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HomeMy WebLinkAbout0651 RIVER ROAD - Health 651 River Road IMarstons Mills - - 044 002 l Dqy-Dam Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 651 River Rd. Xh Property Address Kelley Owner information Owners Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 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 2/5/19 Inspector gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M ve 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•�''� 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M ,••�'y 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown 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. l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins.doc•rev.6/16 Title 5 Official Inspection Form: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 M 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No occupied Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 651 River Rd. Property Address Kelley Owner information Owners Name is required for every page. Marstons Mills MA 02648 2/5/19 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 2016 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 651 River Rd. Property Address Kelley Owner information Owners Name is required for every page. Marstons Mills MA 02648 2/5/19 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2'6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet and outlet covers raised to 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 4" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle >12 11 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pumping suggested every 3 years 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•'°p 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 215/19 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.): 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Top of D-box is 2' below grade, 4 outlets, H-10 construction, no adverse conditions Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ 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.): Chambers were video inspected, no indication of past hydraulic failure, effluent level is approximately 10" below the invert at this time 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M SVBy'�t 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 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.doc•rev.6/16 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 5 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 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 IVA V3' c4A ao eE t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�M 651 River Rd. - - Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 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 round water: feet p g g feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 3 NGW 120" � If checked, date of design plan reviewed: 200 200 ❑ Date Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4"seperation per 2004 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping site is 84'msl and nearby surface water is 40'msl You must describe how you established the high ground water elevation: see above Before filingthis Inspection Report, lease see Report Completeness Checklist on next page. p p � P P P t5ins.doc-rev.6/16 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 651 River Rd. Property Address Kelley Owner information Owner's Name is required for every page. Marstons Mills MA 02648 2/5/19 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 tX No.�<nrj J ^CJ Fee ��v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2ppricatton for �Digaal 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Addirss or Lot No. C�f / ate Ow s N ,Add e Tel.No. Assessor's Map/Parcel Installer' N Add s,and Tel. o. Designer's NamnepAAdddrpsand o. rzS, Type of Building: • Dwelling No.of Bedrooms S Lot Size J..Z Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures. Design Flow e,Se gallons per day. Calculated daily flow gallons. Plan Date /0 3 0 3 Number of sheets Revision Date Title Size of Septic Tank S �� Type of S.A.S. L Description of Soil i Nature of Repairs or Alterations(Answer when applicable) t i Date last inspected: Agreement: The undersigned agrees to ensure the cons ction and mai ance of the of s ribed o s* a sewage disposal system in accordance with the provisions o We 5 of the vi tal Code and not p t e t on until a Certifi- cate of Compliance has been i th' a Signed -Date 4G Application Approved by Date (o O - Application ed for the folio in reas ns Nv �a d.L Permit No. r� Date Issued 0. No +' Fee THE'COMMON EALTH OF MASSACHUSETTS Entered in computer: r ✓ P BLI "HEALTH.D (I I - TOWN �F BAF#iV TA LEMASSACHUSETTS Yes U C IV S ON O O S sr ZIppricatton for ]3igpo.5a1,*p.5tem4A truction erutit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or of No. 6P r O is Na e,Ad ee Tel.No. xl Assessor's Map/Parcel / ; s 4/'`' Installer`s Natne Address,and Tel No. Designer's Nam Addft ss and elrNo. <-�_ (U,,,54r,14 IPA 02&-?S<' eat%2,91 Type of Building: &Za C3 a/ Dwelling No.of Bedrooms 5 Lot Size s `ft? Garbage Grinder( T) Other Type of Building � L No. of Persons Showers( ) Cafeteria( ) Other Fixtures r r Design Flow '� gallons per day. Calculated daily flow gallons. Plan Date �d .3 O Number of sheets� Revision Date Title _ Size of Septic Tank �'� Type of S.A.S. 4 ' C Description of Soil f + i Nature of Repairs or Alterations(Answer when applicable) t � - qr Date last inspected: Agreement: The undersigned agrees to ensure the cons tr ction andmai ntenanc�e of the of escribed or.