HomeMy WebLinkAbout0268 WINDING COVE ROAD - Health 268 Winding Cove Road, Mars! .ns Mills
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TOWN OF BARNSTABLE
LOCATION SEWAGE# ,201/ • 3G I
"VILLAGE ('c'�.M;I�S ASSESSOR'S MAP&PARCEL .5 47• N3
INSTALLER'S NAME&PHONE NO. B s B EX Ca y w);oN N77.OG$3
SEPTIC TANK CAPACITY 1600 9a6
LEACHING FACILITY:(type) 2 TeencJ c s (size). 2 x 3 x 3 Z
NO.OF BEDROOMS
OWNER(Z ar 4:^('�ac Nc a I to
PERMIT DATE: 1 D•2 q-I 1 COMPLIANCE DATE:/Q• Z S - f f
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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No. y } ' ' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplicatton for Miopoal *p5tem Couttruction Permit
Application for a Permit to Construct( ) Repair(-1-11'U'pgrade( ) Abandon O ❑Complete System ❑Individual Components
Location Address or Lot No. 2-�b w//'1 j)1 N(j j�pV e eD Ow s Na Address,and Tel.No. -fog --7 7 G -t&3L
tie le -
Assessor's Map/Parcel 5 4 rs�n S /!'S �/�r rid I(I e/o(,4e aD
In"ler' a Address,and el.No. J 09 LO 7-d -' 3 Desi 3er's Name,Address and Tel.No. S�Q�(3 3-Z.17 7
MY XC G VCLrIOr�T . D8 C 7n�r�o n mce-Ja
e2L 1�-- rD re.S 14411
Type of Building: 2
Dwelling No.of Bedrooms V Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) L�3 0 gpd Design flow provided 3 q C) gpd
Plan Date /a Number of sheets Revision Date
Title
Size of Septic Tank �Jrf7D Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date f O -LL(—(
Application Disapproved by: Date
for the following reasons
Permit No. ac)1 1 —3 6 Date Issued /G
E
No. y _ s� Fee
THE=OOMMONWEALTH OF MASSACH$1SC-rTT°S Entered in computes
z•
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Z IP
plication for Diooal *p$tem' (Cougtruction Permit
Application for a Permit to Construct( ) Repair(Upgrade( do Abann( ) ❑ El System Individual Components
2 Location Address or Lot No. R w i n o I 1 t6 (UV e i/D Ow e'r's Name,Address,and Tel.No. S(, -7 ] 6 - �(� 3 4
�1�►rs fvn tit�l� s � ,V ee- lP y /
Assessor's Map/Parcel a 6 � t)o t:)Cl l r`) l U U(2
e
Installer' a e,Address,and Tel.No. J 09 q 7'- (�(j� Designer's Name,Address and Tel.No. .50 9 9'3 3 217 7
�i xc n va f Iu�
lkj Teab U L - .�v Cq-
Type of Building: 2
Dwelling No.of Bedrooms �.J Lot Size sq. ft. Garbage Grinder ( ;I
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures f
Design Flow(min.required) �3 U �,gpd Design flow provided LID gpd
Plan Date 0 Number of sheets / Revision Date
Title Si f �7.0 LL1 )Q a
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature
e of Repairs or Alterations
(Answer when applicable)
Ili
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date /0
Application Disapproved by: Date
for the following reasons
Permit No. `3 6 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of,compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( )
Abandoned( )by
I /)
at 2 6 J ( ( ( r, (-)V e- C�ed has been constructed in accordance
with the provisions of Title 5 and thdlfor Disposal System Construction Permit No.o2-0/(-" 3 6 1 dated I0
Installer��[� !� ( �l \/ Designer 1 )BL��\/( r CJ m`C]t �Cc
#bedrooms \3 Approved design flow 3 3 U gpd
The issuance of this permit shall not be construed as a guarantee that the systemtawil�l fune'honyas designed.
