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HomeMy WebLinkAbout0080 WINDING COVE ROAD - Health 80 Winding Cove Road Marstons Mills A= 117-113 TOWN OF BARNSTABLE LOCATION '8 SEWAGE VILLAGE 0p-6k'Zr.S j2&iT ASSESSOR'S MAP&PARCEL 657 - 01:7 INSTALLER'S NAME&PHONE NO. 13y> jQJCJ 50," SEPTIC TANK CAPACITY ) 0,zo© CR."\ LEACHING FACILITY:(type) (o ors._ g (size) 29,1 NO.OF BEDROOMS OWNER -rq,4k K•i5 PERMIT DATE: ti .- to COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ?,J / feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leachin lity). ! po feet FURNISHED BY 1} �i al ,6 2 cj, Y Q J r No. 0 — Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfication for ]Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(e Upgrade( ) Abandon( ) ❑Complete System 91ndividual Components Location Address or Lot No.F0 W in d M S co u-fact Owner's Name,Address,and Tel.No. Assessor's Map/Parcel S 7 / 7 5;41n Installer's Name, ddress,and Tel.No. oas�re/�5A�lti/A esigner's Name,Address and Tel.No. 6 k 6'6 Si4erd wrcG�`r+:,4 p SSG 3 ;06C d A/'v� rv� 'P - Z-0 A!5:-4r-r f4-1OC111/(-h 7 Type of Building: Dwelling No.of Bedrooms 37 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures '1 Design Flow(min.required) .3 3 O gpd Design flow provided 7 O 41 gpd Plan Date 2 �� /O Number of sheets %' Revision Date /1 o-w Title Size of Septic Tank �.IC c s7/-7 S /vc, 0 Type of S.A.S. A2(! j-Z) Description of Soil /0/-a-0117 Nature of Repairs or Alterations(Answer when applicable) oe eg ec< r C.a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H e Date } P/ Application Approved by Date s%f —(0 Application Disapproved by Date for the following reasons Permit No. e/ r 11 3 Date Issued 'y�� i No. 6 1 U r aY Fee (!U THE COMMONWEALTH4 OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN�""" OF BARNSTABLE, MASSACHUSETTS Yes ftpfication for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(, Upgrade( ) Abandon( ) ❑Complete System JX Individual Components •�., Location Address or Lot No. FU IN in d (L'U-e/1 Owner's Name,Address,and Tel.No. P-)V 1 S T/(/1 Assessor's Map/Parcel 7 / 7 .SUM 2 Installer's Name,Address,and Tel.No. e 5Ar7,'M/Designer's Name,Address,and Tel.No. 6Y, 6 �i S'r�ncf ,cI- n ,a 0a5G3 /J13C 4::7/V►i/ 3—oF 4rf' j Z p /o ,:5:A.f i f- 4n0w/[..�i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3 3 O gpd Design flow provided Vo C/ gpd Plan Dater I"— /O Number of sheets / Revision Date /7 o iv 2 Title Size of Septic Tank -e-k t S%/--7 s- /oa O Type of S.A.S. X/e C _TD Description of Soil re e /./I ✓� Nature of Repairs or Alterations(Answer when applicable) ( P,O K4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea al;ne / p'/% Date t 1. Application Approved by QJ alv. ,,Z­P 2 , Date Application Disapproved by Date for the following reasons Permit No. 1.2 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliatice THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A) Upgraded( ) Abandoned( )by n ` ✓y, P U c .� at F 0 �l,,�,, �, C y�� cf /l/ i has been constructed in accordance i with the provisions of Title 5 and the for Disposal System Construction Permit No. )-o/u dated ti /d Installer I D v S(- /_ -' � "" �� 1-t -� c r Designer s l c � n J #bedrooms -3 Approved design flow,3 3 and The issuance of this permit shall not be construed as a guarantee that the system willrfu'nctio/n�as designed. Date L) Inspector. �j1�y• � � No. ; .p 1 J— Q 7 Fee loo THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(,.>e) Upgrade( ) Abandon( ) System located at C/,A./ S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. l Date < L; p Approved by / f- Town of Barnstable o�1HE,T. s 4 Regulatory Services _ Thomas F.Geiler,Director + iAR1VS1tkBLEI � • a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,IOTA 02601 Office:.508-862-4644_ Fax: 508-790-6304 Installer &Designer Certification Form Date: ➢ ®� Designer: Dk)I Installer: �056 r✓L Address: . CA51- (54-1 DWI&H Address: A&Ro%xi 0. was issued a ermi (date) - (installer) p to install a septic system at iv401� �V& 6 based on a design drawn b (address) y dated �Z O (designer) V 