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Home My WebLink About0287 TURTLEBACK ROAD - Health 287 Turtle Back Road Marstans Mills ---- - - -- 063 --038 o c,-0 SCE.— old r i I -- �jJ � i L- LV � 1 ^CMG o �. I1+ . 4 1 - CV � J - do 29. e _ r F4r— CD -zoom t ` 4.4 4 1 3 i i it �S It cy �^ /I Commonwealth of Massachusetts DLo 3 3� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 287 Turtle Back Road �- Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. City/Town State Zip Code Date of Inspection CID Inspection results must be submitted on this form. Inspection forms may not be altered in Sy 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 Michael T Bisienere use the return Name of Inspector key. or—� Cape Septic Inspections Company Name 624 Old Barnstable Road Company Address. Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 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 inspectors 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 �0M ej VS i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `e 287 Turtle Back Road Property Address Mary Joyce Owner Owners Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. Cltyrrown 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: This home has an H-10 1000 gallon septic tank and a H-10 D-Box and two leaching pits 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal S 9 po System em•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce ce Owner Owner's Name information is Marstons Mills required for every Ma. 02648 07/08/2016 page. Clty✓Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 287 Turtle Back Road Property Address Ma Joyce f Owner Owners Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. Cltyrrown 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"toeach 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 '/day flow t5ins•3/13 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 287 Turtle Back Road Property Address Mary Joyce Owner Owners Name information is required for every Marstons Mills Ma. 02648 07/08/2016 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 Title 5 Official Inspection Form USubsurface Sewage Disposal System Form -Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. Cltyrrown 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): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): >440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'f 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is every Marstons Mills required for eve Ma. 02648 07/08/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Aug. 2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owners Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. Cltyrrown 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: 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owners Name information is Marstons Mills required for every Ma. 02648 07/08/2016 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 21"feet Material of construction: Elcast 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. 9 g :) Septic Tank(locate on site plan): Depth below grade: 12"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: standard H-10 1000 gallon Sludge depth: 3" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is Marstons Mills required for every Ma. 02648 07/08/2016 page. Clty/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 apx. 35" Scum thickness ill Distance from tcp of scum to top of outlet tee or baffle apx. 5" Distance from bottom of scum to bottom of outlet tee or baffle apx. 12" How were dimensions determined? 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.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co. based on the future use of the home.The Barnstable Health Dept has a list of local pumping co Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other ) (ex lain : p Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from'bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 287 Turtle Back Road Property Address Mary Joyce ce Owner Owner's Name required for is every Marstons Mills required for eve Ma. 02648 07/08/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is every Marstons Mills required for eve Ma. 02648 07/08/2016 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.): At the time of the inspection there no signs of solids carryover or evidence of past hydraulic failure Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: Two ❑ 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.): At the time of the inspection both of the leaching pits were dry and there were no signs of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection 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 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 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.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments is 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r �t ��7 S€I�A � P€�AlIT �Q• �►II.�ApA INSTA �.�Cp'S !IAIAC A AppRC�S .� � NII.pCR� t4R 9�►#!�A DATE PAAIIIT/IsSyAp 10, 5 Z91� DATA COMPLIANCE ISSyfo yQ� lip I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. City/Town State Zip Code Date of Inspection D. system Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check :ellar ® Shallow wells Estimated cepth to high ground water: 15 plus feet 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: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show five plus feet of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 287 Turtle Back Road Property Address Mary Joyce Owner Owner's Name information is required for every Marstons Mills Ma. 02648 07/08/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I . fir, cd, V aAl re el / ,) i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i e COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 2 87 1J11,gv.S as,s i s+ Owner's Name: WA.