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0344 ROUTE 149 - Health
344 ROUTE 149,MARSTONS MILLS - A= 078 031 1 J � 5� G kX oar'16•x 6'-8*--4-4• 5'-6° L` �l 2'6•x 6'-",F---5'-3" y `7- ''' -96'-5" 6�;, a'-o•--�5'-11•�--�'1' r' z'-1°xs•-6° .. - .—�_ a� -^��s" �IY1 O 999...IIf ' O a 8,-6° N W k a7i 00J I Ck A o 7� 1,2 -67 91-61 '2'- '-6°x 6' 4.2" } IF N l-a 16'-5" L]Li - -—�q„� ie'-0� 19/Q 5'41" '1'- 2'-1'x6'-6" __'�1•=^_- __'_' 9'-5° 1'-9'�' b ;yd 2'_8"x 6'-8" 3'-10' 8'-6' 4'-8'w tui 33-4 6 N h N N A N n 39'jl Kl z 2S G � i TOWN OF BARNSTABLE LO(:ATION SV Rf I qJ SEWAGE VTR'LAG ASSESSOR'S MAP & LOT '78- 31 INSTALLER'S NAME&PHONE NO.Oee�✓f 'FInt q xfr -f d a..rr SEPTIC TANK CAPACITY /OUO 0 LEACHING FACILITY: (type) 7 ff<GW l^M size) 11 X Q NO.OF BEDROOMS BUILDER OR OWNER Y**A % PERMITDATE: _ COMPLIANCE DATE: . Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ova Z Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ` Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by sf .. y -7�a 3g.o g y •.o s - J No. 20 Fee ' THE COMMONWEALTH OF MASSACHUSET4TS Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Diopogal 6potem Con!Aructton Permit Application for a Permit to Construct( . )Repair( )Upgrade(V)Abandon( ) ❑Complete System 1 Individual Components Location Address or Lot No. 3 0 p 1[>^ Owner's ame,Address and Tel.No. � eA1 I T 1 C,ZT0 �. Kim M i-rc EL Assessor's Map/Parcel a 10� &d 1 S pV f* 5'12 U Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o �DX'1(03 GdiAQ� DE_� E 1i PR,(SES !.I�Q maw S� ��� z�- z b N V 6 2 141 Type of Building: Dwelling No.of Bedrooms 4 Lot Size 31�sq.ft. Garbage Grinder(4A) Other Type of Building No.of Persons JMV JOWL J Showers(VI Cafeteria(✓� Other Fixtures t (S jMK. N�u - ,O Design Flow 40 gallons per day. Calculated daily flow ` gallons. Plan Date NO Number of sheets I Revision Date Title Size of Septic Tank 1000 05144 Type of S.A.S.&�OC 'eY6ft 106A Q111160 Description of Soil PI.P�f� UV• i Nature of Repairs or Alterations(Answer when applicable) A i E D U:' kcg- P i "— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Board of Health. Signed` ' I Date 5"1-7-20016 Application Approved by Y ` Dates/7'�JC Application Disapproved fo the following reasons Permit No. O�0 ` Date Issued S'-l 7 100, No, 4 Fee THE COMMONWEALTH OF MASSACHUSETTTS Entered in computer: 9,k Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Mi5pool *p,!6tem Construction Permit Application for a Permit to Construct( )Repair.( )Upgrade( )Abandon( ) El Complete System 0 Individual Components Location Address or Lot No. �/ ,t/� /UN,T-A. , Owner's Nam1e,,Addresss and Tell.No.o.�Assessor's Map/Parcel3,`f Pf `� I1�l I"l (�C�' ""' aox 512. , M AlSW s M 1L- ,�, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0 0 �DX b3 G +a�1 S 4a ��� - b ,Type of Building: 1 Dwelling No.of Bedrooms Lot Size 3 ± sq.ft. Garbage Grinder(tLA) Other Type of Building -- No. of Persons �)l.lu 01Q Showers(✓) Cafeteria Other Fixtures Design Flow 4t 4 gallons per day. Calculaied daily flow t711 gallons. i Plan Date DO le Number of sheets { Revision Date A i Title c r _� _ �. G_ - -- Size of Septic Tank /1_ t;�} � Type of S.A.S.(e Or PVK+ifr. 10 C4-)110 A `� t Description of Soil; �c +�-21-p-'A � 7 Nature of Repairs or Alterations(Answer when applicable)TJCA I I eb a R 1 �" Date last inspected: i f ! Y Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. t - Signed Date S-1 L ZOW. Application,Approved by Date 5-- 17-o l j Application Disapproved fd the following reasons Permit No.? i`ta 9. Date Issued S'-/7- U ---------------- — _--->—------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS b: Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( )Upgraded(,,,A Abandoned( )'by C d00,0 t 6F F-At trD �C�t at 11ttL /1 Ir/ /',. .T has been constructed in accordance w with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 llv6 " . q dated Installer AP-9 0I or— Designer 1 LALA The issuance of this permit yhall not e construed as a guarantee;that t says e 1. ndt'on as designed. Date Imp& l No: w Fee J!/. o- t` THE COMMONWEALTH OF MASSACHUSEiii S PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopogai *pgtem Cow5truction Permit Pernussion i&hereby granted.to Construct( )Repair( )',Upgrade(�/)Abandon( ) System located at %% f/ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction m G e completed within three years of the date of this p'�nii/t. 4)Date: �/ / Approved by VV� fi�r TY1•s ue PC) S i/`� " 1 �'Uc L� .P F su J'P itir�h 7'S o C U c I JJ Vecl- Town of Barnstable OF11HE 1ph, Regulatory Services �0 Thomas F. Geiler, Director * BARNSTABLE, MASS. Public Health Division 039. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: Shay Environmental Services, Inc. Installer: C CU_3\,Vie G1'f, Address: P.O. Box 627 Address: 212) East Falmouth, MA 02536 On � 68 a2r:S,2k OF, �t was issued a permit to install a 1( ate) I (installer) septic system at-4 3 4�k 2-�t \LA9, H. M,115 based on a design drawn by (address) Shay Environmental Services, Inc. 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. F� 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. OFA ��N Assq � CARMEN c��n I ler's Signature) o. E. U : SHAY No. 1181 0 STE�� s rjN - (Designer's Signature) (Affix Des i p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form I I -- 4 ` 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, CAQM E� �NflY ,hereby certify that the engineered plan signed by me dated Z!5r 3- (-P ,concerning the property located at 344 ?1,00-If 149, M \\5 meets all of the following criteria: • This failed system is.connected to a residential dwelling only.. There,are.no.commercial or business uses.associated with the.dwelling. • The.soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). L C� B) G.W. Elevation 2�5 +adjustment for high G.W.3,to = 28 0 Q DIFFERENCE BETWEEN A and B J t - 40 i SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum.. No additional bedrooms.are authorized in the future without engineered septic system plans. iv), gASeptic\percexemp.doc Lem — A09,5 .•_ __ __.