1_certify that the septic system referenced above was installed a substaui,a11`t1 y ccording to :lie design, which may include minor approved changes such as latcxa relocatozi of the c3jstrrbution box and/or septic tank, . I certify that the septic system:referenced above was installed "th''-.mapax.changes (x..e• greater thaaa�10' lateral relocation of the SAS or--any vertical.reooahbn of any componeut of the.septir`system)but in accordance with State &Local,Re . aeons. Plan revision or certified as-1;1t by designer to follow. �� DSVID- 4saMei's ign re) Z. WASON y ,9 .Vo:t066 sglTAR�P� (D er s Signature) Affix e er's Stain Here ( p } PLEASE RETURN TO I A"RNSTABI,E PUBLIC:REAI.TD.RI—VISION.. C RTl[k'IC . .TE OF CQML LIANCE WILL. NC3T: `iE': SSUED: BOT$ -3'Igl[S FORM _ BUILL ,'M ARE RECE"I" R ;-T`l :B" STABLE P>U$LI E TR 9MSIQN. THANK YOU. , Q:YealtWSeptic/DesignerCertificat.ioii Forrr, Town of Barnstable P# 1�14 3 Department of Regulatory Services Public Health Division Date L z 11b HAM t 63 206 Main`Street,Hyannis MA 0260'4 Date Scheduled1�6hd Time l Fee Pd. �'o Soil Suitability Assessment for Sew('age qlsposal Performed By: y''rV/� ���'I Witnessed By: r/� LOCATION& GENERAL INFORMATION Location Address (n�, �'uu� D' Owner's Name 01+� `� (X /yl 1 1 Address Assessor's Map/Parcel: a S-7_o C? / Engineer's Name NEW CONSTRUCTION REPAIR t/ Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �I w , Parent material(geologic) )11 Depth to Bedrock. I V Depth to Groundwater. Standing Water in Hole: Z Weeping from Pit Fpce A T Estimated Seasonal High Groundwater AM DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment It. Index Well# Reading Date: Index Well level v..w Adj.factor Adj.Groundwater Level I PERCOLATION TEST bete Time Observation Hole# Time at 4" Depth of Perc a0 Time at 6" Start Pre-soak Time @ Z 'time(9"-6") End Pre-soak s! f Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPI'ICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. n isten % vel b -zl 61- 10Y01b. Lb �6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. psi en %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) 3; (USDA) (Munsell) Mottling (Structure,Stones,Boulders. sistency,%Gravel) f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi ten veil i Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No—Z)es Within too year flood boundary No, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviops mat nal exist in all areas observed throughout the area proposed for the soil absorption system? � ..�. . If not,what is the depth of naturally occurring p ery pervious material? , Certification I certify that on d (date)I have passed the soil evaluator examination approved by the 'Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required training,expertise nd a eri ce described in 310 CMR 15.017. Signatur;�;��, Date Q:\SEVnCVERCFORM.DOC Wealth Management TD Bank,N.A. 40 Main Street P.O. Box 67 Orleans,MA 02653 Toll Free: 800 462-3666 Tdbanknorthwealthmanagement.com February 18, 2010 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 Attn: Thomas McKean, R.S., CHO Dear Mr. McKean: Please be advised that TD Bank,N.A. has been appointed Executor of the Estate of Stanley P. Negus, Jr. by the Barnstable Probate Court. We have received your letter dated January 20, 2010 regarding the septic system at 80 Winding Cove Road, Marstons Mills. We have hired Bousfield Sanitary Services to prepare the engineering for the septic design and to make the necessary repairs to the system. F- 8 Please let me know if you require anything further at this time. Very'trulyyours, Cakd —y Kim Cabral,.CTFA --- s Vice-President J TD Wealth Management is a service mark of The Toronto-Dominion Bank Town of Barnstable 8arnstabte . Regulatory Services Department yea 1 $A.RNWASI£ ,. 