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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECT o
RECEE- ED
SEP 0 4 Z003
TOWN OF BAR,-STABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 184 Jones Road
Marston Mills. MA 02648 MAP .. -- •,
Owner's Name: George&Leslie Pontes PARCEL
Owner's Address: 3 Bedford Place SOT
Forestdale, MA 02644 --
Date of Inspection: Augmt 26, 2003
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
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 fimction and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Need.s Further Evaluation by the Local Approving Authority
Fail
Inspector's Signature: Date: Au zust 30, 2003 '
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
*"*This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or.different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
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.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined", please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
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Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 184 Jones Road
Marstons Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/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 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 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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection ?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ _ Was the site inspected for signs of break out?
✓ Were all system components,excluding the SAS, located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)).
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 184 Jones Road
Marston Mills. MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
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): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in 1997-per owner
Was system pumped as part of the inspection (yes or no): 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)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
May 8197-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 7"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 6"
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present The liquid level was even with the outlet invert There did not appear to be any sign ofleakage Recommend
pumping every two years for maintenance.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
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: 184 Jones Road
Marston Mills, AM
Owner: George&Leslie Ponies
Date of Inspection: August 26, 2003
TIGHT or HOLDING TANK: None (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: eallons
Design Flow: Qallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: None (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: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
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: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 3 H-20 infiltrators(11'x 3S'x 2)
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.):
The leach field was dry. There did not appear to be any signs of failure. A video camera was used to conduct the inspection.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
9
Page 10 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
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10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 184 Jones Road
Marston Mills, MA
Owner: George&Leslie Pontes
Date of Inspection: August 26, 2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25 +/- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately
25'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
TOWN OF B//�� TABLE
LOCATION f � t�C�et,,�- S kC�� SEWAGE # � J
VILLAGE ASSESSOR'S MAP& LOT_
INSTALLER'S NAME&PHONE NO.ZEf Apt'a +�
SEPTIC TANK CAPACITY C)
LEACHING FACILITY: (type)
NO.OF.BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: "'!� _
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
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�vG TOWN OF BARN TABLE
LOCATIG?J�V 6 44/"— l SEWAGE # - r 3
VILLAGE /Wi; ASSESSOR'S MAP& LOT_
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I'd 0--'6
j
LEACHING FACILITY: (type) �J /�"`1" "' J.""s�(size1)
NO.OF BEDROOMS r �''�;
BUILDER OR OWNER c�
PERMITDATE: C "— COMPLIANCE DATE:"
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
16 ! \
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TOWN OF BARNSTABLE
SEWAGE # 9 �3
VfT.LAGE INI. M,)IS ASSESSOR'S MAP & LOT OY7 O rI
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY OW I l
LEACHING FACILITY: (type) 0 /i1P (size) Ilk 3s'x a
NO.OF BEDROOMS__
BUILDER OR OWNER G �4- S
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leac ng facility) Feet
Furnished by�/!jA �' Fa.
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A C3
j a� ly
0
3 y!r Soy
No. , ✓ '\ Fee $5 0 . 00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migogal *pgtem Cottgtruction Veruait
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 8 4 Jones Rd Owner's Name,Address and Tel.No. 8 6 0—4 4 7—2 7 7 8
Marstons Mills, MA William Allard
Assessor'sMap/Parcel 239 Ridge Hill Rd, Oakdale, CT 06370
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic Sry
PO Box 1089 , Centerville, MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder PO)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Leaching system
consisting of D-boy, 3 stonepacked Cultex infiltrators.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this oar f Health.
Signed ` Date ✓���
Application Approved by i Date
r
Application Disapproved for the following reasons
Permit No. 121. Date Issued -3, �`
No. / ! �1� Fee$5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: „
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
2pplication for Migonl 6p!5tem Congtruction Permit
Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No. 18 4 .Jones Rd Owner's Name,Address and Tel.No.
Marstons Mills, MA William Allard
Asseor's Map/Parcel e , 239 Ridge. Hill Rd, Oakdale, CT 06370
Installer's Name,Ad re.,and Tel.No. 7 5—8 S 7 6 Designer's Name,Address and Tel.No.
A E' Ro nson Sr Septic Sry J
RIO B 1089, Centerville, MA
,a
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder PO)
Other Type,of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
I
Description of Soil sand{r ;
f r -
Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Leaching system
' consisting of D-box, 3 stomepacked Cultex infiltrators.