__r —.._— . .. ....._. L3y-104J_U4 P.1 a Cvmmorrnealth of Massachusetts Title 5 Omci.aul ns ection Form Not for Voluntary Assessments Subsurface Sewage Disposal System F om Inspection results must be submitted on thh I form or on the official Title 5 InspecHon form dated t3 IM000.inspection forms ma not be aftei ed Iq anyway, A. CoMficatlon when anr. Co PY %ma on Convuter,� 1. P_:,Z3"�lnfon�nation: /// .only the tab key rropegLy Adam to Rim aasar-dounot �""") 2 e use the ratum DMIR Name key. 0 w 0e1—A ✓J U 91 Own s Addi^ess . Citylrorom slam coda ,.. Date of Inspection: ' No J� Mete 2 Ins r. �\ Nem aF Ifiznpc t", K� Cornpany N��i com — (7 Aln City"C" ! State z>p Mode T Ow ne tVumber - Certification Statement I Certify fhat I have Personally Inspected the sm rawi disposal system at this address and that the lnforma II rdported below Is true.accurate am complete as of the time of the inspection.The inspection was performed based on my flaming and exPer enoa in the proper hmcdon and maintenance of on site sewage disposal syst6ms.I am a DEp approvi id w1rstem Inspector pursntant to Section 15.3g4 of Me 5(310 CMR 15.000).The sysferrc asses 0 Con 9k,wily uses D Falls Evaluation by the Local moving Authority �nspecwee stgnetura. vate The system inspector shag submit a copy o thbi inspection report to the Approving Authority(Board of Health or DEp)within 30 days of Comp ng Ihls inspection.If the has a design flow of•10,000 gpd or greater, m a shared system or report to the appropriate Inspector and the system owner shall submit the regional office of a DID.The original should be sent to the system owner and copies sent ib the twyer, d aAPligble. d lihe approving authority,, "'*This report only describes conditions at a lthne of inspection and under the conditions of use at that'tim%This Inspection does not ad is how the system will perform in the future under the same or difrerent conditions of use. I.%nsp.doc-11now Mid:i 09klW bupecyon Fonm Subsurface,S,w maq DtsPoBat gym Page 1 of.1s (At. I � Nov 10 08 08:35p BILL HARVEY 239-643-04 p.2 Comrnonwea#th of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System I-onn A. Certification (cont) . S I Oj P44 5 0 Owners alarms "- Does of Inspecoon Inspection Summary:Check A,B,C,D or E t aftays coniplete all of Section D A) System Passes: �16 not found any Information wtd IndlcaLes that arty of the failure cttterta descn'bed in 310 CMR 15.303 or in 310 CMR 15. exist Any failure criteria not evaluated are Indicated bekmw. Commenrts: B) System Condi1Jonally Passes: One or more system components as-d bed in the Tondt�onal Pass"section need to be aced or repaired.The system,u completion of the replacement or repair,as approved by the rd of Health.will pass. Answer yes. or not deterrnined(Y,N.N )In the❑for the folknMing statements.if Imt determined;pie explaln. ❑ The septic tank Is and over old'or the septic tank(whether metal or not)Is struchma(ly unsound, Its substanti la itration or exfiltration or tank Mflure Is k;runlnenL System wilt pass inspection axis g t link Is replaced with a complying septic tank as approved by the Board of Heal . 'A metal septic tank will pass inspectic n Is struchlrally sound,not leaidng and If a Certificate Of Compliance'indicating that fhe tank i Isms pews old Is avallable. ND Explain: !'Q L%rmp_doa•iIrA )q rile 5 OfiWW Irrspecom Fome:Subsurface sewage Dbpaw sysim• Pepe 2 of le NOV 1U Ub Ub:;MjP MILL HARVEY 239-643-04 p.3 ComrnoMNeafth of Massachusetts Title 5 Official Ins ec:rtion Form for Voltm Assessments Not tart' Subsurface Sewage Disposal System IF rt111 A. Cer iffcati n (cont) P Addrsj�N ivy s� Zipr4de P4 e2 �vv F owwa Name Data of IrsPecUbn B)'System Conditionally Passes(cont) ❑ Obsery on of sewage backup or brew out-or high static water level In the distribution box due to broken obstructed pipes)or due a titoken„settled or uneven distribution box.System will pass Ins ff(with approval of Boe oi'Health): ❑ broken pf s)are replaced ❑ obstruvcUon�re ed /�❑ distribution fs level re laot1d NO Explain: ❑ The system required pure ' more tha n 4111rmes a year due to broken or obsbWed pipe(s)_The system will pass inspesffon appr Dval of the Board of Health): ❑ broken pipe(s)are repia ❑ obstruction is removed. NO Explain: C) Further Evaluation is Required Ay Ekiard of Health: ❑ Conditions exist which require further a Von by the Board of Health in order to determine if the system is failing to probe%:!public h tth„ or the environment. 1. System will pass unless Board of Health date nes In accordance with 310 CMR 15.303(1)(b)that the system Is not r aiming in a or which wM proted public health, safety and the emriromnent: 0 Cesspool or privy is within 50 of a surface water ❑ Cesspool or privy Is within 50 feet ail a bordering vegetated wetland or a sah marsh tshv.doc•1112M Title 5 Cf xW Mspec9m Form:Submith oe Sewape Disposal System- Pme 3 or 16 IVOV -IU U0 U0:JUP BILL tVAMVtT Lay-bc -U4 PA Commonwealth of Massachusetts Title 5 Official. lnsp colion Form Not for Voluntary Assessments Subsurface Sewage Disposal System Fc orm A. Certification nt.) °vr" S•S 2�1 f� state�y y� v� .�code ts n"In ,i Ownera Name Date of Indm C) Further Evaluation IIis Required by t1w Board of health(cunt:): 2. System 0 fail unless the Board Mitaith(and Public Water Supplier,if any). determines the system is fu ins11 in a manner that protects the public health. safety and en nmw*. ❑ The system a septic tank a sail absorption system(SAS)and the SAS Is within 100 feet of a Ce water sup y or in'btttary to a surface water supply. ❑ The system has a se tank d SAS and the SAS Is within a Zonal of a public water supply. ❑ The system has a septic tank \an SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank dSAS is less than 100 feet but 50 feet or more from a private water hr Method used to determine cti: '*This system passes if the well water ysis,performed at a DEP certified laboratory,for collform bacteria and volatile organic cOmpimnds Indicates that the well is free from pollution from that facility and the presence of ammo h nVoyen and nitrate nitrogen is equal to or less than 5 mxn, provided that no other failure air cage triggered.A copy of the analysis must be attached to this foam. 3. Other t51rup doc-•1 VAM T lil 5 O►l W Inspeatbn Form Subswf m SwmVe Disposal Spd m Page 4 of 16 Nov 1U Uri Ud:Mp BILL MAKVtT p.o Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certiftcation (cont Pmperty Addre!! C/ NJO C11"Tn-0-)N � S S en e -L _ suft/y klo? Owners Nome Dery of 1rgx 5M D)System Faiiure Criteria Applicable to All Systems: You muml indicate*`Yes"or"No"to each*[the following for all inspectlow: Yes No ❑ Backup of ewra sge Udllty or system component due to overloaded or dogged SAS or ❑ a or po Discharge nds of'e luentto the surface of the ground or surface waters due to an or c ol logged SAS or cesspo Elid lev Static liquid el In a d'strfbution box above outlet invert due to an overloaded or dogged SAS or a ooi Liquid depth in assi OWS less than W below invert or available volume is less than%day flow ❑ rd, Required pumping rr ore*ban 4 times in the last year NOTdue to wed or 4� obstructed pipe(s).A urriter of times pumped: ❑ Any portion of the ,cesspool or privy is below high ground water elevation. ❑ Any portion of cess ar privy is within 100 feet of a surface water supply or tributary to a surface walm supply. ❑ Any portion of a cew pool or privy is within a Zone 1 of a public well. Any portion of a 'I or privy is whin 50 feet orf a pmrate water supply ❑ 1 Any portion of a cew pool or prIW Is less than 100 feet but greater than 50 feet from a private water ily well with no ac ceptebie water quality analysis.