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Home My WebLink About0057 SANDY VALLEY ROAD - Health 57 Sandy,Yall&y- a: -Ile �- Marstons Mills A=, 101 - 110 r M 1 A/7, +*� I'X 45 l�� • [i o� d.. , � aj ,34 �Gc4 41 - st rz -70 ; Romw y " DRUM PLOT PLAN CERTIFIED Vpy M.CON MIMMON .TOP OF FOUNDATION- IS".. IN ABOVE LOW IT ROAD. "z SCALE3 DATE / a�rrs� A Ir 4r JHIS PLAN .IS LOCATED ' y "ems `o 1m �` Alto ovt . THE £ Of Ti r...; r — Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Sandy Valley Road _ Property Address Barabra Lynch Owner Owner's Name , information is �_:• required for every Marstons Mills Ma 02648 8-10-17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation rab Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification 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 8-10-17 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. 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 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M , 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. City/Town 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gp ))� Detail: 2016- 12,000gallons 2015- 15,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Sander Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-tank has not been pumped 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(Locate on site plan): Depth below grade: 26 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: 1000gallons Sludge depth: 7" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 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 29 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 16" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. It is recommended that the bush over the inlet cover be removed to avoid root growth into tank and piping. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. CityrFown 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: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in working order at time of inspection with no sign of past backup or carry over. 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.): NA * 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) 6'x6' ❑ 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.): Leaching was in working order at time of inspection. No high staining, damp soils or lush vegetation were present. Pit had 2' of standing water when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �I REAR B 1 DECK 0 3 Al-17' 131-6' A2-20'6" 62-9' A3-32'6" 63-21' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 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: No GW @ 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record planreviewed: 9-13-83 If checked, date of designp a Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. 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 F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Road Property Address Barabra Lynch Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-10-17 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information (5/4 on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS- Debarros use the return Company Name key. P.O.Box 151 ray Company Address Forestdale Ma 02644 City/Town State Zip Code � 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11-18-19 Inspectors nature Date The system inspector sh submit,a copy of this inspection report to the Approving Authority(Board of Health or DEP)within ays of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. '' t5i6sp.doc-rev.7/2612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems . Information on care and do's and don't's can be found at town health dept or mass.gov 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broker or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City[Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �d Title 5 Official Form Inspection p f 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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: ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) 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 CA. 