@. 1
k Date last inspected:
Agreement:
-
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
'in accordance with the provisions of Title 5 of the.Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this oar of Health.
Signed1.11 1 Date s'"7-Q -7
Application Approved by Date
Application Disapproved for the following reasons
Permit No. r► Date Issued 73
T
t ————————— ———————————————— ——————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Allard
s Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( x )Upgraded( )
Abandoned( )by
at 184 Jones Road Marstons Mils, MA has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N .,0 .�Z_'? dated
Installer Wm E Robinson Sr Septic Sry Designer
The issuance of this permit shall not be construed as a guarantee that the syster unction as designed.
Date 9'7 Inspector
r < No. ,� '. _. Fee$5 0.0 0
r y
lt THE COMMONWEALTH OF MASSACHUSETTS
i PUBLIC HEALTH DIVISION -BARNSTABLES MASSACHUSETTS
Allard
'wi!5pogaf *pgtem Con!6tructio � Permit
Permission is hereby granted to Construct( )Repair(xx)Upgrade( )Abandon( )
System located at 184 Jones Road
Marstons Mills, MA,
Installer: Wm E Robinson Sr Septic Sry
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this it.
Date:- �,��- �"" � � Approved y
__�4 ,C2��J_? 0 V-3 4 __e�
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NOTICE: This form is to be used for the repair of failed
septic systems only
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I,.William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated S�-'�"�✓ ,concerning the
property located at 184 Jones Road,Marstons Mills,MA meets all
of the following criteria:
t 'Dfere are no wetlands within 300 feet of the proposed septic system.
*, 7re are no private wells within 150 feet of the proposed septic system.
'-?The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
Khere is no increase in flow and/or change in use proposed.
There are no variances requested or needed.
SIGNED: DATE `—��`'
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
(Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification
plot plan,this plan should be submitted).
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Commonwealth of Massachusetts
ER E I V EDExecutive Office of Environmental Affairs 9 1997Department of TES DEPT.Environmental Protection BARNSTABLE
William F.Weld Trudy Coxe
Garsmor gay
Argeo Paul Celluccl Davld B.Struhs
U.Governor convnwonet
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
Property Address: 184 Zones,Rd, Marstons Mills Address of Owner. Wm & Ethel Allard
Date of Inspection: , �L (If different) 239 Ridge Hill Rd
Name of Inspector. W.E. Robinson SR Oakdale, CT 06370
Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6
4J.E. Robinson Septic Service
P.O. Box. 1089 Centerville MA
CERTIFICATION STATEMENT
I certify that I have peVsonally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
asses
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: I 19 4LL_� Date:
The System Inspector shall submit as copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B, C,or D:
A] BYST PASSES:
\/ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indicate yes, no,or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)5WIG49 a Telephone(617)292•SM
ice,Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddrem 184 Jones Rd, Marstons Mills
Owner. Wm & Ethel Allard
Date of Inspection:
B)SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
-Conditions exist which further evaluat
ion tion by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has aseptic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the wall is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) ER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddreas: 184 Jones Rd, Marstons Mills
Owner. Wm & Ethel Allard
Date of Inspection: 6-5 -7
D]I SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
his determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
ure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
T
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LAR E SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The sy stem serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public
water supply well)
The owns or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirem is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddresm 184 Jones Rd, Marstons Mills
Owner. Wm & Ethel Allard
Date of Inspeotlon:
Check if the following have been done:
Pumping information was requested of the owner,occupant,and Board of Health.
✓one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_LlAs built plans have been obtained and examined. Note if they are not available with N/A.
_LY�e facility or dwelling was inspected for signs of sewage back-up.
_Ie 'he system does not receive non-sanitary or industrial waste flow
_jAe site was inspected for signs of breakout.
�/All system components,excluding the Soil Absorption System, have been located on the site.