Date kol i�! 1� Inspector
————————_— _ — ——————————————————
No. G� � � Fee J (�—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
'tgpo!5a1 6p5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair
/(\ Upgrade ( ) ,Abandon ( )
System located at Eo ' � i r 7�� i (1(', ( l� U 20 )LA • AA i i
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date to
Approved by
Town of Barnstable
Regulatory Services
ti
Thomas F. Geiler,Director
WWSTAMAM Public Health Division
ArEp���s Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 101201 Sewage Permit# 2C 11' &o l Assessor's Map/Parcel 51-`f 3
Installer &Designer Certification Form
Designer: DT3 C F ng I ron me:nta.! Installer: --8t•8 f 1CCU vct, [,Cn
Address: So n6_ej__)1c�h Address: 1 y TeQbe. �y Lc�.rt1L
5ag-, 33-Z.1_11 nr�str .� lA
On 10.Z 4-1 1 St-T3 E,(C_aq was issued a permit to install a
(date) (installer)
septic system at W i nd i n based on a design drawn by
(addre )
QV p �'IA SO r1 dated- 1 p 1 1?I 1
(designer)
JI certify that the septic system referenced above was installed substantial) according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory. l7 00X M0 V ED 'M GENTLE OF T2E"Gr(
1 certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local R.- '-tions. Plan revision or
certified as-built by designer to follow. Stripout (if rP- --cted and the soils
were found satisfactory. _ OF MqS
DAVID 9�y
B.
(Installer's Si ature) MASON
9 No.1066
SST
A � I
D s 's. igna re) .
P EASE RETURN TO BARNSTABLE.PUBL._
OF COMPLIANCE WILL NOT BE ISSUED UN-ill, BUM ti 1 tin YORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
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October 2011 560 F4.M n Avenue
swu 403
Proposed First Floor Plan h-7 617367.964618
617.367.9253
Scale:I/4"=I'-0" �.eeumo°eeely.�
MacNeel Residence Eck MacNeely Architects inc.
Cape Cod,Massa oserts Archi,—,e Interior Design CnnerrucpnnM°nagenr.nr.
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GARAGE
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SCALE: 1/4' 1'-0'
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SW.Existing First Floor Bamn,Mn617.367.96 MI18
Yh",u: 617.367.'M96
Scale:3/I6"=F-O" Fm..ec,wn dYmm3 1,
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Cape Cod,Massachusetts ArchUeci— Evertor Design Conarrveuon M—ge—
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MacNeely Residence Eck MaeNeely Architects inc.
Cape Cod,Mvsac usett6 Arehiwr Awl—D'ig. Coavrni<rhin Mmmxemw
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Mudroom/Half Bath Construction
**** Floor construction 2 x 16" oc
**** Wall construction 2 x 4 16" oc
❖ Ceiling construction existing 2 x 6 16"oc
❖ R10 rigid insulation in floor
❖ R15 Batts in new wall
❖ R30 batts in ceiling
❖ 2 0 min fire rated door
❖ 5/8" firecode sheetrock throughout garage
Town of Barnstable P# 7
�pl Department of Regulatory Services
. RAMSr,,eM: Public Health Division Date D //
p
200 Main Street,Hyannis MA 02601
�01Ep mob
Date Scheduled /0 G �C' Time Fee Pd. /0 1 �d
TSoil Suitability Asses ent for Sewage Disposal
Perform 'ed By. /V I� �L�N Witnessed By7
7, O��(C,/ye'I.T'IO'Nf&GENERAL INFORMATION
Location Address ` " -''r^I��'Y� `-„'V C_ Owner's Name
M#) Address l(\ /►/J (�(1r,�- /
Assessor's Map/Parcel: �?I'y 3 Engineer's Name
NEW CONSTRUCTION REPAIR y/ Telephone<500 —rb l
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body It Possible Wet Area It Drinking Water Well ft
1
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of�e�xact cations t holes&perc tests,locate wetlands in proximity to holes)
2
VV
l
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
yl, PERCOLATION TEST Date Time
Observation {!
Hole# Time at 9"
Depth of Perc I Time at 6"
Start Pre-soak Time Q AAA Time(9"-6")
End Pre-soak 2 -
Rate MinAnch
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:tSEPTICtPERCFORM.DOC
y,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
L5
l T71.
r2l�j Gv
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
Flood Insurance Rate Man:
Above 500 year flood boundary, No �s I
Within 500 year boundary No r/Yes_
Within 100 year flood boundary No_ Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious nal exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth o naturally occurring pervi material? N
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envir nmental Protection and that the above analysis was perfo ed y me consistent with
the required training,expertise Mpenceescribed in 310 CMR 15.017. /
Signature Zpll Date (j�I`
Q:)S EPTICIPERCFORM.DOC
Town of Barnstable Barnstable
�Py°FSHF T°�y 'car'
Regulatory Services Department 1
• BARNSCABLE, • m
MASS. a, Public Health Division
i63q. .� 2007
rfa MAl a 200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL # 7011 0470 0001 4525 5389
October 4, 2011
Ms. Margaret Freeman
%Martin O. MacNeely
268 Winding Cove Road
Marston Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 268 Winding Cove Rd.,Marstons Mills,MA was last
inspected on 6/20/11,by Ricky L. Wright, a certified septic inspector for the Sate of
Massachusetts.
