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HomeMy WebLinkAbout0017 POND MEADOW DRIVE - Health 17 Pond Meadow Drive Marstons Nlilis A= 045 - 035 i a SMEADR No. 53LY, UPC 12943 HASTINGS,MN 2 YC��coZ � z ti QoS7-CON`'J� v" i f Ili v I r D yS= L23S"— Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s<�� 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Cltyrrown State Zip Code Date of inspection " f,y9 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, use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return key. Name of Inspector H.P.S. � Company Name P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774-274-2581 12866 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 ❑ Needs Further Evaluation by the Local Approving Authority _ 4/5/17 In cto Ign re Date The system inspector shall su it a co y of this inspection report to the Approving Authority(Board of Health or DEP)within 30 da of mpleting 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 4/5/17 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: ® 1 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: septic in good working order. Tank was pumped at time of inspection as maintenance B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be 7replaced 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•3113 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 17 Pond Meadow Drive Property Address Albee Owner Owners Name information is required for every Marstons Mills Ma 02648 4/5/17 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): ❑ 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 R . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. CityrFown 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. CitylTown 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 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 i Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '< 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Cityrrown 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? ® ❑ 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•3/13 Title 5 Official Inspection Forth.Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 415/17 page. C4rrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date CommerciaUlndustrial 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 a �< 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Cityrrown 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: pumped 4/5/17 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gal gallons How was quantity tank size q y pumped determined? 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): t5ins-3/13 Title 5 Official Inspection Forth: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 4'M , 17 Pond Meadow Drive Property Address Albee Owner owner's Name information is Marstons Mills required for every Ma 02648 4/5/17 page. CityfTown State Zip Code Date of inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.25' 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 gal Sludge depth: 6" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Cityrrown 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 28" Scum thickness 8„ Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2 years as maint. to protect leaching. tank was pumped 4/5/17 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Cityrrown 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.): tees in place tank in good condition Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 4/5/17 page. Cityfrown 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dbox in good condition no cvarry overs no cracks or leaks liquid level at bottom of outlet pipes with no staining over pipes to indicate past failure 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: inspected through Dbox. no inspection ports in field t5ins•3/13 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Amm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 4/5/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 12x24 c4 cultecunits ❑ 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.): dry no ponding or signs of hydraulic 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 Forth: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 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 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 M 17 Pond Meadow Drive Property Address Albee Owner Owner's Name required fo is Marstons Mills Ma 02648 4/5/17 required for every page. Cityrrown 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 g o � 0 i Drl LkWcy I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/5/17 page. Citylrown 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: 8 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: 2013 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see plan. septic designed 5'over ground water 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Pond Meadow Drive Property Address Albee Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 4/5/17 page. Citylrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 CERTIFICATE OF Page: 1 ANALYSIS �yrrkcFn� h Barnstable County Health Laboratory V Report Dated: I/27/2006 Report Prepared For: VX Kathy Maloney Order No.: G0634379 Coldwell Banker JMW 16 Braddock Drive Marstons Mills, MA 02648 Laboratory ID#: 0634379-01 Description: Water-Drinking Water Sample#: 34379 Sampling Location 17 Pond Meadow Dr.Marstons Mills,MA Collected: 1/23/2006 Collected by: K.Maloney Map 045 Parcel 035 Received: 1/24/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.43 mg/L 0.10 10 EPA 300.0 1/24/2006 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 3111B 1/27/2006 Iron BRL, mg/L 0.10 0.3 SM 311 IB 1/27/2006 Sodium 58 mg/L 1.0 20 SM 311113 1/27/2006 LAB: Microbiology Total Coliform Absent P/A 0 0 309 ' 1/24/2006 LAB: Physical Chemistry "3 Conductance 330 umohs/cm 2.0 EPA 120.1 1/24/2006 pH 6.0 pH-units 0 EPA 150.1 1/24/2006 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physician. Approved By: — - -------- - (L irector) w cr. "T1 s 31 Q7 ` _ 1 p* i 7Z T", t RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r 0 COMMONV4'EALTH OF MASSACHUSETTS p EXECUTIVE OFFICE OF ENVIRONMEI�'TAL AFFAIRS 1 r7� ' DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ; Owner's Name: Owner's Address: Date of Inspection: Name of Inspector: le e print) q Company Name: r 40% f _W& Mailing Address: en (a¢t.T� D� 03� Telephone Number: 6CIf _ •- � ,f CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority c Fails Inspector's Signature: Date: (L-1 jr The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/152000 page 1 r Page 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. System Passes: A_r 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" 'on need to be replaced or repaired.The system,upon completion of the replacement or repair,as app ed by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the owing statements.If`not determined"please explain- The septic tank is metal and over 20 years old* the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfil or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. 