=s to sewage disposal system in accordance with the provisions o tle 5 of the von ental Code and no lade the t -o eration until a Certifi- P P cate of Compliance has been 1 e y this -,oard 1 ea, ' �,� aG d • Signed - Date Application Approved by J v Date U P AppnnlicationD.isapp. wed for the following reasgns ry iqnn t- , -_ C�IX�Nw bHFIF ?Pa.t� 7r�ad���/ ID U 1�T✓ I`t H J�1n J� S s7+'n1, ' ri Permit No. �a ao -"�✓ --" Date Issued 7 6 ZQ V THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(�) Repaired ( )Upgraded( ) Abando ed( )/�by J(,14ctr m at �( /C�W r �. has been constru ed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. A qo 3:��'� dated 7 V Installer Designer `s The issuance f thrmit shall not be construed as a guarantee that the sy � will fun tion as desi-t ed. Date Jr-,b L. Inspector q - v r� a No. aCP� 2/ -------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &5po5a1 *p$tem Congtrurtton Permit Permission is hereby granted t Cons t��+( Nepair =eX.pgrad� "�,�bandon( ) System located at y _ l' j and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditio(�s. Provided:Co stru tion . ust be completed within three years of the date bf this pe Date: Approved b -----�� PP Y r• TOWN OF BARNSTABLE LOCATION t � �'v .�' _ SEWAGE VILLAGE - SS O ' MAP LOT C t0N _ INSTALLER'S NAME.&PHONE NO. � SEPTIC TANK CAPACITY / H`10 t LEACHING FACII.ITY: (type) Ze-' �4Y& QA-*Mbe-f-S (size) 13`AS& NO.OF BEDROOMS ' BUILDER OR OWNER ` PERMIT DATE: 7/a3/wed COMPLIANCE DATE: Separation Distance Between the: p Maximum Adjusted Groundwater Table and Bottom of Leaching Facility d2nk £ 0� eett Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Le Facility( wetlands exist within 100 feet of e g facility) 14" Feet Furnished by E 4� fi EV -VOV-CA- ®/ -9 I l ,®t 1 V µ Town of Barnstable Regulatory Services Thomas F.Geffer,Director tMASSs Public Health Division 39. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 60104Sewage Permit# zao3 S fwk Asscssor's Map\ParcelC-) p®2 • 't- Designer: C � i� ,_%Jq,Installer: Address: P Address: 24�- Jc�icA1, On 6AJ a. was issued a permit to install a (date) septic system at t 4fc ?J Jam Q�� , based on a design drawn by- (address) to Ic dated b (designer) V 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. 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 Regulations. Plan revision or certified as-built by designer to follow. H OF�s9 �S oy SCHNED�. Wfler�'s $ 9N Cho 8-�o-oy (Designer's Signature) (Affix De§ikftr SGaWp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WELL NOT BE ISSUED UNTEL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION: THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doe r r TOWN OF BAR.*1STABLE LOCATION f � �`y�.