-X J-'0 r,4 Owner's Address: 2,37 Ti. Zt V — �Z 153/ 411A.-s cis i s / d'16 98 Date of Inspection: - Name of Inspector:(ple se print) /ry?— Company Name: J �n Aac �pyvi�o Mailing Address: /$2 SZ ar ohs lK s MW Telephone Number: 7-779 CERTIFICATION STATEME NT �- I certify that I have personally inspected the sewage disposal system at this address and that the informition reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: G� � 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 r, gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of l l OFFICIAL INSPECTION FORM—r4OT'I'OR`VOLUNTARY-ASSESSh .� - S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :1 , PART A CERTIFICATION(continued) Property Address: 2 87 ur s s /�' a� Al,' s Owner: Mtir o cae Date of Inspectio : Inspection Summary: Check A,B,C,D or E/ALWAYS complete aH o(Sec A D A.' System Passes: ( ys I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B tem-Conditionally-Passes:— One — --- - -—Ss Y 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. Answer yes,no or not determined(Y,N,ND)in the 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 faiha+e 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. ND explain: 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 tepb=d obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tines 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 obstruction is removed ND explain: 2 Par-3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART X CERTIFICATION;(continued) Property Address: !2 87 7 t & k 1?d Owner:_A/&uYy Joyce Date of Inspectio 9—O 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 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 aseptic 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 I 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 front 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 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 1 I OFFICIAL INSPECTION FORM—NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA"SYSTEM INSPECTION FORM,- PART A CERTIFICATION(continued) Property Address: 2 87 7&--et/o gc.c� Rat ur ur,s ' s /l�/x S i Owner: Ma), e Date of Inspecti n: 9'-�2 -D�- 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 _I ,-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 invert _ q o above outlet m e due to an overloaded or clogged SAS or cesspool i/ Liquid depth in cesspool is less than 6"below invert or available volume is less than V2 day flow i/Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number - -----------of_times-Pumped-- - ------ 1/ Any portion of the SAS,cesspool or privy is below high ground water elevation. 4/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i/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 feetfrom 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.] /Vo (Yes/No)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• 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 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. 4 + }gage 5 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 87 Tire-f p Ai el RJ Kars oh,s i s � Owner: Aaev 40yce Date of Inspection: 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 t/ 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_ofthis-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? f/ _ 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 jSAS)on the site has been determined based on: Yes no v _ Existing information.For example,a plan at the Board of Health. 1/ _ 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)J 5 Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR"VOLUNTAItY ASSESSMENTS , SUBSURFACE SEWAGE DISPOSAI..SYSTEM INSPECTION FORM PART C SYSTEM:INFORMATION Property Address: 2 8 7 .Tkr�7p ck �� u►-s vti Owner: /Navy 3o yr e Date of Inspectio : 9-2 F—OS FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): I/ Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): y yo Number of current residents: / Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no):Alv [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): ¢ec.#>, CSOAX&trd Ya 7vivn wat1v Sump pump(yes or no): NO Last date of occupancy: --— --- -----COMMERCIAIJINDUSTRIAL— — — ----- - -- ----- --—_ —_ - Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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: 6"A c Was system pumped as part of the inspection(yes or no): S If yes,volume pumped: > 00 allons--How was i'quantity pumped determined? Reason for pumping: /Nuih lNHyG� e F .