HomeMy WebLinkAbout0030 LAUREN DRIVE - Health 30 LAUREN DRIVE
Marstons Mills
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J.C. ELLIS DESIGN COMPANY, INC.
SEPTIC SYSTEM DESIGN&ENGINEERING—SEPTIC INSPECTION—
SITE PLANNING—WETLAND CONSULTATION&PERMITTING
P.O.BOX 81,NORTH EASTHAM,MA 02651 PHONE 508-240-2220 FAX 508-240-2221
EMAIL jason@jcellisdesign.com
PROPOSAL
Septic Work
Alfred Schofield
30 Lauren Drive, Marstons Mills
1. Install new H-20 D-box and riser $ 1500
Permit, labor and materials
2. Install new schedule 40 piping throughout system $ 400
Permit,labor and materials
3. Install H-20 reinforcement top, H-20 lid and riser on leach pit in driveway $ 1200
Labor and materials
--7 4. Install riser on pit not located under driveway $ 350
Labor and materials
5. Install ADS riser on septic tank inlet and H-20 riser on septic tank outlet $ 750
Total= $ 4200
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J n C. E ' ,R.S.
March 19, 018
Estimated completion time: 1-2 weeks
$2000 deposit required.Payment due upon completion.
Upon acceptance please forward all of the following:
1. This signed proposal
2. $2000. deposit
Thank you for contacting J.C. Ellis Design Co., Inc. for a proposal.
agree to the terms and conditions of the above proposal.
Client Name
Signature(Client Acceptance) Date
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Town of Barnstable Barn
Regulatory Services Department j
MASS
Public Health Division
v i639, u
`� m
200 Main Street, Hyannis MA 02601 2007
Office: 508-8624644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7015 1730 0001 4988 0183
March 15, 2018
EGELSON,LOUIS I & DEANNA L TRS
600 EAST GILCHRIST CT - APT 1A
HERNANDO, FL 34442
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 30 Lauren Drive,Marstons Mills, MA was inspected on
03/13/2018 by Jason Ellis, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following:
• Distribution box needs to be replaced. The driveway must be relocated or
components must be upgraded to heavy duty loading (1120).
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
iC
OF TH OARD OF HEALTH
e
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\30 Lauren Drive Marstons Mills.doc
M Town of Barnstable
• ti l wMS' r, R
' Regulatory Services Department
Public Health Division
200 Main Street,Hyannis MA-02601
Office: 508-862-4644 Richard Scab,Director
FAX 508-790-6304 Thomw A McYzan,CHO
Feb 6, 2007
Rev. 5111116
DEADLINES TO MPAIR FAILED.SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000) _
'An`z'marked in the ❑is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA I
❑Discharge or ponding of effluent to the surface of the ground
❑Pumping more than 4 times during the last year not due to clogged of obstructed
pipe. :.
o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE(1)YEAR DEADLINE CRITERIA
❑Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool `
❑Any portion of the-SAS, cesspool, or privy below high groundwater elevation
❑Any portion of the cesspool within a Zone 1 to a public well
❑Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis.'('This system passes if the water analysis
indicates the well is free from pollution).
TWO (2)YEAR DEADLINE CRITERIA
q Single Cesspool
/ ny"conditionally passed systems"(broken cover,relocation of a pipe,relocation
of a driveway due to H-10 components, etc)
o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code
§360-9.1)
❑Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
.. 1�
Rep �e��,adlhine:
Q 1SEPTIe1DEADUNES TO REPAIR FAILED SYSTEMS.doc ��
. 1 of
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 30 Lauren Drive
Property Address
Louis &Deanna Egelson
Owner Owner's Name -
information is required Mills ✓ MA 02648 March 13, 2018
requiredd for every -
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms � w
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Jason C. Ellis
use the return Name of Inspector
key.