[This system passes If th a i Al water analysts,performed at a DEP certMed laboratory,for coilf bacteria and volatlle organic compounds Indicates that the 0 ill free from pOilutlOn from that facility and the presence of ammo to niibrogen and nitrate nitrogen i s equal to or less tan h 5 ppin4 t1i.at no other falilure crtt da are triggered.A copy of Um analysis must attached to this form.] Yes No ❑ The system fails.)t eve determined that one or more of the above failure criteria exist as dOW b&l in 310.CMR 15.303,therefore the system fails.The system Owner should contact the Board of Health to determine what voll be necessary to correct he failure. lSinsp.dac-i112004 TWO,5 OMcW inspecOm Forth Subsurface S e+wage Dicposel syslecn Page 5 of 16 IVOV lU U0 U0:J/P MLL rIHKVCT 23.9-643-04 P 6 Gpmmonweanh of Massachusetts .Title 5 official Ins e!!ction Form Not for Voluntary Assessments Subsurface Sewage Disposal System onn A. Certification (cunt) c 0wn s av coft O+Ws owe of Rspecft E) Large Systems: 'l' considered large system the system must serve a facility with a design flow of 10,000 9 to'i1000 For large systems,you must to e •'rr;s'or'nd to each of the following,to addition to the cueations in Secilon D. YES NO ❑ ❑ the system is in 100 feet of a surface drinking water supply ❑ ❑ the system is within feet of a bib' kin utary to a sur%w drinking water.supply ❑ ❑ the system is I In , n sensitive area (interim Wellhead Protection Area—MIPA)or a ppI one If of a public water supply well If you have answered"yes•to any questi in Secdo tie system Is considered a signillcant threat. or answered W in Section D above the largil system failed The owner or operator of any large system considered a significant ttueat unc er Section E or under Section D shall upgrade the system in accordance with 310 CMR 15.3)4.The system own should contact the appropriate regional offace of the Department. t5insp.doc•11 Title 5 DrkW hsPecGon Form Subsurraces swWavapmasystm. page 6 of is Nov 1U Utt Ud::31p BILL HAKVLY 239-643-04 p.7 "Mmunwearth of Massachusetts Title 5 Olficial Ins ectio-n Form Not for Voluntary Assessments Subsurface Sewage Disposal System -onm B. Checklist Props_rM Address,-- ,1Syw - ��h.�Y��1 �SS�-tee sstatez�e r� ' c«d Cl Name Dole of kupedon./ Check if the foilowing have been done.Yo j mast indicate°yes'or'ne as to each of the I'Mowing: YES N4 ❑ Pumping Information i vas provided by the owner,occupant,or Board of Health ❑ Were any of the syste rn components pumped out in the previous two weeks? Has the system receh ed normal flows in the previous two week period? ❑ Have large volumes waver 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 WA ❑ Was the faciiity or Ilin g Inspected for signs of sewage back up? ❑ Was the site InspectEm I for signs of break out? ❑ Were all system comp onents,excluding the SAS,located on site? ❑ Were the septic tank ani"Oles uncovered,opened,and the Interior of the tank Inspected for the conO ition of the baffles or tees,material of construction, dimensions,depth of I qutk;i,depth of sludge and depth of scum? ❑ Was the facility ovine (and occupants if Menent from owner)provided with Information on to pm Der maintenance of subsurface sewage disposal systems? The size and IMUOI I Of'the Soil Absorption System(SAS)on the site has been determined 01'r ❑ Existing Information.F or eikample,a plan at the Board of Health. �( ❑ Detemllned in the fie (if any of the failure kxfteria related to Part C is at issue approximation of dWta xm is unacceptable)P10 CMR 16.302(3)(b)j l5tn qAw•11/20D4 7itka 5 Olfidal kzpec k n Form:Subsurface Sewage Dts�&yslem Page 7 0l 16 I Nov 10 08 08:38p BILL HARVEY 239-643-04 p.8 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System F orni C. System l rmation T > 4 zocoda sage v ' 9 ownees Name Dale at kLvedw Residential Flbw Conditions: Number of bedrooms(design): Number of bedrooms(actual): , DESIGN flow based on 310 CMR 15203(or eKample:110 gpd x#f of bedrooms): )-- /Uo�� Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?' if pits separate inspection required) ❑ Yes No Laundry system inspected? [� Yes ❑ No Seasonal use? ❑ Yes [ No Water meter readings,if available(last 2 .1 usage(gpd)): Sump pump? ❑ Yes No I C-1.i n 50 Last date of occupancy: l� Comrnerclatlhtdostrial Flow Condition Type of Establishment Design flow(based on 310 CMR 15203): Gallon per day(sid) per Basis of design flow(seaWpersons/sq.ft.,eta,): Grease trap present? ❑ Yes ❑ No Industrial waste holding tarn present? A/ ❑ Yes ❑ No Non-sanitary waste discharged to ttte'Tttl 5 s:ptem? ❑ Yes ❑ No Water meter readings,if available: Last date of occupancy/use: Dais Other(describe): t5k=p.doe•I IMOD4 TV&5 OWd UopsGbn Soffm&uba nface Sewage ObpaW Syslam Page a of 15 Nov 10 08 08:38p BILL HARVEY 239-643-04 p.9 Commonwealth of Massachusetts .Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Fonrn. C. System Information (corn.) 6 slime Zip coda cvmees Marne Dale of Gen rat Information Pumping Record$: fA Source of Wormation: f V Was system pumped as part of the Insped ionril ❑ Yes)q No /Uv If yes,volume pumped: How was quanttly pumped determined? Reason for pumping: Type of System: Septic tank,distribution bc x,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ ivy ❑ Shared system(yes or no (if 3,es, attach previous inspeLton records,if any) ❑ innovative/AitemaWe technokgy.Attach a copy of the current operation and maintenance contract(to dYtained from system owner) ❑ Tight tank Attach a copy 4 xf this DEP approval. ❑ Other(descr be): Approximate age of all components e i fled(if known)and source of information: �, o l Were sewage odors detected when arrMn at the site? ❑ Yes No Mhlsp.doc•I IrAN Tito S 015dat Inspection Form:Subsurface Sewage Disposal System Pape 9 d 16 IVOV 'IU Uo U?3::itSp BILL tIAKVLY Ley-ti4:S-U4 p.1U Gommonwealm tat Massachusetts Title 5 Official. Inspection. Form Not for Voluntary Assessments Subsurface Sewage Disposal System I oml C. System Information (cunt.) en el. CitylT nn srataA)a 0 �Zoz rp Code owners Dalle a►nspectr«, Building Sewer(locate on site plan): Depth below grade: (14 feet Material of construction: Q cast iron ❑40 PVC er(explain): Distance from private water supply well or on e: feet Comments(on condition of joints,venting, dlenc ,of 1 1@ge,etc.}: Septic Tank(locate on site plan): G� Depth below grade: testr�^ Material of construction: ncrete ❑metal fiberglass ❑polyethylene D other(e)plain) If tank Is metal,list age: ywrs Is age confirmed by a Certificate of Compi amix.?