HomeMy WebLinkAbout0195 LOVELL'S LANE - Health 195 LOVEWS LANE, MARSTONS MILLS
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftplitation for Disposal �&pstpm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Kndividual Components
Location Address or Lot No. °S j�� 11 Ojw,;neerr,',slName,jddress,and Tel.No.S6�-aa/-o�/�-
Assessor's Map/Parcel ON Oa g/y�J"g 004 V 8
Instalier's Name,Address,and el.No.6ZI6-`)7/- t•3`�9 Designer's Name,Address,and Tel.No.
C' �iprn,Z jits rc�• va44
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Mature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and m ' of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Enviro al Code an of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hea _
igned Date f
Application Approved by Date I�
Application Disapproved by Date
for the following reasons
Permit No. CAL r7 C, Date Issued
No. ✓�1 — 0",v Fee /D v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
21pplitation for Misposal 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) .Abandon( ) ❑Complete System individual Components
Location Address or Lot No. J �`� Lo OeA('5 Ln Owner' Name,address,and Tel.No.Sb�- 2 3/ -
It ire S t ou U o-
es C.
Assessors Map/Parcel 0% Upq $t�/U r s s !`1 ��S ,Mars iit As • fq V
Installer's Name,Address,and Tel.No. 5 `T)/- 79 Designer's Name,Address,,and Tel.No.
-(?v r,,1 ci i Oons�-r X+ c,0
s us4 cu IRA rs F��s i(s L1 v�c�yg
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) - --
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
.�� Size of Septic pnk Type of S.A.S.
Description of Soil
fNature of Repairs or Alterations(Answer when applicable) /` ( .• ,.
Date last inspected:
Agreement:
i
The j mdersigned agrees to ensure the construction and ainterr�n of the afore/described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environme tal Code an of to place the system in operation until a Certificate of
Compliance has been issued by this Board of He K.,
Signed Date 11 f
Application Approved by Date C)Ay
i
e Application Disapproved by r Date
r for the following reasons'`` -
Permit No. �� � � � Date Issued
------------------------------------------------------------- ------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of CDIIYtIYIAYCLP
TIES IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(lk) Upgraded( )
Abandoned( )byt7]
at q5 (S (I) has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Naz-,%f5—U-V dated a 1
Installer �O-tt G nST�00 1� Designer N /`
#bedrooms Approved design flow, / e gpd
41
The issuance of this permit sha 1 not/be al
oo'stru�as a guarantee that the system will tionlas de i(!gned�
Date Inspector
----------------------------------------------------------------------------------------------------------
No. .- Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstr Construction Permit
Permission is Zereby granted to Construct( ) Repair(7 Upgrade( ) Abandon( )
j System located at /95 Lo U �m , ��try rS Ad/5
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 ist b completed within three years of the date of this p rmit. _----�
Date a a 5 Approved by
I
Town of Barnstable Barnstable
: . Cft
Regulatory Services Department Q p
>�ST"M p
N"& Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7014 1200 0001 0358 0369
February 17, 2015
Jared Wallin
195 Lovell's Lane
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 195 Lovell's Lane, Marstons Mills, MA was last inspected
. on 1/19/2015,by Michael DiBuono, a certified 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 5 (310 CMR 15.00) due to the following:
• Distribution- box needs to be replaced
You are ordered to repair/replace the above listed septic system components within
Sixty (60) days from the date you receive this notification.
Failure to repair/replace the septic_ system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Ltr not sent—permit# 2015-020
Thomas McKean, R.S., CHO 2/4/2015
Agent of the Board of Health Report not received after
QASEPTIC\Conditionally Passes Ltr\195 Lovell's Ln MM Feb 2015.doc
Town of Barnstable Barnstable
: . °� Regulatory Services Department P
tSTABU.� p
9 Ate ' Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-5304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7014 1200 0001 0358 0369
February 17, 2015
Jared Wallin
195 Lovell's Lane
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 195 Lovell's Lane, Marstons Mills, MA was last inspected
• on 1/19/2015, by Michael DiBuono, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
udder the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Distribution- box needs to be replaced
You are ordered to repair/replace the above listed septic system components within
Sixty (60) days from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Ltr not sent—permit# 2015-020
Thomas McKean, R.S., CHO 2/4/2015
Agent of the Board of Health Report not received after
Q:\SEPTIC\Conditionally Passe,,Ltr\195 Lovell's Ln MM Feb 2015.doc
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Parcel Detail - a. . t , ; �., _
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d� Parcel Info
Parcel ID 078-024-008 Developer Lot LOT42
Location 1195 LOVELL'S LANE pri Frontage 20 _
Sec Road . Sec Frontage
village MARSTJNS MILLS Fire District C-O-MM
Town sewer exists at this aidress No Road Index '09255
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Asbuilt Septic Scan;
Interactive Map '�$ 1iV
078024008_1 f i
1. Owner Info
Co- '
Owner BRACKETT,KENDRA D� owner
6 streets 195 LOVELL'S LANE J Street2 `
city MARSTONS MILS state MA Zip 02646 country
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. land Info
Acres 0.32 use Single Fam MDL-01 Zoning RF Nghbd 0105
Topography Above SfreEt Road Paved'
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utilities Septic,Gas Public Water Location ':Rear Location z
_ • Construction Info
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Start ��ii Parcel Detail-Google Ch, /® N1
Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT(5.1)
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a. 195 Lovells Ln
Poperty Address --
Jared Wallin _-
Owner Owner's Name - —
information is
required for every Marstons Mills _ _ ma _ 02648, 1/19/15 _
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 _
on the computer, - I
use only the tab 1. Inspector: 5 key to move your
cursor-do not Michael DiBuono
use the return
key. Name of Inspector
DiBuono Sewer and Drain
Q Company Name
8 Johns path -
Company Address
S Yarmouth MA- 02664
City/Town State Zip Code
508-364-9587 SI 13522 .: c• ,;,;,,;.