1Ae septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction, dimensions,depth of liquid,depth of sludge, depth of scum.
size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 184 Jones Rd, Marstons Mills
Owner. W?n & Ethel Allard
Date of Inspection
FLOW CONDITIONS
RESIDENTIAL
Design flow:_' ` ons
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no) ti a
Laundry connected to system(yes or no):_
Seasonal use(yes or no):/L J
Water meter readings, if available: N/A Well Water
Lest date of occupancy: °7
COMMERCI46L/INDUSTRL4LL-
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non4anitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (,yes or notA,0
If yes,'volume pumped: gallons
Reason for pumping:
TYPE OF YSTEM
TYPE
tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yea or no) (if yes,attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information: ®g'
Sewage odors detected when arriving at the site: (yes or no)Al
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
propertyAdduess: 184 Jones Rd, Marstons Mills
Owner. Wm & Ethel Allard
Date of Inspection: 5'^g q 7
SEPTIC TANK:
;locate on site plan)
Depth below grade: Cs
Material of construction:-tedlol�=rete_metal_MP_other(e:plain)
F4 'it
y �
Dimensions: t
Sludge depth:_(
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: 0
Distance from top of scum to top of outlet tee or bafn,: W'_
Distance from bottom of scum to bottom of outlet tee or baffle:-
Comments:
('recommendation for pumping,condition of inlet and outlet tees or baffles, depth ofliquid" level in relation to outlet invert,�gtructural integrity,
evidence of leakage,etc.) /0 c5 ✓ 7.9
O E TRAP:_
(loca on site plan)
Depth low grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensi ns:
S,,um ess:
from top of scum to top of outlet tee or baffle:
Distan from bottom of scum to bottom of outlet tee or baffle:
Comments
(recomme daton for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence f leakage,etc.)
(revised 11/03/95) 6
I
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 184 Jones Rd, Marstons Mills
Owner. Wm & Ethel Allard
Date of Inspection:
TI OR HOLDING TANK_
(locate n site plan)
Depth w grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimens na:
Capaci gallons
Design ow: gallons/day
Alarm 1 1:
Co nts:
( n of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) b�
PUMP C BER_
(locate on site plan)
Pumps ' working order-(yes or no)
nts:
(note ndition of pump chamber,condition of pumps and appurtenances,etc.)
�r—
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
PropertyAddreea: 184 Jones Rd, Marstons Mills
Owner. WM & Ethel Allard
Date of Inspection: S^,S-9 /
SOIL ABSORPTION SYSTEM (SAS):_v
(locate on site plan,if possible excavation not required,but may be approximated by non-mtruaive methods)
If not determined to be present,explain:
Type:
leaching pits,number:_
leaching chambers, number:_z
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number, dimensions:
overflow cesspool,number:
Co nts: (note oorylitionsoil,a' of hydraulic failure, level of ponding, condition of vegetation,etc.)OT
C OLS:_
(loca on site plan)
Numbe and configuration:
�P - P of liquid to inlet invert:
Depth o solids layer.
Depth o scum layer:
us of cesspool:
Mate ' of constriction:
Indica ' n of groundwater:
inflow(cesspool must be pumped as part of inspection)
Commen : (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
PRIVY-
(locate on ite plan)
Mate ' of construction: Dimensions:
Depth 017 solids:
Co mme ta:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
I � ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 184 Jones Rd, Marstons Mills
Owner. Vim & Ethel Allard
Date of Inspection: SS$ '
SKETCH OF SEWAGE DISPOSAL SYSTEM: S_8- 4
include ties to at least two permanent references landmarks or benchmarks _
17
locate all walla within 100'
� 1
0� 1 1
1
�v
7�
u)v
DEPTH TO GROUNDWATER
Depth to groundwater: 1� `4 feet
method of determination or approximation: F >
(revised 11/03/95) 9
33 y
L 0•CA T ION S E W A G E PERMIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
B UIIDE R OR OWNER
DATE PERMIT ISSUED �0 7
DAT E COMPLIANCE ISSUED _
1
u�
i
77
S
No.. ....... Fws......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN
._... ...-.O F.....................BARNSTABLE.............
Apptiratiou for Biipuuai Works Tomitrurtiuu Prrmit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at: Lot 474 Jones Road
................__.................................................. ...................... --•---------•-•---....•--...........-•--•-••-••----...............................................
� �....Lo anon- ress !� k/Y ....Lot.No--•-••----•...............................
�C._......-.. ��►
Owner Address
® aM
Installer Address 20,000
Type of Building 3 Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Q'O )
�! No. of persons............................ Showers — Cafeteria
p,, Other—Type of Building�Ap��S�vll`no. p ( ) ( )
a Other fixtures ...........................
W Design Flow..............55..............................gallons per person pier relay. Total daily flow.............................................
r
WSeptic Tank—Liquid'capacitylQ Qgallons Length_$-_6_..... Width...__.. �..- Diameter................ Depth.... _.........