'A metal septic tank will pass inspection if it i structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20-years d is available. ND explain: Observation of sewage bar p or break out or ingh static water level in the distribution box due to broken or obstructed pipe(s)or due to a b en,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)ace replaced obstruction is.removed distn16tim box is Ieveled or replaced ND explain: The sy em required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspecti if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner Date of Inspection: 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 I. System will pass unless Board of Health determines in accordance with 310 C 15.303(i)(b)that the system is not functioning in a manner which will protect public health,safe 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 wetl or a salt marsh Z. System will fail unless the Board of Health(and P lic Water Supplier,if any)determines that the system is functioning in a manner that protects the ublic health,safety and environment: _ The system has a septic tank and soil ab rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfs water supply. — The system has a septic tank and AS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. — The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. ethod used to determine distance *"This system passes if a well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile or is compounds indicates that the well is free from pollution from that facility and the presence of amm is nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are ggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA SY'STEM INSPECTION FORM PART.A- CERTIFICAT1®N'(continued) Property Address: 00 � `U`Q Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate`Yes"or`110"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 L Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool /t Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ t 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,far cohhwm bacteria and volatile organic.compounds indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal;to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CNM 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 desi of 10,000 gpd to 15,000 gpd. r You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the - 'a above) yes no the system is within 400 feet of a s e drinking water supply _ the system is within 200 feet a tributary to a surface drinking water supply — _ the system is located in nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public er supply well If you have answered'yes" o any question in Section E the system is considered a significant threat,or answered "yes"in Section D abov a large system has failed.The owner or operator of any large system considered a. significant threat unde ection E or failed under Section D shall upgrade the system in accordance with 310 CUR 15.304.The system er should contact the appropriate regional office of the Department- 4 Page 5 of 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Or Aj„ji✓K Owner: S Date of Inspection• Check if the following have been done.You must indicate`eyes"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? 1K _ 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? t — 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? 0�6 _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition o 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 m intenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no — Existing information.For example,a plan at the Board of Health. l_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance aiceptable)[310 CMR 15.302(3)(b)] 5 rage 6 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: V (!�! Owner: _ Date of Inspection: -7 p RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): �v DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system or no):— [if yes separate inspection required] Laundry system inspected(Ay��or no):` Seasonal use:(yes or no):AL Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAIANDUSTRIAL Type of establishment: . Design flow(based on 310 CMR 15.203): apd Basis of design flow(seats/persons/ c.): Grease trap present(yes or no): Industrial waste holding es (yes or no): Non-sanitary waste disc ged to the Title 5 system(yes or no): Water meter readin ,if available: East date of occ cy/use: OTHER( scribe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):— If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank ____Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date' s sled I if know )and source of information: Were sewage odors detected when arriving at the site(yes or no):— 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (Q Owner- Date of Inspection: a '� BUILDING SEWER(�Slocaatte on site plan) . Depth below grade: — ---- Materials of construction:_cast iron T_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joir_-ts,venting,evidence of leakage,etc.): SEPTIC TANK:�(locate or,site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_^polyethylene _other(explain) If tank is metal list age:_ Is a confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: �-'V Scum thickness: Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to aottom outlet tee or b e: How were dimensions determined: Aga 6/! Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related t outlet invert,evidence of leakag etc.): `[ �Q GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal erglass_polyethylene!other (explain): Dimensions: Scum thickness: Distance from top of/onunendations, let tee or baffle: Distance from bottomm of outlet tee or bailie: Date of last pumping Comments(on pumpons,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet ineakage,etc.): 7 Page 8of11 OMCL4L INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYS INFORMATION(continued) Property Address: ! V a Owner: Date of Inspection: TIGHT or HOLDING TANK: (tank must be ped at time of inspection)(Iocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(expiain}: Dimensions: Capacity: allons Design Flow: ailons/day Alarm present(yes or n9f. Alarm level: Alarm in working order(yes or no): Date of last pump' g: Comments(co ition of alarm and float switches,etc.): DISTRIBUTION BOX:''\ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 4611& Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage..;t rout f box,etc.): LL nn Lt4d �Q� I t S c` (1 cc GQe.� 6 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or Comments(note conditio pip chamber,condition of pumps and appurtenances,etc.): g Page 9 of H OFFICIAL INSPECTION FORIM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTE INFORMATION(continued) Property Address: O� fu Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):A(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: / leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number. innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding damp soil,condition of vegetation, etc.): r s VS 5 , b� (�o i�G iS cl' m, of CESSPOOLS: (cesspool must be pumped 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 constructio Indication of ground er inflow(yes or no): Comments(note c dition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: gconstruction: Materials of Dimensions: Depth of soliComments( of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SU BSURFACE SEWAGE DI SPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Elate of Inspection- SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. V 70 �n Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM 99FORMATION(continued) Property Address: 2 p r Owner. � Date of Inspection•` a SITE EXAM Slope IJ0 Surface water L Check cellar Y<5 Shallow wells iK-b Estimated depth to ground water cS`y feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how yo stablished the high ground at elev ion: � O `J 11 Penit Number: Date-- Completed by HIGH GROUND-WATER LEVEL CCUPUTATION Site Location- �t_ -z-�k-7 . b Lot No. Owner: Address. Contractor: Address: Notes: STEP I !Measure deP--P,to water table tonearest 1/10 ft. ............... ........ --------- ......................................... Date F STEP 2 Using Water-Level Range Zone and Index Wail w1ap locate site and determ.ine- Appropriate index we[t............... IrAl Water-level range zone .....................................................F STEP 3 Using monthly rsport"Current Water Resources Conditions" 1 determine Mr-rent death to water level for index well ...... ................... monthlyear STEP 4 Using Table of'Water-level Adjustments for index wel! (STEP 2A),current depth to water leve;l for index weal (STEP 3), and water-level zcnw (STEP 28) determine water,'.evei adiustment --------------------------------------------------------------------------.............. STEP 5 Estimate depth to high water by subtracting the water- ieve.'adjustment(STEP 4) from measured depth to water ievelat site STEP 1) .......................................................................................... FQ= 13--FWM&Mbb WHOOM fam. f a,. CERTIFICATE OF ANALYSIS Page: 1 of 1 rR 9w` Barnstable, County Health Laboratory (M-MA009) c %`yf Report Prepared For: Report Dated: 4/1.8/2017f X Robert Gonzalez Order No.:, . G1798957 17 Pond Meadow Marstons Mills, MA 02648 Uaboratory ID# 1798957=01 Description: Water-Drinking Water yp1 Sample#: Sample Location: 17 Pond Meadow, Marstons Mills, MA . Collected: 04/14 Ol7 Collected by:. R G. Received: 04/14/2017 Routine . ITEM- RESULT UNITS RL• MCL METHOD# ANALYST TESTED , NOTE Nitrate as Nitrogen 0.93 mg/L 0.10 10 EPA 300.0 LAP 4/14/2017 Copper 0.37 mg/L 0.10 1.3 SM 3111113 LAP 4/1 812 0 1 7 Iron ND mg/L 0.10 0.3 SM 3111B LAP 4/18/2017 pH .6.7 , PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 4/14/2017 Sodium 19 mg/L 2.5 20 SM 3111B LAP 4/18/2017 Tofsl'Coliform 0 /100ml 0 0 SM 9222E RG 4/14/2017 Conductance 200 umohs/cm 2.0 EPA 120.1 DCB 4/14/2017 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: - (Lab Manager) D�2c�J a l ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02636 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS � Barnstable County Health Laboratory (M-MA009) Recipient: Matrix: Water-Drinking Water Robert Gonzalez Sampled: 04/14/2017 8:00 17 Pond Meadow Received: 04/14/2017 8:57 Marstons Mills, MA 02648 Collection Address: 17 Pond Meadow, Marstons Mills, MA Order#: G1798957 Sample Location: Description: RE Kit/ONE DAY TAT Lab ID: 1798957-01 Date Analyzed: 4/14/2017 @ 15:40 ,Sample#: Analyst:. yn Method: EPA 524.2 Dilution Factor: 1 Comment: Water sample meets the recommended limits for drinking water of all the above tested parameters. EPA 524.2- Volatile Organics by GC/MS. Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroform ND 80 0.50 Chloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND .0.50 1,1,1-Tdchloroethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 1,1,2-Tdchloroethane NO 5.0 0.50 Isopropylbenzene ND. 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5:0 0.50 1,1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.5o 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Tdchloropropane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluede ND 0.50 1,2,4-Trimethylbenzene ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butylbenzene ND 0.50 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene NO 1000 0.50 1,2-Dichloropropane NO 0.50 Total xylenes ND 10000 0.50 1,3,5-Trimethylbenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND o.so trans-1,3-Dichloropropene ND 0.50 1,3=Dichloropropane . NO 0.50 Trichloroethene. ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 _ 0.50 1 Trichlorofluoromethane ND 0.50 2,2-Dichloropropane ND 0.50 Surrogates 0 Recovered ° 9 QC Limits(/o) 2-Chlorotoluene ND 0.50 p-Bromofluorobenzene 930/b 70 130 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 1130/b 70 130 Benzene ND 5.0 0.50 Bromobenzene ND. 0.50 Bromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromcform ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Attached please find the laboratory certified parameter.list. Approved By: � . • (Lab. Director) j� ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Leve 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 FLOORPLAN SKETCH Borrower:Robert Gonzalez File No.: 177317SLF03 Property Address:17 Pond Meadow give Case No.:FHA 251-6016215 City:Marston Mills State:MA Zip:02648 Lender:Salem Five Mortgage Service;: q -7 11-7 aoc - aal NOT TO SCALE �J- Deck 36-0' 0' Former In-LawApt 20.0' of4-OW' Bedroom 20.0' Bedroom o #1 F 32 B 16-0' SECOND FLOOR 36-0' 5.0' 16-V 3.0' 7 3.0' 14.0' Faoily Roan 11.0' Mod Deck v� 4.0' FIRST FLOOR HI--- Full Dining IGtchen i Bath 35H CL - 20.0' Livinc Room -D ,(ate` � J JK- . A 5 g 4 ' 16-0' 36-0' CG First Fidelity Appraisal Services of New England T 781.295.0200 F 781.295.0201 l FLOORPLAN SKETCH Borrower:Robert Gonzalez File No.: 177317SLF03 Property Address'17 Pond Meadow Drive Case No.:FHA 251-6016215 City'Mansions Mills State:MA Zip:02648 Lender:Salem Five Mortgage Services NOT TO SCALE Deck 36-W 40 Fortner Bedroom In-LawApt 20.0' #2 o Bedroom 20.0' Bedroom o #1 � Full Bath we 4A' 16-0' SECOND FLOOR 36.17 5.17 16,0' 3A' Mr 14Y 8.5' Family Room 110 'Abod Deck FIRST FLOOR 4.0' I Full Lining i IGtchen j Bath 35A' I i p- Fortner —i — In-Law Apt Living 20.0' Living Room b lGichenet' Room Fortner In-LawApt .5 Dining 4.0' 16.0' Bath 36D' xis� � First Fidelity Appraisal Services of New England T7B1295.0200 F 7B1295.0201 Town of Barnstable r# Department of Regulatory Services Public Health Division Date S aasr MARS. $ � g G'v 200 Main Street,Hyannis MA 02601 �ArEV MAt i ' ' 1 II ,,gg Date Scheduled_ U, Time Fee Pd. Soil Suitability Assessment for Sewage Disposa o Performed By: Witnessed B : ksl) 6 L CAT G NERAL INFORMATION Location Address f 3�' Owner's Name W) Address '-7 Y ity7j_jz�, jz> Assessor's Map/Parcel: 5135 Engineer's Name Y L ,A��L 5�y NEW CONSTRUCTION REPAIR T lephone# �} `cs, p Land Use Slopes(3'0) m Surface Stones Distances from: Open Water Body ! 5 ft Possible Wet Area Drinking Water Well ft Drainage Way ft Property Line Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) `t Y 4 Depth to Bedrock f e. Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater a DETERNIINATI N FOR SEASONAL HI WATER TAB 2. Method Used: Depth Observed standing in obs.hole: u. Depth to soft WC in. 7 Depth two weeping from side of bs. le: in. ©round ater d fitment ft. i q`J Index Well#�,"S Reading Dateri d lndex Well]evil Adj Fact r Adj.d and a er LCv c b PERCOLAT dN TEST mute? Thne Observation Hole# Time at 9" Depth of Perc � Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch � Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division' Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC i DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency.%Gravel) DEEP OBSERVATION HOLE LOG. Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) f � a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. e• DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture f Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o si to ' Flood Insurance Ratc Ma. Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary Nat Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _— If not,what is the depth of naturally occurring pervious material? _.._._ Certification th soil evaluator examination approved I certi that o (date)I have a ed roved by the P Dep rtnite of nviro to do nd th the abo analysis was performed by me consistent with . the ui t i ing,exp d erie s ibed in 10 CMR 15.017. Signature Date - Q:\S.EPTICIPERCPORM.DOC _ 0t oil S e ' � 1 1 � I m 9 HIM I - El7Nl I — X RO U BATH. I '2 2443 1 p -F m GRILLES _AI .6'-0'MIK . -0 I/H 4-5 4 IEADRCOM AT STAIRS KITCHEN �, rev noDR JOlsrs ILTO MATON 1®611T AT 1 �EI45TM6 NOTE-REFER TO'FRAMIN6 PLAN 1 ALIGN YYN.L� 1 2i SAn' 3• LIVING F�ObTOM RAILINS,NB'B5 Aim OAW�TERS ' FAMILY - J ALI6NYW15 DECK `~a+°P.TF'RA�i� -- Q 0 --- NN!x 12O --- - OF 51AM ••REFER TO FIRST /,,•/ FLOOR FR %PLAN 1 C,�KITCNEI/DE.`A(�-- i iG � IXI5TN5 DOOR TO RAISW �ATI�ONS� __...a m ORHtS / "V EtlIAL EOW- ANOMRH.00AT® 1 !� R i ENTRY ,—AusN - HALL KITCHEN 21 t I C • I c I - y `—RaVVE EMMV,GARAGE Kv SIIIO f� ff XED O WNDOMI AS GENERAL PLAN NO 1 E)OSn%NOU5E:FIRST FLOOR I ^ ry ^ IJO450LLARE FEET I pp pp pplWr. 1 n•aoK =Vo2ip( nmK ALL MA%N TO oL.MaEss Nol9 0 NEVI IIOIFiE,FlR5T FLOOR 1 FAMILY APARR-81i�FIRST Fl.00R 5lilARE FEET 532 5GUARE FEEF 4'4' 4'-9' 1 -OoLa S BY'ANDI DQRL 7_> E-WNS Zoo T-0' • •REFER TO ELEVAT Ewsms Ro.Ime,rlls Aern F I R S T FLOOR PLAN - ---------------------------------------------------------------------------------------- { 1 1 ' I - 1 1 w^ I " L//.///// ✓ (�J Ir.--oT ------------- LOFT ------------------------------------------------------------------------ - OFFICE TOWN OF BARNSTABLE LOCATION 1 'PO kk�j tAC- oU) SEWAGE# Z013—2ZI VILLAGE `�®�S' U I LLr ASSESSOR'S MAP.&PARCEL 10 4S-103s, INSTALLER'S NAME&PHONE NO. J A-rK �`� S—D rfi�za® () SEPTIC TANK CAPACITY C) C-61vl fA au�� LEACHING FACILITY:(type) ( ,Le.TC C.-'-f (size) (Z)C 7-4- NO.OF BEDROOMS OWNER M i w-E A—Lg t'i PERMIT DATE: 3 COMPLIANCE DATE: 11 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist ori:` " site or within 200 feet of leaching facility) /®l, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY 'PLAFAO By mT'e I, A I 37-D � 2- o 3 !�-2-® - ( 7,3 -0 - 'B i � 72-� No. ® �/ { Fee Q CJ i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for MispoSal 6pstem Construction permit Application for a Permit to Construct Repair V -U ade Abandon Com lete System ❑Individual Components PP ( ) P �✓1 P�' ( ) ( ) P Location Address or Lot No. J 1 'PtMb M >� g Owner's Name,Address,and Tel.No. kl 1(r AL$EV7 17 PeuA M L-AtoLd Assessor's Map/Parcel Q par 1 u'$ Installer's a eM�resso,land��. S ffg37_(03 f q Designer's Name,Address r,an�T1.�Noo. TDC �-�'�; (D 6 2-1 J,L f2_vttD mttasnoAJS M r t cS r<•t $ lL��,€ fo S p �l. Type of Building: Dwelling No.of Bedrooms Lot Size. 3(o®47 sq.ft. Garbage Grinder( ) Other Type of Building RES, DUJG1-1allo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 O gpd Design flow provided ��3�— gpd Plan Date J^- 2_3 = 1:3 Number of sheets Revision Date Title ge"G9 SLI5Tet4 'OES160 Size of Septic Tank PS0p e 2 et d Type of S.A.S. cL(L7_6C- C— Description of Soil D—9,, LG —24 f oPt-AA kgA.4ib P 2--t—(20 IAE-b S AI*j b Nature of Repairs or Alterations(Answer when applicable) IK?L"iv: s S' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C de and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ff Signed Date co 3 P Application Approved by Date CA Application Disapproved by Date for the following reasons Permit No. , �. Date Issued No. r "�`? Fee ( d V F THE COMMONWEALTH OF MA8SACKUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for MIsposal 6pstem Construction 3dErmit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. I`7 (womb A g-kt pi g Owner's Name,Address,and Tel.No. k 1(l� L�L$1� / /7 t"' b'ub /�t�-�iouJ A�¢. Assessor's Map/Parcel p��/Y03� dV 1- d"^''! kt VUTD O-g M i l..l-S MA - Installer's Name,Addres ,and Tel.No. SDB-737�1d319 Designer's Name,Address,and Tel.No. �tT, R-N. 66 Z/ 9 F ,24 v,67Z 1?_vA o Xk haST-ox4 M t t.i._S fAk 18 j(loU-re 6 A SPoi Dw/O k Mid Type of Building: 2 s Dwelling No.of Bedroom-. 3 Lot Size 3(o4 7 sq.ft. Garbage Grinder( ) Other Type of Building. ( ) ( )2� �fA.1E1�-1�16No.of Persons Showers Cafeteria Other Fixtures C Design Flow(min.required) 330 gpd Design flow provided �32 gpd Plan Date �` Z3 ' 13 Number of sheets Revision Date Title s CW.-KG t= S LJSTt--�- U&S 16 IJ Size of Septic Tank (S'00 e#J/ Z 1CD V1•p Type of S.A.S. 6U Description of Soil 0-91, to" -2-4 (-oA7 4 �SAr4JD , 7_'j (ZO IAL--aIC16 •Skj b I , Nature of Repairs or Alterations(Answer when applicable) C %0A4?C S t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C de and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. • Signed f Date (3 Application Approved by > Date Application Disapproved by Date for the following reasons Permit No. 0 1? c) Date Issued / --- ------------ TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �feG"J"" THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓) Upgraded( ) UrC M _r Abandoned( )by �O ->✓/2- S o l� Cm AI�R • CO - LL C' at T� "1 "b Nl T�►J4 -MILLS 4AA; has been constructed in accordance with the provisions of Title 5 an the for Disposal System Construction Permit No. 26(3-;01 dated Installer �Fr+M�3 rT°�- -• Designer O•t2A- #bedrooms 3 Approved design flo i —gpd !, The issuance of this rmit shall not be construed as a guarantee that the system wit�on as de 'gned.� f Date � � � 1p�'3 Inspector 1 r ------------- ----------------------------------------------------------------------------------------------------- - No. �`y �v( Fee I d u, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS bisposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(V Upgrade( ) Abandon p ( ) System located at 17 j o N D /yk rkix) t) A at tJ e. M Pf-2STyJx M t t_ S , M A i 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 permi )I' Date / - ( - Approved by J i i t HIGH GROUND-WATER LEVEL COMPUTATION -� K� Date: r1 Site Location: ?0 wx) is, k) b2 Permit. MAR- t P AJS Mt" , tk-0- Owner: N�Q M(L.S fl�tK� //�Lg Phone: SD$ t7JO�f Z31o9 Contractor: tY1QUk_12 + SplJI t-E dirit. Phone: S�8— / 37 6 3( 1 Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. (depth is in feet below land surface) Date: m /dd yy feet below Is STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A)Appropriate index well �JD� B) Water-level range zone B STEP 3 Using monthly "Current Water Resources Conditions" determine current depth to water p level for index well. mm/yy STEP 4 Using Table of Potential Water Level Rise for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment. +� 0 STEP 5 Estimate depth to high water by subtracting the water-level adjustment (STEP 4) from measured depth to water level at site (STEP 1). NOTE" Tables 1-9 "Potential Water-Level Rise" are attached as worksheets to this file. monthly index well data: www.capecodcommission.org/wells.htmi Model # C-4, Contactor® Field DrainTM C-4 on Cultec,Inc Page 1 of 2 1 ' HOME CONTACT US ABOUT US DISTRIBUTION CALENDAR CASE STUDIES CATALOG WHAT'S NEW STORMWATER SYSTEMS• Advantages Product Catalog • Chambers e Headers Search Catalog a Filters • Accessories By Keyword ® Storm4vater Design *All Categories ContactorO&RechargerO ® AER Video Chamber SEPTIC SYSTEMS All Categories>Septic Products>Chambers>Contactoris?&Recharger(z)Chamber>Mal • Advantages #C-4 ® Chambers ...... _ ._........................... m Septic Design i ......... .........._..._..............._..._.......................................................".._................