---, Li
Telephone Number - - -- .
•`•� I •.- ;; • cense Num_ber_
C.
B. Certification
I certify that I have perso•n•ally 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
❑ Needs Further Evaluation by the L_gcal Approving Authority
1/20/15
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. 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.
****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.
o
t5ins•3/13 Title 5 Official Ins cli n o :Subsurface Sewage Page 1 of 17
a
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner, Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15�
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:
The system contains a 1,000 gallon tank as well as a concrete Distribution box. Distributin box is
rotted and in need of replacement. All tees and baffles are in place. The leaching is made up of a
single 1,000 gallon,leach pit. The pit is working well and the level of water is 28"s below the invert.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box forges", "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):
15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
page. Cityrrown 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):
System will pass with Dbox 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
(Sins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
195 Lovells Ln
Property Address -- _
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
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 indlicates 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 copyof 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
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® 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/z day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°�M ,•° 195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
page. Cityfrown 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:
❑ ® 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 Y
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 1:95 Lovells Ln
Property Address --
Jared Wallin
Owner Owner's Name ---
information is
required for every 11�arstons Mills ma 02648 1/19/15
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?
0 ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ 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): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is
required for every N1arstons Mills ma 02648 1/19/15
page. Cltylrown State Zip Code Date of Inspection
D. System Information
Description:
The system contains a 1,000 gallon tank as well as a concrete Distribution box. Distributin box is
rotted and in need of replacement. All tees and baffles are in place. The leaching is made up of a
single 1,000 gallon leach pit. The pit is working well and the level of water is 28"s below the invert
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use?
❑ Yes ❑ No
Water meter readings, if available (last 2 years usage (gpd)): 2013 78,000
Detail:
2014 98,000
for a total of 244 GPD
Sump pump?
❑ Yes ® No
Last date of occupancy: Occupied
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.): _
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
l5ins•3/13
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 .
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is Marstons Mills ma 02648 1/19/15
required for every _
page. Cityfrown 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: tank has been pumped regulary
I
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1,000 Gallons
gallons
How was quantity pumped determined? Site glass on truck
Reason for pumping: Maintenance
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):
l5ins-3/13 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
,M 195 Lovells Ln
Property Address —
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all,components, date installed (if known) and source of information:
22 years
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: e8t"s ____------_----_-."--
Material of construction:
® cast iron M 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
System is vented throu ht the roof
Septic Tank (locate on site plan):
Depth below grade: 1 ft
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1,000 gallon
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 Gallon _-
Sludge depth: 3"s---------- ---------...-----.
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 195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is Marstons Mills ma 02648 1/19/15
required for every _
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 24 s
Scum thickness 3"s
Distance from top of scum to top of outlet tee or baffle 42 s
Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was pumped at time of inspection as well as on a regular basis
Grease Trap (locate on site plan):
_
Depth below grade:. NAfeet
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M ,•'" 195 Lovells Ln
Property Address -- — -
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
page. City fown 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.):
Tank was pumped at time of inspection as well as on a regular basis. Tees are in place and levels are
normal.
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 El 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
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
195 Lovells Ln
M
Property Address
Jared Wallin
Owner Owner's Name
information is
required for every Marstons Mills ma 02648 1/19/15
page. Cityrrown 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 Needs replacement
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.):
Distrinution Box is decayed and needs replacement.
Pump Chamber(locate on site plan):
Pumps in working o der: ❑ 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:
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
t v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address — ----- - -- ----
Jared Wallin
Owner Owner's Name ---
information is
required for every Marstons Mills ma 02648 1/19/15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length: ----
❑ leaching fields number, dimensions: - ---- - -- --"
❑ overflow cesspool number: -- -----
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No signs of carry over. no si ns of hydrualic failure
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner Owrer's Name
information is
required for every Marstons Mills ma 02648 1/19/15
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.):
No signs of ponding or hydrualic failure.