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 t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)) t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 2 bedroom DESIGN flow based on 310 CMR 15.203(for example: 11.0 gpd x#of bedrooms): 220 min. Description: 6'x6' pit with 2'stone max design 549 gpd. Existing house 2 bedrooms at 220 gpd. Additional bedroom flow is at discretion of Health dept and building dept. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: pumped 2 years ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.25'feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 25'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal. H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6"x5' Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness lessthen 1"' Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge-judge- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): baffles in place no major decay present. no visable cracks or leaks I t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� /ri 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglasss ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dbox is solid scaling present common to oler Dboxs. no visable cracks or leaks no carry overs t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v� 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 6'x6' precast pit with 2'stone. pit has 8"of water in bottom with clean sidewalls over current level 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): } t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts f� Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w� 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 .Sys n Y Or A- 3 - g-: ^a I ; 0 j 01 / 000 �- og U0 d 0 0 Do 00 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: town GIS mapping You must describe how you established the high ground water elevation: lot el. 80' in area of septic. low in area el. 50' bottom of SAS el.71 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 c Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Sandy Valley Rd Property Address Thomas Owner Owner's Name information is required for every Marstons Mills Ma 11-18-19 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No...... Fmc...�b ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town of Barnstabl e .................7........I................................................... liration for Uiopoottl Workii Tonotrnrtion Pumit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Marstons Mills, Y.a�,�e3�..Ra. ...a............... '� '4A.......... � ��s Ai It 'S Location-Address or Lot No. Capricorn Realty Trust _765 Falmouth__R__oad,___ yann ........................ Owner Address a Steve L..bel Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___3......................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ran h------------- No. of persons............................ Showers (2 ) — Cafeteria ( ) Ga Other fixtures ................................--------••••• W Design Flow........5,5..............................gallons per person per day. Total daily flow.........33Q..........................gallons. WSeptic Tank—Liquid capacitylOOO.gallons Lengtl$!.6........ Width4:!1.0.'. Diameter................ Depth.5'.$".-_. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area—.................sq. ft. Seepage Pit Nod................... Diameter...... '...__..... Depth below inlet.....6.�.......... Total leaching area...26(a......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... i.dre du...Gngi?: a ari?.1g............ Date....11:-5: 8l.............. Test Pit No. 1.2..Q......minutes per inch Depth of Test Pit_12........... Depth to ground wate=ne_...enCounter- 44 Test Pit No. aI/A--------minutes per inch Depth of Test Pidi/A----------- Depth to ground water.-V/A------------- e a ----•----------------------------------••-•----...........................................-------- ----•-------•--•-------...............................