(attach a copy of 0 Yes 0 No certificate) Dimensions: z�oo Dimens Sludge depth: 3 Distance from top of sludge to bottom of a Met tee or baffle ` 16' Scum thickness �( 1 Distance from top of scum to top of outlet c,r bathe 3 Distance from bottom of scum to bottom o•outlet tee or baMe `"d How were dimensions determined? Z� t5trt�.doc•11/2004 TW11 S Official Inspectim form:Subsurface Sewage Disposal System Page 10 of 16 Nov 10 08 08:39p BILL HARVEY 239-643-04 p.11 Commonwea of Massachusetts lth Title 5 Official Ins ection Form Not for Voluntary Assessments Subsurface Sewage Disposal System orrn C. sitem infer a i (cons) dcc& � yg State��v /off goner's Name Date of inspection Comments(on pumping recommendati .Inbid and outlet tee or baffle condition.structural Integrity. Uquid levels as related to outlet invert, encii of leakage.etc-): Grease Trap(locate on site plan): Depth below grade: Material of construction: ❑concrete D metal ❑iberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scan to top of outlet or baffle Distance from bottom of scum to bottom ouiflet tee or baffle Date of last pumping: Date Comments(on pumping recommendaft 9.Inlet and outlet tee or baffle condition,structural intDgM. liquid levels as related to outlet invert,e 'Jeom of leakage.etc. Tight or Holding Tank(tank must pu pe,J a or Inspection) Ncate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass polyethylene ❑other(explain): t5ir�sp�doc-1112004 7 da 5 oRidd rnspecGon Form:subsurface sewage Disposal System pogo 11 of 16 IVOV IV VO UO:')yp DILL r1F1r%VCT p.12 s ' Comrnoni wealth of Massachusetts Title. 5 Official Ins (,bIction Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cons) Cr/V 12 7 P7 .n'" /o") owners Name Date at mspectfon Tight or Holding Tar*(cont) Dimenslons: Capacity: Design Flow. 90ow pwday Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes❑ No Date of last pimping: p� Comments(condition of alarm and float S NW'ms,etc. Distribution Box(if present must be ope riad:j (locate on s' ,;plan): Depth of Liquid level above outlet invert Comments(note if box Is level and distnb .i to outlets equal,arty evidence of solids carryover,any evidence of leakage Into or out of box,a ): v t Pump Chamber(locate on site plan): Pumps in worldng order. ' ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No *U-Isp.doc•11/2004 'Elite 5 Of1dal Inspec9m Farm Sub8wf9oe Sewgp Disposal System• Page 12 of 15 Nov 1u Ud WA4Up BILL HAKvtY 239-643-04 p.13 Commonwealth of Massachusetts Title 5 Official Ins eiction Form Not for Voluntary Assessments Subsurface Sewage Disposal System on-n C. System Inf rmation (cunt.) k7- prop r1y Address CWT State�UrJ Zip Cade Owner's Name Dale of Inspectlon Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, ex ain wh Type: ❑ leaching pits number: ❑ leaching chambers number. leaching galleries number. ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/alternative Systc m Typefname of technology. Comments(note condition of soil, signs o hycftulic failure,level of ponding, damp soil,condition of vegetation, etc.): l5insp.doc•1112004 Tilie 5 Official inspedon Form:Subsurface Sewage Disposal System Pape 13 of 16 Nov 1U Ud UdAUp BILL HAKVLY Z3J-b43-U4 p.14 Commonwealth of Massachusetts Title 5 Official Ins 06tion Farm Not for Voluntary Assessments Subsurface Sewage Disposal System orim C. System Information (cons) prop►addrss ow 1�10 C( �r1' d, 2� � c ZIP Cade Owner's N me Dab of hwpecOm Cesspools(cesspool must be pumped ass par,of inspection)(locate on site plan): Number and configuration Depth—top of liquid to ini avert Depth of solids layer Depth of scum layer 4 Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil;signs of hydiaufic faflure,level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of soiids Comments(note condition of soil,signs of hydtiaulic failure I of ponding,condition of vegetation, etc.): 15hwp.doa•11MM Td4 5 Oflidal Mspection Farm:Sub Sewage Disposal System Pa"14 or 16 r Nov 10 08 08:40p , BILL HARVEY 239-W-04 p•15 Commonwealth of Massachusetts Title 5 Official ins p e►ction Form• Not for Voluntary Assessments Subsurface Sewage Disposal System onn C. System 1 orrnation (cons) zip codo ownees Name Data of wvedw Sketch Of Sewage Disposal System:Prov de a sketch of the sewage disposal systern lnduding ties to at least two permanent reference land ujui or benchmarks.locate all wells within 100 feet. Locate where public water supply enters the bi,sifding. 10 07 3 W III 15nsp.dx•,1/2004 _g y S'rl Tde 5 otif W lmpecWn Fwn Subsurface Sewwo Disposal System- +,/� P8e 15 of 16 Nov 10 08 08:41p BILL HARVEY 239-643-04 p•1n Commonwealth of Massachusetts Title 5 Official Ins ElCtion Farm Not for Voluntary Assessments '= Subsurface Sewage Disposal System Wn C. System Information (cont.) ,,3 qy 12fi1 Property Address / q ,s„7 P / / t'/'�l ( v .)( / Clly[T,pyvn State Zip Code Owner's Name Date of Insped n Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water. Please indicate all methods used to deterrT ine :he high ground water elevation: [ / Obtained from system design lam;on record If checked date of design la revl awed: g p Date Observed site(abutting props yloUservation hole within 150 feet of SAS) Checked wilbHocal Board of H i-explain: Checked with local excavators Installers-(attach documentation) Accessed USGS database-e plaint: You must describe how you established the high ground water elevation: IF C4 OU't/o 1 '1 t5insp.doc• 1112004 ltle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 6137 —) C) (003-40 d��e . / awe - a��l• (It V\, Att 1,2 "\ _ N� �� 5" LIE r b V X o• '1 m r � j ( ��jj N A b 4'-0"x 3'-0' 2'-8"x 6'-8" 2'-0"x 2'-0" 2'-0"x 2'-0" t j 10'-B" :�-3'-10" 8'-fi' 4'-8*- �• N % O1 a X � - i ✓"'���� " x 6'-8°.k-4'4'— —5'.6" Z" 26'x 6'- k---�5� i -t6-5' N � I 4'-0'- -5'-11 '1' r 2'-1"x 6'-8" IF N h L T i L J — -8•_ .—a-.. 10'-8" r-3-f0 ., 8'-6° AI 4'-8"� 1,- � ,�2'4'4 _ of Q x N Oi % m a � 4J/1 ,IZV v� 67 DATE :_5/11 /98 _ PROPERTY ADDRESS: 344____ui_-Road-------- Marstons Mills,Mass ------------------------ 02648 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 1 -1000B � gallon precast leaching pit packed in stone. /� ' 4 . 2-6 x8 block c,ess o 1s. / ased on my Insppec?lon, I certify the following conditions: 5 . This is a title five septic system. ( 78 Code ) 6 . The septic system is 'in proper working order at the present time. S I G N AT U R Name ; J .