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
;M 195 Lovells Ln
Property Address --
Jared Wallin
Owner Owner's Name —----
information is
required for every Marstons Mills ma 02648 1/19/15 '
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
i
I
I
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Assessing As-Built Cards 11ca
TOWN OF BARNSTABLE
LC ATION �lo���_lorc/%5 �n WAGE if
VILLAGE_ ��oHs f��//S
ASSESSOR'S MAP & LOT^
INSTALLER'S NA14E& PHONE NO. yap �to Y,Z p- 'n-Xs-
SEPTIC TANK CAPACITY
LEACIII.NG FACILITY:ttype)_ (sizc) 6X/✓
NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER e
DATE PERMIT ISSUED:_ !� _ q`
DATE COMPLIANCE ISSUED;_
VARIANCE GRANTED; Yes __No_
a
/dj Gj
i
a Jxr I •
N0 yl) �
hup:i/\v\v w..Lowitofbitrnstable.us/Assessiii&/FIN1display.asp''ma.ppar-O75O?4DOti§ I;16;?U1
I
• Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is required for every Marstons Mills ma 02648 1/19/15
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: 20+ ft
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers -(attach documentation)
® Accessed USGS database -explain:
usgs map
You must describe how you established the high ground water elevation:
Property sits 25 ft above nearest water venue. According to usgs maps system is approximately 25 +
ft above ground wager.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
195 Lovells Ln
Property Address
Jared Wallin
Owner Owner's Name
information is Marstons Mills ma 02648 1/19/15 _
required for every
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
...-.moo
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE S
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY
SUBSURFACE SEWAGE DISPOSAL SYSTEM FOERSMSMENTS
PART A
(� CERTIFICATION
Property Address:
�NL
owner':,Name: l l_5 , m
Owaer'a'Addtt+ess: _ J
L I
Date of Inspeetiion:
Name of Inspector:(please print)
CompenyName. pe ` cT 1C1 cTY .
tr S� py-
Telephone Number: 0�-
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that
below is�ac'mrate and complete as of the time of the ins the information reported
tremmg and experiencemaintena nce of on site se in the proper function and inspection The inspection P my
was erformed based an;,
approved systeiu inspector pursuant Sectiondisposal
e 15.340 of Title S 10 C R I5.000 systems. [am a DEP i 0
The system:
i x
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority Fails
Inspector's Sign$ture: arc' a
Date:
The system inspector shall submit a copy of this inspection report to the Approvin Authority DEP)within 30 days of completing this inspection. If the syste►n is a shared system or has a design flow of I
h (Board of 1-leaith or
gpd or;rester, the inspector and the system owner shall submit the report to the appropriate regional office of,h0U
DEP. The original should be sent to the system owner and copies sent to the buyer, rap livable and
authority. e
P the approving
Notes and Comments
f
1
1
****This report only describes conditions at the time of inspection and wader the conditions of use at th
time.This ins y at
pectiioa does not address how the system will perform is the future under the same or differea t i
conditions of use. I
i
_.?age 2 Of 11.:.. ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection: --
Inspection Summary; Check A;B,C,D or E/ALWAYS complete all of Section D
A.' Sys. Passes:
Zf 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:
i 1-C11 u
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired,The yystem,upon Completion of the replacement'"repair,as approved by the Board of Health, will pass.
Answer yes,no or not determined.(y,N,ND)in the for the folio „
explain. wing statements.If"not determined please
The septic tank is metal and over 20 years old*or the Septic-tank(whether metal or not)is structurally
unsound,exhibits substantial with Mit anon or exfiitration or tank failure is imminent,System will pass inspection if the
*A me tank is repined with comP�g septic tank as approved by the Board of Health.
� 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 s available.
ND explain:
I .
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 %
I '
ND explain:
Page 3 of!1. '
II OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: a Z F[ L,'S L N
Owner:
Date of inspection:C— C.— e% Q
C. Phether,Evaluation is Required by the Board of Health:
Conditions exist which require fiuther evaluation by the Board of Health in order to determine if the stem
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
col or privy is within 50 feet of a bor . ve
g g led
eta
wetland or a salt marsh
c
•I .
2• SYSUM will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioaiug in a Wanner that.proteets 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 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 S
pm,provided that no other
Whim criteria are triggered.A copy of the analysis must be attached to this form.
3. Other: ,
Pagg 4 of 11
I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: f—(i5 i�p Q
Owner. W, 1^ S���T--�►lrL,/
Date 4Io pectiont — O
9.
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes INo
o sewage into facility or system con dent due to overt
f Po ended or clogged SAS or cesspool
or pending of effluent to the surface of the ground or surface waters due to an overloaded or
. - eeloggedAS or cesspool
;qujd
uid level in the.distribution box.a+ove outlet invet't due to an overloaded or clogged SAS or
_ pth in cesspool is less than 6"below invert or available volume is less than %day flow
pumping more than 4 times in the last yearNOT due to clogged or obstructed pipe(s). Number
pwriped
on of the SAS,cesspool or privy is below high ground water elevation.
portion of cesspool or privy is within 100 feet of a surface water supply or tributary to
ly. pp y ry a surface
ion of a cesspool or privy is within a Zone 1 of a public well.
y 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 a free from pollution from that facility and the presence of ammonia
nitrogenand 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.)