��"A t.,Xi cl"ivy 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.Atta fi'a copy of the ruarnt operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: inA 0�13aX . a /06,0q*I Z¢ac� lJi �Sr/lej 6yl3 '- 8y Were sewage odors detected when arriving at the site(yes or no): 6 . Pige 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2 97 XavrJ-f &ck A& ur•S OsxS /l�i S, /� owner: Ma �71v c-e ' Date of Inspecti n: 7-18—O,S' 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 su n e: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) ----- - - - - --Depth-below grade: �-$'-------_------ Material of construction: concrete 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: la ' 'X 6 Sludge depth: /6'� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: y•, 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: i1 " How were dimensions determined: /yllafar�yy vvc( Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, yert,evidence of.leakage,etc.): /uhk was rJt�cM � tD�t / re-- GREASE TRAP:_(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.): 7 Page 8 of I I OFFICIAL INSPECTION FORM NOTI?QR VQ) .UNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SY$TEM.INSPECTION FORM PARS'C r SYSTEM INFORMATION(continued) Property Address: 2 8 7 Ack V Owner: lkauv, -T�ovc Q Date of Inspection: 9-2 b-oS- TIGHT or HOLDING TANK: (tank must be pumped at time of inspe aktw:ate an site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallonstday Alarm present(yes or no): Alarm level: ' Alarm in working order(yes or no): __Date of last pumping:-- — -- -- - - - -----------.._ Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: D Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into,%out of box,etc./l: / fi PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition ofpmnps and appurtenances,etc.k Page 9 of i I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: it�7 7ar*Jo 11eh R/ ��// lir S onS J� fJ �g Owner:_ May y MU5ce � Date of Inspection:_ 9'-1$—O,S- SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explainwhy: . �- Type leaching pits,number.`1 leaching chambers,number leaching galleries;number. leaching trenches,number,length: 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.): •-•c Cks f /oov g NJfJ {-/ 4vel q- I /sfB" mck �aL , 'wg nm 444 r, 'cvv,°rr 01 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions• Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): - 9 Page 10 of 11 •s �" OFFICIAL INSPECTION FORM NO�'FOA VOLVWXAY ASSESSMENMS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM - PART::C • SYSTEM INFORMATION(continued) Property Address: 2 $7 .T vtlo 4k Rot • 6i`S vat I � /J • Owner: Mtir �v c ' Date ofInspec on: 9—2 B-oS-. 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 withinn..100 feet Locate where public water supply enters the building. . %v 1A wa/1 r ?n71 rS a ��'a h f v /�ui Id' a� a� fie /N I " p�k (over 74' 10' Page rl 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ;2 .87 Ral Owner: /he� f Date of Inspec n: 9—:�z f—OS- SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water yvr 8 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ---- —-- - Checked-witli local"Board ofHealth=explain:--—" Checked with local excavators,installers-(attach documentation) r/ Accessed USGS database-explain: You must describe how you established the high ground water elevation: dot �lkvatiaN ,'s a � 92, 5 re-ef L41(.c l�;vU ;ati is a LIP7 et (� Al rVa W4 2Y ?le ve. ION 'id y, 07 ¢e AI 4,0- *-.0- b 76P4" af /e&I 21 lfaZ fe-It 3S" fe4 11 Fxs............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................ --------------..OF.........-•---..............._.......... Appliratiun for Uiupuual Works Toustrn.rtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal System at: .......--•-- Location- dd r or Lot No. ! r:�..I!` .. ... !�...I•---•-•-•-••-••----•---•-•-•- .........•-----•---•-------•------•--...... ........................................ caner Address a .............. v�i_IV... 1 -. . -•--....•-------•------------••-••-------- ----------- -------------------- PQ Installer Address � S Type of Building Size Lot........................... q. feet Dwelling—No. of Bedrooms.....................3_.._...............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity 41+qi allons Length................ Width................ Diameter--._.---_-______ Depth........_....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------------------------------------------------------------•------- �t�� ............................................................ Description of Soil.................... _ x - - _ w -----•--•••-•••-•-•----••••-----••••-•---•----•----••----- . �T........ ,�� -.......................................................................... -------- U Nature of Repairs pr Alterations—Answer when applicable> '+ '1_ . ? .. _t�e��.s?,� ......................... % !" `may-------45-----4 � -ate-- ---------------- 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 be sue by the board of health 11 igned-• ---- --------------- ®/ y Da Application Approved ---. ----•� •--- ...... .......................-.................................. .... . ------ Date I Application Disapprove or t following reasons---------------------•-•----•--•-----•------------------------•-----------------••-----------------•--•-----•--•- --------------•-----•----.....-----•------------....---------•---•--------•-----••------....-•---•------.-------------------------••--------•-----•------•-----••--•-----------•---•--------••------•--- Date PermitNo....................................................... Issued-....................................................... Date f'. No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. . ...----------..O F..............