•-- Description of Soil..........0.' - 2 ..........103m-4...tO.pS_011......................................................................................... xV1Q.......I►Ie dium..yellaw...s-e,nd----------------------------------------------------------------------------- U ...................................... 12.........Me.d._...white---sans/tmame s.._of...gravel/no...watex..at.. 12' U Nature 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 iITLi: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has--been i�su d by the boar health.. Signed l.L .. Peres 911.3a3.... Date ApplicationApproved By--.....---••--•••-•......................................•-••-•--••--..........................-- ......................................... Date Application Disapproved for the following reasons:-----•--------••----------------------------•---....._..-------------------------------•..............--- ........................••••••••--•--•-••••••-•••-•-••••••-••.....•••-•-••....._..................................••-•-•-••-•--•-...-•--••--•-•••••--•••-=••--•--••••............••............................................... Date PermitNo.......................................................... Issued....................................................... Date Q No................_....... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town... . . ...................OFBarnstabl e............. Appliratiun for Dhipuutt1 Work.5 Tnnutrnr#inn ramit Application is hereby made for a Permit to Construct X ) or Repair ( ) an Individual Sewage Disposal System at: Marstons Mills, T wand Jalle Rd. r ......A" . --------------�....:. .............. : __:_?!�.M.�#___1r A.--•--•--------.....-----•---•--------------__---•----•----•---__-- Location-Address or Lot No. Ad BA ......Ca�ru.Arn...gealt�...Trest•---------------------------- 7.. S.._FalmQ�.tb...,R9---...,.--�----------••------------------_----- Owner Address ------------------ ••------...........------•--- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_3........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Builditt No. of persons............................ Showers a YP gY`ek3=2G-��--------------- P Cafeteria ( ) WDesign Flow.Other .fixtures•..--------------gallons per person per day. Total daily flow.......33Q............................gallons. V. Septic Tank—Liquid capacitA00G.-gallons LengtB.!.6.......... Widt4.111,Q_..... Diameter................ Deptltj... ......... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area=...................sq. ft. Seepage Pit Ncl---------- ------ Diameter....6.'----------- Depth below inlet...b.._..__.._... Total leaching area.2.6.6........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..Eldr-e-dge...Enginaerixlg.............. Date.11.M?_5.7&i............... Test Pit No. 1 1'?,f.�.(�.......minutes per inch Depth of Test Pit..12. .•.-----._ Depth to ground wat�Orie...encount er— fi, Test Pit No. minutes per inch Depth of Test Pi N/A Depth to ground water.0 A--------------- e a ----•-----------------------------------------------------------•--------------------=---_--_............................................................. ODescription of Soil......... -�--•----2!..........-0am-•8c-•-taps,011----•-•------------------•----•----------•------•-------- ........................... 2•'----�-•--1-0--'----...Medium... el.l.aw...sand---------------••----•-----•_.. _. . .._ _... W -------1.Q-'-------121------mad-•----whit4...sand/tracres---of.. r seljnQ... a..'r---a-.---12 VNature of Repairs or Alterations—Answer when applicable____-_•........................................................................................ •----- ---------------------------------------------------•--•-------•--•--------------•----............----....•--•-•----•--•------••----•------••----•-•......_.......................-----.......---• Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .._._.._.... ..Pres . 9/13/83_._. Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons--------------------------------•------------------------------•----------------•---=------=--•-------.....----- ---•-••••-••-••-----•-------------------••••-•-••-•-....------------------....•--------------..........-------•--•------•---------------------------------------------•--••---•-•---------•-••-••-•----- Date PermitNo......................................................... Issued-----------------------•---•---.......................: Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Toti+fn................. OF.......Barns t abs-e...........................................:.. Trr#ifiratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (K ) or Repaired ( ) by................................................. teve-•1-ebel--•-•-•---------•----•----------...---------•----- •--•--._...----...._•-----....._..-•--•-•----- Sand cells Rd. Installer A A l�xt.. Marstons Mills,Ma. has been installed in accordance with the provisions of TIT -599'& State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM L UO. JNCTION SATISFACTORY. /. .. /-DATE...... .. . Inspector =• -----------------------------------------•----.............---....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�d ......'.m4n........................OF....Barnstable.................................................. No...........•--- / FEE........................ �in�oo�il nrk� �oa�n#rnr�tion .rrnii� Permission is hereby granted-----------••---•S.te.V4g L&bej----------------- = - :: to Construct (, ) �pird r) Idiv' al Sewage Disposal System at No.....:•r.. 3 a a�-�'ey � ' ' X �rp'l� IvIarston jMi ' , Mass . Street as shown on the applicationor sposal Works Construction Permit No_________ ated.__.__._. :_ _ _ J _................ ='c`; ...................................... Board of Health DATE---------------------------------•-----•- FORM 1255 A. M. SULKIN, INC., BOSTON- F 4, OT _� 1 cy pA LNSERG �. No: 366 O ,. ISTS , � Lo r 33 Lo•r" .. 2-9, 6e9sF ./ � t �y ROBERT j �� TGtf q ZF BRUCE c"+ `0'V x CAN 8 r�-aRE . \oo �/p 1''4 , /, o f ` cl b � 11 CA t ?- r (L or 31 (L..Dr 34) 3 u ,o / Z:2N�ap R- F .- '43.564SF MIw AaEa * A"� 150' Nlinr FAoNTACE. 30' M/N F.S. 15' MIN. Q_ SB. 'Y �jSl/ML1� T�•�ptA G77ew v M 3 �X LEGEND �,+ap' �r939^ EXISTING SPOT ELEVATION Ox0 f _ CEkTI ED PLOT- PLAN EXISTING CONTOUR --- 0 Pole-0 �� ,' G� � -23U� /., FINISHED SPOT ELEVATION [ j Af. Lor 33 .SANDY YZI ; AA MARSTOA&Mi FINISHED CONTOUR 0 ci VA APPROVED � BOARD Of HEALTH S '��DAD . IN Wh(140 y .��1��`��'�'�►��,��►.�� DATE AGENT SCALE, 1 „ •3U1 DATE�$e1pT/3�` '83 ,€LDREDGE ENGINEERING CO. IN CLIENT. Fa»Nco 1 CERTIFY THAT THE PROPOSED LEGISTERE REGISTERED JOB NO. 83 z-G BUILDING SHOWN ON THIS PLAN CIVIL LAND DR.BYt wD CONFORMS TO THE ZONIING LAWS GINEER RVEY R —�------- OF BARNSTABLE , MASS. 712 MAIN STREET , CH'. BY' .s �� R , i M A S. � - � -- - — --- N YA N N S, S SHEET� OF ATE REG. LAND SURVEYOR 20 FT. M/N. NOTE /F E/TNER THE.SEPTIC TANfC OR --AC.KiIVG P/r ARE MORE 77N.9:"1 /2"BELOIV C /D PT. M/N. rRAOE� /4 24'O/11METER CONCRETE CO:e= SHALL B.F BROUGHT TO GR.4 OE.�.-+ ✓ EXT�PA °yp GONG4ETC 4 P✓C' P/PL t�+EAV y CAST IRON CO{iER S'AS�A L L a,,-- C1 SELF M/N. P/TGN COYERS /B-OFR FT /F/N Z>R/✓AFWA Y' 2% MIN. CONCRETE CO VER CLEAN .SANG 4. 4-CAST ?'LAYER ' /RON Rl/PE �jOO v v o �� OF /B.-3IB` b /1?!N.0TU!/ 0/ GAL. • + • • • • • • • • p •�o %4 PEir�r SEP�r/C TA/VEC D/ST, o • • • • • • • • • • e • • WA SHED S71?NE BOX o • • e • • r• • .•• • o is• • •EFFECT/VC • ' •� 31 4 • • + • • OL�PTi+/ • • • • • e WA3t/ED STONE Al y-7 r 6Pp. • ' • . . •. • . . • , D • PRECA5r SEEpAaE .- . lNiiBRT L'LEf/AT/a/4Is , �8•S X lo = 7$ isi•` • • • • s • • • • s••a P/7 OR EQU/v. F,p • s JNYERT AT B/J/LDIN6 O/AM. ??r �c i T y G Fr TJ /,VLET "PT/C T.4/VI!C 101.7 FT. -,. L !/If FT. OIA!W. � �C(SEE TABULA Oiv OUTLET SEPTIC TANK l°1.S . FT INLET D/STR/Bt/T/D/V BOX Ah3 F7 GROVVP t1fATER TABLE .SECTION O/m' �• OtITLETDISTR/BI/TYON BQX FT. IMLEr LZACN/NG PIT Uv. Fr, .SEyNAGE AV SAO�SA L SY.S•TEM LEACH/NG. P/T Ti4Bl�LATIO/V DES/6N CRITERIA SCALE D/MENs/ON a 0/NEWS/ON $ 6- -o FT. N/JMSER OF BEDROOMS 3 D/HENS/ON Cry o GARQAGED/SPOSAL UN♦T t-0^4L SOIL LOG TOTAL EST/NNTED FLOI4I 3 3y GAL.