- -Macomber-Jr . Macomber-Jr . --- -- ------- ------- Company ;JosQRh _P,_ M�icom Son, Inc . V Address ;--BQx-��------------ � 'f v_iUP,-ba-_Q,Z_632-0066 eq r 2 P h � 5 --_ 3338 -_-____- 01, THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. N1A 02108 617-292.5500 WILL1.4N1 F WELD TRUDY CUNT Govcmor Sc;rcw� ARGEO PAUL CELLUCCI DA\1D B STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionc: PART A CERTIFICATION Robert Parker Property Address: 344 Cotuit Road Marstons MillsAddress of Owner: 140 River Road Date of Inspection5/11 /98 (If different) Marstons Mills,Mass. Name of Inspector: ber Jr 02648 1 am a DEP approv system inspector pursuant fo Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.MacoMber & Ron Tnr Mailing Address: Box 66 r entervi 1 1 o,Mass 02632 Telephone Number: 598 7-75 3338 CERTIFICATION STATEMENT ' I cenify that I have personally inspected the sewage disposal system at this address and that the information reposed below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper funciion and maintenance of on-site /seewage disposal systems. The system: i� Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: / Date: The System Inspector all submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C,mR 15.303 Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: 12 4) 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. Indicate yes, , or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not AO The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cenificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltrauon, or tank failure is imminent: The system will pass inspection if the existing septic tank is replaced with a conforming septic tanK as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 OEP on the World Wide Web: hhp:/Avww.ma9nel.state ma uvoep Printed on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 1`02.1,1 PART A CERTIFICATION (continued) ?,open, Aooress: 344 Cotuit Road Marstons Mills,Mass. O.ner Robert Parker D.te 01 ln,pcetion:5/11 /98 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is duz pipets) or due to a broken• sealed or uneven distribution box. The system will pass lnsxclio Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstrucsed o :e s 'e +•, e' rnspecl.on if (with approval of'the Board of Health) broken pipe(s) are replaced obstruction is removed 0 FURTHER E-VALUATION IS REQUIRED BY THE BOARD Of HEALTH: Cono,00ns exist which require funher evaluation by the Board of Health in order to deterni-nr .i �,ohc health. wiery and the environment s) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCT O,,I C WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ,) Na Cesspool or pA1ry is within 50 feet of a surface water a Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt maim 2) SYSTEM WILL FAIL UNLESS THE BOARD Of HEALTH (AND PUBLIC WATER SUPPLIER, If APPROPR AT: ^; ;• THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAF;'1 AN D ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 `rc tributary to a surface water supply. NfJ The system has a septic tank and soil absorption system and the SAS is within a Zone i o; ; :.� .; • _.. .__. The system has a septic tank and soil absorption system and the SAS is o rlh,n 50 ire: Oi a .- The system has a septic tank and soil absorption system and the SAS is less than 100 tee! private water supply well. unless a well water analysis for colrform bacseria and volx,le or3; c. the well is Iree from pollution from that facility and the presence of ammonia nitrogen anc ; e r. _5 less than 5 ppm Method used to determine distance 47 O% (approximation not va 7) OTHER IJ4 N��// � t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 344 Cotuit Road Marstons Mi11s,Mass. Owner: Robert Parker Date of Inspection:5/1 1 /98 D] SYSTEM FAILS: You must indicate eir.er "Yes" or "No" as to each of the following: Alt) I have determined that the system violates one or more of the following failure criteria as defined in 310 Ch1R 15.303. The bans for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes �o / Backup of sewage into facility or system component due to an 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. ZStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 0 . Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. -4-11 Any portion of a cesspool or privy is within a Zone I of a public well. Y Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: •10 The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 oa the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 0 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 344 Route 149 Marstons Mills,Mass. Owner: Robert Parker Date of Inspection: 5/1 1 /9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No �/ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, �celuding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. — The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 1 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 344 Cotuit Road Marstons Mills,Mass. Owner: Robert Parker Date of Inspection: 5/11 /98 FLOW CONDITIONS RESIDENTIAL: Design flow. g.p.d./bedroom for S.A.S. ~umber of bedrooms: Number of current residents4jNe Carbage gander (yes or no). VO Laundry connected to system (yes or no), � Seasonal use (yes or no).-d—z:) V-ater meter readings, if a�v�ai able (last two (2) year usage (gpd): I�9�(rs ' "�lJ� b�/)� J�Js•;lwr,,/af�>s /���. Svmp Pump (yes or no): �vir `���% �j'�800 C�i9f.KfllC� l5lo.�fo C7.T�llr :ast date of occupancy 6-0 1F COMMERCIAUINDUSTRIAL• Type of establishment: 104 Design flow:,_gallons/day Crease trap present. (yes or no)" industrial Waste Holding Tank present: (yes or no)A-* -,on-sanitary waste discharged to the Tale 5 system: (yes or no)&4 Water meter readings, if available. 4W N.4 last date of occupancy:—A14— OTHER: ;Describe) Last date or occupancy:�f� GEN'ERAL INFORMATION PUMPING RECQR�d sou of infpr ;. System pumped as pan of inspection: (yes or no)_ li yes, volume pumped: A[#gallons Reason for pumping TYPE OF TEM 4 0 Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool& VAV Privy _Alb Shared system (yes or no) (if yes, anach previous inspection records, if any) I/A Technology etc. Copy of up to date contract Other �(f APP OXIMATE AGE of all components, date installed (if known) and source of information: tJsfr_vyl /B� yPJ $ c�s1- t� i1v lrS� T Sewage odors detected when arriving at the site: (yes or no) tr.vl..a o.ilsis�) rage 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert, Address: 344 Cotuit Road Marstons Mills,Mass. O»ner: Robert Parker Date of Inspection: 5/1 1 /98 BUILDING SEWER: :ocate on site plan) Depth below grade. 6`r material of cons(ruc son: cast iron L140 PVC _ other (explain) Distance (forprivaie water supply well or suction line d� Diameter Y Comments: (condition of joints v Wring, evidence of leakage, etc.) _ S Gjq SEPTIC TANK: Q ilocate on site plan) '/V Depth below grade - material of construction: Zoncrete _metal _Fiberglass _Polyethylene _other(explain) .. Lank is metal, list age &d is age confirmed by Certificate of ComplianceA4 (Yes/No) D,mens,ons Yx, W 10 ?,��(/W Sluage oepth ' a If D,stance from top of sludge to bonom of outlet tee or baffler Scum lhlckness D,stance from top of scum to top of outlet tee'or baffle: Distance from bonom of scum to bonom of outlet tee or bafile: 7T^tl'c now dimens,ons were determined. Comments trecommendancin for pumping, concliticin of inlet and outlet tees or baffles, depth of liquid level in relation to outlet Inver, sttuctural miegriry, evidence of leakage, et .) �-5 T;` ' T .i° A;A14Ce h i�9 U GREASE TRAP:-.