6 Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-63014 Thomas A.McKean,CHO CERTIFIED MAIL# 700818300002050091.75 1/20/2010 Estate of Stanley P. Negus Attention: Sue Cwartkowski 90 Pearson Blvd. Gardner, MA 01440 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 80 Winding Cove Road, Marstons Mills MA was last inspected on October 31, 2009,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00)-due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure_to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH UJ .Thomas McKean, R.S., CHO Agent of the Board of Health Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is Marstons Mills MA 02648 October 31, 2009 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key +tctc""" ✓ I """ °°'`/ to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 State Zip Code Cityrrown 508-428-1779 SI 12855 Telephone Number License Number a B. Certification LU crt 1 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 ve `l was performed based on my training and experience in the proper function and maintenance of on site 4t c,- sewagerdisposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of co U ° Title 5(310 CMR 15.000). The system: 4. �. � � ❑ Conditionally Passes ® Fails r C�- [I -Passes © ED CD ❑ Needs Further Evaluation by the Local Approving Authority October 31, 2009 Irl pector'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. c lystD Title 5 Official Inspection Form:Subsurfa a ewage Disposal Pag 1 of 15 09-229 Negus.doc 08106 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every 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: B System Conditional) Passes: Y Y ❑ 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. 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 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. 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 replaced ❑ obstruction is removed 09-229 Negus.dac•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. 09-229 Negus.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is Marstons Mills MA 02648 October 31, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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_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. 09-229 Negus.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. 09-229 Negus.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 15 r Ih Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. Citylrown 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)] 09-229 Negus.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 6 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Da eonths ago. 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: Last date of occupancy/use: Date Other(describe): 09-229 Negus.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-229 Negus.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is Marstons Mills MA 02648 October 31, 2009 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): 2 Depth below grade:p g feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 2' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. 6" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 4" 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 Measured How were dimensions determined? 09-229 Negus.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every 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.): Tank had previot,sly been full to top. Tank is structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pt mping 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): 09-229 Negus.doc 08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-229 Negus.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 XL Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Winding Cove Road Property Address Estate of Stanley Ne us Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit. ❑ 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 pit was empty at time of inspection, observed staining to top of structure. Pit is in hydraulic failure. 09-229 Negus.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 12 of 15 Commonwealth of Massachusetts•� usetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liqu d 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.): 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.): 09-229 Negus.