�' (Z� _ SEWAGE �3'Sys VILLAGE SS�O 'S MAP �,OT UPI l�o�- INSTALLER'S NAME&PHONE NO. ' C�10� SEPTIC TANK CAPACITY I-00 H-f �6 -S 9-0 LEACHING FACM=: (type) Qh,.A1be--S (size) 5 S i.3'/-S©' NO.OF BEDROOMS .: BUILDER OR OWNER ( PERMITDATE: '7`: 3le)ey COMPLIANCE DATE: � Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Loos COWL) Feet Private Water Supply Well and Leaching Facility (If any wells exist A)10, Feet on site or within 200 feet of leaching facility) Edge of Wetland and 1,pe� g Facility(If wetlands exist within 300 feet of/le ng facility) �" Feet Furnished by � curt.Si�9ffUyL co5�- 1 C( A"3 qi ` Ll l.. , 0 .0,-9 a, 1-4'- 12'-4 IT-3, ..................................................... .. ....................................... ............... ......................I............ IL • .......................... Ihi--)foor?/--,to d(op 7' hove 0 4'frost WO// Ca ................. ........ T..... ................... .......................... (n .................. ....... U- concfele du--5i cover .................. El.................. ................................................... ...................................... 00 F 24" 1 Uj LU -j Uj LU < > U < LU ....... ....... ................ JOI F'70Fenl'41 L....................... 1-4 1-4. 9 i e -4' T I I ED ...................... .. ................. ... .... ..................... .................. ................... .. I.............. ... ... .................. LLJ pad -112"0 lolly on 0 5OX . ............r...... 50 X/6 Poured cone. 2xlO--,/6"on cenlef pad MCC C < .............. ..... . .. ..................................................... ........... ................ ............ ............................................................................................. 11--718"padm Li Z CQ /Az 0 Anchor Max, CO z 6'acno morc than 12"of > U3 co in in v the co(xf5 Q 04 l�o--,emenl square footage Go LLJ ................... perimelof-264 I-F 0 CL L) U') z 3 0 U-) W) Z V0 Ui Ui CM Cy.. IL z IX Ul U) Ui ........... ...... F- C) F-I ....... V-4' C/l/ UYLA--l'V 12'_q• 6'-4' --13'-3' U'_g• _4' 0 0 �• i• i• 0 0 _11�'- -2'-T ' -51" _4 •-1 2'-11 • ........... .......................... J Family room o n" RCD OMfIOORTG O 1 41, m '. Screened Porch ..a, '-Ty _' 8e O un 90 909 • a u sae r-9� LL 0 ' Dininq loom � Q W J W N rr�o Kilc%n LU Q 1— > R[D OM fLODRnG M 1 c1n) c1n) in m ,{u _1• �, o(bdc aLcve O T-T•_ 4'�2' O r •• U in R[DOM rLOORKi I o � a 6' Ol' -mJ EE �•-M• " W Q 'as J T o w z r R[D OM?LOO" a 1-1Vinq loom 'open°" RLDOMfLOORAfi orzn rdllrt7 ^�1) > ' ^ R[D OM?WOO* . Goo/ R[D OM ItOORAB < iD � IL1._ _4 � T W ^ I ...... ..... .:b.. ............':�:. DO 9e6 yt»i Dolh#I 4a6 M-4 2 1- a/o LVL ontef ooaw -g16• ^° -9 '-9 ' - _4'-9 '-___l -6'_9 ' +-- 4'_2'• FO­ -u N �. 