J.C. Ellis Design Co. Inc.
raa Company Name
P.O. Box 81
Company Address
North Eastham MA 02651
City/Town State Zip Code
(508)240-2220 SI 3600 IRS 1126
Telephone Number License Number
B. Certification
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:
❑ Passes ® Conditionally Passes ❑ Fails
❑ Need r u alga In by the Local Approving Authority
%iG iS i 0;P; R
4 March 13, 2018
Inspect i re Date
e system ris;.ectora`: submit a copy of this inspection report to the Approving Authority(Board
of Health or DEPf1 itHin 0 days of completing this inspection. If the system is a shared system or
has a design flow of 10 00 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.
****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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°w. 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/ always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
Z One or more system components as described in,the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
® Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ 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):
D-box is in a very deteriorated condition - D-box has eroded through on the sidewalls and sand and
roots have penetrated into the d-box. D-box needs to be replaced.
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® 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 1/2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last.year NOT due to clogged or
obstructed pipe(s). Number of times pumped: 0.
❑ ® 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 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 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ® the system is within 400 feet of a surface drinking water supply
❑ ® 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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ 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?
E ❑ 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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system-inspected? ❑ Yes ® No
Seasonaluse? ® Yes ❑ No
Water meter readings, if available last 2 ears usage d '17-44 gpd, '16-
9 ( Y 9 (gpd)): 44 gpd
Detail:
Sump pump? ❑ Yes ® No
.Last date of occupancy: Months
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°.0 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is Marstons Mills MA 02648 March 13, 2018
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: BOH
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.N 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1980-Permit at BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 4.0'feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Satisfactory condition - Piping thoughtout rest of system is light duty schedule 20 PVC. Recommend
replacing light duty piping under driveway with Sched. 40 PVC
Septic Tank(locate on site plan):
Depth below grade: 3.0'
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallons
Sludge depth:
18
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 16"
Scum thickness
6"
6
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
8"
How were dimensions determined? Direct observation - 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 was in satisfactory condition at time of inspection. Inlet 36" below grade; Outlet 38" below
grade. Septic tank should be pumped at this time due to sludge volume. Recommend installing risers
on inlet and outlet openings of septic tank tank to bring lids close to grade so they can be accessed
easily for maintenance. Septic tank appears to be light duty (H-10)-driveway should be relocated off
of top of septic tank to prevent damage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;.� 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna. Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
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 in poor, deteriorated condition and need to be replaced. - 50" below grade. Sidewalls have
eroded away and sand and roots have penetrated into the d-box.
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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
y Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number:
2
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pits were in satisfactory condition at time of inspection - Both pits were dry at time of inspection
with no evidence of failure. Pit# 1 -top of pit 68" below grade, lid 14" below grade. Both pits appear
to be light duty (H-10) and at least partially located under the driveway. Pits should either have a
reinforced top installed or have driveway removed from above them to prevent the pits from being
damaged. Both risers should be replaced - riser for pit#1 is light duty plastic and pit#2 is concrete
and cracked. Pit#2 -Top of pit 77", lid at grade.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
❑ drawing attached separately
0
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o a.
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EXISTING w
DWELLING
SEPTIC TANK
A 0 4 EDGE OF
2 �DRIVEWAY
APPROX.— //3/ NCH IT 1
D—BOX
D—BOX o 5
EXISTING l LEACH PIT 2
GARAGE
DRAWING NOT TO SCALE
A B
SEPTIC TANK IN 1
SEPTIC TANK OUT 2
D—BOX 3 18.8' 27.0'
aaE�E
15448.8'
3.8' 34.2'
56.0'
t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 4'+ below leach pits
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: William M Warwick &Assoc. 1-22-80
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:
USGS topo and groundwater contour maps
You must describe how you established the high ground water elevation:
Checked elevations of pits and level of pond on site. Bottom of lowest pit is 15.54' above pond
(groundwater) level.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
e
Commonwealth of Massachusetts
N Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�.N 30 Lauren Drive
Property Address
Louis & Deanna Egelson
Owner Owner's Name
information is required for every Marstons Mills MA 02648 March 13, 2018
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
❑ System Information— Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliLation for MispoSal *pstem ConstCULtion permit
Application for a Permit to Construct( ) Repair(Upgrade() Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 30 L,,w9,G--j 9 rL k v= Owner's,Name,Address,and Tel.No.
