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HomeMy WebLinkAbout0026 SAMOSET ROAD - Health (xsb- 1 C b S e t �a a d 1 -N7ills F f FROM :down cape engineering inc FAX NO. :15083629880 Jan. 04 2006 02:04PM P2 9 i �G 7f, ry P00�2 Zo i DECK LOT 56 20,012t SA, FT. I-AS1. OWLLL. •. PAVED DRIVF. 1'- I 05--2.70 ............... _ --....�.. ._...._..__._.._ _ SEPTIC A S-B IIII T LOCATION ,fib' SA.M.OSET ROAD MARSTONS MILLS PREPARED FOR: SCALE : 1 "— .30' DATE : JANUARY 4, 2006 BORTOL0MITAMASH r,[..FFrNF.NCF : ASSESSORS .MAP 101 PCL f f7 ARNE H.err San-cyaz-.an, OJAL.A fax UOB 382 9880 4 N0. 6 8 - down cape engine ring, W, F IG/ � (� CI\/IL ENGINELRS Y LAND SLrR\/EYORS ----- �--- 919 Mulr'i 51, y0.r"MOUth, m0, DATE REG. L SI.JRVEYOR OM :down cape engineering inc FAX NO. :15083629880 Jan. 04 2006 02:04PM P2 yap SHED ti DECK 4 LOT 56 20,012--k SO, FT. k.451. WELL is ki PAVED DRIVE J%k 05-270 ............................... ......... SEP TIC A nT-' Ullj T LOCATION 26 SAMOSET ROAD MARSTONS MILLS PREPARED FOR: SCALE : 1 30' DATE : JANUARY 4, 2006 BORTOLOMITAMASW P\[-F'FPNFNCF ASSESSORS IVAP 101 PCL 117 \jv�OF Ajq A R N E H. off 800-1152-4541 OJALA fox 5013 362-9880 No. 6 8 down cape c»qin&&ring, Mr. CIVIL ENCANECRS LAND SuR\/EYOPS mulri st, yo.rmouth, ry)a DATE REG. L SURVEYOR FROM :down cape engineering inc FAX NO. :15083629880 Jan. 04 2006 02:04PM P1 µ' Town of Barnstable ` Regulatory Services 161— // 7 Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: / Sewage Permit# z0a5"`�1 Assessor's Map\Pareel/0� ��q Designer: J)O W r\ oC �!Ittn►�. Installer: Ur r7 &7-1 Address: Ma r bk— U r _ Address: / . 0. 16OX 20 you - a mt'�.0 .P On Z<1�`�✓ ,�©/ 7°�� � Celj�5�' was issued a permit to install a (date) (installer) septic system at o1 U r'1 M -r G�i^10J is �� based on a design drawn by / (address) 4 � dated /J /d` ( •$n er) 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. _ `1 4 OF 14q^�� A'RNF H s ( aller's Signature) OJALA `, CIVIL No. 30792 (Design s i ture) (Affix lamp Here) PLEASE RETURN' TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL pgr'H THIS FORM AND AS-BUILT CARD ARE RECEIVED BY TIDE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q;Health/Septic/Designer Certification Form 3-26-04.doc f Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 -- — ----- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return Name of Inspector T key. Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address r South Dennis MA 02660 Cityrrown State Zip Code (508) 385- 1300 _ _ SI682 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 — _ March 17, 2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. S t5ins•3/13 Title 5 Official In act Form:Subsurface Sewage Disposal ystem•Page 1 of 17 t Commonwealth of Massachusetts . Title 5 Official Inspection Form -- - a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° M 26 Samoset Road, Marstons Mills M- 101 P- 117 Property Address Nicholas&Judith Lowitz _ Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 March 17 2015 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 required for every ------ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N [IND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health; safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ye 26 Samoset Road,_Marstons Mills _ _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills' MA 02648 March 17, 2015 page. Cityfrown 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P- 117 _ Property Address Nicholas&Judith Lowitz Owner Owners Name information is required for every 26 Samoset Road, Marstons Mills MA 02648. March 17, 2015 - -- -- -- ------ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M- 101 P - 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA_ 02648 March 17 2015 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 - Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 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 26 Samoset Road, Marstons Mills _ _—_ M - 101 P- 117 _ Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 ------ page. 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 ears usage d 14=52,000 gals. 9 ( Y 9 (gp )) 13=48,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: ooccupied__ Commercial/Industrial Flow Conditions: Type of Establishment: N/A - Design flow(based on 310 CMR 15.203): Canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts � ------ . Title 5 Official Inspection Form 9 -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills _ _ M - 101 P- 117 Property Address , Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 March 17 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Last pumped on 6/9/14 per info from 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 26 Samoset Road, Marstons Mills _ _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name — - information is 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 required for every —._ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank was installed on 8/15/84 per as-built. D-box and leaching were installed to existing tank on 12/28/05 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+ — — feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): --- Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon Sludge depth: 4" -- - - - t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts x -- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Sa_moset Road, Marstons Mills_ _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marston_s Mills MA _ 02648 March 17, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness none Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/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. G 