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 • Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 80 Winding Cove Road -- Property Address Estate of Stanley Ne uc�s —_ Owner Owner's Name information is Marstons Mills _ MA _ 02648 October 31, 2009 required for — State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Winding Cove Road Water Service \ \ \ \ \ \ \ \ \ \ \ L \ ♦ . . . \ . \'.' 15 t 39 16 nb 'ry, I'�a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 80 Winding Cove Road Property Address Estate of Stanley Negus Owner Owner's Name information is required for Marstons Mills MA 02648 October 31, 2009 _ every 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 ground water: N/Afeet 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 09-229 Negus.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 03nSS1 IDNVIIdW03 31Vao a3nSS1 1114111d 31Va a3 NMO a0 a 3 a l I n a -Z fy a SS3aaaV I 3W.VN S.a311 VISN1 IOV11IA. 'aN lIWM 3d 3 0- V M3 S! P� � N01 1. V :� 01 i g4= c p THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............... ...... ...............O F....................................... IirFa#iun for Disposal Works Toustrnr#iun thrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: / ......r� �d �7 s o.,l_..���ill .......................................... Location-Address or Lot No. ... q- .................. ................ p .. -- �.'......... .......... Address 1- 1 2� AeT Owf � Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms.._......ems..................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons........... Showers Cafeteria ( ) a' Other fixtures .................................. W Design Flow..................../V0----gallons per person per day. Total daily flow-------------- ....................gallons. WSeptic Tank—Liquid'capacity_�OW.gallons Length._,8.�_...._ Width................ Diameter__-_-__-.__..-_- Depth................ x Disposal Trench—No. .................... Width..... ............ Total Length......_............ Total leaching area....... ............sq. ft. Seepage Pit No--------------------- Diameter.......6__.__..... Depth below inlet....../P.......... Total leaching area..../ao......sq. ft. Z Other Distribution box (✓f Dosing tank ( ) aPercolation Test Results Performed by..... 4X7 ?Z E.............................. Date....�/_7,,/�f.....•...... Test Pit No. 1................minutes per inch Depth of Test Pit-----/-_'Y.5-__.- Depth to ground water..-_MOME....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .--.----••....................................................... -------• -.--••----._.----------•----------------- •---------------------------- •------•---• 0 Description of Soil-----�GZ14X•----lyl �l e1 Sty✓✓. ............•-------•--------------••---•-•------•---•-------------•-•-------•-•-•-----•----......_.. x 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 TITLI: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in opera ' ntil Cerf cat f Compliance has by the boar ned..... plic ion Approved By----•-- -----------• ---••••°jTk=G '---.......•.....-••••-•---------.......... ter Date Application Disapproved for the following reasons---------------•••-----------•---••-----------------•-...-------•-----------•--------•-............•--••--•-..... --•--•..........................•--•-••-••••-•-••••---•-•----....--••--------.._.....--------•------•••--••---------------•---•-----•-------•-----------•-•----•----•--•••...••--•--•--•------•--------- Date PermitNo...............................................- Issued-........................................................ Date .. -- - -- - -- - ----------- - -- _ - ---- -------------- No. .................... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------- --- ------- ------------ OF...................................... Appliration for Disposal Works Tonitrnrtton Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ;..... -# 7 GtJi�iviv,c �✓� cr'..._... �J�.r's� •r/....J%>i//S... . ........................................... •• •-- Location Address or Lot No. .. . ....�r/-•-••-C...r:f..4 ///:-••................. Owner W . .