(Je--, uocate on site plan) Depth below grade Ahop %,tatenal of construct son N.,`9concrete4fAmeta1449 Fiberglass,e?&Polyethylene4Aoiher(explain) AA Dimensions. /V'V Scum thickness.& Distance from top of scum to top of outlet tee or baffle: -VA Distance from bonom of scum to bosom of outlet tee or baffle: Date of last pumping: A2d Comments: trecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, structura, .ntegrlry, evidence of leakage, etc.) vrN_�4.�P__ (r.vijs.d 04/25/97) P696 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 344 Cotuit Road Marstons Mills,Mass . Owner: Robert Parker Date of Inspection: 5/1 1 /98 TIGHT OR HOLDING TANK:MNiVank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: V4 Material of construction:V.4 concrete,,I i4 metaWf FiberglassWAPol�,ethylene.(w other(explain) A114 Dimensions: AZA Capacity: V4 gallons Design ilow: NA gallons/day Alarm level: ON Alarm in working ordeAL Yes; No Date of previous pumping: -V14— Comments. (condition of inlet tee, condition of alarm and float switches, etc.) 1� r IIIr o..IAI�; / s "I D 7, DISTRIBUTION BOX:Z (locate on site plan) Depth of liquid level above outlet invert: Ale _ Comments: (not.., if Lev I and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) .�1 dr PUMP CHA&iBER:_4j,4,Ve. (locate on site plan) Pumps in working order: (Yes or Not Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) u� C (revised 04/25/97) Pnge 7 of 10 i SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORm PART C SYSTEM INFORMATION (continued) Properly Address: 344 Cotuit Road Marstons Mills,Mass. owner: Robert Parker Date of inspection:5/11 /98 ) ,�y � 501L A850RPT10N SYSTEM (SAS):Z ©2 Gtp� CX>T Y`r' IOWX Ar h46e-k &lJtd)_-x— ;locale on site plan, If possible: excavation not required, but may be approximated by non-intrusive memods) 1f not determined to be present, explain: Type leaching pits, number: leaching chambers, number: leaching galleries, number:_ leaching trenches, number,length:— � -- leaching fields, number, dimensions. CJ overflow cesspool, number. Alternative system: 1 Name of Technology: a &')e Comments thole c nodoon of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) r'i4� CESSPOOLS: uocate on site plan) Number and configuration: EL Depth-top of liquid l0 inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of Conslruclion: indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments tnote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: djAve_ ;locate on site plan) Materials of construction: �/� Dimens,o�i 'Depth of solids 10 _ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, et: ) Ir•�:••d 0�/75/97) ➢•g• 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Robert Parker Owner: 344 Coutuit Road Marstons Mi11s,Mass . Date of Inspection: 5/1 1 /9 H SKETCH OF SEWAGE DISPOSAL SYSTEM: 1nciude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locvrl Ore pyt�i5 at r� su ply Comets into house) t - C,t v (revised 04/25/97) Page 9 of 10 w SUBSURFACE SEIYAGE DISP. SYSTEM INSPECTION FORM C SYSTEM INFOI. !ON (continued) Property Address: 344 Cotuit Road Marstons Mills,Mass. Owner: Robert Parker Date of Inspection:5/11 9 8 Depth to Groundwater' E� Feet Please indicate all the methods used to determine High Groundwat¢y E-le,ation: Obtained from Design Plans on record/ P Observation of Site (Abutting property, bservation hole, baseiyuni•s imp etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records // Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwa-terElevation. (Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 (revia.d 04/25/97) Pac. IL"�f 10 •ternr"T-ntTttT-.r—irnrmr•nmru-nn arnrrr.rr.•n+:.vtrr�+►rsrnn•t rsrrs�nt+'m�.�cr.m'+ .. 1 SO TOWN OF Barnstable BOARU OF HEALTH1 SUIISUIIFACF SEWAGE DISPOSAL SYSTEM I NSfECTION FORM - PART D •- CERTIFICATION II �•••T!'l�T•'. ::t—T.tII�.TTTbT•.1t1'R.YTt TTr.4Stl ift'TTT•t'I"{VTT�7rR1irTTRR'Vi� T1 RTIt It•ini!'Tr."ti��T�TT.••��T'TT�..�..A -TYPI OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRESS 344 Route 149 Marstons Mills Mass. ASSESSORS MAP , BLOCK AND PARCEL 0 T S O 3 OWNER' s NAME Robert -Parker PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Setrf 'INc" COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or CSty State LIP COMPANY TELEPHONE ( 508 1 775 - 3338 FAX (508 1 790 - 1578 R , CERTIFICATION STATEMENT A I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : Sys teoi PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLll or the environment as defined in 310 CMR 16 . 303 . Any failLire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con tcted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , AInspector Signatur �` Date 5/1'1 /98 i T��••��'STj7 -— One copy of tilis rt.ification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEAL'111. * If the inspection FAILED, th-e owner or" perator shall u within one year of the date of the inspection, unless allowed dortrequiredm otherwise as provided in 3.10 CHR 16 . 305 . partd .doc ,<� V 1 7 z S .1 S THE COMMONWEALTH OF MA SSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby Y authorized to use the title CERTIFIED TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. J une R. 1995 Acting Dircctor of tlu L) ion ul Water Pulluti0n Control TOWN OF BARNSTABLE LOCATION y �1G1/ 14 �/7T SEWAGE # VILLAGE Zy og, ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. ,f SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �f ��! (size) NO. OF BEDROOMS BUILDER OR OWNER 7 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 f�an yFeet Furnished bf b ���'. CP TOWN OF BARNSTABLE LOCATION -3�� Co/�„ � SEWAGE # - ��7, i VILLAGE �y�/�y s /��i��t ASSESSOR'S MAP Cz LOT®76'®3/ INSTALLER'S NAME & PHONE NO. J1�� SEPTIC TANK CAPACITY ®®0 qv r, LEACHING FACILITY:(type) (size) NO. OF BEDROOMS_3PRIVATE WELL OR PUBLIC WATER ,, BUILDER OR OWNER e,h a ti ow." DATE PERMIT ISSUED: DATE .C01IPLIANCE ISSUED: VARIANCE GRANTED: Yes No Al, \ \ r� a I +� ASSESSORS NEAP NO: PARCEL NO.: N .......Q >Fiz'.... .... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....---...7,0-141.N.. ......._0F......9,j.th �-' XVIAirFation for Uiiipootal 10orkii Cnomutt min Prrutit Application is hereby made for a Permit to Construct ( ' ) or Repair ( ) an Individual Sewage Disposal System at: ............................... ..�..----------------------------....---•----------- Locati Ad ess / or No. ---T��" oc1�afr�!- ¢ o� JU� Ow er a ---------------------•----- �!'-- ... /!