9 :) Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need ofpumpinq at this time. Grease Trap(locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form .i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 26 Samoset Road, Marstons Mills — M - 101 P- 117 _ Property Address Nicholas&Judith Lowitz ------ --- Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 required for every -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): --- - ---- Dimensions: NIA N/A ------- Capacity: gauons N/A ---- -- ---- Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A - Alarm in working order: ❑ Yes ❑ No N/A ---- Date of last pumping: Date Comments (condition of alarm and float switches, etc.): N/A - — - -- o ❑ - Attach copy of current pumping contract(required). Is copy attached. El Y t5ins-3113 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 26 Samoset Road, Marstons Mills _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz_ _ Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 March 17 2015 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines. No evidence of solid car -over or backup in the past were found at the time of inspection. PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments note condition of m h m r u c a be condition of pumps and appurtenances, etc. ( pump � P P PP � ) N/A *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS.not located, explain why: t5ins•3113 Title 5 Official Inspection Porte: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 .r 26 Samoset Road, Marstons Mills _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 _March 17, 2015 — - --------- page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: -- ------ ® leaching chambers number: 2 -500 gallon with stone Elleaching galleries number: -25'X13'X 2'--- ❑ 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.): Soil was sandy. Chambers were found with 1"of water present with walls found clean above. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A -- ------ Depth—top of liquid to inlet invert N/A— --- N/A Depth of solids layer --------- Depth of scum layer N/A —_-- —_-- Dimensions of cesspool N/A -- ----—�- Materials of construction N/A - Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts a: F Title 5 Official Inspection Form -- — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills _ M- 101 P - 117 Property Address Nicholas&Judith Lowitz _ Owner Owner's Name information is required for every 2_6 Samoset Road, Marstons Mills MA 02648 March 17, 2015 page. Citylrown 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.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments > 26 Samoset Road, Marstons Mills _ _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills _ MA 02648 March 17, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I � 0 0 Is 31 3, s010 2srr t5ins•3/13 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 26 Sa_moset Road Marstons Mills _ _ M - 101 P- 117 Property Address Nicholas&Judith Lowitz Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 March 17 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 15.0'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/10/05 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database -explain: SDW 253 Zone B 49.1' 3.3' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 11.1'. Hand augered 5.1' below bottom of leaching with no water found at a depth of 10.0'. Groundwater adjustment at the time of inspection was 3.3'. Bottom of leaching at 4.9'was found not to be located in the high groundwater elevation at the time of inspection. USGS Groundwater maps estimates groundwater at approx. 39.3'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills _ M - 101 P- 117 _ Property Address Nicholas&Judith Lowitz Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 March 17, 2015 required for every _ — _. _ page. Cityrrown 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 r t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 • 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 26 Samoset Road, Marstons Mills M- 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:Whenfilling out forms A. General Information on the computer, use only the tab 1. Inspector: U key to move your cursor-do not Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections t�Q Company Name 19 Hummel Drive Company Address South Dennis MA 02660 City/Town State Zip Code (508) 385- 1300 S1682 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 r, ❑ Needs Further Evaluation by the Local Approving Authority r , C- °'`� � October 11, 2012 = Inspector's Signature Date UL- , The'system inspector shall submit a copy of this inspection report to the Approving Authority(Board ' of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or lasa 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. thins•71/10 Tide 5 Official Ins orm:Subsurface Sewa a DiZ!S?z gPage 1 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Luke& Laura Crosby Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 October 11, 2012 page. 