�DAY soli- TEST f*/ SOIL TFS77402 SD/L TEST NUMBER QF t .4C///NG P/rS fe�cEK /62• �^-ELEY, OATS OF SOIL TEST 8 S/DE 41'ACH/NG PER P/T Sq PT. RESUA rS N//TNESSED dY M BOTTOM A.r.4CN/NG PER P/T 78's $0. FT. �� G-2` LaRM C PERCOLAT/Ow MATE /. Z !+►1! ♦NChI TOTAL LEACH/NG AREA ESQ. FT. 5v35ufL P0XCOLAT/ON RATE A2 MIN.IINCN RESBRVEGEACN/N6ARE^ Z—ZSQ. FT. or LoT 3 3, S,&* y V;*-c-C:.Gy /2.a.4H� PH!LiZE RDSEftF BRUCc A 9 0. 366 $ t° �° ELOREDGEENG/NEER/XG CO,/NC. 90.9 7/2 MAIN ST. , f/YfaNN/S. "ASS- S.o�-r , 'f \�q�,p T ,�, L� NO GROVNt� 1-vi4TER ENCOUNTE'REp CL/ENT:�jP,c}�/Gp DRTE� 9 �3 f93 ' GROUND 1V,4TER A7- EZ- EEV _ JOB NO.• 8 3 ZSU SHEET z-OF Z 7 � . A � 4�41Jj . GE LA L}J CATION la � E T NQ. YILLAGE INST, LLER'S N PADDRESS R U I L D E R OR_gWNER DATE PERMIT ISSUED A DATE COMPLIANCE ISSUED - �� F -�� v F �� _ �7 r .� 3, Lb CATIO k AGE PERMIT NO. INSTA LLER'S NAME ..DRESS BUILDER OR OWNER CQ DATE PERMIT I S S U E D 3-93 DATE COMPLIANCE ISSUED z z� 3� 3l o lafs79 'I J No......��j ` ' Fss......:(..< ............... THE COMMONWEALTH OP MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..................OF..........................................----------.............--------•----------------- .� lirtt#ion for-Uhipoiitt1 Worko Tonitrnrtion ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Marstons Mills, L ot #57A Sandy Valley Rd A WMU1 ILIA ..................................................................•-........--.... ...••................................-•••....._....----••-----•••--...---••.................. Capricorn R� t`yAj`rfptzst 765 Falmouth RdkIdt,NTlyannis . ......................_.......................................................................... ..................................................-•.............................................. Steve Lebel owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_......................:..................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ranch.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) G" Other fixtures -----------------------------------•------------•--------------•---------------------------------------------------•---------•.-•--------•------•---- d W Design Flow.......0...............................gallons per person per day. Totot al 1il( flow........ ............................Pnllons. WSeptic Tank—Liquid*capacity1...........gallons Length............... Widt 4.............. Diameter__._..__...._._. ....h?...........__. Disposal Trencl —No. .................... Wid i_.........__..._.. Total Length...._. �._____.... Total leaching area.:_...._._.. sq. ft. x Seepage Pit N p b a 266 ................... Diameter.................... De th below inlet.................... Total leaching area.................. ft. Other Distribution box ( ) Dosi to�k l z dredde Engineering 11-25-81 Percolation Test Results Performed by----- ................................................. Date...............................=........ 1_4 Test Pit No. 12!_0._..___minutes per inch Depth of Test Pit.12-!........... Depth to ground watePone encounte�- / e (i Test Pit No. Y A..........minutes per inch Depth of Test Pi��/..A............. Depth to ground water.!_�.............. PG ... •.......... ... ......•-...• --:-:---•:• -----......�.............................................................................•............... Description of Soil......... 21 �------- & topsol_ ------------------------------------------ ....._...... ------•-•---------------- x 2 - id Nledium, yellow sand U ................. �............ f------------- ---•--------r•_................ ......................................... _.... -----......-....---------_. l... 0 10 - 12 med. while sand braces of gravel no water at 12 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 iITLL 5 of the State Sanitary Code—The undersigned rtlier agrees not to place the system in operation until a Certificate of Compliance lits been ismed by the bo d ealth. Signed.