_.........................................................................................................................._........_.................._.............._..........._.._......_............. e Pipe Distribution Systems Model#C-4 Contactor®Field DrainTM" C-4 MORE Printable Page INFORMATION 23 Email This Page a Downloads o Links d Save To r--avontes a i'AQ,5 • Feedback r_ MORE IMAGES, • Warranty Contactor®Field DrainTM C4 C.t)LTEC PD$ j The Contactor®Chamber series consists of lower profile,lower capacity Cultec Septic a e 1 chambers used for septic installations with depth restrictions or where larger i Field Drain a units are may not approved by the local authority.The Contactor Field Drain C- j Interlock 4 is our lowest profile septic chamber with largest bottom area infiltrative �..,. capability. DOWNLOADS n v CAD-CA 3 view P.._I C 1003 (PDF,128KB) Septic Design, —(PDF,21 KB) j ` Septic Design larger image GUide I (PDF, 1651 KB) .Septic Brochure a — CIJt..017 (PDF,750KB) larger image Unit of Measure: Imperial I `` Metric I '>Both Specifications 8.50 ft 4 Town of Barnstable �tKGE�° Regulatory Services ti Thomas F. Geiler,Director >MASS. Public Health Division t3� A1�� Thomas McKean, Director FD MA'S 200 Main Street, Hyannis,MA 02601 Office: 508- 62-4/44 Fax: 508-790-6304 Date: 6 ,712 Sewage Permit# Assessor's Map/Parcel ®�S Installer& Designer Certification Form Designer: Installer: C " 1����� C' Address: Address: On 13 JprwL4 was issued a permit to install a da e) (installer) septic system at��c��Q� ��' NJ based on a design drawn by (address) 'j�L L P dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Re s. Plan revision or certified as-built by designer to follow. Stripout (if require ed and the soils were found sati actory. HARRY yG o EARL LANTERY, JR. Installer's Signature) '� p<1' zs5� c�sT��' �. NAL iIs Signature (Affix Designer's Stamp Here) PLEA URN TO BARNSTAB PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE 'SSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc NO. �`+ THE COM-MONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH=1", APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgradc ( ) Abandon ( ) - ❑Complete System ❑Individual Components c Map/Pareel N Address v _ / I 0 L t i 1,< Ly '1. k,) C A7R L L Tel Address Jy) Addrree\Js•Y V/ Telephone it "rclephone k Type of Building: � �. L Lot Size C)5 7 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) 33 D gpd Calculated design flow 3"+1 gpd Design flow provided34-1 gpd Plan: Date Number of setevisiQn Date Title - Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation D CRIPTION OF REPAIRS OR ALTERATIONS CC TJO 0- ? ) W tx C) ®� �- a The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to pla the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspection I FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 f"%?'L'^�- ^..,�,. .�r'-'3��j^._syr i ^1•y ....Y:''.- -• -,.... ,..y---�.� f-rl't.,,.:� 4...-.e,. _e .:k r�-. ,.'• - ,,.�..,�.:.x.+.,rr '"'.'r'r^ti;k'�, .t� `; l a =1 No. l ��' THE--0OMM'0NWEALTH OF MASSA.CHUSET�T�S FEE I BOARD OF HEA Tff To o F P-21 i Al!S�rA3 APPLICATION FOR DSPOSAL SYSTEM CONSTRUCTION PERMIT r Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components LZ p1! . Map/Parcel# Address OL L C L -Iel• i,r�`� r„I Isla a im D•sign is Nam Address Addre:s 6Y` ^^ Telephone R TcicpFfone# .. j Type of Building: Z r L. " Lot Size '5 30 y T Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ' Other—Type of Building No.,of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) 33 gpd Calculated design flow gpd Design flow provided3+J gpd Plan: Date Number.of et�e� ev n Date Title Description`of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation D RIPTION OF REPAIRS OR ALTERATIONS ) r'�0 Qf"' _ 1 0 f.200 'I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to pia a the system in operation until a Certificate of Compliance has been issued by the Board of Health. 'I }Signed Date -3 Inspection i f FORM I - APPLICATION FOR DSCP ,-_DEP APPROVED FORM 5/96 i k r, ,. r�aa—r�.__,y__a rr_i—.—._.— rw r_. —... _ THE COMMONWEALTH OF MASSACHUSETTS FEE wIL BOARD OF H E A LT H { C RTIFICATE OF COMPLIANCE Description of Work: Individual Component(s) ❑Complete System The undersigned hereby-certify that the Sewage Disposal System;Constructed( ),Repaired(V),Upgraded( ),Abandoned( ) by: -- • A , 1 has been installed in accordance with the provisions of 310 CM 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow - (gpd) Installer ! � � Designer: Inspec r Date h? The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 i f No �5 THE COMMONWEALTH OF MASSACHUSETTS FEE �✓� BOARD OF HEALTH µ , DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby grant to Construct Re air (� Upgrade >A andon ( ) an individual sewage disposal system at 7 � a V�I V as described in the application for Disposal System Construction Permit No. q [�')�,dated �� I �. j Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Date ✓ l� ` Board of HealthS. �`�, FORM 2 - DSCP DEP APPROVED FORM 5/96 r• - FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON Innovative/Alternative Technology Operations and Maintenance (0 & M) Contract i This service policy("Agre ment")a tered into this day of W L 201=� by and between ("Homeowner')and IU6J („Service Provider" . Se3il a Provider agrees to operate and maintain the system known as WMVb1 fk<t 2 located at 01 PO►Jb u VA-VO /lti"a6_00S FA IU-$for the period of two(2)years i beginning 20 and ending ♦3 cTA!u l ZD11pursuant to the terms listed below: This agreement will provide for all required inspections,maintenance and service of your Aerobic Treatment System. Service Provider and Home Owner agree to the following: 1. Service Provider shall perform.--+inspections a year/service calls(minimum of one every months),for a total of visits over the ?—,year period including inspection,adjustment,and servicing of the mechanical,electrical and other aeration operation,and replacing or repairing any components not found to be functioning properly. 2. Such inspections shall include an effluent quality inspection and process testing consisting of D.O.,pH,Turbidity,color and odor. If other testing parameters are required by your permit,they are not covered by this agreement and will result in additional charges. 3. If any improper operation is observed by Service Provider,which cannot be corrected at the time of the service visit,Home Owner will be notified immediately in writing via Email of the conditions,estimate of cost for repair,and estimate of date of service completion. 4. Home Owner understands for the system to operate properly,the system must be maintained under a continual service agreement per Mass DEP policy. This contract will be offered on a continuing basis,for annual purchase,by trained service providers,licensed by proper authority in Massachusetts at a minimum-training level of Class 2M,municipal treatment qualified personnel. 5. Service Provider agrees that within 48 hours of,a request for service,Home Owner's system will be visited by the Service Provider listed below or their authorized agent. If there are any items which need correction that cannot immediately be remedied,Service Provider will inform the Home Owner,in writing via Email,of the conditions and the estimated repair date and costs. 