i7 U 00 G �l Iry :�q6f �4 0 0) ° ,3 OF 314�1/'2 „ ! 'ur BQX j o C7 (o} C� ® p Jo _ `v _ RErlYFORC { (�TO Sr C,QL1SH�d 57D�VE 1 � �•CNt R x, t?EEC fO EN�lCiCER'_Ei.s� T4�31 � 1� 1NVmo -�►sa ©/$+�� .A;iC UG l J�B�CDD/Ta n� ` f, 4� V U0 �3 Ea1 ,E,O,E ID 7-0 AC 1-5VEL STA TYPICAL &EWAC7E 5Y5TEM P�OFILE �T r 4 La ? 6 } -- NOT TO .5CAL E �4 i SEC TION P,4RCE,C., kO T APPREsS �` }�NL UA 1� 4C�'vji i:>� /N5'` � ZONIA16 P1.S7-RIC'7- F400.0 h`,4ZARP Z01VE1 �' �- r f C _ 1 41 12= 170 00 PE3161v cRirE/fI PROP05EAR Z OCn./4 TION OF ,t WEI,ZI UMBER OF BEDROOMS _ __ E AIAST CON TOUH __ ____S � Brost err �:',` + V /l�V PUP 44 5l5TG 19 PERSONS PER CEEPROOM Ph'C?Pc SEO C01VTdUR __ _ _� ____.___-_ �. r !o. Ft4YNQfJD 3 �I'`�11� � _�f 6A/-4.Q/VS PER PERSON PER PAY EXIST SPOT EkEVATION S*O A, No EAG'N/NG RCQuIR o 3�_ ��o�os v sPoT E� EUAr�oN fo 1--f A kEACNING PROYIPEP __ PERCOZATION TEST M NO P1 L OBSERi1,4TioN P1r "�� ,�4RP�G/CANT , ENGINEER : AJ sPosA � e-L:T 4RR0W ENQNEE1?ING�rIINC. G ,Tee- ,T '� ot--(G a /�,44J{�l� T lyrr �..�.1 a:rG' e�.P�l,..t G;,;,a�:`�'t�,�r�,,� �._i e1 +-- �1 ;,' , � ,• SC.,4�C,E" �.4 TE B©T -OM Tr x 4" 11 1 .� �a 4S NO r�A y /? TD TA 1, = 4 2-T c-,r: ORAWN B Y ICqZ -C Fd� BY' AYF'V f3 Y: P,C AN No.