�......................... `�D �� a.......�! _dt�'a n s o Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......-�..............................:Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of ersons............................ Showers YP g -------------•-•------------ P ( ) — Cafeteria ( ) 04 Other fixtures ------ ----------------------------------------•------------------------•----------------------------------------------------------------••--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................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.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_-______--_-_____-_. (Z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M ----•------------------------------------------------------------------------------------------•---•........................................................ 0 Description of Soil........................................................................................................................................................................ U --•-------------------------------------------------------------------------•--••---------•...---------.......------------•----•------------------------------------•---•--•-------------------------- VW ---------------------------------------------------------------------------------------------------------------•- --- --- ---------------------------- Nature of Repairs or Alterations—Answer whyapplicable-___�`�5. ._/O�® s .. f �?_!4__9`................ ............................................. L?VV..-ire---f e—tr ---------...------------...---------------------------------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTii; p of the State Sanitary C e— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has s bee is ied,$y the board of health. Date Application Approved BY j Date Application Disapproved for the following reasons:-----•-•-----------------------•----•-------•-------•-----------•---------------------------•---------••-•------ ...-•-------------------------------------•--•----------.....----•---•---••-------......._.........------------------------•----------------------------------------------------------------••-••---•--- -- -n. Date Permit No.-�.fit- � ----..... IssuecL..........................•------•--------------•----- Date f ` No....n...../.r1 '—I .. ............ THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ------. - ................OF...... � Appliration for Uhip oal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........................^...,............---------•---- ---•------•------ ^-----..... Locat -Ad�lrzss or Lot i�o. �•�• { Owner Address W t�U litrr��r r5`�-L✓=/`' �! S? �! /S., a ........ .:... ....••--------•------•-.......------ Installer Address d Type of Building _ Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........3..................... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers Ga YP g -------------•-•------------ P ( ) — Cafeteria ( ) a � Other fixtures ...................-.................................................................................................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width...._............... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...................... Diameter................_--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ----•--------------•--------------------•--•--•-------•---.......-•-------.......---•-•......-•-•--•......................................................... 0 Description of Soil........................................................................................................................................................................ W -----------•-------------------................................_.............................................................................................---•-•-•••:-............................. U Nature of Repairs or Alterations—Answer when applicable.__/'�3 f '.__....�p.... se,�' .. t �."� `" 4 ................................. Agreement The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of J ITt. l: j of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued,4by the board of health. _ � f%/f` � '-' /e2_ "ter Signed---••--------•...:......................•-------`�--•- ---...----------- Date j ApplicationApproved BY.................................................................................................. ...............f---- --�-4............ Date Application Disapproved for the following reasons--------------------------------------------------------•--------------------•---------------------------------- --•-------•--•••••---••......................•---••---•-•-----••-------••--------•-----•--•--•-•------••..-----•----•----------•-------•--••--•---•-------•-----•-•-----•--•----------•--•----....•-•--- Date Permit No...----------=- .----•L ~~ .............. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................::..�"'� . = _ , 1 ---.................OF......................... .L... 4�.... .................................... Tntifiratr of f ompliancr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------------------------- ------...........--•---......--•---•-•-----••---••--•-- •••---......-•---•......-•----•-----•---.._............---•-----.............-•--•----•--•--•--. Installer --••-••...............••---•-----••-----------•--•••••-----•--------•--•-•......••. ••-•-- has been installed in accordance with the provisions of T I IE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.................................. ... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....------. ------------------------------------------ Inspector ...........-•-••---------•---•••-•-------•--------•......--•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........1 OF...............::" n ..!: \r0........... ....... FEE:...... .......... Disposal Endo %Tnnstrnr#ilan rrntit Permissionis hereby granted------. ............................................... .'....--------...----•-----•-------------•--...----------.....•••..............•• to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at - •1 r t � Street as shown on the application for Disposal Works Construction Permit No...=._.......!... Dated................ ....:........................ J Board of Health DATE.---••--•-------•-••---•---•-•-......r.._....................................• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Old Fslntount Rd 2-1e' DIAM. ACCESS MANHOLES • .� `� ,,.ti:r. w 4, '•,- ••:.I� f14•G1: •-'.•iL.�:i�.i_ / �\ �1.