6. Any additional visits,inspections or sample collections for testing required by specific municipalities,Water/River Authorities,County agencies,the Mass DEP,or any other regulatory agency in your jurisdiction will not be covered by this agreement,and will require additional payments.Pumping of sludge build-up is normal for operation of an Aerobic system,and is not covered under this agreement and will result in additional payments. li oD/ 7. Cost for visits under this contract is J per visit,totaling 50D / per year,payable prior to the first visit,which will comme G on I =0A 12, Zc 1 l Labor hours for system repair,if required will be billed to Home Owner at a flat rate of per hour,charged from time out to time in at Service Providers address listed below. Home Owner Service Provider Name (CIS.CA,, f-,gc_V Name d LL+�►'1, � S01J I��f�L� Address(mailing) Address(mailing) . ��0' �� -70•Z 11 PofJD wt457*V0cJ 9 �h /z�v 2D Mg42-$ �, Ititi1,1f�, 1v�� M**LsZop1S A4 LL s r44 A Phone Phone '5-08 v$ • 272 8"' o . ©Zf�'� Email m 1 C ,e . eoyt— Email J frvl V a Signature Signature IL Copies to Home Owner,Service Provider,and Board of Health r EXCERPT FROM BOH MEETING MINUTES 7/12/2011: B. H. Earl Lantery, Jr., Muddy Waters Environmental Inc., representing Michael and Christine Albee, owners — 17 Pond Meadow Drive, Marstons Mills, Map/ Parcel 045-035, 0.79 acre parcel, failed system, proposal to install an Aquaworx Remediator under remedial approval. Earl Lantery presented the plan. This will be completed within a week if approved. Earl said he would be happy to return to the Board with the results in October or November. The leach field is in partial failure and the customer has been pumping. (Cost = $5,200 and —6 months) The bacteria will die if they do not have oxygen, so they pipe in the oxygen 24 hours a day. The existing tank must be tested and shown to be water-tight. They do this by observing the effluent level at the pipe. If it hasn't been put Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to approve the Aquaworx Remediator system be used provided all the requirements listed in the DEP approval dated 12/22/10 are followed. (Unanimously, voted in favor.) FOLLOW UP IN OCT/NOV 2011 — RESULTS FOR THE BOARD (as the Board is interested to learn to what extent the procedure works.) Assessing As-Built Cards Page 1 of 1 L O CATIAN, G E PERMIT N0. u.�` d:4 9 vd�c c��/.✓i[1CG�r/.tL,Li , Q•-�9,�,� VILLAGE INST LLE S AME i ADDRESS 11UIL ER OR OwNgn DATE PERMIT ISSUED Za _ 3— Ae DATE COMPLIANCE ISSUED 3_ z — .e� I } c; �,j.T J r r u v http://www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=04503 5&seq=1 5/10/2013 1 LO.CATI N SE AGE PERMIT NO. VilLAGE � T INST LEA'S" E 'Sf ME i ADDRESS V. op- ,� U 1 l E R OR OWNER R D T PERMIT D A E 1 - DAT E COMPLIA.NCE ISSUED � � /Z _ �� �� �}_ ��r � � �-.�. `_y ` _. �� � o --I .� No........1�' ' ..... - - F�"s..Q ... tfM COMMONWIEALTH.OF M4ASSACHUSETTS BOARD OF HEALTH . . ..... OF.........8_66 : /.s - r P P b -ors Appliration for Disposal Morks Tontrnrtion ramit Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal System at• L4* � p U� ®'Yl'�tl. ec> ... _ .1 . ........... . .._................... ..... ......................................... ....--------•---......----- �r�cdt' n-Add ss I� ....._...-.. "Owner .--•---- -----•-.. ._.e. .. �............... f` Address --------.. ----------- ---- ..:... Address Type of Building Size Lot..._.�4!,.__0S2Sq. feet r-r Dwelling—No. of Bedrooms------- ..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building . _P�.......... No. of persons............................ Showers W Other—Type g --- p ( ) — Cafeteria ( ) Otherfixtures ..------•--------------------------•-------•----....---•••••-•-•-----•----•••••-••-------•••---•-•••-••••........................••-•-...._......._.. W Design Flow............................................gallons per person Sr dAy. Total daily flow..... ®._........................gallo s. u .n WSeptic Tank—Liquid capacity�..... llonsL Length_...._'_&..... Width_. Y"/6 Diameter................ Depth.._ x Disposal Trench—No..._..2........... Width.................. Total Length.__..Fa...3.........Total leaching area..._02__P._.......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank `-' Percolation Test Results Performed by....cf.j�..._1' �.'!... qN _ Date....... /6.._�C. .... a Test Pit No. 1__ ._..._..mmutes per inch Depth of Test Pit- .1�1 •....__.. Depth to ground wa ter..___. _._____. LX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a Y ............... .....,--•......................;...........D�....-•--------- .......--•-•--- 0 Description of Soil •• • .............a2-`f. Y... ........._... -- 1 -Z K-M---------------•---------------------•------------ U Nature of Repairs or Alterations—Answer w en applic le_____________________________•....__........._...__.........._.................._...........__. .........................---••••........_-•-•-•-•••••••••••••••••••-•-••........-•••._.....................-••-•-•-•••-•-•••------•-•----••-••••----••••••-•--------...--............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System_in accordance with the provisions of TITL IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sied - ------------------------------------------------ ..................... Da,��gg " Application Approved By....__. _._.g1,. ....__. . � . `' - Application Disapproved for the following reasons:..................................... ................... Date ........................ ..................... ...•••-•--••- ••-•.......---•-----------------------•-----------•--------••---•-----•----•---------........---.....----._...-------•-----------•------------------.................................................... Date PermitNo......................................................... Issued-------•-•-........................................... Date t � _ w No.. !' --.. Fps... ......T ....... THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH OF...................................... ..................._..._.... Appliration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systean t: / �a � � el�� �?�o x GIGO et� ��a`�'�d..,� S j ................_.._....._............-----.. .-- --•---•-.--- --------------•---_--- --• -----------------• - - -• • ..................... Loc on-Address -•••or-Lot No. E -� �W!C �i�..:I ca U �vi7: � L� �t.,-e_ kV? ---3 �d� A-7 ..... _..._..... ................ --d............................. .... ............ W /,_ �Ojv-er �Q�Y1Z(� (1 (s�ss 7u/�/ i + ........ Installer Address Type of Building Size Lot... _.d.g._2q. feet Dwelling-No. of Bedrooms-___----_�_.__..... ...._.....Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type T e yp of Building .COY°.............. No. of persons............................ Showers ( ) — Cafeteria ( ) `-e a Other fixtures -----•--•----------------------------------•-••-. W Desigri ,Flow............................................gallons per person day. Total daily flow__..._._. 42_.._.............._...._ ons. 9 Septic Tank—Li Liquid ca acit _& 92 allollls Length--el..Width._�_""/PDiameter................ De thy'_''_..y. W P � 9 P Y�---------gP � x Disposal Trench—No.......a........ Width....a........... Total Length...... Total leaching area..�0__P'...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by...... c.... .... �'wN._.. -✓ .__----•_ Date.__. .__ ? _. .. . 14 minutes per inch Depth of Test Pit.-/1 _....._ Depth to ground ater_..._...:_.Test Pit No. I........42_ _.A..... Test Pit No.