(Yes/No)The system fails. 1 have determingd 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 now of 10,000 gpd to 15,000
gpd.
A You must indicate either"yes"or"no"to each of the following:
J` (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.
Page 5 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ASSESSMENTS
PART B
CHECKLIST:
ProPerty Address:
Owner:
Date�ilaapecUon: — — O
Check if the to]I
owing g have been done. You must inUicate` es"or"no"as to each of 'the following.
Yes No
ing information was provided by the owner,occupant,or Board of Health
any of the system components pumped out in the previous two weeks?
f
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 at but&pleas of the system obtained and examinei?(I they were not available note as N/A)
Was
the facility or dwelling hmpected for signs of sewage back up?
Was the site inspected for signs of break Qut?
Wem ai system components,excluding the SAS,located on site?
Were the sepuc tankthe mks uncovered,
or tees,aoaterial of on.dam-Opened,and the interior of the tank inspected for the condition
mns,depth of liquid,depth of sludge and depth of scum ?
Was the facile owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems'?
The size and to"Wn of the Soil Absorption System(SAS)on the site has been determined
Yes no based on:
Exisdng 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
3s�ccePtable)[310 CUR 15.302(3)(b)] fence
Page 6 of I I
OFFICIAL-INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMEN
TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property:Address: Q
l.. tl
Owner -- crrl0+f C 1-t1r)S w,I T
Date of fuspectlon•
ICES FLOW CONDITIONS •
RESIDENTIAL r
Number of bedrooms(design):3- Number of bedrooms(actual):
DESIGN flow based on 3 10 CM
Nuni�er of current residents: 15.203(for example: 110 gpd x#of bedrooms): Q G--�
' b
Does residence have a garbage grinder(yes or no): IJ
Is hmndry on a separate sewage system(yes or no):Laundry*%em fyes separate inspection required]
Seasonal use:(yes ja °O)'—
umpWate krseter readings,if7aviable(last 2 years usage(gpd)):
Sumpto oP(Yes or no): U
Last date of« r_-- H Ga r'S Q c� ® � 2_(`)O - o�
CONA99RCLUMMUSTRUL
Type off
Design on 310 CW R I S.203): gpd
`Oasis ofdesign now(seats/persons/sgkctc.)r
Grease ftV present(yes or no):_
1nduS3rW waste holdiag•tm*present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no
'ifav$ilable•Last deft of )•
ocarp=cy/q
OTHER(desm-b* ,
Pumping rids GENERAL INFORMATION ,
Source of bhrinwm-
2 c.c•re+-aK 4'
Was system psunped as pan o the• on(yes or no):
If yes,volume pranPed ___gallons—How was quantity Reason for pumping;
q ty Pumped determined?
i
N�ePtic
SYSTEM
ank,distribution box,soil absorption system
_Single cesspool
Overflow asspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_InnovativeJAlternative technology.Attach a copy of the current pperation and maintenance contract(to be
obtained from system owner)
Tight tank a Attach a copy of the DEP approval
Otber(describe):
App oxiruate age of all com ne ts, to installed if kno j
• l,,n t n �°��� P� ( )and source of information:
Were sewage odors detected when arriving at the site(yes or no):��
Page 7 of 11
s
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_ [a��
Owner:
Date of inspection: 1
. 1 i
BUILDING SEWER(locate on site plan) :•. ., t:. .
Depth below'grade: `�
Materia9s ofconstruZi-o�nr�_--coast iron Z40PVC_other(explain):
Distance ihm' private water supply well or suction line:
Comments(on Condition of joints,venting,evidence of leakage,etc.):
—r�e� 1•ea�a a e_
SEPTIC TANK: (locate on site plan)
Depth below grade: / �
menial of amsttuciion: V"concrete_metal_fiberglass_polyethylene
Iftenk is mewl lid SW_ Is AP Confirmed by a Certificate of Compliance(yes or no):=(attach a copy of
fie) _.