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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): N/A t5ins-11110 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 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 October 11 2012 required for every , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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): N/A ❑ 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): N/A 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•11/10 Title 5 Official lnspadSon 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 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A 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'/z day flow t5ins•11110 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 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•M10 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 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 October 11 2012 required for every , page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5fns-11110 Title 5 Offlcfaf 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 w r 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Luke& Laura Crosby Owner Owner's Name information 26 Samoset Road required for every , Marstons Mills MA 02648 October 11, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 11=98,000 gals. 10=82,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is required for every 26 Samoset Road Marstons Mills MA 02648 October 11, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): General Information Pumping Records: Source of information: Last pumped in Sept. 2011 per info from 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•11/10 Title 5 Official Insp ection 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 w 26 Samoset Road, Marstons Mills M- 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 October 11 2012 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Tank was installed on 8/15/84 per as-built. D-box and leaching were installed to existing tank on 12/28/05 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+ feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon Sludge depth: 411 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 October 11, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A F Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M- 101 P- 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Capacity: N/A gallons Design Flow: N/Agallons 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.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official In spection nspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines. No evidence of solid carry-over or backup in the past were found at the time of inspection. 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.): NIA Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M - 101 P- 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 -500 gallon. with stone ❑ leaching galleries number: 25'X1 TX 2' ❑ 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 found with little water present with a visible stain line approx. 1"from the bottom. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 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 26 Samoset Road, Marstons Mills M - 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is required for every 26 Samoset Road Marstons Mills MA 02648 October 11, 2012, page. Cityrrown 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.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions NIA Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•11/10 Tithe 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 26 Samoset Road, Marstons Mills M- 101 P- 117 Property Address Luke&Laura Crosby Owner Owner's Name information is required for every 26 Samoset Road, Marstons Mills MA 02648 October 11, 2012 page. Cityfrown State Zip Code Date of Inspection D. System information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately + I 0 0 3l '6'' 2 - So'6 two—11/10 r to 5 ONOW tnspwftn Form:SulmuAxa SswaW Dbpnef SyaMm-ftp 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 26 Samoset Road, Marstons Mills M- 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road, Marstons Mills MA 02648 October 11 2012 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/10/05 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ® Accessed USGS database-explain: SDW 253 Zone B 49.5' 3.7' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 11.1'. Hand augered 5.1' below bottom of leaching with no water found at a depth of 10.0'. Groundwater adjustment at the time of inspection was 3.7'. Bottom of leaching at 4.9'was found not to be located in the high groundwater elevation at the time of inspection. USGS Groundwater maps estimates groundwater at approx. 39.3. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w 26 Samoset Road, Marstons Mills M- 101 P - 117 Property Address Luke& Laura Crosby Owner Owner's Name information is 26 Samoset Road Marstons Mills MA 02648 October 11 2012 required for every � , page. Cityrrown 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 r t5ins•11/10 6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f ' L TOWN OF BARNSTABLE U,)CATION,26,y.�,l,� +9flJ� I�� SEWAGE #,2-aZ 1� V q LAGE / hy//r ASSESSOR'S MAP & LOT -O `? INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f7lo 64-aa—A .- q (size) L` f-X.Z NO. OF BEDROOMS 7 BUILDER O> �� a�! i PERMITDATE: >'I-13-er COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S�t 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 II �.?G ��Y � ' � u oI � 'r 37 ��� :. 3� � -. No.. S Fee THE COMMONWEALTH OF MASSACHUStETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpPlicactiou for ]Mpoaf �&p5tem cotY.5tructton Verna Application for a Permit to Construct( ) Repair(4) Upgrade( ) Abandon( ) ❑ Complete System [!J Individual Components Location Address or Lot No. f ;? Owner's Name,Address d Tel.No. Assessor's Map/parcel lRel"51,V11,IF -1///6�; Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. 717 /-j✓ °�� Cam / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Buildingl La G(� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �,jFj gpd Plan Date h1151057 Number of sheets_ Revision Date Title Size of Septic Tank ®d Q �5 %�4 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this BoardAf Health. Sig d Date ®C� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. PP q Date Issued Z c3 �— No.,. Fee /U >" Entered in com uteri THE COMhAONWEALTH:OF MASSA`�r1u5�fTTS computer.