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RIS RS AND COVERS TO - Tr,, � � 1 FIRST FLOOR' - __ . ,. _ 1 119.5 - 1. ' RISERS 1. ,LL CONSTRUCTION ION AND MATERIALS SHALL CONFORM TO MASS ENVIRONMENT L , K /�t „ Qr,, :. :.FINISH GRADE N THE LOCAL BOARD OF HEALTH. 2 TOP OF FOUNDATION - 2 118.5. ( ) 2. H-10 COMPONENTS AND ODE 310 CMR 15.00,TITLE 5 , AND �:.., 3 PIPE INV.` A1" FOUNDATION = V PIPE THROUGHOUT 2. HERE SHALL BE NO CHANGES MADE IN THIS PLAN WITHOUT THE WRITTEN i Koo --= _ SCHEDULE 40 P C f i:. ., s:e % .� HE LOCAL BOARD OF HEALTH. �� e�. V F PIPE AT SEPTIC TANK INLET _-- 4 115.75 = ERMI5SION OF T S 2i� MINIMUM V F 'PIPE 'AT SEPTIC TANK OUTLET 5 115.5 5. ALL ERRORS, OMISSIONS, AND CHANGE OF CONDITIONS AT THE SITE SH, LL �twltlsr. 5 INV. 0 Pbnd j,,.LOCUS --' '<'.>`^1(,S.''ir,L' Ira. �" >f � � ,�,, tr,• , _ _ _ _ . :: � BE BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO PERFGRMiNV THE (', n 45 >' z�', :e yj :; 4 ` 6 INV. OF PIPE AT D BOX INLET 6 1:15:4 12 J{ 'akl.;+.., V .\"�`•J'Y+,j rt,.. ,yi;,V,,; . - r\ELATED WORK. :. ¢ 7 INV. OF PIPE AT- D-BOX OUTLET= 7 115.23 14 13 -� 5 10 ter'. - �.. • �, TIC SYSTEM DESIGN AND . 8 1.13.8 IS PLAN f,i.._: SEEN PREPARED SPECIFICALLY AS A SEP � � ` -8 INV. OF PIPE AT START _OF .LEACHING FIELD 11 i BE PROPERTY LINES OR BUILDING SETBACKS. I N TO ttt USED TO ESTABLISH r +.. r- r 9 BOTTOM OF LEACHING _.FIELD 9 112.8 4.•:• . _ MIN BR EAKOUT I I_ �•:- " : •-- :.: nu- .. ._'.'. .. 1 SAND BUILDING LOCATIONS ARE GRAPHIC ONLY, PROPERTY LIR,_S .. . . , . ., - _ PROPERTY LINE STONE _ 1 1145 0 T P OF r I ! CERTIFICATION AS TO I,-IE r_... .......... . REPRESENTATION OR CERTIFIC 5 i t VERIFIED. NO REPRESENTA 0 , , ,�1, BEEN VERi ED . .I{ .. ;._...-.. _. NOT HAVING _B E I f F ,. .s ... ... i `ITY 11 117.5 ,__. .,... ,., , ... ._ V R LEACHING FACIL I H D GRADE- 0 E _ ,.- FINS E v I _ I R INTEND r , , f ,. : SHOWN THOSE A a 1, L,y WITH I � \ 1 a .� t' _ _.. ♦ ._.. .V._.I..,..a ...c:........ .. .. ... 1 - ,. ,. :. ..,.,, � .. t, ,D B 12 1 5 „ : , . , . RA OVER,., . , FINISHED ,.-0 . _ � . , . .._ _,,. .. , - d_.I .. . . ...... ...... . ... . „ � _ MAINTAINED - ,. _.., , I �, „ I .-: ,. ... ., s c�TLET .. _ N FILL M SEEDED AND . I , . I:, r , , . , _. ,.- f CLEAN ARE TO BE LOA ED , ,. ..a ,. , ,,,. AREAS , .. . _- , 1 ,. _ , . ,... ., T . . ,.: �. ALL DISTURBED QQ _. Irv. ::.. .r ..-. :_, .... -. _ 1 .. � Box ,, ��.. 1 RA OVER SEPTIC-TANK. _ ,.,.:. ,,,�,�. ,.,. . .: ,. :: s.�, .'..: . ,:!. .� ,t... ...,., .-_ 7.� 3 FINISH GRADE - .n -. ... r I ,1 ., , ., -.�. ,. � , .nx TO PREVENT EROSION. 14 I I H GRADE AT FOUNDATION 11$.5 F N S T _ , _ SHOULD BE INSPEC I ED AT LEAST 1_ i1r.Yl: .c. u. FOR PROPER PERFORMANCE, SEPTIC TANK LOCUS MAP NOT TO SCALE TTOM OF SEPTIC TANK - 15 111.0 _ ' 15 BO _ :. I ���-'�� WHEN THE TOTAL DEPTH OF SCUM AND SOLIDS EXCEEDS ... il,:.� _, , ;;;;.:-, L,, ,.: C ONCE A YEAR AND ...: •. __,,.. ....'.....,!} ,., s,... r.c...::ti S..,,,1. 