Dimensions: ar (, 00 o GQ f=L o�j
Sludge depth: y-'/
Distance'from top of sludge to bottom'of outlet tee or baffle: ( c3
Scum thickness:
Distimm final top o�top of outlet tee or baffle:
Distance from boom of scum to bottom of outlet tee or baffle:
How were dmaeosions deoermined -rG o e w j( h; a .�-+�
Comments(or pumping recommendations;inlet and outlet tee or bfiffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
n _ C n C r, cl
GREASE TRAP:(locate on site plan) ^
�1
Depth below grade:_
Material of construction: concrete metal fiberglass_-polyethylene_other
(explain): —
Dimensions:
Scram tlhicla .-
D from top of sctmh to top of outlet tee or baffle:
Distance from bottom of scrim to bottom of outlet tee or baffle:
Date of last primping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Y Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Cj L ?-OS L n
Owner:
Datf Of Laspecuon: - 9
TIGHT Or HOLDING TANK: (tank must be pumped at time of ins-- f pectionkocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass
—_polyethylene other(explain):
Dimensions..
m"— stallons
Pallons/day {mot
Alarm present(yes or no):
Alatm level: Alarm in working order(yes or no):
Date of last pumping
Comm0OW(condition of alann and float switches,etc.):
DISTRIBUTION BOX: `
(tf pneseat must be o1Wnted)(locate on site plan)
Depth of liquid level above outlet invert:
Cotrurtertts.(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
-leakage into or out of box,vm)c
or
PUMP CHAMBER: (locate on site plan)
in working order(yes or no); •
'lam in wing orderr(yes or no):'
Comm(note condition of pump chamber,condition of pumps and appurtenances,etc.):
pagei 9 of]I '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: .e i s (—)
Owner. f r .M i t__L_5
Datelof Inspection:
SOIL ABSORP'1710N SYSTEM(SAS): ]��(locate on site plan,excavation not required)
If SAS not Pocated explain why:
leaching Pits,number,
leachiag chambers,number•
leaching galleries,number:
leachigg tr' S,number,length:
leg Be*number,dimensions:
ovagow cesspool,number:
inn0vatiWaltanative system Type/name of technology:
Co •(note condition ofsoil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
x('o leach '�- n lie}e1 Q
0,.,.,C
P
CESSFOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan)
Number and-oonfi :
Depth— rt:
top of liquid to inlet inve
Depth of solids layei: .
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.):
Plitivr• `�
(locate on site plan)
Materials of construction: ,
s Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Pa,ie 10 of 11
l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Pw rty,Addtiess:_ `1
Owner:
Date of Inspection
SKiTCH 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.
t,.3aTa2.
R- I Zj
34
. 0
(px(o leach
•pap III of11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
owner: _ - n 3 m tL1.�S
Date of Inspection: -�— �j q
SITS EXAM - .
Slope .�
Surface'water
Check cellar
Shallow.wells
4- .
Estitnatod depth to ground water/-feet
New 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:
bserved 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: _
s ;
You mast descnbe how you established the high ground water elevation: t
4P
o cn - QqZ
SUBSURFACE: SEWAGE DISPOSAL SYSTZX INBPECTION .PORM
Address of property
Owner's name `�l�c� o .1 �: l>'VV,. �_..✓
Date of Inspection
a�•� PART a
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of
Health.
None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
As built plans have been obtained and examined.. Note if they are not
available with N/A. _
The facility or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs of breakout.
All system components, excluding the SAS, have been located on the
site.
✓ The 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 -cum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance •of SSDS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
number of bedrooms
7 number of current residents
garbage grinder, yes or no
laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available:
i (yli�rst` i Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information
System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Ty a 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 an})
other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
Sewage odors detected when arriving at the site, yes or no
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK:
(locate on site plan)
depth below grade: rL ,�
material of construction: concrete metal FRP ____other(explain)
dimensions:
sludge depth ,
distance from top of sludge to bottom of outlet tee or baffle
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
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, recommendations for repairs, 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, recommendation for repairs, etc.)
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or no
Comments:'
(note condition of pump chamber, condition of pumps and appurtenances, •
recommendations for maintenance or repairs,etc. )
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM I ORMATION continued
SOIL ABSORPTION SYSTEM (SASd
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
Type-
leaching
leaching pits and number r �lC.�y.�a c1;�. VJ
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations fo maintenance or repairs,etc. )
CESSPOOLS (locate on site plan) :
number and configuration _ .r
depth-top of liquid to inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc.)
PRIVY: 1
(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,• recommendations for maintenance or repairs,etc. ) .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INBPECTION .FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE L:SPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
DEPTH TO GROUNDWATER
t4dilr- depth to groundwater -
method of determination or approximation:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined", explain why not)
'Backup_ of sewage into facility?
Discharge or ponding of effluent to the surface. of the ground or
surface waters?
4— Static liquid level in the distribution box above outlet invert?
Liquid depth in cesspool <6" below invert or available volume< 1/2 di
flow?
L� Required pumping 4 times or more in the last year?
number of times pumped
Septic tank is metal? cracked? structurally unsound? substantial
-infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
below the high groundwater elevation?
within 50 feet of a surface water?
,L within 100 feet of a surface water supply or tributary to a surface
water supply?
within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh.-
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply well?
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 analy
. .for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of •Inspector•-- ,t.,,CL,-.,",—\2,C
Company Name
Company Address
: c' , � r �{
Certification Statement
I• certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true, accurate and
complete as of the time of inspection. The inspection was performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Chec one;:
have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15.303. Any failure criteria not evaluated are As stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the- environment as defined in 310 CMR 15. 303 . The basis for this
determination is provided in the FAILURE CRITERIA section of this
form.