-......... Appliration for 14spniial Workii Tonotrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (4 an; Individual Sewage Disposal System,at: . Location Addr q or Lot No. • ..... .: e S. •• �.a2 .... .... " Owner ..Address -----•.................................... i 4...................................... ... Installer t ddress Type of Building Size Lot.................... .....Sq. feet I—. Dwelling—No. of Bedrooms................... ......................Expansion Attic ( ) Garbage Grinder Other a —T e of Building ._ No. of persons............................ Showers YP g --------•----------------- P ( ) — Cafeteria ( ) Other fixtures ----------------------- :. W Design Flow............................................gallons per person per day. Total daily flow........................................._..galIons. WSeptic Tank—Liquid capacitytS gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................Sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by.....................................................--•--- • Date Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O = Description of Soil----•••--- ' -... .......-- c - e► r�`------ V -----------------•-------.---- . A-- "`- - w x --•- •• ••• ---•------ --- ------------------- V Nature of Repairs or Alterations An wer when applicable � - Mt+ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLU 5 of the State Sanitary Code— The undersigned further agrees not to place the system,,m operation until a Certificate of Compliance has be sueyl by the board of healt ,r', �-/ f - D IfIr ,. Application Approved --• ----- -------------•--•-------•-----------•-••-------•---------- _., f.......-- J Date Application Disapprove or t following reasons:-------•------••...............:.............:...._......_.....--_-.._ .._..--_-_-.. --------------•---•-------------••----------••------ ;.......------••------ --------------•-----•---...--•--------------------------•-•---•-'- ...---•------- Date PermitNo...................................................---- .Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................... ..... .... ('111rdifiratr of IuBnplitiitrr TT .� CERTIFY, That the Individual Sewage Disposal System constructed (¢ ) or Repaired by. e - -- -------------------------------------------------------------------- at..----- a`. P__.. Installer has been installed in accordance with the provisions of TI F 5 of_The State Sanitary Code•"a . �r>bed in the application for,Disposal Works Construction Permit No.__ .. ___.. _. �. ---- dateel_ _ - e •- the THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC DA�aE --Q� A Inspector............. ........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ./ ..........................................OF....................................... No ... ... FEE... .................... Tnnotrn ion amit Permission is hereby grante . ---- ......................--•-- •............................................................................... to Construct ( Repai air I d e e Disposal System _ at No........ •--•-- ................ -- -----•-------------•----------- ------------------------------------- ~� Street as shown on the application for Disposal Works Construction Permit No_ .__ -, .......... Dated.......................................... .................. . ........................................................... Board of Health DATE---------------•-- ----`-.....••--......................................... �R .FORM 1255 A. M. SULKIN, INC., BOSTON �y0 ys3 MOW �F� 1.1/. LOCATION T �I � c% 0;jel-SEWAGE PERMIT N0. VILLAGE INSTA LLER'S NAME 6 ADDRESS Jv 4"7 1,;7, /!5z? R U I L D E R OR OWNER DATE PERMIT SSUED DAT E COMPLIANCE ISSUED G �l3 l� Jj Uc !:jet ri LOT 377 N 43'10'00" E BSS 634' h FENCE 238.63' D E S I G N h ENGINEERING PROPOSED ;n GARAGE 1r DR/VEWA Y o PROPOSED & SURVEYING SHED 301116' f www.bssdesign.com `D DIRT 70�1. SHOWER \\,`,\\-"\ DRIVE BSS Design, Incorporated \\ \ Q 164 Katharine Lee Bates Rd Falmouth Massachusetts 02540 1 S FN \ �\ \�. '�\ 508.540.8805 FAX 508.548.8313 \� \ w O w co \\,; �" o o � 0 0 LOT 376 \ � \� �� 0 cb ry \ \ \ \\ `° � (n ^�' 45,170 SF m , EXISTING , 1 Q _ I, HOUSE cn 0 0 I— \,;.l` #287 \ Q w \ \ .\\ \` 99.2' 0 Q cn TANK �.\\\`N'\�\� .``�\\ \ 2 ��.\ > U 0 o Q U cQn LEACH PIT \\.:\ (— �... 0 O ElD—BOX �, \ �1/ O .W Of m Q Q Q w a_ OBLOCK PIT UJ a Of Lj r' ( z Z) m ELECTRIC 0 Q 325.99' PAD Q H LOT 375 s 43'10'00" w Q 00 Z Q A�-�l{OF I4gs m NOTES: � y`" \q`Ix � 1. LOCUS IDENTIFICATION: 5. SEPTIC SYSTEM WAS DRAWN AS OUR '� TH�,�h4ti5 G' LEGEND I 1ACKSOf\1 suNK.ER ^ ADDRESS. 287 TURTLEBACK ROAD INTERPRETATION OF INSTALLER'S SKETCH AND RI ft NO.32653 , 1..1.E ASSESSORS No. MAP 063 BLOCK 038 HAS NOT BEEN VERIFIED. ` / LOT 376 LAND COURT PLAN 30751—F 6. EXISTING BUILDING OFFSETS ARE MEASURED TO PROPERTY LINE '��'��F, �o r` scale O o o FENCE 2. LOCUS IS WITHIN: CORNER BOARDS, NOT FOUNDATION. ST�� 1" = 30' ZONING DISTRICT: RF 7. THE CONTRACTOR SHALL BE RESPONSIBLE FOR - 0 ��D date FLOOD ZONE: X OBTAINING A TRENCH PERMIT FROM LOCAL JAN 3, 2017 BUILDING CODE WIND EXPOSURE CATEGORY: B MUNICIPALITY IN WHICH THE WORK IS BEING � `�\��•; EXISTING STRUCTURES ZONE II OF A PUBLIC WATER SUPPLY PERFORMED IF REQUIRED. \., �\\.I drawn GROUNDWATER PROTECTION OVERLAY DISTRICT 8. CONTRACTOR SHALL NOTIFY DIG—SAFE AT + EJP, MRT RESOURCE PROTECTION OVERLAY DISTRICT 1-800-322-4844 AT LEAST 72 HOURS PRIOR checked_ SALTWATER ESTUARY PROTECTION TO ANY EXCAVATION. PROPOSED STRUCTURES "�l) ENDANGERED SPECIES HABITAT job number 3. LOCUS IS NOT WITHIN: 16222 AQUIFER PROTECTION OVERLAY DISTRICT title 4. LOT COVERAGE BY STRUCTURES: • EXISTING: 3,411 SF 7.55%, 0' 30' 60' 90' SITE PLAN • PROPOSED: 3,996 SF 8.84% �. drawing number P24-81