1-;:4 S(Y',9.' r,_.���'_ ..'e*,'s."..�;'4":,• O 5 HD 40 PVC TEES . ., _. . . .t!, .e,. ,_. C1 ® ©® 16 111.0 C l �, ,., �, , t. , _ . . 16 TOP OF CELLAR FLOOR = VARIABLE1,,. ..: K Iry I ,> _ .• � , ; r, .--I d" rr : ..,,_.. t. ,� •J:'. s r, ..: .-„ . r- - . o � o] ® TANK SHOULD BE PUMPED. � a © � I� 1 3 THE LIQUID DEPTH OF K, TH 5, f'`F - / THE TAN E � a _ - .> r_ .. .w�r. _ I ' . ..'� r, D ;,�r ;.: t.:..,. ., . , . T �. IA REVIEWED AND AC�NONLEDGE ,-.;.t',�. �..�._',.� , .-�- 7. �HIS SYSTEM HAS BEEN. DESIGNED FROM DA . fl:,�, (:'_.i,::i:i 1.,. I,. la.,,:: t(,-a' -_s l lJ 16 - 1 1 GAS BAFFEL :, b �.: .,. ♦.- , .- , . , „ ,,, ,_. I BY THE. MASS. D.E.P. AND THE LOCAL BOARD OF HEALTH; AND r. LD E E fi F NATJRALLy OC(CLIRRING MASS. SARdTAR �,0 L. 4 0 ,r t •- tl,,,: :, I: I:; ,1� { ,i' , PERvlous t`4ATEERIAL � st: I CONFORMS WITH THE REQUIREMENTS OF TITLE 5 0, THE 1 , r OF PERFORMANCE IS EXPRESSED OR IMPLIED. r NO GUAR ANTEE r 7 I , FOFJti� 6 �:��{ •:,� II TO SGI I_ CONDITIONS . ,Y� � .,a:�: . : t,.w �.,:- , : _ .; ,.w N IS LIMITED . ,-.:�: _,.t,..,. .�,. �� �. . . .,. :, : � . _„r:..l }I 1 ,' i s,._. . , ;., INFORMATION SHOWN HEREON a,,.� •; ����.: �.�' :�� � '�, _ 9 .. � _< ._ ,.:, , ,,., I 8. TEST HOLE INFORI • t 1500 GALLON SEPTIC TANK t,$,.,.. ., _ � AT THAT PARTICULAR TEST HOLE LOCATIONS AND IS NOT CONSIDER�L? AN ! H 10 PRODUCT ACME ! v !'" . . ,--t kl, 11 4 PRECAST MODEL OR EQUAL i '',, : USE 4 GALLIES WI i�I 4r8 STONE ALONG IMPLIED OR EXPRESSED WARRANTY OF SOIL CONDITIONS BEYOND I. ,. , OF ' .: .. 2" N, 4�8" ENDS ,..,.SUCH TEST HOLES .•,•-•_.-. I: f;,l ,, .,,:. i, + 1 tl!I(I I, , ; if ii , `, SIDES 3 BETWEEN; I M THE AREA DIRD TI..Y F ?} �...,. ! . . _,.'.. {..•,, . : CRUSHED STONE` BASE 9. ALL ORGANIC MATERIAL MUST BE REMOVED FROM 6 MIN UNDER AND BEYOND THE PROPOSED LEACHING FACILITY. THIS AREA MUST BE BACKFILLED TO THE ELEVATIONS INDICATED ON THESE PLA''.S WITH i 15 + SELECT ON-'SITE OR IMPORTED SOIL MATERIAL, CONSISTING OF C'I_;_�'. f a I GRANULAR SAND OR OTHER GRANULAR MATERIAL, FREE FROM 0�?'J " C i MATTER AND OTHER DELETERIOUS SUBSTANCES. MIXTURES AND LA` EF=:S CONFORM TO MA i I � SHALL NOT BE USED. THE FILL MATERIAL SHALL CC. _MATE T\ I AL ! +VE \ \ ! PERCOLATION RATE OF BETWEEN TWO AND FIVE MIN. PE INC � ESI Gi ;.;� ATA HEALTH CODE TITLE 5 - 310 CMR SECTION i5.225(.�� AND Si�H, E'r O,�E AND , � t aK \ 114.291 0.57 \ i AFTER PLACEMENT. - 3 :.� \ 120.86 a I 1 1. BUILDING TYPE: 5 BEDROOM HOUSE 10. ALL STONE MUST BE DOUBLE WASHED AND FREE FROM FINES ANC? ANY 118.70r 2. DESIGN FLOW: 110 GPD PER BEDROiOM = 110 x 5 = 550 GPD ORGANIC MATERIAL AND MUST HAVE LESS THAN 0.2 PERCENT MATERIAL \t c . 