Assessor's Map/Parcel 1 n% 6 Z- I 600 GAUT &j4L1jit,cGT f3L�G-�2 Un l !T /A
Installer's Name,Address,and Tel.No.JAS," Designer's Name,Address,and Tel.No. Ft-
J.C. 1 ".0 I ts.+ Co =_�t
Po (30 .r3 M4 v�ri
Type of Building:
Dwelling No.of Bedrooms Lot Size 1•35A e, sq.ft. Garbage Grinder( )
Other Type of Building Vsq► r J t:S No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) `N V gpd Design flow provided b 3 y 5 gpd
Plan Date t/L7_/1100 Number of sheets 1 Revision Date
IF
Title
Size of Septic Tank 1 s� 64-L Type of S.A.S. 2. GEiarr 4 1'r-5
Description of Soil Co►4nS 6 SArV1 �'�+�►Z
Nature of Repairs or Alterations(Answer when applicable)RPL^t,g-,,A•-+ 2� N Sa>M F
1AI
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 En ' o ental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o
Sign Date Y Z /
Application Approved by Date �1
Application Disapproved by Date
for the following reasons
Permit No. ��� Date Issued L 1
No.C�)De Fee
- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION.-+TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4
9ppliLatlon for Mispo8af1*pstrm Construction j3erntit
Application for a Permit to Construct( ) Repair(,�,�Upgra�d �) Abandon( ) ❑Complete System ❑Individual Components mot'
Location Address or Lot No. ?j tJ D Yz:v Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1 a % -2- 60G Ee,yr J Lfit,.2 2 $7 1
Installers Name,Address and Tel.No.,,,1' , ,�.S�.,a �,,,-,� Designer's Name,Address,and Tel.No. ,-r-k 2 MJ;.�u„ �<-
voA
Type of Building: a
Dwelling No.of Bedrooms L{ Lot Size S A c_ sq.ft. Garbage Grinder
Other Type of Building ��S+�w cs No.of Persons Showers( ) Cafeteria("" ) `
Other Fixtures
Design Flow(min.required) 41 t1 y gpd Design flow provided ' y 7 gpd
Plan Date 1 h Z , Number of sheets 1 Revision.Date
Title
Size of Septic Tank A 64 c. Type of S.A.S. 2 e-
Description of Soil (,,)A,,(
Nature of Repairs or Alterations(Answer/when applicable) Zp_1, ,-_, �ar� 1)- LA t-J Sao,i0-1
��..�C..�'C v� - �t �•J k : tA,' 'v f !!r v C �t-,a,? S.l r�! 1� ��!� !n� Q�1�\;�..r dr6-•r
PI lea,
r
Date last inspected:
a. .
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-4nental Code and not to place the system in operation until a Certificate of ,•
Compliance has been issued by this Board of --east .
Signed'( r Date Vh 1,(/`:S
Application Approved by _ '^^---- Date a�cj3 5r1i 6
Application Disapproved by Date
for the following reasons
Permit No. / Date Issued L_l ) c7 5�f
-----------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
TC•�� r Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( ))by
/
at Ca all-VIV kaf �Yl t'f' has been constructed in accordance a /
with the provisions of Title 5 and the for Disposal System Construction Permit Noes dated �,---
Installer ` 5 Designer
#bedrooms Approved design flow Ll C/0 gpd
The issuance of this permit shall not be construed as a guarantee that the system Irs, icc�icon as desiled.
Date S/ f Inspector 1 NCy',.1 tC�
- _ ---- ------------- --------------------------- - - "7�7 -- --- - - -- - -- -
No. _ " �! Fee 160
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair(k) Upgrade( ) Abandon( )
System located at
_ t
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:Construction must be completed within three years of the date of this permit.
Date I / Approved yb _
LO CAT 10 SEWAGE PERMIT NO.