Disposal Trench—No. .................... Width.................... Total Length............ r Total leaching area...... _.._....sq. ft.
Seepage Pit No...... Diameter.__.._.. 0_._... Depth below i et. .0 _.... Total leaching area..... 7_.._.sq. ft.
Other Distribution box ( � Dos i tank ,,dd
a pe hoc Survey Cons nts May 16,1978
Percolation Test Results Performed by----------- ----- -- ---••-... - ----.................. Date -------- ------.----------
aTest Pit No. 1......_2_._.__minutes per inch Depth of Test Pit.....1A_t5.... Depth to ground water------n9ne......
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Chi :,
-----------------------------------------------•--..............................-•-•-----------...................•---........i-. �...
O Descriptio of Soil-O - -Q.6....WQQd...loam.. Q�� '..2-..Q...0_Ltbj8-ail.---•---•-•----•---------------'.... ��� OF MA
x .0 - 11.5 layers of medium to coarse sand_ &- gavel �P ss9
w -•--•-----------•--------------------------------•-••---- -- -----....._.....----- ---..--- --------• .....- -------- -------- -------- ---------- ---...RQI3ERT N
UNature of Repairs or Alterations—Answer when applicable......................................................................... ......bAYLOR 't
N
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor N
the provisions of iITHIL 5 of the State Sanitary Code—The undersigned further agrees not to place the sy NAt E
operation until a Certificate of Compliance has been issued by the board of health. U : a
igne --- --------------------------------------------------------•-• -•-----1V
ate
Application Approved By... . ..................•-•------- - = ---
Date
Application Disapproved for the following reasons_______________________ ......-•-•----••------•-•...................................... ........__.___
--••----••---------------•-------•-----....--•--......_..._.....--•-••----------.............------------•--------------•--------•••------------------•---------------------------•------------•••--•••-
V—
............................... ate
Permit No......................................................... Issued..... - t
Date
Or
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TO...W .--..._.....O F....................BONS
A#V iratiuu for Disposal Works Tonstrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot 474 JonCS Road
.........---•--.__.......•....................................•-•-•-------------................:.,......... ...... . .............
Location-Address f or Lot No.
rJ6 _C.'c �_L_... •�/�t it ....................................... ...............r �1 i 1 111./.t•- --------••---------------------•------.-----•----.---
v
Owner Address
( / .......
Installer Address
Type of Building Size Lot____ _ .......Sq. feet
V Dwelling No. of Bedrooms............................................Ex Expansion Attic Garbage Grinder
� g— P ( ) g
p., Other—Type of BuildingcA'M..5n LTt!lth. No. of persons............................ Showers ( ) — Cafeteria (- )
a' Other fixtures ..
W Design Flow..............0........... ..gallons per person perday. Total daily flow................3- ...................gallons
WSeptic Tank—Liquid capacitylQ00.gallons Length 8-_6 l_..... Width.4_11.0 . Diameter................ Depth.... ._..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.................... Diameter.......19.1..... Depth below inlet......... ...... Total leaching area....2 .....sq. ft.
Z Other Distribution box ( ) Dosi tank-�
Percolation Test Results, Performed by _. {'�d.. !��_.:�'Q�:����._... Date.......pi4y .......fA_7
P.
Test Pit No. 1......2......minutes per inch Depth of Test Pit....1 :YJ___ Depth to ground water......n011e.......
Test Pit No. 2................minutes per inch Depth of-Test Pit.................... Depth to ground w,'�Eer ,,�_:.______..__._._.
C>♦' -- _._ ...... _.... .. .-- -----•---•--.......................... ::_.......-
O Description of Soil•- 1110.0d F3.ICs fl i `�, ��19��J�. -•. . - ---�--• F MAssq�,
U * ._c�. 11,5_• ii i ...Q ' 121 4 �1TTk C) fi? �' H_sand_-&C ,�-3'�i a �2 RC�SERT yG
W ......----••----•----- ---------------•••-•--••••••---•---•-•--------------•-•--•••-•----••-•---•--------•-••••-•---•------•-•---•---•--•---•.................................... .... F.
VNature of Repairs or Alterations—Answer when applicable.......................................................................... `' _ .N+4YLOR �
,* .o .p 1Vo. H
23741 O
------------------------------------•-•------•-•-••-•------•---........._.....................--•-----•---•---•------------------....•..--•-••-•-•---•• ...................... �......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor a
the provisions of T I T LE 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.