<2......... ....minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------ ........................... Description of So . -- n ".-Nature Nature of�Repairs or Alterations—Answer w en appli le............................................................................................... - :: Agreement: The undersigned agrees''to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.i-: 5 0€ the State Sanitary Code—The undersigned further agrees not to place the system in operationEuntil a Certificate ofCompliance has been issued by the board of health. Si ed. Appl>cation-Approved By.....• ...... 4.j ✓L7 — --­-------------------- Date3' D . ----------- App�lieation Disapproved for the following reasons__________________________________ ........................•..... --••--..._..._ -------------------------•---•-----••--------------------•--...---------------------•-------•-------------•---•••....._...-•----•••-------------••••-••••••••••--••---••-••••--••---••••-•••--------••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......i .......OF........... y?. ............................... (Irdifiratr of Tnntplittnrr TI IS S T CE TIF , That the Individual Sewage Disposal System constructed (� or Repaired ( ) by--- �( -------.- ----------------------------------•----.---.----------.-.---.--.-------------.-- ��h �....... • .. ------------------------ has been installed in accordance with the provisions.of T 5 of The State Sanitary Code as des ri ed in the application for Disposal Works Construction Permit No.._.._.__.__k'? ............. dated__/ — ". .'....._.._._.__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE r SYSTEM WILL FUNCTION SATISFACTORY. DATE.. f i't-. ---•----------• Ins ector.....----• ---•..C.! .. ............... - ------------- P � � THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT Gq2 '..........OF..........................:•-.••---•--...._ .........•••....... / No......................... FEE.Zd...-.......... Map . I � nnstr Permission,i hereby granted----...............--- - ............................... ---- .. ................................ Co Ic ( ) Aepa ) an I dividpal age po ystem at N � ..- h �d •...•G✓ �1,..., '.I .................... ----------------............................................ Street / as shown on the application for Disposal Works Construction P it No _.;._ Dated_.._•..................................•-. ...... �--- -------- - r---------- ------------ �> . 2 / Board of Health DATE..--•-.` .......................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - �t i f 1 a F... it iq 0DAll tq Jt Al '. +`"+O is �\✓',. /V �� ,. \ _ i Ey.. v l� .r' � r ' � � � .Nam+ ' ✓ �3'` �P E 7 S T II7-7�- -7-7-7 77-, f7 III7777 X,77 if r r 0 V V +a b LOT yl V L � 1 1 i 1 c V 1 m p i I - ___ I Fld1AL ( ♦+ ' — 2aa2 \ s BATH. I p MAINTAIN 6'�'HBl ROa 2-0 VB X�4-5 LEI ' m E 'O IffACFOOM AT STAIRB /� — KITCHEN STO. TO MA;TIM�I6HT I EXI51'IN6 NQ15E-REFER --_— {////yam •O U TO F:UMIN6 PLAN ALNSN WALLS 2j S'-I Vl' 9' - _ 9AlW Iii 1885 i ' LIVIN6 - �— - FAMILY - J '�0PErxIN6 rA Au6N wALls DECK ON P.T.FRAhff •— O O _ I"XI24 ti -- ED CHLIN6 OF STAIRS • IRST M 47 •REFER FR MIN6 w 1 FLOOR FRAMING PLANFOR WW- -0 By O"D / i iU EfiIAL bLL'AL EXISnRS DOOR TO RAISED IDLATla6�� __J !` AND Be REI.OGATED f� ENTRY V V HALL m KITCHEN M O c Al fr W 3 e 1 c � � a--• R04OVE ENI5TIN6 6ARA6E V `bx ax �x PUTH 1b XED CUT YUNDOW AS 5 I.,sn FEET FLOOR ; ,4 ,ry ,4 65�•PLAN NOTES 1 n p' OL PRQES L5 TO BEn2ff 4*5 016• Yaapp S p Au ry SDK rvK .+mK 0*01=65]5WAREFIFEET FLOOR i `i3�3I Fg FIRST FLOOR a 4• a•4• OOLELE4QRK 200 5ER16(NO 6RILL6) -REFER TO ELEVATION5 FOR WINDOW EX6n15 F O.106WS ABOVE SUBFIOOR . F I R 5 T FLOOR PLAN 50ALE 1/4' • 1'-0' _� ei9m 5<q'S,Arc -- ac�V<og' 1 'e'3 va " `" Y---------------------------------------------------------------------------------------------------- I ---- ----- - .�-S'e m ;✓ g mo`B' 1 1 ---- 1 -------- ------ _____=___ ---'--- C ;1 % : Icl i '4'TALL L =--,'--= LOFT a-� C O 00 I i T— aA/TH. OFFICE _ BE pROOM/514� 6N N ON-p 2 vBEDROOM 2 1 �� O ` -c L' 2 14 1 '------------------------ WALL/DEMO Ht 1 . I 6ENAL PLAN NOTCS job no. 1003 -ALL INT.WALLS TO BE 2X4S s 16' __ ___ �7�L 02 APRIL 2010 OL.aKZ55 NOTED OTHERWISW ._______ WALLS AND ITEMS TO BE REMOVED tC21C A5 NOTEO FXISTI1 1II � 6WAus TO llO _ REMAIN I5a RE F I NEN WALLS rev. K1••1y� NFri/105E�SEGOIID FLOW R I FAMILY APARTMENTS SECOND DEMO NOTES ILO. n3 SOUARE F ; 26B SQUARE FEET - i 1< DASHED _ _____--� TO BE�REN10/ED AND PATCHED AS NEEDED OR RV%.V D AS NOTED. A- 10 5ECOND FLOOR PLAN 5LALE. 1/4' • 1'-0' c ISSUED FOR CONSTRUCTION txt I of 3 a c o EE u'i V a m � A o 'o ro • F � o LVV H P N A v Y V M • q m y o � E EXISTINS HOUSE EXISnN6 HOUSE oo y H O .c o ARCHITECTURAL ASPHALT ARLl�HMLgECTURAL ASRULT ` SHSNGLES TO MATCH SHIN TO MATCH TT11NN66 STItYS 1X54�RAKE ON IX9 M RAKE ON Ln FlNISIED FLOOR AT 17 tR yA� IO PPRROOFFf055EDD/STAIRS u �`_fS.OND FILYJRR E%IST IX CASINS/mm ?,I- V 15ECOIID FLOORTe-XISTr— CASEq OPEAIRAT BAY ON SlU7 OJEFHN16 YU CUSTOM(CONYLUCASINS/TRIM T DAY ON STUDS ^-ERACKEIs unroll RAIUNSs.T a5'�'''� T �Ll DECCFATrvE - U N __ _BRACXM �Q FINISHED FLOCK AT �IRST FLOOR 5T) FflIAL EOUAL EdIAL FlRST FLCY.R AT 15T1 IX4 Ir DEGKIN6 ON �� FRAME 04.1�cw/� • VI94 X4 KI N ON I DECKIN60N%Clips Ir Tk6 VERTICAL DECKIN@ ON DELKIN6 d!IX 0.1Pi . P.T.FRAME 4•n✓EApS) ITUBEDI(N7 FOOfIN61 FRONT E L E V A T I ON R 16 HT E L E V A T I ON SCALE I/4' • I—O' SCALE. I/4' . I'-O• e=$r ai hs oif <c HE�o'�'a' :!E .au. _'_�"� R EXIS11145 HOUSES=i c_ ARCNSHILTEgC�URpL ASPMW T EXISTiNb TO MATCH � \ IXSTTRIIMM BAKE ON V Q Z 4a 4- 4•'I 3 O ] O �4- 001 +, FRU51ED Fi00R AT S� �_ fd SEGGND FL�R dST� T`— (A 0•0 M Ec W DE nVE BRACKES O/��^//` (A Lu L- �LV� C L /U^���`"a 0 CUSTOM RS'AND -- BEYOND TAI QJ W C L �X BALUSTERS,AND i - NEI'�SI-- (lS u j I; - r FRUSVED FLOCK AT . FIRST FLOOR EX$T) job no. : Ioo3 1X4 VERTICAL 03 AF'RIL 2010 DEOCIN6 ON 1%CLIPS - scale AS NOTED drawn I I"DECKINS CN y,NyN' P.T.FRAME Oa•TREADs) �. rev. ------------- ---------------------- rev. f REAR ELEVATION a C SCALE, I/4' . I'_0 l A O H /L/ O O C p ISSUED FOR CONSTRUCTION sbt: 2 of 5 r o Eo E Lyy � N C� ' ` Y o � � o C V Y � A a-' N s Y m E O L Y N 4J O b U �Xp .--_'_--i--_;---i---i--; TO f��NAIN �5 a'v'.i• c�l�e/ER�"Ev oex � I� FLOOR JOISTS TO IxOR MN 1EAD' FRAMING BE FRAMEDnJALONSSIDE T-`'� jg) IF ___ ___ ___ ___ ___ _ ___ T015RET�MIN(BOnIP91DE5) V --- t� sraoR O T CA IMO S ING LANE.FLOOR JOISTS 1%10 LEDGER FASTENED AT$tAIRWAY) 7XI0 LEDGER 1 TO E%15TIN6 SW WALL FlN T A6EM£D IE)3X4 POS ABEA i e LEDGER LawnDN ) FAS ppr.3%a s E5 TOf d o o r (3 P.T.51LL TE5 TO BE g m g o DRILLED.EPDXIED AND' r�. r�A. r'S A. r �y SLAB V D TO E%ISTN6 P.T.1X9 DEL% SLAB W 5/8 ' ROD O 4'4'OL:ROD O i—i , • ENGAGE EOM PLATS I )T y i T _ r � r_ _EXsn6 BEAM i IY Y` �y A 2o __ _______________ ______.__�________ ___ TJO15T5I Ib'Of. JIO )3X aC __. _ __ _ r T FEl&?T TO ATV ' ' ' u�i N s i Y Y - T (S)3X4 EXISTINs , , Ru� ---------------------------------------- PaSr o d o V V r Y 1li� m__________________________________________ 6nN6 POOR JOISTS P.T.3XB DEOC ; ! DIREL DOOR O c O O c : r JOI TS Ib OL. Y d REMOVREMOVE EXISnNb GARAGE i '�• r�• m ELLL IN ... ___________________________________________ r n I%4 i EXIS11%FOUIIDATON ' ___ ___ - __ ___ _ i Q i n 19/4'% I/4' ��XX}}LLRRIOR LD%PLYWOOD SIFAMIN6 AT BAY WINDOW Q occ i �____________ _____________ T I II AT .