/-oz
vlLrACE 41 /off - 06�
41#24 PAJ ZI LL 4
L
I N S T A L`LER'S NAME i ADDRESS
L"),t�z M l2lA O JCS c�
BUILDER OR OWNER
DATE PERMIT ISSUED
S
j DATE COMPLIANCE ISSUED 7-1�
I�
r --
� /lam
�! b
_.� � �'
��
(tis' ,
�.`�
� g'�
..._ i l
No........... .... Fss,. ....J
THE COMMONWEALTH OF MASSACHUSETTS � =
BOAR® OF HEALTH �d c��vZ.Q
................ ----......._...._oF............. ...................L7.�®------ 'O.-V... ���VNJ€ C"
AIirttiaan faart #aaa1 Workii C05"co g,� ertt
Application is hereby made for a Permit to Construct ( i,'�or Repair ( ) an Individual Sewage Disposal
7stem at:
T 3 eJ.X-/f'9
Location Address or I o� No.
elsv.......Awner------.----•---•--------•-------•-----.-. d(/ �i��?!Address
a -�E 1--•.............................. ............... ...••--------•-------...----------•-----------•-............................
Installer Address d Type of Building Size Lot__/,.35_A_.........Sq. feet
Dwelling--L;�`No. of Bedrooms............;Y-------____-_---__-..-__-Expansion, Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures
W Design Flow........................r..........._gallons per person per day. Total daily flow--------;�� ..........................gallons.
WSeptic Tank—Liquid capacity/_�8�..._gallons Length---------------- Width................ Diameter_-.---__--__-.-_ Depth................
x Disposal Trench—No. .....................Width.................... Total Length.................... Total leaching area--__._ --_--__------sq. ft.
Seepage Pit No./_1 .2---____- Diameter.._.. Depth below inlet......Z......... Total leaching area.,i0Ye_f7.sq. ft.
Z Other Distribution box (t%j Dosing ank ) _ �
'-' Percolation Test Results Performed b u j^�2/ / Dat - . ........ . . .
4 Test Pit No. -_---minutes per inch Depth of Test Pit_L�__-4!. __._.... Depth to ground water#ez.'1_-_e............
Test Pit No. 2_`..A_._._minutes per inch Depth of Test Pitl.4_ ......... Depth to ground water.A��-_-f._e..._._...
a -----------------------------
O Description of Soil_._.Cee% .19.......Sam' .
x •••---•-••---•------•••-••---••......-••---------•-------
V ....................... •---•-•--••-•-••-----•-•-----••-•-•------•-------•-----•---••••--•-•.............•--••---•••-•-------•-••------------•--••--••------------•-••---------
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 i T`.LEE
p 5 of the State Sanitary Code— T e undersigned rtl er agrees not to place the system in
operation until a Certificate of Compliance has been issued e b d f
Sig •----•• • -------- -•• ------- ....................
� D to
Application Approved By..."....Z
Date
Application Disapproved for the following reasons:____.._---------------------------------------•-•------------•...............------....... ......----------
...........
------------------------------------------
----------
..••--------------------------------------------------------------------------------------------------------------------------
` Date
Permit No......................................................... Issued_ / �.:U._
---- -----•----------------•------•
Date
No..........1..1........ F�a ®... ..
i. .r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. .. - OF......:......t ----.......... .............................
Appliratinn for Bhgpp,gal i8lirkfi Tomitrnrtinn rrrmit �
Application is hereby made for a Permit to Construct (rY or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or No.
........................................................... . `..r ar..... ! r......✓... .+?r/.
Owner Address
W s
14
14 Installer ' Address
Q Type of Building Size Lot_ -A..........Sq. feet
U Attic ( -`•Dwellin AeNo. of Bedrooms_........._{. .Ex Expansion Garbage Grinder
( )
04
Other—Type of Building ............................ No. of-persons........................:.._ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------------------------------------":
W
Design Flow......................,�r............gallons per person per day. Total daily flow..._..._*.& .....-....................gallons.
WSeptic Tank—Liquid capacitylVA....gallons. Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width ..._...._.._._.. Total Length............j_..... Total leaching area....................sq. ft.
Seepage Pit No.�_-t }._-l--._--_-- Diameter ..... Depth below inlet....r.......... Total leaching areal.3)1,. 7.sq. ft.