,)Sign e _ _ ..,,... .. ...............
!y! /Date
Application Approved By.. !!-.... -- d ,rt�'/� ............................. '"" f = ,
te
.Application Disapproved for the following reasons:................... ..............•---------•--------.......-•----........................•. Da......•--•--•--
.........................•-••--------•---....•-•----••--•••--•--•-••---•----•-•--•--•----•----------------••--•---------••--•-••----••-•--------...-•••--•---•-----....................................
Date
PermitNo......................................................... --•------•----•---Issued --------....._......---•-•--•--.---•-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ....OF........;;�' ..........................................
'rrtifiratr of Tompliourr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by........................................................f'= 1 .._._.....1 __.
Installer
iat
has been installed in accordance with the provisions of V.7 -j�.Y-f-
5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ____________ da.ted... .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........................................•-•------.....--••-----...--•-........ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFEALTH
....OF............ ......................................... o�
No...._...•. FEE... ..-.
Disposal Works Tonu#rur#ion rrmi#
Permission is hereby granted....................7,......2A.AA....--...-•------------•----•------••--..._..............---.....--••-----..................._.
to Construct (ff') or Repair ( ) an Individual Sewage Disposal System
atNol.A1t ...k1"I-Y....... a-fistl.....lA.L#..............A.. c.ALA..---•-----------------......-----...---......_...................----------.................
Street as shown on the application for Disposal Works Construction Per ......... ..... ..% dJ/..-,/Y..74:_*..........
oar d of Health
DATE....................................................................----.._.....
x
FORM 125S HOBBS & WARREN. INC.. PUBLISHERS r
t $OIL LOS '
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2"PEAS TONE LOAM s FILL 12" MA+
f f— i — — ---- — it 35.5
DIST
00<
Box i. ° ,...e „ ,I M
+i, 24"MIN
• a ° 0 -
/°'MIN. 1000 ISO, .�• 1000— GAL. � 0) yE S
GAL. 1 s PRECAST OR CF
VII
SEPTIC
6'1, o, • BLOCK TD
(( SEEPAGE PIT f G i4
I, e:o o pp
20, MINIMUM i,° �° _ n o� °� �A-4 L v
` FOUNDATION ° 4 8�5-
1 1 '/c�� WASHED STONE
l SCALE : 1=
ELEVATION SKETCH r' ID "'41M 4
SCALE I"= 4 _ TEST BY : �'rilf9ff
TOWN INSPECTOR: J44&4 —
�•G BACKHOE OPERATOR : -Z040 Xr
ROAD TEST MADE ON MAY /&• 19745
30
-
A, FUEL. SuR_YE'X 0tj MA 1i),-1'
� t�ji I '4` � itFlS�'I�►$1,� r1�S5� _ _ .._...._.
> �
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,05
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41G T Q{ '
SIGN ;;i.Ovf;.
5:5DRM' x I 10 GAL/8,_ /`"`4�='63'6"
�' 'I.1 4 LEAt H1NG. G1f�RG
`+"9•p t S1 DEWALI,.. -.I 88. L*3 is f f/b -411`�
AE9 A
h ,4.f..P4RWY6 P!T L
+ *+11/ � •
fit
ELEVATION SCHEDULE f
PROPOSED SITE PLAN
L INV.. AT FOUNDATION
13tm.t'l SEWAGE SYSTEM 018ION
2. INV. INTO SEPTIC TANK zIN
3. I NV. OUT OF SEPTIC TANK c 1 +�- j� OFM, AZ 1 lI` I �.► f.�,, *tip ,
_ J°r. � Jf..�W N QI" K'W SJ'T#49> -C-, o • ,
4. INV. INTO DISTRIBUTION BOXY ROBERT " ' 1 x � •+�
r . F SCALE-, i =` iMA 19 � u I)A
f DAYLOR y C—.;.�". 7 - � 1110,YOI�
5• • INV OUT OF DISTPIBUTION BOX •- !35'71 No.2374I �F c
INV INTO SEEPAGE PIT = t Fc C E COD SURVEY CONSULTANTS
IS
w ROUTE 132 ��V
7. ,BOTTOM OF PIT ` $• }� •� HYANNIS,MASS.
x I '/ �1 A 0 N 9OSTON fUNVNT CONSULTANTi, INC.
8. OOTTOM OF STONE LAYER _ ��Qf, Y 4► ii
� _ f
J