`-_==-.._P "/ ! Ufj7 .........• 17NLU��f���/�/ ........ ll n , l /��'/T711 U//�dr.. 2.11V-. ................. } .... ............... ......................................... ------------------ a Installer r Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...... .................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ........................... No. of persons.......... Showers (2) — Cafeteria ( ) Other fixtures ------------------------ Design Flow................a7y?' ..1/..--gallons per person per day. Total daily flow........._�0....................._._gallons. W a' Septic Tank—Liquid capacity./AW..gallons Length....,_...._.. Width---------------- Diameter................ Depth................ Disposal Trench—No. .................... Width........._:':___..... Total Length..._ _:_.5....... Total leaching area.___:-_-.__ ....sq. ft. Seepage Pit No..................... Diameter.__.._ri._.__..... Depth below inlet.....A........... Total leaching area...Z� ..-....sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by.... ='�Zr- ..................... --• .... Date... 3'/�L f.............. Test Pit No. I................minutes per inch Depth of Test Pit..... Depth to ground water_._!:% !! ......... 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ DP4 ---••--•--•-------------------•---------------•---•------------•-•----•-.....---•--•-------•--_...--......................................................... Description of Soil..... _ t....... �/j..................................................................................................... U ------------------ ------------------------------ •------------------ •---------- •--•-------------------------------------------------- •------------------- •---------------------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 TITLF, 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. ne ---------------•--_---------•--•-----•-------••---------- - e ,. ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------------•--------------------------------------•--------------------•----•--------•-------........_ ..............•-••--•------------•------...--•------•--------...-•-----------------------....------••-•---------•-------•-----------•-----------•-----•------------------•------------------•-------•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF _ Tnrtifirab of Tort hatta THIS IS TO CERTI Y, That t�idu ewag Disposal System constructed ( ) or Repaired ( ) by.. ............. •-----•------------•-----------.........-•--•-••------•--............._............. ....----- i at......-••-s. -.--..----------------------------••---- has been installed in accordance with the provisions of TITtR 5,Qf-g1j,�4tate Sanitary Cod t bed in the application for Disposal Works Construction Permit No_________________________________________ dated_..------ .............................._.__..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUE® AS A GUA NTEE THAT THE SYSTEM WILL F NCT N SATISFACTORY. DATE................ gy ...................................... Inspector............ - --_-• ---•-••--•- THE COMMONWEALTH OF MASSACHU ETTS BOARD OF HEALTH i No......................... . FEE........................ or, �on,�trnrtion �erutit I ��-�-: Permission is hereby granted -----------••-•....................•-..._..........----- to ConstrucL6(- ) otN Pir (v/qt xd Wi4lud Sew '. .4.Disj6usWSystem at No .............. Street as shown on the application for Disposal Works Construction Permit No.-- •------•-------•------------------------------------- ----- DATE..........- •----� Board of Health -••--- -•---==------------••----...-------------•--•---- FORM 1255 A. M. SULKIN, INC., BOSTON TOWN OF BARNSTABLE LOCATION t�_ eov SEWAGE # 8)0t-5k"-( VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME em PHONE NO. �k\0(,C'T COAJ r CQ- 'O SEPTIC TANK CAPACITY k,_pi�_o LEACHING FACILITY:(tgpe) (size) 1, Lrt.'-J NO. OF BEDR(70MSPRIVATE WELL t�PU13 L CWATE _ BUILDER OR OWNER. 