- �-PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for �Digo!gal *p.5tem Con.5truction Permit F Application for a Permit to Construct O Repair(V)/Upgrade O Abandon O ❑ Complete System l=J Individual Components Location Address or Lot No. s���s��/� Owner's Name,Address, d Tel.No. !O/-//7 77a, lQ5h Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms p -3 Lot Size Zoe/_Z sq. ft. Garbage Grinder ( � I` Other Type of Building /1�J�/ . U�i � No.of Persons Showers( ) Cafeteria( ) Other Fixtures zz Design Flow(min.required) , gpd Design flow provided �J„� gpd Plan Date // /8/O5� Number of sheets yc Revision Date Title D r Size of Septic Tank _/���. 'll' ,�/Sj`/+1y Type of S.A.S. ��d �L�✓�f� L"��' Description of Soil A9 X3 epIle Nature of Repairs or Alterations(Answer when applicable) A N 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 Certificate of Compliance has been issued by this Board of Health. Sig ed s Date /ZA�le Application Approved by Date c �3 Application Disapproved by: Date l for the following reasons a Permit No. 9(b_A:; G )q Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( J-1j/Upgraded ( ) Abandone,,..d,,( )by Aol_&l 1i at 21:57 l�Y�J�G��` �' - ���5�'D�J/f9/��,5 has been constructed in accordance ) with the pro(v�is�ions of Title 5 arid the for Disposal System Construction Permit No. �\�J r0 dated -'-) /3 s Installer Y�G --��C� 1 Designer #bedrooms Approved design flow ?j C� gpd The issuance of this permit shall not be construed as a guarantee that the system I Zffl-fuii.tion d ned. Date Inspector No. 5 '-_ C Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS mi.5 pogat ,p.5temY Construction Permit Permission is hereby granted to Construct ( ) Repair ( ✓ Upgrade ( ) Abandon ( ) System located at `-" 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 must be com leted within three years of the da e of this p Date 113 I Approved by .FROM :down cape engineering inc FAX.NO. :15oe3629eeo Jan. 04 2006 02:04PM P1 Town of Barnstable Q0PV7 LIL Re ulatorY Services s � � Thomas F. Geiler,Director t634• ' Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# W'5-'0f Amessor's Map\Parcel��� 4 Designer: J)0 W r� Cut J-JtCn�. Installer: Ur 0 n.o/yLt G/✓� Address: Not I y _ Address: / . 160 7d M 1.4?/tl,4 / % �T o Lbs� on 1 Z 113105`- �� � Co w was issued a permit to install a (date) (installer) septic system at o1�,- QJ/►AM0,f G f 0. - M- M�, based on a design drawn'by // (address) dated dir',si er 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/OT septic tank. 1 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. ARNE H ( taller's Signature) OJALA CIVIL No. 30792 ' J (Design Zj —ture'j-..._� (Affix tamp Here) PLEASE RETURN TO BARN TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL pgr'H 'THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q;Health/Septic/Designer Certification Fortin 3-26-04.doc TOWN OFF ARNSTABLE LOCATION �G sG � -� oQ`� SEWAGE # ,v1,LAGE ASSESSOR'S MAP & LOT /01 //7 05A INSTALLER'S NAME&PHONE NO._ 20e70 orToLot�`� Oh SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 9 NO.OF BEDROOMS B;A�OR OWNER PERMITDATE: �COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Tab'I'e to the 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 feet of leaching facility) Feet Furnished by .Z� 4- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION --- - ,N FXLED INSPECTION HOAR 0 3 2005 TOWN OF BARwSTA�_E HEALTH DEPT, TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: � EL. Owner's Address: cr Date of Inspection: Name of Inspec (please rint) 4,j,_ ,L,7, / Company.Nam /J ;�C - Mailing Address:' PSG l Telephone Number: "7 CERTIFICATION STATEMENT, . I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper.function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(31Q CMR 15.000). The system: 'Passes Conditionally Passes Needs Further Evaluation by t•k--Local Approving Authority .Fails Inspector's Signature: , '`` Date: 3&<_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I Title 5 Inspection Form 6/15/2000 page 1 . 1. f• � Page 2 of 11 1. f , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A UCERTIFICATION (continued) Property Address: _901 5�O-e I. Owner: — Date of Inspection: 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'ailure criteria.not evaluated are indicated below. f Comments:, r B. System Conditionally Passes: One or more system component-,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, gill pass: Answer yes,no or not determined(Y,N ND)in the for the following statements. If"not determined"please explain. I 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 insp.ectionif it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain_ Observation of:sewage backup or break out or high static water level in the distribution box due to broken or obstructed.p ipe(s)or due to a broken, settled or uneven distribution box. System.will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is.removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health).: broL-n pipe(s)are replaced obstruction is removed i ND explain: 2 Nee 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:��P �1 y 0 Owner: / Date of Inspection: C. Further Evaluation is Required.by the Board.of Health: Conditions exist which require further evaluation by the Board of•Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(r)(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 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 