Z Other Distribution box (&r'f Dosing tank ( )
Percolation Test Results Performed bY.......................................................................... Date........................................
Test Pit No. l.<..P_-____minutes per inch Depth of Test Pit..6A'*....... Depth to ground water&., �............
fs, Test Pit No. 2.N•_�.....minutes per inch Depth of Test Pit,rl_�.�.......... Depth to ground water.100W!C`.........
a •-------------- ......
•------
••-------
•---•----------------------------------------
••------
•-----•---------
DDescription of Soil....�'m�ff.!-..-•---,�-`i�.t�. :� tr`,C!t'!! ' -------------------------------•-••----•---------------•--------••-•---•---.....-•-•-•-----
x
V •-••-----••••-•••--•---•-••-•--••••----•-•--••-•-•--•-•••------•-•-----•••-••-••---•••--•-----•--••--••---•--••-•----•-••••-------•••-----•-•--•-•-••----•-------•-••---•-----•------•-•••......•-•-_...
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 TI T LE, y g g p y
of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sig
Date
Application Approved B .• .f,`.f 1�C s .. ......................•--- ...... '. 4�.
Date
Application Disapproved f or the following reasons-.............................................=--------------•------------------•---------------•--------------
--•-------------••--•-•-••••---•-----•-•...-••-••-•--•••••--••-•-•-••.........--•-•-••-••-••-•••••--••••.-•-••---•••-...-•-••----••••-•--•-•-•-•--••••••-•-----••-•--•••-•--------------•--•-----•--•---
Date
PermitNo......................................................... Issued-.......................................................
Date
-THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA TH
!..G �...........OF.......... ...................,.. ..
Trr$ifiratr of ToutpliFatta d
THIS IS TO CERTIFY, That the Individual Sewage Disposal S;Istem constructed ( ) or Repaired ( )
by staller
. ..
Y � <at
has been installed in accordance with the provisions of of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ---_-------_Y7................... dated-_.)-`_a_1''_.............................
,a
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM WILL CTION SATISFACTORY.
DATE ...... ... ...... •--••-......._.._ Ins ector
1
THE COMMONWEALTH OF MASSACHUSETTS !
BOARD . OF HEALTH/
No. -1 ...........r''r'. `1..........OF.... .:: l,�!._... ...._.`....................... FEE.:
i u M4 ,17,
k11 (9n trnrtion rrtnit
Permission i hereby granted " �I -- `��------------------------•-----------..................------........-•-•-•---
to Construct ( ! or Repair ( ) an In v' ual Sewage Disp srra�.l Sys efnjt
// J�.. .�.1 G-..n. _j-�.___�. �_._""_ �__ ____�__ __-t&....................................
Street
as shown on the application for Disposal Works Construction Per/mi o _. -----
-- -----
Dated-__�'-----........0... ...........
dof Health
DATE....... --- -------y-,....................... .f
FORM I2,88 HOBBS & WARREN, INC., PUB. 15HER5
T.
SITE PLAN T YPICAL PROF IL E
SCALE � �~ s �O' c-� �7 ;. ;-,
NOT TO SCALE
/B"STD. L T. WG T C.L MH COVER
cp
4'C.I. PIPE 4 B/T FIBER PIPE TIGHT JOINTS
-� 30 OUTL E T LEVEL
5o -_` FLOW L/NE�_ O' O TO /RST JOIN — -- -
�� --Go DWELLING /p�� S ,.