� ice• 'y 10' min. from 'NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. / �4} ` SECTION A -A INLET ) v, M Existing Foundation house to Be tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM - - ou T f �•q lCve„L" 344��� III Septic tank oovers must be D-e0X cover mwt be ( TOP OF FOUNDATION ELEV. 100.00 (Assumed) within B In. of flnhOwd rode �� I( !' � within a In. of finished grade q THE ACCESS COVERS FOR THE SEPTIC TANK, / Grade over Septic Tank - 96.00Grade over D-Box - e0.00 over SAS - e0.00 3' of 1/8' - 1/2' Watched Peaaton - r DISTRIBUTION BOX AND LEACHING COMPONENT '� ! 3/4' to 1 1/2 ' Washed Crushed Stone •�' !:^ ''� ^; -'r•'^+^'*T ;,•,^ SET DEEPER THAN B INCHES BELOW FINISHED ,. I ► \ n Ln FINISHED GRGRADE RAADEE. RAISED TO WITHIN e' OF ! �.- 5 - 0.02 _ 4' PVC(CAPPED) INSPECTION PORT TO BE STEEL REINFORCED PRECAST CONCRETE 3 MST. BOX 3' Maximum Coves I /� \/ ti ° c•n re h.�V INSTALLED AND 10 BE MTIiN 6' OF OR PLAN VIEW INSTALL TUF-TTE OAS BAFFLES OR EQUALS p 2S' EXIST. 5.0.01 or Greater Top OF System- EI«. "67.7s 160•m xtc�T,PIPE o v1 1,000 GAL S- i 3-24' REMOVABLE COVERS FRDN EXIST. FOUNDATION Ln N 30' 0.01' par foot r EMecth• Depth rn + SEPTIC TANK g � � � �eoo� �►�v M��� r s2 zev6 amd os:Njs ti It rn n 8' CONCRETE FULL Foul V N H-10 II N ri In S : •.^•i.. 4' , p o.e3' (10 inches) min. clearance GENERAL NOTES _ 6 1 8 _ t 6 mlm.- 2' min. Inlet to outlet ttfua SYSTEM PROFILE a ti.°' 3 `'-1 + 2 1 ,. INLET j-_- r mm./ / er, �� , L Tw.r- auTLET 1. Contractor is responsible for Digsafe notification comp«ted stone o °D , ,•' and protection of all underground utilities and pipes. Not to Scale c � 1 _ FT r > 3.5' I� 3.5' N active Len s' -7' S 2. The septic"tank o distrl L>Jion box shall be set 1 level on 6 of 3/4"-1 1/2 stone. 3' SOIL A SYSTEM (SAS) ..*no r I• ua,IDd a.pih 3. Backfill should be clean sand or gravel with no > e.4z' e k,.of 3/4'-1 i/2' EFFectNe Vlldth TG Provided stones over 3" in size. compacted stone INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GE❑RGE ❑ BRIEN 5Z NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE c 4. This system is subject to inspection during installation o m (OR EQUIVALENT) .••,,; ,},. •: •• •.• - y by Carmen E. Shay - Environmental Services, Inc. Li Groundwater-Observed Bottomor T•.t Hole 1 D«.-7q.00 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10' e'-0. 4' -10' 5. The contractor shall install this system in accordance nd - -"-"-"-"tterved- NONE OBSERVED CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan and Local Regulations. 6. If, during installation the contractor encounters any TYPICAL 1000 GALLON SEPTIC TANK soil conditions or site conditions that are different NOT TO SCALE from those shown on the soil log or in our design installation must halt do immediate notification be made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components. 8. Install Tuf-Tito gas baffles or equals on all outlet tee ends. Date of Percolation Test: MAY 2, 2006 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees do fittings shall be 4" diameter Results Witnessed By. WAIVER (Per Barnstable B.O.H.) EXCAVATOR: Shay Env. Svcs. Schedule 40 NSF PVC pipes with water tight joints. Percolation Rate: Less Than 2 MPI O 30" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding Properties. Test Hole Test Hole No. 1 No. 2 DEPTH SOILS ELEV. DEPTH SOILS ELEV. 0 92.00 1 0 90.00 NOTEi THE PROPERTY LINES ARE APPROXIMATE AND Sandy Loam I Sandy Loam COMPILED FROM THE PLAN BY NELSON BEARSE AND RICHARD LAW, RLS to YR 3/2 10 YR 3/2 ENTITLED "PLAN OF LAND IN MARSTONS MILLS, MA, " � 47 0'-6' Ae 91.50 ANDA IS JUNE NOT NTENDED9T0 BE A S PLAN �RVEY1 P PLOT PLAN PAGE 83 PROJECT BENCH MARK I sandy j °•-6. AND B9 50 ,N I Loamy IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. TOP OF FOUNDATION �' I ELEV. = 100.00 (Assumed) ,o YR 6/6 i to YR e/e \'r� 6'- 30"1 89 89.501 6'- 30'1 Be 87.50 V L Medium/Coarse Medium/Coarse I Sand Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 2.5 Y 7/4 2.e Y 7/4 FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED O O c' LOT #2 30"- 132 c, 30'- 132 c, OF AS PER BOARD OF HEALTH SPECIFICATIONS. o � O EXISTING LEACH PITS TO BE PUMPED DRY do FILLED IN PLACE 9�F i ASSESSORS MAP - 78 PARCEL - 031 ZONING - RESIDENTIAL 01-1 --- Pere �11 FLOOD ZONE C 9J 5� #344 p�j Depth to Perc: 32" to 50" 9�• t Pere Rate= 2 MPI �\ I LOT #3 4RBEDROOM TING i No Observed ESHWT1 Groundwater Not served THERE 31,B20 Square Fset +/- / ROUSE � OFTHE PROPERTY WETLANDS LOCATED WITHIN A 200' RADIUS 98 ADJUSTED H2O Elev. = Nona, N/F JOSEPH dN ALTA LAFARR M !THE ,2' aatlatETE �� LEGEND SET LEVEL.FOR AT LEAST 2 Pr. 1- \ ,.. .. 3- 6' OUTLET v .tie. ..... 2 KNOCKOUTS 8X0 DENOTES PROPOSED SPOT GRADE DENOTES EXISTING ---- / -�_ ____ �-- --__ �.'��/ SHED ��' +a6' +.76• X 104.46 SPOT GRADE -�_� ---_ ____-- PLAN SECTION CROSS-SECTION N/F DONALD MELIX _ - ---- PL PROPERTY LINE DRIVEWAY 3 HOLE DISTRIBUTION BOX - H--10 LOADING PROPOSED CONTOUR 96----- NOT TO SCALE ' EXIST. 1,000 GAV 97- - - - - -97 EXISTING CONTOUR SEPTIC TANK �4\ -�/� % �-1S �(( ,�•�� ���' DEEP TEST HOLE & \ Failed , Design Calculations �X �� I , PERCOLATION TEST LOCATION Leach Pit -,-' ___-----_ i � U SHED O 1 Failed _ ,�� Garbage GriNumber of Bdler:o Nos. 4 Equivalent to 440 Gal./Day V5� �, + tC•��° � � FENCE -' Leach Pit Chicken -�,' Leaching Capacity Proposed: 440 Gal./Day I l� JI --------- ------------- �- Coop Septic Tank : - 2 x 440 Gal./Day - 880 USE EX ST. 1.000 GAL. Septic Tank. 94------ ------- /SHED SOIL ABSORPTfION AREA: Using percolation rate of ;2 min./Inch p PRIVATE DRINKING WATER WELL Bottom Areea: 0.74 gal/sq. ft. x 500 sq. ft. - 370 gallons REVISIONS ----__� • _ Sldewall Artea. 0.74 g q ft. x a• s vid g gallons ------------------------------ _ llons Providing:g 443.70 ------------- TEST HOLE #1 '��. • • •_ • • • fh 1 "-------------- ------90 ►+ ELEV.- 92.00 D-Box f �, .�I '.� �7r ,:(,i• '�':�% �i' + Use: (7) INFILTRATOR HIGH CAPACITY H-20 UNITS HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, NO. DATE: DEFINITION 92 ---_ _ ___ ',`-- TO BE USED YMTH 3.5' OF WASHED STONE ON THE SIDES, AND 0 OF WASHED STONE --_____----- __ --- -__ TEST HOLE #2 ON THE ENDS. NO STONE UNDER. 90'� ------------------------------------------------ ELEV.= 90.00 ____ 88-------------- ----------------------------------------___ 84 ----------------- PROPOSED 82_____---------------------------- -- PREPARED EO R : SUBSURFACE SEWAGE DISPOSAL SYSTEM OF CID N/F GEORGE T. GIFFORD CIDMS. KIM E. MITCHELL #344 ROUTE 149 (. 0 /t41' _ P.O. BOX 572 r �� ` 5 MA Bath MARSTONS MILLS MA Bedroom Bath Kitchen + ,,,��^�Q'=-e• .�F PREPARED BY: 02648 ���=,�,of Bedroom �G / i CARMEN E. SHA Y Icy ,i ENVIRONML'NTAL SERVICES, INC. Bedroom /Dining I c� Living Room Bedroom P.O. BOX 627 0 20 40 50 F�'sTER� EAST FALMOUTH, MA 02536 S�N(TAR\P� TEL/FAX 508-539-7966 SCALE: 1 "=20' SCALE: 1 "=20' DRAWN BY: CES DATE: MAY 3, 2006 4 BR HOUSE FLOOR SCHEMATIC PROJECT#SD-912 FILENAME: SD912PP.DWG SHEET 1 OF 1