'I` n— N Ek S DATE PERMIT ISSUED: U DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes - No I 70A �b�61 SECTION - SEWAGE. lam.;►: ���. - SEPTIC TANK - - "D"BOX - - LEACH I \ Z \ j c_�� �•_J TOP OF FDN_ . . . . .. (MSL)* r 2..OF BTO h" \ r•� .. r a••� 10 a-LEJ -�\ WASHED STONE IN OUT• IN C. OUT• IN• ..Z.t"� STAN EPTIK ? ELEV. ELEV. ELEV. ELEV. ' ELEV. ELEV. WASHED STONE TEST HOLE LOG TEST BY ��`�kcnZ tr` C= TEST DATE - t -a`} WITNESS DESIGN BEDROOM HOUSE T.H. T.H. 2 1 NO DISPOSER ELEV.6,A �) ELEV. 0o 6 PERC RATE G MIN/IN. DISPOSER �• FLOW RATE 33,J(GAL./DAY) SEPTIC TANK 3'>� 4 h _ REO'D SEPTIC TANK SIZE a`'"'� P / / �'`' ' ___-�•- C LEACH FACILITY SIDE WALL )r� g(� .� 1 = 4-I l . G/D. BOTTOM IC>Z `r�4 - lr3 _+1 o) G/D. ep y �7 TOTAL _ USE: LEACHING PST DrP` �\9 �� _ 5� ► �4 iD �d WATER ENCOUNTERED \ �. 6 NOTES: (UNLESS OTHERWISE NOTED) + _ �' •.•.,I 1.DATUM (MSL)-TAKEN FROM.........................................QUADRANGLE MAP 2.MUNICIPAL WATER... ...............AVAILABLE \ 3.PIPE PITCH: 14"PER FOOT y�r ~� \ G 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO \ •44 -- ---O DISTANCE AS CERTIFIED /' . � 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. � + 44, rF't:`y Ff" r3V� 6. PIPE JOINTS SHALL BE MADE WATER TIGHT ` tr .I '�� -'••'� .` �� "' �---�' -- SITE PLAN 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. L.•'. �.�>•;,4. ��}'' '• �t'C \• \ STATE ENVIRONMENTAL CODE TITLE 5 t ~" LOCUS: :-.A ' ' q OF SSIONAL thGI}bEEp REF: L<n: � 3K ? t°. �`�*�"� L1�•Y+[ � � ` 'f` ;',,� t c �oc✓n c�r�@ engineering PREPARED FOR: KA2Ct� �Itiw3ltel CIVIL 'ENGINEERS LAND SURVEYORS REG.LAND StJRVEYOR- l 11 = �/ BOARD OF HEALTH J 9n SCALE- -DATE ` x CONTOURS (EXISTING).._-•--...... APPROVED QAQNS TAF3�.EnnA 1 tn�.—�"'- ..tom '� (PROPOSED)-0--0--0-O- ' ti ASSESSORS MAP: _--- ;57 TEST HOLE LOGS NOTM: ,.----~~ PARCEL -�'- FLOOD ZONE SOIL EVALUATOR : \/I dzz)� /VO�---- pl._/�� � 1 The installation shall comply with Title V and Town of l�E Board of - _ WITNESS : ) PY n REFERENCE: �&^t4--/ P✓1�' 'P'� 8 .__. DATE:. .A L _ 4 2C31 Health Regulations. 2) The installer shall verify the location of utilities, sewer inverts and septic PERCOLAT ON RATE � 2 /YJI� / ._�___d components prior to installation and setting base elevations. 3) CA11 gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.The first TH- I TH 2 two feet out of the d-box to the leaching shall be level bwi-tia� 4) This plan is not to be utilized for property line determination nor any other LAI$ 12 �o I G> purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 64-4 L44LILA Y2 b►k�a,h� lo" 6 Parking shall not be constructed over H 10 septic components. 1 iLb w t 10, 1 L, ` jp ; 7) The property is bounded by Property corners and property lines. , LOCATION MAP U w 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt / v of payment f r the plan and installation based on the plan shall be deemed approval ofthe design Sow by the owner. " --,. ---- -- 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. / 10 I t�� _trio w . !. ' �?' :�`'` Z- 10)System components to be 10 fleet from water line. Sewer limes crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if f '✓- ---� - applicable. The proposed SAS is being installed below the water service SEPT I C SYSTEM DES I GN line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the �{ to .,._.._; FLOW ESTIMATE , , owner to ensure such. M 112)The installer is to take caution in excavation around the gas line if such BEDROOMS AT lib GAL/DAY/BEDROOM -Z�5CbAL/DAY exists. 2 —' 13)The installer shall verify the location,quantity and elevation of the sewer b SEPTIC TANK lines exiting the dwelling prior to the installation / - ?j34GAL/DAY x 2 DAYS GAL t- / �Vl USE ICOO GALLON SEPTIC TANK (, X-lei 11 � SOIL Al�iSORPT I ON SYSTEMH-zD AV-:5 AQe* sp uw rr& W/ U SIDE AREA: 7- 29 11, /65 > ` BOTTOM AREA: 1 1 p "� ^ z ! 4� � a 1 h 011 1 (; SYSTEM SECTION w 2 : �yQ i • ' i C D-BOX (� o q ¢ j o r 1�0 GAL 0.3 IL 7,55 i 0 ► SITE AND SEWAGE PLAN LOCATION UipW D �1 } MIA PREPARED FOR : )U �— UJ o � J SCALE: a DAV I D B . MASON ", DATE: 2 o DBC ENVIRONMEN�'AL DESIGNS J EAST SANDWICH . MA W DATE HEALTH AGENT ( SOS ) 333- 2 1 77 3 W 2