3. DESIGN PERCOLAT!ON RATE: 5 min/'inch FINER THAN A NUMBER 200 SIEVE. ' I �, 8.46\ 11. THE DESIGNER HAS NOT BEEN RETAINED BY THE CLIENT TO CONSTR 11CT OR \ 122.41 '\ ` 4. GARBAGE DISPOSAL. NO \, f "` \ SUPERVISE THE CONSTRUCTION OF THE SYSTEM. THE CONTRACTOR IS 112.21 \ �- \� PROPERTY -INE IS - 5. SEPTIC TANK DESIGN REQUIREMENT:, 200� DESIGN FLOW RESPONSIBLE FOR MAKING ARRANGEMENTS FOR INSPECTION OF INSTA:LLATIGti 1 \ \ pp \ 16.79 "BY THE C£` NTERLINE" 550 X 2 1100 GAL. (USE 1,500 GAL. MIN. PER TITLE 5) " OF THE SYSTEM WITH THE LOCAL BOARD OF HEALTH. \ ,•. a,� . \ , �120 \ p� 6. TOTAL LEACH AREA REQUIRED: ! \ 118 121.72 118 �# \O C 12, THE GENERAL CONTRACTOR IS RESPONSIBLE FOR ALL i-ORIZONTAL Ai I ,., � � ART TITLE 5: 550 GPD / (0.74 GPD/S�O.FT;) = 743 SQ.FT. (CLASS I ,i"ill.) VERTICAL CONTROL OF ALL SYSTEM 'COMPONENTS. ! C POLYVINYL CHLORIDE' / \ \qr�; ' '' '7. �i�' iAL AREA PROVIDED: 13. TIGHT.JOINT PIPING TO Gi�Si` OF ..) �. ��� / • \ � -'..>, � '� \ 1�j. � • ^0 � ,16 <,9 t � _., '• SCHEDULE 40, UNLESS OTHERWISE aNOTED. I } 1 1:! X 50 LEACHING TRENCH SEE DETAIL ( ) µ' GTiFY THE tDESiGiJ' tNGiNEcR FOR CONST?.,; TON �. t 112.0 T r4. THE CONTRACTOR SHALL N :.., tFl ECTIVE DtP H 2.0 L�NGTH , 0.0 . WIDTH - 13.0 - - _ FOR H L AG"iING'' �?E_y P ,1rJR TIC f' -, ... INSPECTION raf I C,. EX�,AVA LION I Ot THE L 13 1t. r ,n 1' 17 t _ - PRIOR T0 BP;`.f<�ILLIiN'G. _ ♦ � ,,.s � � F///� �,: 116.80 �� ?,:�, ;��� SIDEWA,LL AREA (2x50)(2, ,- 20� .SQ.FT- i/; I /� f r,.4r. V•. , ,� 1 AREA 13x50 - u50 SQ. -, _�:- ,, �Y ,�1 % P .. ../ / BOTTOM \ , naa \ \ '�ti O • _ 15. ,DESIGN ENG.iN��f-� ;Si•I/�:_L C__RTII CO;`!c ;Qi I� },_jig C� SYSTEM, A��D , ,. '"•iAu_�:, 1 j t \ r '�, _ :• \i18.52 ^' �'' AREA = 2x13 2 ' = 52 SQ.FT. ,, I ' SIS C FI! ENt_ �! LL ( ),( INSTALLED. THE CONTRACTOR, SHA,_� I ROVIDE A SIEVE hiJA�. 112 WE , ,. - \ ^ �° -'e , T MATERIAL REQUIRED. AN A =F ll!,.T PLAN SHALL BE B` : :`tD• TO T f iE i OCA_ Seri\ T�. +AL AREA PROVIDED = 200 + 650 + 52 = 902 SQ.FT. \ \\ BOARD OF HEALTH UPON COMPLETION. 1Tlq 100.04 1 aeorEnrr unt s i t \., i 1 r' A.. V 1' - - P^.r,- �, •YTME� EFt�,IE � \ � % ,t/ ,•X5 ed � ; �'� 650 SQ.FT. x 0.74 SQ.FT./GPD = 667.5 GPD ;6. NO RUBBER TIRE CO, 11� ,� 'vSTRUCTfON 1 „ �NINER I SHALL DRIVE OVER THE P;�G v �tD f ` SEPTIC BED EXCAVATION 5.8 -�. 1 p fir`.,_ ____1 ,iJ. ;.� _�. r l�17.84 TOTAL FLOW PROVIDED = 667.5 GPD N DURING CONSTRUCTION. 5 17. DiG-SAFE AND ALL OTHER NECESSARY AUTHORITIES SHALL BE NO I FIED FOR sM r \ �\ ,a 7. _ _ T N OF EXISTING UTILITIES PRIOR TO ANY EX.CA`,'ATION. � _ THE PROPER LOCATION Trl : \\ �•.� ��., �, CO NOTE: SYSTEM IS NOT LPL SIGNED FOR A GARBAGE GRIPv�?r._(-�. ' �J Y7E ~ , t 11 11 {a, y17s�M lY ,.` \, `� /� �•`. \t I I �•'\ t r r- ! 4115,3 .. - ` 1 1 �3 � 16.57 s� \ �, 4,•e� \;' \ 105.88 'q T / '\ Depth from Soil Soil Sci! Soil Other ow � i '� \� \ E/� I jO 1` Surface Hor. Texture Color Mott. Relative ! �� (Inches) (USDA) (Mun�el) Factors I \ _ f E 107.b5 _ DEEP OBSERVATIOiN HOLE 1 3.z� \ - 10..E S 4, \. ,d 98.6� 107.13 �`� 10,E �� It1s, r I I I -� ,z,o 70 6 -6 A L/S 10YR 6// BY APPR e -,--��' ,; '•, -`.