Inspector's Signatures
Date ..
Original to system owner
Copies to: U, f�
Buyer (if applicable)
Approving authority
S TOWN OF BAR NSTABLE
LOCATION_4a�of �, Lore//5 (ri; SEWAGE #
VILLAGE' ---S 5' AS
_�s =_ ASSESSORS MAP & LOT
INSTALLER'S NAME & PHONE NO. �p�i`► ���� y��� ����
SEPTIC TANK CAPACITY oy
LEACHING FACILITY:(type) (size) w Xli�
NO. OF BEDROOMS 3 PRIVATE {SELL O PUBLIC WATER
BUILDER OR OWNER e
DATE PERMIT ISSUED:
{
DATE COMPLIANCE ISSUED: 16
VARIANCE GRANTED: Yes No
d �IL
1
V7 � r
Fxs....../. ��.....
THE COMMONWEALTH OF MASSACHUSETTS
P79 3� BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uispnia1 lgjarkii Tnntrnrtinn ranat
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at: / . A
Iy ation:Address or No.
9�� ���....---`-m jj..,.,r ----------------------------------------- ............................................I....................... j...:!:.........0�63 a
O er k �o Address
� Installer Address
U Type of Building Size Lot-___-_13 j _1�_Sq. feet
Dwelling—No. of Bedrooms............ ............................Expansion Attic ( IUp Garbage Grinder (lu)D
`PL4L4 Other—T e of Building !� A....... No. of persons............................ Showers — Cafeteria
PL4 t
dOther fixtures ..................._/A--••-•-•---•----•-•--------•-----------•--------------------------------------------•------------.....--•--..........._..
Design ..gallons per person per day. Total 'daily flow.................... .�.n......_...._..gallons.
W Desi Flow--------------------��--'�-------------
WSeptic Tank—Liquid capac>ty__1 Ogallons Length_.8-_..o._.. Width.. . Diameter__- ..... Depth................
x Disposal Trench—No. ._._A?`t�....... Width.................... Total Length..........;.....«. Total leachinarea....................sq. ft.
Seepage Pit No-------------I...... Diameter.........Csz.-o`" Depth below inlet..... .- _.... Total leaching area... ft.
Z Other Distribution box ( ) Dosing tank
`" Percolation Test Results Performed b ofns�s�xk _ �. ......... Date.......04 �'�2
a y „
a Test Pit No. 1-----c�_..._..minutes per inch Depth of Test Pit____�z_-o___ epth to ground water.. An<__fn-u u»4"4
LT4 Test Pit No. 2....a........minutes per inch Depth of Test Pit------lZ^-o'. Depth to ground water............t!..._.___.
w •-'•--•..........................•_•.... _' ---•-•------•-••-•------------...-..........................................
Description of Soil.... � _h�____;�_ o-o - _oti o`•��."1`t Sub�o:l ' _).n — 12.c,' ►�n cd;• rn- wars
j ._........ ...............4----------------- / ......-
fi-------1 L i
(� `�G�r�d---end raV_e1. [ST_x1s�:._Yz__:_..1�_h.¢-Jc�rvcc GS.�sT._.4?o`t._�'!4.:.1_�_
W
UNature of Repairs or Alterations—Answer when applicable._................................. ........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian has been issued by the bo d of health.
Signed cr g Z
.............
.....-----.1/.... ---------------- ---------------------------------------
Da[e
Application Approved B ----------------' ............----------------------.......--------------...--- --------f :NL- cJ�
PP PP Y �.E -�
Application Disapproved for the ollowing reasons- --------------------------- --------------------------------------- ------ .....---........----------------------
- ---------------------------------- -- ------------------ -- -- -- - --- ------ .................------------------ ...........-----------------.......---------------------- -- ................-------- ---------
GGDa
PermitNo. --------..l.--�.. L,�.�.. ---------------- Issued -------------------------- ..................................--
-.`- Dace
No... .....�.✓l.j FEs.... � .�`��...
_.
"pt 4 THE COMMONWEALTH OF MASSACHUSETTS
P79 3 BOARD OF HEALTH
TOWN OF BARNSTABLE
App iratinn for Ditipaiial Worko Towitrnr#ion ramit
Application is hereby made for a Permit to Construct )( or Repair an Individual Sewage Disposal
PP Y ( ) P ( ) g p
System at:
........... ...................... .. --------................--•-•-........ ......................................L_t
Q
cation-Address or Lot No /
.. ......................................... ......7-:�..................................�-i —A`--..�.n c!::..
�Ow;er Address
a .....................�?r............•••--•......•........ lS.: .."ti!` 51.1.�.............................................................................................
:.....