-.. . _ .....Pre s .... ..9..1..E A.3...-------- /it Date ApplicationApproved By.................. ----------•-•--•----------•-•----•----..............---•-•------- ........................................ Date Application Disapproved for the following reasons:................................................................................................................. --••-•---------------•------•-------.......-•------•-----------•---------•------•----•-•--•--.....................---........-----•--------------•---------------...------------••---------•----....-••-- Date PermitNo....................................................... Issued....................................................... Date No......................... Ficz.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..---- ...... ... ....................oF.............................................•--------........-----------................ AVVfiraffon for Diiipniittf Workii Tonirnrtinn amit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Marstons Mills, -'-ot ='�7A sandy 'Talley Rd � �i , IYsA ... ............................. .--------•...--•--.._...................--•------......---....--••----------•--•-•-- Loca'o -Address or L. No. t,aor�cons R �j ty trust 765 Falmouth Road, Y�yrz,?,.� ,�......... ......... ._ ...----•--••-•-......---.- .....----•-•-•-•••••----•-.......•.............•--- r Owner Address Steve Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__..?.......................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building y ATl.0h............. No. of persons............................ Showers (2) — Cafeteria ( ) Q' Other fixtures ................................... W Design Flow..........5: .............................gallons per person 6per day. Total daily flow.._....._.�_3P..........................gallons. • �.� I- t� YY 811 W Septic Tank—Liquid capacity 100gallons Length............... Width. __.10.... Diameter---------------- Depth.._____...._. x Disposal Trench—No. .................... Width-.i................. Total Length..........t........ Total leaching area............r.---..sq. ft. Seepage Pit No..................... Diameter..... ........._. Depth below inlet................. Total leaching area... .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.._._ _ft?.�� =___._........ ^..�.'...... ._.._____._. Date._..`_......_.....14 ..._................. a Test Pit No. l__29.Q-__--minutes per inch Depth of Test Pit.... ........_. Depth to ground water!-A^,!e...e11cOunter- / S rX4 Test Pit No. 2N/A........minutes per inch Depth of Test Pitj__=r :........... Depth to ground water-___- ............. e Ix -------------------------------------------------------------------•---..........................---......................................................... 0 Description of soil........... _'_..-...2...........I.QAM.&..topS c� = = x 2' - 10' Medium yellovr. sF"..Lf 0' - 12' med. white sand tra.oes o� -�°~a 4;s:.�� 1 " ,-..-. .o-..-..-..r at 12' 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed......................................................................Pres. 9/13/$3 Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons--------------------------------•----•-------------------------•-----------•--•-•---------- ••-•--•-•----•------ ---•.................•-------•---••-•-------•------•---------•--••--------------------.................--•----------------•----•-••-••-••-•------••--•----------•---•---•-----••--•----•-••-•••-------. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town................OF........Barns Viable............................................. Tntifiratr of Tont pliattrle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (:X ) or Repaired ( ) by....................••-••-•---•--•-•••...........5-: Q:Ze...Leh.e2..............--------------------------...------------.........------------------------------.........----•------- 57A Sandy Valley Rd. Installer __ t ..--...