- � REVISION DATE DESCRIPTION ___ Y 4,: +-Y` � ARC -�'-l-1 `y-' 1'f`.�.9r3 6 -42 B L/S 10YR 5/6 _' .8aa _ w,?a °z \ :, \ `` Oq 1 6+ 5. �113.88 APPLICANT: 13.61 3, Jl-'1�1J RS / \ \ 1 \ 42"-120" C1 M/S 2.54 7/6 NO GRAVEL 10% PA tJ fi SELL 1 / L / 39 TOWN, HALL SQUARE l --'� \ er / ^-. ,,., ' \ -__ ` ` I FALMOUTH, MA. 02540 ;� )RDA _. / / ~�, \` `� `' --9 1 t1R C S #2 PROJECT: I TP 12.19 DEEP OBSERVATIOIN HOLE ATE: PUBLIC WATER SUPPLY IS Av AB' TO THIS LOT ,. \ } 112. 6 0"-6" A L/S 1DYR 6//2 4 : . _ 6 1 "� � � 2 I � / �� ' _ I S, r:�.G.�` DISPOSAL S YS T.� D�'SI G1�1 , SITE PLAN 6 42 E3 L/S 10YR 5//6 I i , �-, ` \ ~--•- GRAVEL 10% GRAPHIC SCALE 92. 7 I 42 -120' C1 M/S 2.54 7/6 No 651 R ? T 88.09 90.73 �'' PERC@54" I r i 80 0 40 80 160 320 / 5 ' 1 .76 / r1-► r I 3♦�6 r 1'�iZ S 011S ILLS, �IASSACTIUS.�' j f 86. t 9.23 09 86. 7 / + J, \� FBI-i:,�,;_)LATION RAT' 2 MIN./Iril_!-i N FEET ( ,,,, _ r I I ;. I ,, ,,:. _ u r - n ! DATE. 9 0130103 � NT Rt 0 l D N TO GROUN:_ ER N0� _ OU E SHEET NO.. > 1 9 1 inch 8 ft. _ l� -1.66 OBSERVATIONS BY: -)AM WHITE �,30 -� 10 77 , SCALE: As Noted PRG FILE: RIVER_659_KELLY /' d` � 10 DATETESTED: 10;'1 :� 03 i 1 DESIGN BY.• DAVID FRENCH CHECKED BY: CHRISTOPHER COSTA, FLr� LEGEND- • f / N4472'10 W . ' N 0 r F S -- _ .� ♦ -- D f ' �J g,4 8 -"" _ Y PREPARE BY. L-143.98 6.71 �' f j R 4_85.07 94.80-'96 J. F J r �` �-`� 1. THIS LOT IS NOT IN A FLOOD HAZARD ZONE II II EXISTING PROPOSED _______.�___ � ��.81 93_.�� U UDL- 2. 11.iUEFA _ __ Chris" � - ® A�sOo� � AS SHOWN ON FIRM FLOOD INSURANCE RATE MAP. / 1 C. CONTOUR ELEVATION 2. WATER SERVICE LINE SHALL BE LOCATED AND MARKED CIVIL ENGINEERING LAND SURVEYING ENVIRONMENTAL CONSULTING RAI' PRIOR TO ANY EXCAVATING AND 10' MIN. SETBACK 50.5 50x5 SPOT GRADE ----NOTE: PUBLIC WATER SUPPLY ;S AVAILABLE TO HIS LOT I TP - -- DISTANCE FROM SAID SERVICE TO THE SEPTIC SYSTEM I Q TEST PIT (TP) P.O. Box 128 / 465 East Falmouth Hwy- 508.543.0350 FAX ZH OF SHALL BE MAINTAINED. _ MA 02536 East Falmouth, 508.548.6424 PHONv ❑ ® CONCRETE BOUND CB ��.� ss9� F,ygss 3. ALL SEWER LINES SHALL BE SLEEVED WITHIN 6" PVC - ( ) N. ti 9 SCH .40 PIPE FOR 10 ON EACH SIDE OF WATER SERVICE. ` ,- DOUGigs G� ' o �' DRA-WING TITLE: I 0 o GRAPHIC SCALE sc�Ilu�cflER �, CHRISTOPHER �, 4. GROUND ELEVATIONS ARE BASED ON AN "ON THE GROUND" SPIKE (SPK) CIVIC -; o COSTA m 2ao No. c> -, SURVEY. fio � 3854 No. INSTRUMENT UTILITY POLE (UP) 30 0 1s 30 F 0 3t3o5SITE �N� S ' '�'I�` I� '' ,SIG PL. G 9 0 16 PAGE 088 / F PAN BOOK 3 '�•, STEP � { S/STEPF• 5. PLAN REFERENCE. L LIGHT s, 4'O � N EN S VC UR Da N WATER GATE (WG) ( IN FEET ) - - - -- ---as^ - 1 inch 30 ft. �� ! � ASSESSORS INFORMATION: MAP 044 SECTION 002 -- - - - : -- i