� Tp gES�TO NWSE o�.ao�r�w •• E-- WALL ub- \ �ooff€a VRAF�5 AND Q5. \ ��3mY�a�S•�-m S�c JOISTE a Ib'OL. \ / _ c �r IL ABOVE TOICBE BUILT 10'DIA LOW.TUBE � IWO THE WALL SYSTEM MD FOOTING)W / - g�_C o P.T.4X4 POST ATTALIED m TO L .TUBE W ABJ66 POST BASE N F I R5T FLOOR FRAMING PLAN V QQC 3< 5EGOND FLOOR FRAMING PLAN A^�`` 5C•ALE: 1/4' = 1'-O" O W O N •E SCALE. 1/4' • 1'-0' LA G LL C N �� C o 0 a"1 N C L N +--0 O to QQ a-2 n T ` LL- job no.: 1005 dais 00 A 11-2010 Seale AS NOTED dr2Wn rev. rev. Q o . A— 3 0 ISSUED FOR CONSTRUCTION sk 3 of 3 110 VOLT ELECTRIC LINE BY CUSTOMER To blower unit inch sch 40 PVC Bacteria stick extended above top of effluent for ease of removal IF- Zabel A-1800 Effluent filter or equivalent Existing Single compartment Septic Tank With Remediator Retrofit NOTES 1. Contact Muddy Waters Environmental at 508-888-6021 for unit order/delivery. Allow 7 days notice. 2. Unit to be placed under inlet precast lid, offset away from inlet T by 2 inches minimum. 3. Unit rests on bottom of tank with no support necessary. 4. Route 1/2" PVC air supply line through riser, align with center of unit. 5. Maximum distance between blower and unit is 100'. 6. No vent required. 7. Cover over inlet and outlet lid to be brought to grade with a riser to service bacteria & effluent filter. 8. Covers to be secured with bolts or screws to prevent unauthorized entry per Title V. 9. Contact Muddy Waters Environmental for installation and start-up. 10. Blower unit requires dedicated 110-volt 15-amp GFCI outlet at desired blower location. 110 VOLT ELECTRIC LINE BY CUSTOMER To blower unit Yz inch sch 40 PVC Bacteria stick extended above II top of effluent for ease of removal ILi Zabel A-1800 Effluent filter or equivalent New Two Compartment Septic Tank With Remediator for Remedial Use NOTES 1. Contact Muddy Waters Environmental at 508-888-6021 for unit order/delivery. Allow 7 days notice. 2. Unit to be placed under center precast lid, offset away from inlet T by 2 inches minimum. 3. Unit rests on bottom of tank with no support necessary. 4. Route 1/2" PVC air supply line through riser, align with center of unit. 5. Maximum distance between blower and unit is 100'. 6. No vent required. 7. Cover over center and outlet lid to be brought to grade with a riser to service bacteria & effluent filter. 8. Covers to be secured with bolts or screws to prevent unauthorized entry per Title V. 9. Contact Muddy Waters Environmental for installation and start-up. 10. Blower unit requires dedicated 110-volt 15-amp GFCI outlet at desired blower location. REMEDIATOR INSTALLATION Muddy Waters Environmental 18 Route GA - Sandwich MA Office (508) 688 - G02 I ---- Cell (774) 313 - 9547 ,l itr F-LoaR s L. 5q. 5 �op o�- W A��- RCM ov E ac, { I`�1�TE�T�� l . S 5 ' ARouNA � �•� ��xr 6 S oaE. � y ST& r o� - J o Nn . - - r -o___�To l�,R�iaE I.— ',u M) Ao S W �l,�l G o�=GR'�-► 6 rM lN./3'fv1AX C oV C�- , f- �� I I "-'2 LEV EL tzo 5s L / ___ _ _ nCC�S S PbT 'S — , 1 LU �C)Za /SooGI�,L FosZ t.�V�� �-�--- �� - -��4`�.R.I- F3 1�. . i•d �D 1A1N� •�" T 'k �� A -- �---1 a cz — "Cf2U9K�A SToNC ��o�N,Pr�c;ea NOTES: OG U S DC71- Drv, 1. )W1V) '`� ) jnrL_6T Tom. Dc�rt�, - I p' � 10 f3ELo\,,/ 1. Disposal System to be constructed in strict accordance with LL - -- Commonwealth of Mass. Environmental Code —Title V. 2. This plan is for the purpose of construction of a new septic system PRO T—! i_F_ oF �D) 5? CjSAL SX ST E. Y\ including 1,000/500 two chamber septic tank only. -+--- --_�.CNo-FTo s�aiEj � 3. Contractor to call Di Safe 72 hours nor to beginning of excavation. 70\,J N �„/>a-r L2 g- p g g 4. Existing septic tank to be pumped, filled with sand and abandoned. i i 5. Existing S.A.S. (trenches) to be remove with all contaminated soils. t 6. Contractor to check invert at building foundation. 7. Bench mark is top of foundation wall, elv. 58.5. TP_p 8. APN is 045 / 035 for Town of Barnstable, MA. - N - )vc►is 9. The plan view is based on actual field survey. ' P.--3o i a�=�z.�� , 10. Use new 1,000/500 two chamber septic tank, install "Ts" and gas ba ffles es l per Title T V. �+ L Q `T°f,PF )7 . : a 35 `` — FROND' � "-� 11. Use 9-8 x4 x8.._Cultec C-4 Contactor leach chambers without stone, 4 �- o�-� , Y1500 \ with filter fabric on top. . � o � , ° 12.� Installation to include grading, loaming and hydro-seeding. o r _ o T AN ID I YE W T I>?tV,oCNA L D/NTC t - _ '7- TF 5 T fat r t PF-A C,�ST- � of 77 EXIST/N6 o`' CARL HARRY c\C SITr PL a , C DLSI C�I� REV. 6 - 5- ► (S a\A/E1.Ll 51NIULE R\M1t-_ DWF LL.1Nib W/ ZBEVR'D M5 5 C./A F_ % II =-50 � I�P�kG�.. V1sP 05;�L �YS�.E>�\ D�SI�� M 1z'D C w1k 't Dt'11 LEI FL U W - I I L x -3 = 3 -6 ® o ao �0 5 s>�N I �� SEPT C TNhY, Cvz) �r�L M4 PA. M41 E ALISE o , Y 2 - 6 60 GALS. 1 fi` aI�.., , '�eaj 00 ry a ILL . TN r`\�: - AP.�T QW S 3� 1I-LS LE CI HG /1-FC'C__ 1\ C S . k. S,:� - -�24� - PROPOSrC CONTOuR\ —45-n PN _ 04s/ Q35 U 5E 9.-- 9' x a-' is a" cu LTE-C C r. w+ to ST®NZ 10 f>ONZ) )'� EAI0vj : .a�P\� -�, — - PR A4 `h 2.o._._ L -L A N T~L C:\l - h jo 13 - 4� 0 C O lit SU LT C I GIR , Slily D, MA' T O T ILL C_J1\ A ITS ` 3 5 6 GAta. T. 1J DaTEo S/�31i3 DW G.� 523)3 OLD ER it r • yi DO 1 Al 75-50-001r 3 p i O O O 1 O t 2 to I.o-r T Age 9.A► = -6 047 '5Q-FT• � SS � L CT 8 ~' Awram= 34,05-C 5q. - P o� �°o- •a' 9 - � R�c�2.50 �Y NO o e �O O1A 0 '41 O �0 N c9 L us, �Plv Q � , o O �b� 2 0�~ n , TA�1 ���I��."QIA►�� , t: :gEPT�G a r /* 40 TABLE Or- ELEVA'T%c ►ws LOT 'T LOT 8 , Top O;= Fc Luwoe,T%oW 101.4 %ok.s I►.rv. (4"G.0 P1PE Ou-T 0=1140uss 98.7 9B.8 INTO TANK 98.5 98.5 INv.(4" PV•C.) P►PE Ou-r OF TAN► 98.2 98.2 1WT0 D{s•T. Box 97.2 97.0 0 N 3 INV. (4 P.V.C.)P1PE OUT OP U1ST. BOX 97.0 9G.8 CVz 64\j- (4" PERF) PIPE A'T Bsamvj TRENcw 9G.8 C)G-s in i9 Q Ln 00 (t3V.(4 PERF•�PIPE AT ENo TRe{sc� 9�.5 9�o.rj 9. 0 2, f TA ST I MY TLE-r li RQ 04 �5 E 4 HARRY G o EARL �t LANTERY, JR. in o p No.25575 ST6¢G�tc. FOR RF-M�-p>A TOP, ) )�STALtAT i o N �� � CEQ'T►��! THAT THE FOu..,OtT10N8 A+.,O SEPTIC. ` , .SYSTEM GOMPO►JMEIJT3 ARE LOCATED A� Sb.10WN AS u%L:T PLAN ANo T1-1A�' T1-lE FOU►.IOAT 10�1 L OGAT 10tJS G01.1FORM ' TO THE 7-c>w%NCo S-4 —LA.W6 OF T"e TOWN OF .�.Ar,A ✓ i', JOB NO. BARI�ISTA6L.E •" �'� M h POWD MEADOW DRIVE 81 - S 32 r f 4•. PREPARE-0 FOR DWG. NO. RECa�STERET� LPNr� SUi2VSYORp "y �'/;;7TC 'r DATE SCALE DRAWN CHECKED 12 ,nal tun do, C.O.R. B.G.W. E. J. FLYNN ENGINEERS , INC. 127 TAUNTON ST. CONSULTING ENGINEERS MIDDLEBORO, MASS. 00 PI 75-50-00 E 3 0 ao 00 047 SQ. 1✓T• �s ? 6 si 3 L o-r 8 -c\o� ° Q JJ �Qo s, Od N • ,, Qw`o� ,, Q r moo 9 0 N���, /�O �./ Q j TABLE OF ELEVAT101JS LOT -T LOT 8 ToP O;= FouNob now 101.4 101 .5 INv. (4"C.0 Pipe Ou-t O= E4ouss 98.7 98.8 / INv. (4'C.1.) PIPE 11JTo TANK 98.5 98.5 INv.(4" PV•C.) PIPE Ou-r OF Tl>A1K 98.2 98.2 INv. (4" PVC.) Pipe IN-ro D%S-T. Box 97.2 97.0 Q !n Q INv. C4�� PV.C.�PIPE OUT OF D1ST. BOX 97. 0 4� - Itiv. (4" PERF.) PIPE A-r Bsc.%1,1 TRENcu 9ro.8 9�.8 L9 N ;�' lNv. �4" PERR�PIPE A� ENC> TReNCN 9�.5 9�.5 0 [Z ���. p 07 ER o % , 5• S g9 Op Az� o4'05E ea 1 CER-e�FY THAT TEE �OUNOATIONS ANO SEPTIG SYSTEM GOMPONMENTS ARE LOCATED AS 51-�10WN As Bu,LT PLAN A1JD TuA.T T1-aE FOUL�DAT\Opl LOGA1'�ONS GOitFORM TO TF-IE 7-Owt\NC7 S-- ' ,CaWS OQ -V"F- TOWN OF 13ARA1STABLE .�� _ a�t+� . . POND MEADOW DRIVE JOB N0. � , 81 - s32 Q j-' �_�cE BA.RNSTAElL.E M ASS . WA!T w, 7 1 21-307:. PREPARED F:OR LS AMES M 1 t_.A1�t0 DWG. NO. `9 c�C/S7f.�'`4 REU�STEREp LAND SuRvE�loR Z� ,,+tit DATE SCALE DRAWN CHECKED r tsu MAR. 12,1981 1" = 30' C.D.R. B.C.W. E. J. FLYNN ENGINEERS , INC. 127 . TAUNTON ST. CONSULTING ENGINEERS MIDDLEBORO, MASS.