- i -- p i at•--•--...... ----------------------•------------------------------------------------------•---------------------xX - ...XX Marstons Bills Mass, has been installed in accordance with the provisions of TITLE 5-of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I DATE............................................ ----•---- Inspector...................... {�`-'............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .. .................... .........................:.............................................................. J; No....................... FEE......�¢ ."...- r i t Disposal Workii Tun#rnr#aan "muff Permission is hereby granted-----------------------..._r.._'_•.,.':wc '...-•-----------••---------•... ............................................................. to Construct Re r ''TT d Sevt a e Dis os �� n�y)t�..L t�l. g P ' XXXXX Darstons Mills, Mass. atNo.••----••.-• = _j[ ''I!>._�a_..1`-..' _-----•---•--•--------•------------------••----••----.-......------...--••-•---...-----------. ............................ Street // / as shown on the applica n for Disposal Works Construction Permit No,:__ 3'9_�1 Dated................tt--I.1_(L_��_.... ......................... Board of H I th DATE........ ...�� FORM 1255 A. M. SULKIN. INC., BOSTON i AfF-A 30' F. �n lam` alP� . M-4z.nnc-O P kol-Ec ncn r l utirQ!_"' A-P-7= , nn �� 1 crv5c -� sA z ��• In -� "�- � / % �\ � �^" �:� �..-• -a I xi� S SN OF / of ;,;�4. C',••m ^"f,,• p, ER a ROLE: i .0( Ze" BRUCE , 14 .S yq/ , \ r %» J GMOsuRV 11:57 No. 23GR LEGEND EXISTING SPOT ELEVATION 0x0 Z_ IFIED PLOT PLAN EXISTING CONTOUR --- 0 of FINISHED SPOT ELEVATION �`` • r •n S"� FINISHED CONTOUR 0 � `�' M Al%r/ �. P P I N APPROVED BOARD OF HEALTH + NBERG t tr No. 366 614 + o .. .+ DATE AGENT - -- SCALE, f = 40 DATE " G NEERING CQ !N n ✓�v LOREDGE EN l �. CI.I�NT.�._. I CERTIFY THAT THE. PROPOSED EGISTERE REGISTERED JOB NO.S3?Q� BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING -LAWS ENGINEER Y DR.BY OF SARNSTA8 E MASS. PT r ��en � G) Jae, PA) 712 MAIN STREET CH. BY �c. �:-- NYANNIS, MASS. - Z _ �-... .`-..-_.._.............__ ._.._.._._...�._._ SHEET-L OF ,..� DATE R,EO. LAND SURVEYOR 20 FT. 'MIN. NOTE /F E/TNER T/•✓E SEPTIC TANfC OR ^� LEi4CAVI,/VG PIT ARE MORP 77NA:"/ ./2"45EL0 /O PT MIN �RAOE, A 24'O/AM ETER CONCR ETA COiiER SNA4L BF BROUGHT TO GRADE. J= 7"R.q. CONCRtTE 4 PVC P/PL h+ERVY CAST /RO/Y CO a-= e s-=.O M/N. PJTCN COVEMS /B oFR FT IF/JV OR/VEw.4 Y Z J MiN. G'ONGRLC TE CO NER G'L EAN .SANG lROA/ P/PE oo b o 0 0 • ► Q o GiF ��8 -S/B V4 PER SEPTIC TANK DST • . • • • • • • • • • • s +MIN.ArreW WASHED S72�NE =; BOX v • : 8 • r • • • .•• • � ` 314 fir' .• �• � � •EFFECT/VG . •i 4 -'/ v2" >° , • t • • DEPTH • • • • v . WASYAFP STONE 2.S = y7/ 4Pp i d, • • • •. • • • • • P•�.p PREC.45T SEEPAGE`' lNYGR'T eL ENAT/ONS 7� S y` I•o = 76 t • • • • • • • • • f • 0/7 OR EQU/V. • a /NYERT AT EIvlLD/JVG 97•S FT St/9 cps Irr. DRAM: /NLET ,WPriiC TANK 1973 FT. -Lo FT. l7lAm. C CWE 7.48L/LATJOAV) ; OMTLET SEPTIC TANK .157,1Pr. INLET D/37R/40I/TION BOX,_FT. SECT/ON.O F GROVNO.WA rElf TABLE D�lT1E7DI STR/®l/770N®QX q FT. INLET LLrACN/A/G. PIT ��fc FT. SEWAGE OISPOrS'A L SV&lrcM TABULATlDN LE4CH//VG PIT o/M�ivs/ow A DESAIN G'R/TER/A SCALE : %s' _ /-0- 6 D/�fENS/ON $ FT. NUMBER OF BEDROOMS 3 DJMENS ojV C —FT. GitRBAGEPISPOSAZ.UN/T NO"c SOIL LOG TOTAL ESTJMA'TED FLOIV 33o GAL.IDAY SO/L TEST Al SOIL 7WS770*2 SO/L TEST NUMBER aF 4rACM/N4 PITS 1 f'EtEV. �� -ELEY. DATE OF SOIL TEST . SIDE LEACH/JVG PER PJT Sty PT. P RES lJLTS PVJ ' 9O TTOM LE�1 CM/NG PE 1� JT 2e•5, �'� el-Z� 4Z1" TJV E SSED B Y Jew.. m•`�. FT o .SJFySur� PERCCAA71.ON MATE j/ -1- 2 /7J/VV1J/VCH TOTi4L LEACH/NG AREA7 SQ. FT. . _ FEIVC04LI4T/0N RA_ 7'E�(E� Jy/N.JINGH. .qE5ERVEGE4CN/IV6 AREA I•7 SQ. FT. "of,\� Z-07 y� /�C� 03,E 33 y, ,mac S PHILYPi H.s o ELOREDGEENG/N.6ER/JVG GO,/NG. J 1cEi�" 2 axe C�c� /gTcF A• EZ, 7/Z ,WAIN Sr. , AIYQA1At/S. M.9S.T A�41:D$� jFy�� _: Ii�NO GROVNI� YYi4Tt�R ENCOUNTERED CL/ENT: /Z,QR/lo PAT EJ /3 P� --� '+vvvav M GROUND YvATER .JOB NO; E32-S6 SH�ET�Z-OF �- J