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 aseptic 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 D=P certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other` failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL;INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION(continued) Property Address K Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no."to each.of the following for all inspections: Yes No Backup of sewage into facility.or system component due to.overloaded.or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged.SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded-or clogged SAS or cesspool. Liquid depth in cesspool is less than.6 below invert or available volume is less than%2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ' of times pumped _ V Any portion of the SAS,.ce5spool 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-Drivy is•within a Zone 1.of aipublic 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A.copy of the analysis must be attached to this form.] (Yes/No).The system fails. I have determined that one or more of the above failure criteria.exist as described in 310 CMR 1530 ,therefore the system fails. The system.owner should contact,the Board of Health:to detetniine 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• You must indicate either"yes'or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system.is.within 400 feet of a.surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water sup?ly 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 faBed 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. 4 Page 5 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM PART B CHECKLIST Property Address: (. � OwnerA h,L /r} �'Z,� Date of Inspection: ;;;7 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 V 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? V 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?(Ifthey 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 ? V _ Were the septi:tank manholes uncovered, opened, and the in.er'or 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? Vth _ Was the facility owner(and occupants if different from owne-)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: Yes no Existing information. For example,a plan at the Board of Health. V_ 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(3)(b)) 5 _ 1 Page 6 of I 1 OFFICIAL-INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION Property Address 4/ Owner: iZe/.r�IGC Date of Inspection: LOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-3— Number of..bedrooms(actual): a DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms)c� �' Number of current residents: Does residence have a garbage grinder.(yes or no): /U Is laundry on'a separate sewage system(}its or,no):. Q[if yes separate inspection required] Laundry system inspected(y or no):/) Seasonal use: (yes.or no):&d Water meter readings, i4(JJ ay able(Fast 2 years usage(gpd)): 3'�l p Qd Sump pump(yes or no) Last date of occupancy. , � -✓�� -,Q„G? 6,/I COMMERCIAL/INDUSTRIA� Tyoe.of establishment: Design. flow(based on 310 CMR 15.203): or Basis of design flow(seats/persons/sgft;etc.); Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of.occupancy/use: OTHER.(describe): GENERAL INFORMATION Pumping Records Source of information. (.j Was system pumped as part of the i sp2ction(yes or no , If yes, volume pumped: gallons--How was qua titypumped determined? Reason,for pumping: TYPE OF SYSTEM L/Septic tank, distribution box, soil absorption system _Single cesspool Overflow cesspool _Privy. _Shared system(yes or. no)(if yes,zttach previous inspection records, if'any) _Innovative/Alternative technology-Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy'ofthe DEP approval _Other(describe): A ,proximate age o=,date installer(' kn w )and s y of info ation: Were.sewage odors detected when arriving at the site(yes or n 6 f , Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j SYSTEM`INFORMATION(continued) Property Address new Owner: Date of Inspection: BUILDING SEWER(locate on site plan Depth below grade: Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: locate on site plan) Depth below grade:�[ Material of construction:i2concrete_metal_fiberglass ,polyethylene . —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: /9/1 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: of Distance from top of,scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee,_or baffle: f How were dimensions determined: Comments(on pumping recomme dations, inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, e idence of leakage,etc.): >✓ !r ��� Q.r�r�%yn�G���?�u:�CNi.�.`-� .C,�/►t-r��,�-�'GG��. GREASE TRAVxM(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels. as related to outlet invert,evidence of leakage, etc.): t Page.8 of 11 OFFICIAL INSPECTION FORM-NOT FOR.YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM:INFORMATION(continued) Property Address Owner: Date of Inspection: ✓ 00 TIGHT or HOLDING TANK: fta_-tk must be pumped at time of inspection)(locate on.site plan) Depth below grade: Material of construction: concrete metal fiberglass_ o]yetfiylene other(explain)::. Dimensions: Capacity: gallons Design Flow: gallons day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION,BOX: (if presenE must be opened)(locate on site plan) Depth of liquid level above outlet invert:- Comments (note if box is level and discrib tion to outlets equal, any evidence of solids carryover,any evidence of .