Installer Address f /
3 —I,
d Type of Building Size Lot............ S feet
a Dwelling—No. of Bedrooms___........„............................Expansion Attic ( /Up Garbage Grinder (fJb
aOther—Type of Building ---------h-j_H....... No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -------------------• -f J -•--•--•-•••............•••--•••••-•-•-••••----•••-••••-•••-•••••------••---•-••---•--•-••-••-•........-------•------•---
W Design Flow.................... ..............gallons per person per day. Total daily flow----
n............
._gallons.
WSeptic Tank—Liquid capacity._I M..;gallons Length__$_` C.`:__ Width..4� t>:_.. Diameter.•.j a.:-_- Depth................
x .Disposal Trench—No. ....... Width.................... Total Length................_. Total leaching area.................... ft.
Seepage Pit No.............'I....... Diameter......... --o_. Depth below inlet......... .... Total leaching area...2�_g:E2sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by_______________5r..ds a_..�..� �s. ......... Date.......2 ..`-3-9l
Test Pit No. 1.....c�.......minutes per inch Depth of Test Pit.... bepth to ground water_."pn n.ei?cyuv,�u,4
(s, Test Pit No. 2....a........minutes per inch Depth of.Test Pit...:........ Depth to ground water............
-•••-•-••-••-• •-------•--•......•-•••••l..... -------------- .........................................................
� V —V% --k SL, , . ' �.9 - 0a,
M. c .Soil yu
x -
�V 1Q � ? ....:...................•---•
W v
UNature of Repairs or Alterations—Answer when applicable----------------------------------- --- ..................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental 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.Signed ......... _
� Date
Application Approved BY ��� .>---------------------------------------------------------------------- - 4 Mte
r Dare
Application Disapproved for the llow reasons` -- -------------------------------------------------------------------------------------------.....................................
..........------------------------------------------------------------------------------------------ ---------------------------- ----------------- ------------------------------------------------ -------------------
Date
PermitNo. ......- :— G ,� Issued --------------------------------------------- -------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Trr#tf rate of gontylizince
'THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( >,,),or Repaired
by........................... ........ .
...... ------- ------------------------------------------ ----------
Installer
at .........
has been installed in accordanceth the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ............�...,.-..47e./ .. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE NSTk(IED`JAS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. —�-�
DATE.. �A....., -> C? -) ----------- Inspector ......---- - ........1 ,.y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i TOWN OF BARNSTABLE
No.....� FEE......//--T >-.....
Ehip al Works Towitrnr#ion, frrmit
Permission is hereby granted-------- ��s?.Lt; t....a�?. ..
to Construct ( or Repair ( ) an Ittd�vidual S'e'wage Disposal System
at No........... / �lQ..._. .._
c d --.------.--•---------•-----•-------------------------------
Street
as shown an the application for Disposal Works Construction Permit(No._.q?,� .�15_ated.._...c� _.!.7Z ?.............
`` -- � ;-f Health-------------------------------•-----•------•---
DATE................�-•-----•t�:--��.-- .. ,_... Board o`
FORM 36508 HOBBS IN WA EN.INC.,PUBLISHERS
i
_ 02 6
20 JMV
TOP OF l ATION
�tl i7ND
O R COYERS
2}LA
CO NC L� YL77 OF
••••• 1 8 —1 2
p
f
LEVEL
L-1O0. 6 GROUND EL
- 99. 0 �rAs sTo
E coNCRE covers
--
4
- 98. 0E
1 f
C ULE40 / ice � �OR S I1ED i i
P.V.C. PIP
1
FT 40 .V.C '
H 1 4 PF.R 4 SCHL�'DULE P.
. P17L^ �
<: DlS .
. - - N
- BOARD DL' :HEA LTI
PIPE — MD1t
APPRO TEED. B . .
i �X
Y10 W _
= 4 PRECAST
10
1LEACG
INVERT 19
#` 0' e8 e h C
_ 11lDV
OR
CRUSf�D e $
WVERT DIVALENT
. . EL. 96. 60 �
e e e S a e ei
s s o
.... � S7T111>� e o s s s e e s o 1!e r.�rJ1J
q •
DA TE' AGENT , INVERT EL. 96. 05
J
95. 73 7
_ o
— c
EL. ��Q
1'00�
4. s 4 To 1-1 z
o o fiASII W SMIM
_ _ o_
sEPTIc TANx _ 95. 90 _EL_ �.�3
EL. _ o
ODO :GALLONS o
. . 10 MIN 1. 91. 0.
• � ,1 2�--6 DIAM---I2
r
LEACH PIT ,
w 3.5
N
_
l J o w 87. 5
- BOTTOM OF TEST HOLE EL-__ _
. \ 1
1 t
LOI' 4
N
64-4,0
wa, N 3 1 E
�- \cA / 01 ►y SEE TEST PIT
1
LOT 9
� � FOR L
LOT 3 -� ,, � � P 7939
3. 2
0 2 � � .