r' /4
C.I. T£E C. TEE
_•�- I STANDARD PRECAST 3. SoI do
—
\ _ O CONCRETE%—�20GALL0N
- 5TO PQECA-1r C0-v- :n
O 15Oo CiA4 YY,E `=E- SEPTIC TANK
T,4/v�C DISTRIBUTION BOX
- p TO BE INSTAL L ED ON ,
` o LEVEL , STABLE BASE
SEPTIC TANK
TO BE INS TA L L ED ON
T r n?'Q a LEVEL STABLE BASE k
l/B TO //2 WASHED PEA STONE
LEACHING PIT
h�P ALL AROUND FREE OF IRONS, FINES BASE TO BE LEVEL
N 1 a P AND DUST /N PLACE
BRICK 8 MORTAR COURES 3/4" TO 1 //2 WASHED CRUSHED
AS REOU/REO TO BRING STONE ALL AROUND FREE OF
T. COVER TO GRADE 24"C. I. MH COVER /RONS, FINES AND DUST /N PL ACE
AND FRAME
os
c
LEACHING PIT SEC T/ON—
1 INL '91 FLOW LINE
z t P/PL� i CONCRETE TO BE 4000 PSI 28 DAYS
2 REINFORCED WITH 6" x 6'' NO 6 GA W W M
=' 3 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER
DEPTH REQUIREMENTS
w �� a OPENING WITH 4- 118" 4 NUMBER OF PITS REQUIRE(, Two
! � I OUTER DIAMETER 8
l-3/4" INSIDE DIAMETER NOTE EXCAVATE TO ELEVATION f`—pOR LOWER AS
3,. REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH
/! PIT REPLACE EXCAVATE;' MArERIAE WITH CLEAN
GRAVEL TO DESIGNED GRADE
/- 53 Ac- •:
19
\� 2 O"" -------- --6 6 -- - --- -� 4 O -�-1
4' MIN. i EFFECTIVE DIAMETER
(NOT TO EXCEED 3 TIMES EFFECT/VE DEPTH)
D
•�-� WATER TABLE
SOIL A ND PERC. DA TA GENERAL NO TES
Zo
M PERC. RATE < 2 MIN /IN . NO HEAVY EQUIPMENT TO RUNI OVER SYSTEM.
SEPTIC 'ANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD
TEST BY. GVM tit �S/A,21-Yi...k �5 f1 ���
PRECAST REINFORCED CONCRETE UNITS
m WITNESSED BY �'yy�- �►�✓��'�_ }' ' /� ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
i ! TC REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE
DATE ,
TEST PIT GR EL.: �e TE /�22 �O
"t MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF
cp
TEST PIT NO, I TEST PIT NO 2 SANITARY SEWAGE EFFECTIVE I JULY 1977
0" � 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE
BOARD OF H E-L r H
1/4.r .+r,x AT COMPLETION OF CONSTRUCTION , PRIOR To BACKFILLING. - HE_Sowo Sa^moo 'yi't7vf_� BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION
PITCH ALL SEWER LINES I/4 FT UNLESS INDICATED
`L Gov • 16,0 -.o.^o OTHERWISE
• �. � k'. ,°.� �t3 �-,_ NO c:�i<:ND W.q TE.F' ::e b ,1:'." :-`+.Fh'..7 35•'pT�,e
'SIGN DATA
f::P 7-- <<- / 4 9 BEDROOMS DISPOSAL Al "-
EST TOTAL DAILY EFF. GALS
L EGEND — SEPTIC TANK GAL
SIDEWALL AREA 2•5O GAL /SO FT
Ox00 EXISTING GRADE
BOTTOM AREA GAL./SO. FT SEWAGE DISPOSAL �� YSTEM
LEACHING REQUIRED 226- 09 SO FT
ZONE
o. oo FINISHED GRADE ACTUAL LEACHING AREA 27 SO FT FoR
7'ou/"2 /-tea
• • l INVERT ELEVATION
DOMESTIC WATER SOURCE
--T�._._ _ 3 L NU.E'144 Of
PROPERTY LINE /'�* M+s -/ ' A,PLAN REFERENCE o'e"`� ' ' R ,t,r� M. ft SCALE ' AS INDICATED GATE
- - - - MEAN HIGH WATER M.
WARWICk
s - = ti „�- ✓ ,�tr �C f /Q r ,r WM M WlJRW CK & ASSOCIA/ ES
BENCH MARK DATUM MARSH s �` "�"v '91d7 T
4GiSfE BOX 801 - IVJRTH FAL:MOUT H
MASSACHUSE T T S 025,56