---leakage into or out of box,etc.): PUMP CHAT _(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or.no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 i Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INF,OeR,M�ATION(continued) Property Address: gJ �' Owner:TO — , Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:1 leaching chambers,number: leaching galleries, number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of_soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): y CESSPOOLS- (cesspool must be pumped as part of inspection)(locate on site plan) Number a'd configuration: Depth"—top of liquid to iniet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIV .(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.): i i f 9 Paoe 10 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM.INSPECTION FORM" PART C _ SYSTEM INFORMATION(continued).-, Property Address: OwnerAf Y", -1,-WAqL4,0 X Date of Inspection: �fJj1(� � SKETCH OF SEWAGE DISPOSAL-SYSTEM Provide a sketch of the sewage disposal system.including ties to at least two permanent.reference landmarks or benchmarks. Locate all wells within I00 feet. Locate where public water supply enters the building. 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: y2 Owner: Date of Inspection:,: SITE EXAM Slope Surface water Check cellar Shallow wells ? ". Estimated.depth to ground water 7-1 feet Please indicate(check)all methods used to determine the high ground wa_er elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation C i l I] 1 Permit Number: Date: Completed by: HIGH GR--).UND•WATER LEVEL COMPUTATION Site Location: r�LYNI) Gl' yL� . /��'dS�i��✓/-���lS Lot No. Owner: /J f". �' s� Address: Contractor:— 0601&1,9 i� v Address:��-� l dS y Notes: STEP 1 Measure depth to water tE le to nearest 1/10 1t. ............................................_....................._........... .Date / l month,/day/year STEP 2 Using Water-Level Range ?one and Index Well Map locate site and determine: OAppropriate index.we 1...................... ��. ......- I OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditicns" determine current depth to water level Tor index well ........................... month,/year STEP 4 Using Table of Water-lever Adjustments i Xor index well (STEP 2A). current depth to water level.for index v.ell (STEP 3), and water-level zone (STEP 2B) � determine water-level adjustment ......................................... ................................................. STEP 5 Estimate depth to high wester by subtracting the water ' level adjustment (STEP 4: Trom measured depth to -dater l�7 levelat site (STEP 1) ...... ..........:........................................... ................................................ i Figure 13.--Reproducible computation ram. 15 i i — ray- lr7 - - L (JCAT_ ON ,s4pvlo"S4� oe,6 SEWAGE PERMIT NO. l —LA GE INST-A LLER'S NA #01' ADDRESS BUILDER OR OWNS ',ATt PERMIT . lSSYED CDAT't COMPLIANCE ISSUED 0 ti -•F�s �.j 1 ^ lam. No �s�f.�°. F�s...S .:............. THE COMMONWEALTH 6F MASSACHUSETTS BOAR® OF HEALTH ............... ....... . ..............O F.:.............................._......------.------------........_......----------•------ Appiiration for Di"ofi al Works Tome xa tion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......... .. 4 -........ ------------- I�ation-Address or I.ot No. ..... ...- t .................................. --....------------------ ........... .. ....------. Owner •Address . ...-----•-•-•-----_. ...-•---•----•-. ..........-•---•----•-•--------------- ............. . ...------ Installer Address dType of Building Size Lot___--P -------Sq. feet U Dwelling—No. of Bedrooms........ ........................... .....Expansion Attic ( ) Garbage Grinder (A- CO QNenP_/? ._ No. of ersons_...._. Showers — Cafeteria Other—Type of Building p ( () ( ) ----------------- Aa Other fixtures d ...................................... ... Design Flow..............:. .. .. gallons per person per day. Total daily flow__-__---33. ._......... gal W g ��.•----•---•-------g P P -------------- Ions. WSeptic Tank—Liquid capacity�'5?L .gallons Length--------- Width........ Diameter__._- ...... Depth_-__--........ x Disposal Trench—No.SIP.......... Width...°-= Total Length-_- Total leaching area----------------....sq. ft. Seepage Pit NO.... ---------------- Diameter.....lZ___-___- Depth below inlet...... .......... Total leaching area....Z!; ....sq. ft. Z Other Distribution box (r) Dosing tank ( ) ~' Percolation Test Results Performed by._.j .... 1i-_ -1Z ................................ Date___ ZS .......... Test Pit No. 1_41:.._.minutes per inch Depth of Test Pit----- Z........ Depth to ground water._,P,,' _--_.-_. Test Pit No. 2- - minutes per inch Depth of Test Pit...........--_-.. Depth to ground water........................ a •-•-••-------------� �•--•-•-••-••••---....----------•------.........._........•-•.....-.-------------------•--- ---------- Description of Soil-------------------------f � ' Sc/eSa. •�------ W �'� ---------------------------------------------------------------------------------•-•------------------- - UNature of Repairs or Alterations—Answer when applicable._____! ............................................................................... -•--------------------------•---•--••------•-------•-------•-------------------•-----.........-•--•----------------------------------------------------•------------..........--••-•.........__._...••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'LLln, 5 of the State Sanitary Code—The undersigned further agrees not to place the s tem in operation until a Certificate of Compliance has b issued by the board of health. Application Approved =/O<--................................................ Date iy afollowingApplication Disapprove o reasons:-------•----•------------------------------------------•------------------------•-----------••-••-••--••. ----------•--•---------------••-------•---•------•-•----••-----••----------•---------....------------'--•-----•----...------..---------•-•------........................--------- .---------•--. Date PermitNo........................................-•--............. Issued....................................................... Date • w THE COMMONWEALTH OF MAS ACHUSETTS BOARD OF HEALTH ...----- . ..............OF...........I.............------.-,..... Appliratiou for Biivu.ial Workii Toutiuurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: •'- -------- --•• ......................'•'"''''' i —Location-Addxess or Lot No. Owner �— •Address �f { � _ ��I_. ,. ---_-_ ply' //j{yrj' r� Installer Address % / Type of Building Size Lot....4_________________.......Sq. feet Dwelling—No. of Bedrooms......... __________Expansion Attic ( ) Garbage Grinder Ga Other fixtures ....................................g - .. r _rhY ,.... i P __._.._... - w ( ) ( ) . Other—T e of Building No. of ersons_________ _______________ - s __ Showers Cafeteria i WDesign Flow................................' -------------arlons per pero e day Total daily flow________--n_-:�________-_•________------gallons. at .. . lj�.t-e" a'h' .� Septic Tank—Liquid capa, t`tv ,. on ength ___ _____ �tiidth_______________ Diameter__.____.________ Depth._ :_______.... W Disposal Trench—No. _��/ ........... Width Width_____________________ Total Length.__:---___--.:=--.. Total leaching area_._.____--`._____sq. fI. x e., Seepage Pit No....I____.._-_____ Diameter.....1----------- Depth-below inlet....... ___._.--_. Total leaching area___- 2........ It. Z Other Distribution box (;'") Dosing tank ( ) `"' Percolation Test Results Performed by.,_.1,'`_'=.............................................................. Date____'/ .j" ,a Test Pit No. l.- ..'_____minutes per inch Depth of Test Pit.....! __....... Depth to ground water-_/'`_:' _....._-. /44 Test Pit No. 2....--`::_._minutes per inch Depth of Test Pit____________________ Depth to ground water........................ w ..............................J_____-_-'_j___-__________________-_____________- __________________-_____-_____.___ . Description of Soil----------------•----- � = ir•>, x .,.s. r r..,.. c�....... _ z. ---------------------------- •-----------------------------------------------------,---•-----------------------------;=--------------------_---•-----•-•----------•---•-------------------•------------- V Nature of Repairs or Alterations—Answer when applicable.-_-__ : -------------------------------------•----------------------=-------•-----------•-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System inIa�ccord rice with r,ITI e the provisions of .....��SF;ot.,the State Sanitary Code- The�undersagn�ed further agrees not�to p.�ac� the a+ em in operation until a Certncat`'of Compl' nce-has bej issued b :ahe board of health. r� ----VY a Application Approved �ja' Date Application Disapprove f or e f ollowinq reasons----------------------------------------------------•------------------------------------------..------..._----•- -•------•-•-•----------------•------------•------------------------•..................................................--••••---•----------•-------•-•-•-------•----"-•---•-••••-----•--••••---••------- Date PermitNo......................................................... Issued_....................................................... L. Date THE COMMONWEALTH OF MASSACHUSETTS j/BOARD CHEALTH .............. 13✓-...OF.......... .................................... Tratif iratr of Tontplianrr THIS IS TO E TIFY t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) = ---•-166--=�----------- •- ------------------------------------------•-------------•-----------------------------•-----------•-- r•` — =1 I to r �1 2 ------------ { has been installed in accordance with the provisions of T1 � 5 of The State Sanitary Code�as s� ed in the ( application for Disposal Works Construction Permit No �--_-_.._� �._____-.___-•__. dated__7_/ `__-_._ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILVFUJ1CTION SATISFACTORY. n DATE....-a.../3..� ------------------------------------------•------ Inspector....._.. t -----•----------- THE COMMONWEALTH OF MASSACHUSETTS t BOARD' OF EALTH ��� �.� r OF..................................... ._.................................. 1rU .................... FEE ........ Billpoott orko onptrnr1ion "unfit Permission is herebyranted-------- ' <c'=�� •--orkgLfonptrtu1iott "unfit Construct x) or,epair' ) an Individu2 . age Disposal at No....... cy J� r_k... . `I?�ICv System 1 -------------------------•----•-------•-•-•------_-----------------------------........ StreeZN�o. ...._. as shown on the application for Disposal Works Construction Permit ___ Dated.._..-......_.:_-__-._-...-..----_.....--. ----.....•-• - ------------•---DATE-------------------- ✓ . •--•--•------••-------••••-._..._. d of Health ' FORM 1255 HOBBS & WARREN, INC., PUBLISHERS � - J. L VA -� Z U cal 2 s; F. 1 �Ax _ tAcN� l \ •O 100 J �� • REseeve�. � ' � � �- S.S M N 8 z,S P .501 - ` `• � N N , i z, -bo q t Ll ai I o ;,Jq n� T MORSE v, ZQ N491? 120-Z `� No.10951�O w ZgiovU . Pas' ��_'z��_.._ .:.. ---- ' _y_... -_•_.- _,.._____.__ __-IO - 3o�iU�bFFSSNA�-�a LEGEND EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR ---- p ---. �,��;;r, �,�� �o TS s� �054 D FINISHED SPOT ELEVATION .Y. � FfE,ai SHED CONTOUR. 0 ROBERT ;aIA /z� `c� AF af,"rucc IN g APPROVED , BOARD OF HEALTH .,ELDkE. � ', �' ��d���'��►��r,�,�J���� xaATE AGENT ���`°�,�u SCALE,/ 3 0' DATES S tLDREDGE ENGINEERING CLIENT rh�st� - ---�-- I CERTIFY THAT THE PROPOSED LEISTERS REGISTERED JOB NO.