_ 1 � p ,
5 t ILE OF WITNESSED` BY. J DUNNING
� � PROF
cfl HEALTH OFFICER
.a 1
0 � 1
/ SEWAGE DISPOSAL SYSTEM BARNSTABLE
5 rowry of _
- -- CIO
J. LANDERS-CA ULEY ENGINEER
99 ' \ NOT TO SCALE
O ?" N� _ \
r
<2 MIN INCH
� ALL ELEVATIONS ASSUMED PERCOLATION.:RATE �-
/� = _ w r
i
F
19 SOIL LOG- P 7941 SOIL LOG P 7939 _.
LOT 5 SIGN DA.�'A.•
9392
DE
- _9 3-9 _ DATE
--� � ---
lp rn_ DATE -�-�
ROOMS 3
TEST HOLE 1 TEST' HOLE 2 NUMBER OF BED
EL. 96.1
EL. 99.5 NONE
A � GARBAGE DISPOSAL
1 _ 9
w GPD
TOTAL-ESTIMATED FLOW 330
1 3 0
o LOAM & SUBSOIL 10 x 3 B1?
\ p -2 Q AM &_SUBSOIL _0 -2 Q --- - - -- -- ( -1 GAL/BIB/DAY
1 000
SEPTIC TANK CAPACITY __--
1
13 �
_ 0 0
�' S LEACHING AREA REQUIREMENTS
o ` I
v c;J�' o 6 MEDIUM TO COARSE MEDIUM TO COARSE
o o
\ to 141.3GAL S.F- x R..5 353.4
o� SIDEWALL AREA ��_
GRAVEL BOTTOM ....AREA _7�1 GAL/S/F x `I.O 78.5
o SAND -& GRAVEL SAND
N _ 432
, — — _ ACHING CAPACITY BOTTOM & SIDEWALL) __ GAL
_ _ 2 0 1,2 EL 84.1 LE'
\ o - --
1 G, 0 432
'? RESERVE LEAG'HING CAPACITY _ GAL
S 83 03 41 - \ ,
138. 60
NO WA TER ENCOUN TERED
PROJECT LOCATION.- LOT 6
LO VE'LLS LANE
LO 8
. �4 .,,, y
T �/j .��..�J , ����•.-. MARSTONS MILLS
LOT APPLICANT' •as APPLI JOHN McSHANE
ES b A.
l
GENERAL NOT M P. 0 BOX 618
9 \
\. -. COTUIT MA. 02635
� :t,� LOCUS
rF ., 45� -'gnu
I - fi�Q`'
c .. tea
ANTS
C� YANKEE> SURVEY CONSULT
o
CAPABLE ROUTE 149
7. ALL COMPONENTS OF THE SANITAR Y SYSTEM. SHALL BE C P. O.OBOX 265
1. THIS PLAN IS FOR INSTALLAT
ION OF NEW`SEPTIC. '
— LOADING UNLESS THEY ARE UNDER SONS MILLS MA. 02648
OF WITHSTANDING H 10 LOADI MAR T
REFERENCE BOOK 4g6 PAGE 49 ARKING AREA H 20 LOADING
2. PLAN REF OR WITHIN 10 - OF-DRIVES OR P
H. 8 4 -� - 0 - 42 3
HIN 10' OF DRIVES OR PARKING.
LAN IS FOR INSTALLATION REPAIR OF SEPTIC SY
STEM SHALL BE USED UNDER DR WIT
3. THIS P � �
SS NOTED. SCALE DATE
OR ZONING PURPOSES. UNLESS BE USED FOR SURVEYING - Q, :, 9114192
AND NOT TO � ,� _ 1 2
SONRY UNITS USED TO BRING COVERS TO GRADE SHALL 28
8. ANY MA p ZJTE '
CONFORM TO D.E.P. E.
R
4. ALL WORKMANSHIP AND MATERIALS SHALL BE MORTARED IN PLACE
WITH P.
LE RULES AND REGULATIONS 0 HAS BEEN MADE AS TO COMPLIANCE REV. RE
TITLE`5 AND THE TOWN OF BARNSTAB R. 9. NO DETERMINATION
FOR THE SU
BSURFACE DISPOSAL OF SEWAGE DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
UNITS SHALL BE `BROUGHT TO WITHIN SUCH DETERAIMINATION FROM APPROPRIATE-AUTHORITY.
5.' ALL COVER TO SANITARY U1VI OBTAIN
JOB<NO.
IS TO BE PLACED IN THE DRIVEWAY 50093 6 SHEET 1 OF 1
-12 OF FINISHED GRADE. 10. THE WATER SERVICE LOCATION MAP
ES SHALL .REMAIN ESSENTIALLY THE ALONG WITH THE OTHER UTILITIES. THE GENERAL CONTRACTOR
6. EXISTING AND FINAL GRAD -
MINE THE FINAL LOCATION.
SAME UNLESS <NOTED BY FINAL CONTOURS. SHALL DETER