� BUILDING SHOWN ' ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING _ LAWS GINEER URVE R DR. OF BARNSTABLE, MAS 12 MAIN STREET CH. BY R 3• S- ��` "y 4— HYANN I S, MABS. z l ' y $MEET_...OF DATE WE LAND SURVEYOR a0 FT M/N• NOTE /F E/TNER T.t/E SEPT/C TANK OR LEAGNING P/T ,4RE MORF TNAN I2"BEd.OJV ID I�7 M/N r�RAOE, Af 24'A/AM ETER C'ONCRETE CONER S,yALL 9E BROUGNT TO 4KA04c.IA y AEX--req 4'PVC P/PS. i LOE,4vy CAST /RON C0P/4=R SOYALL D,E USED ti CONGRCT�i . � iy/N. P/TCN ' -Z- .16Z,� GOYE/�S "Q�FT /F/N DR/YEy1/AY A !— p of co ►DER CL EAN SAND 4: ,`..CAST a' '. 2 LAYER e / ' J�8 i /RONP/PE.. c /pdO o ao /N O o/TGN GAL. D/ST, o' a • • . . . • • • ' > 04 WASHFO 57VAle /4 PER/"T SEPTIC TAA,,K , 4 , • . . . . . • • , • . ?IrIr s • • plP '" • • • • • w o WAS//ED STGNE �� a.. o • • • • • •• • # o 15ZJ.S x Z.s-.= 377 . . o . • . . . . • I a gob//3-/ x ./•v --�--- � ' .• • • • • • • • • p �y PREC,A.S T SEEF�4Glr l NY.�J�7 CL rEYAT/CJIV s �!T c.4 Pig+c •, • • . • . .. � • s� �L C.7/.$!T OR EQu/V. INYERT AT AWLDI"Cr 79,S FT. 6 FT: PIAM. -INLET .SEPTIC TANK 79,S FT /Z FT. OIAM. 04 C SEE 7A1/LA7I0IV, D4/71-ET SEPTIC 7-ANN _Z 3 FT tIVLET D/STR/8!/TLON-80X8 F7. GROUND NITER TABLE 0UrLETD/STR/B[?_!ON BODY 7 FT. . INLET A,-ACN/NG PIT 7S 8 FT SEyt/.4GE O/S~AIL SYSTEM L EACH/N!s P/T TA�LATlON' DES/6X CR/TER/A SYCALE :_ �4" /=o" D/MENs/oN A 3 PT. .•. DhfiHYSI a N B�FT. �t/tIMdER D/�BEDROOMS 3 _ D/MENS/ON C�_FT. �?i n/. � GAAt6.+tGEDISP05AL u/v.#r ,yo.yE. SOIL. : LOG 7"�7TAL EOT/M►+�rED FLOH/ 3 3O G.r4L.�DAy' cS0/L TEST !. SOIL 7EST02 SO/L TE$T iiNIJMAER aF 4OAGN/NY P/TS / f^EtEY. 79.8 PATE OF SOIL TEST S/dE LAM-A<W/NG PER P/T /SZi.S 5%9 R.T. RESI/LTS iV/TNESSED dY C Gl,c�v p &OTTOM'4,54CN/NG PER P/T // • l - i S4• �T - Lv �9 f'E/gC0AAT/O!V RATE / l ss MIAVINCH 1 TOTi4L LEACH/NG AREA _LSQ. FT. AEhCOLAT/ON RATE 2 T'`!'`f"! MIN�INCN �..QBSgR1ELE4�'NIN6AREA SQ. FT. - w 'SolL u Sv/L T�sT P- 2 6� j sn ititE�/c�M SRMDS -T 7ZoArJ ;r --•� ���N MASS 5/ n/a �, 7 La S�OF . -!E RT' -� Z�`�' 'goy ��A vE� MA �s TO A s Al/Z- LS El=":.:;� o ALA. B RT 10951�0� RA.RED6E E)V G/N"W1'W S CQ,INC. 7t2 MA/N •.9•F.y HYANNI9, MASS'. v` +L �1 . . 90�FSGt57 E���� NGG/eOUND :y�'e'�TCR ENCOCJNT1rREP CL/.ENT.: I SIONAL, TIt MA St/ DATE' GRO CJl1/ll 'L✓.4 TE.P AT EL EY; JOB NO. �S'3 zS 6.A TOP FNDN. AT EL. 85.45' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE LISA LYONS, IRS ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6". OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 81.0' DON DESMARAIS, IRS ANT 2" DOUBLE WASHED PEASTONE 1 1/10/05 �- EL 82.6' RUN PIPE LEVEL DATE: I LOCUS EXISTING 1000 FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH SAMo SET 7 Ll �f GALLON SEPTIC 81.2't* 78.0' CLASS I SOILS P# �iTANK (H- 10 e�FLE aA 77.31' n p O CI 0 0 0 0 I� 1� o 77.48'/ITEE � r 77.17 0 � ED O m ' E7 ED O I� 6" CRUSHED STONE OR MECHANICAL !� COMPACTION, (15.221 (2]) 8 2' 0 0 0 C� 0 0 1,71J 75.17' 7 ELEV. ) DEPTH OF FLOW = 4' 1 " ON$ 82.0' 0" 80.5' yr (L327. SLOPE) ( SLOPE) 3/4 TO 1 1/2 DOUBLE WASHED- STONE TEE SIZES: 0/A INLET DEPTH 10„ LS LS OUTLET DEPTH = 14" 14" 1OYR 4/3 7" 1OYR 2/2 LOCATION MAP NTS LEACHING B FOUNDATION EXIST. SEPTIC TANK 27' D' BOX 16' FACILITY B *THE INSTALLER SHALL VERIFY THE 5.37' SL LS ASSESSORS MAP 101 PARCEL 117 LOCATIONS OF ALL UTILITIES AND ALL 10YR 5/6 10YR 4/6 BUILDING SEWER OUTLETS AND ELEVATIONS 36" 79 O' 27„ 78.25' PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR C RE-USE 69 C .8' PERC CS PERC MS 4. 2.5Y 5/3 2.5Y 5/4 I 3,5 BENCH MARK - CORN OF 00 CONC. BULKHEAD EL. = 84.8 .8 16 83,7 06 _. 135" 70.75' 128" 69.8' SHED 3.4 -I' NGWE NGWE NOTES: 7 83,7 1. DATUM IS APPROX. NGVD W 1 8118 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) _ _ EXISTING 2.6 v� _^_ _- _ 2. M jJ _� IPAL WATER I•S + 83.5 ^ 78.6 DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD USE A v30 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. + 84,2 /�� - GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 2 660 SEPTIC TANK: 330 GPD = (_) 5. PIPE JOINTS TO BE MADE WATERTIGHT. 0 3,1 1000 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. / DECK + USE A ^_ GALLON SEPTIC TANK ' (RE-usE EXISTING) ENVIRONMENTAL CODE TITLE V. $4,5 / L LEACHING: �, + 5 0 2(30 + 9.83) 2 (.74) = 118 7• THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT .6 �+- 78.G LOT 56 1 84,8 SIDES: TO BE USED FOR ANY OTHER PURPOSE. 20,012t SQ. FT. BOTTOM: 30 x 9.83 (.74) = 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 4 3 31' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 85,5 a' TH2 TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED I EXIST. DWELL 3. USE (2)-500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. 8 ,,' 2'6 EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR, FILL W/CLEAN SAND) EXISTING LEACH PIT ,. `n BETWEEN UNITS 5 rn + 83. 84.2 84.6 4.4 �. + 79.7 +182,2 8 3 0.0 �`� o LEGEND \ r - TITLE 5 SITE PLAN \ ` 84,1 3,3 ° 100.0 PROPOSED SPOT ELEVATION OF 26 \, PAVED SAMOSET ROAD --4, 82 6 100x0 EXISTING SPOT ELEVATION \ \ 83,1 4>s 83 DRIVE IN THE TOWN OF: `' ° 100 PROPOSED CONTOUR ( MARSTONS MILLS BARNSTABLE 82,5 1 \\ 82 �0' 2,4 100 EXISTING CONTOUR \ 8 g PREPARED FOR: BORTOLOTTI CONSTRUCTION/TAMASH \ 81,7 81.9 \ 20 0 20 40 60 2 BOARD OF HEALTH Q 80.6 - MA SCALE: 1" = 20' DATE: NOVEMBER 18, 2005 •1® \\ APPROVED DATE \ + 81.0 \\ + 79.3 \ off 508-362-4541 fox 508 362-9880 \�f- 79.2 + 77,8 OF 1,fq down cape engineering, inc, o�� ARNE q�yG �``����oFr,��'shc o� H. `n�'' � ARNE H tin\ CIVIL ENGINEERS oJALA N o OJALA ��` No.26348 CIVIL LAND SURVEYORS �ss\o � No 307091 014 l �- 939 main st. yarmouth, mo. 02675 ti OJALA, -- DATE AR1'l P.E., r