The inspection of the septic system showed that the system"Fails," under the guidelines
of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an
overloaded of clogged SAS.
You are ordered to repair or replace the septic system within One (1) year from the date
you receive this notification.
Failure to repair/replace the septic system with the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
e:;oma McKean, R.S., CHO.
Chairman
Q:\SEPTIC\Letters Septic Inspection Failures\Town of Barnstable.doc
Town of Barnstable Barnstable
p7HF TO
P
Regulatory Services Department j mica My
+ BAR AS
t1 BLE, : Public Health Division
9 S. � m
�'ArFn 1:6MA.t 6", 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 _ Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7011 0470 0001 4525 7574
August 08, 2011
Margaret Freeman
268 Winding Cove Road
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at, 268 Winding Cove Road, Marstons Mills, MA. was last
inspected on 6/20/2011 by Ricky L. Wright, certified septic inspector for the State of
Massachusetts.
According to the private septic system inspector, the system "Fails" due to the following:
• Static Liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS.
You are ordered to repair or replace the septic system within One (1) Year from the date-
you receive this notification.
Failure to repair/replace the septic system within the deadline period may result in future
enforcement action
PER ORDER OF THE BOARD OF HEALTH
Womas McKean, R.�., CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms / I
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Ricky L. Wright
use the return Name of Inspector
key.
B & B Excavation, Inc.
r� Company Name
14 Teaberry Lane
Company Address f
Sandwich MA 02563
City/Town State Zip Code
508-477-0653 S14595
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 ®Falls �- CID
a .t
❑ Needs Further Evaluation by the Local Approving Authority w
6/20/11
EJ`)
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving AujDorityRoard
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•09108 Title 5 Official Inspection Form:Subsurface S age Disposal System•Page 1 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is Marston Mills Ma 02648 6/20/11
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ 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 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
informatics is required for every Marston Mills Ma 02648 6/20/11
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
I -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. CitylTown 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 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
® El Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or,cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
!Sins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
268 Winding Cove Road
M
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Citylrown 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 5 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
° 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
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? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ® Yes ❑ No
Water meter readings, if available last 2 ears usage n/a
9 ( Y 9 (gPd))�
Detail
Sump pump? ❑ Yes ® No
Last date of occupancy: 2009
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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is
required for every Marston Mifls Ma 02648 6/20/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
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
0 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•09/08 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
tiM 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is
required for every Marston Mills Ma 02648 6/20/11
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,date installed (if known)and source of information:
10/11/84
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >20feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good shape no signs of leakage or blocks e
Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 5.2x5.2x8.6
Sludge depth: 611
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth
t of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
32"
Scum thickness no scum
Distance from top of scum to top of outlet tee or baffle no scum
Distance from bottom of scum to bottom of outlet tee or baffle no scum
How were dimensions determined? scour stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection tank appeared to be leaking. Water level was 3.5 feet below invert.There was
also staining and signs of solids over the invert which are signs of hydraulic failure at one time due to
i
clogged S.A.S.
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
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
l
Commonwealth of Massachusetts
4 v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Citylrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
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 time of inspection d-box showed sign of leakage and solid carryover.
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
At time of inspection leaching showed sign of staining above invert due to clogged S.A.S.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Cityfrown 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is
required 'or every Marston Mills Ma 02648 6%20/11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
AZ= 36 '
A3 = 5 7' U
�N rN i; CovedoOct
9
t5ins•09/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
• ' Commonwealth of Massachusetts
G Title 5 Official Inspection Form
• Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: >12feet
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: 10/11/84
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:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
' Commonwealth of Massachusetts
M . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 268 Winding Cove Road
Property Address
Margaret Freemen
Owner Owner's Name
information is required for every Marston Mills Ma 02648 6/20/11
page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System.either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
T� Y"
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me PO Box2 h9 e � x
x Teatrcket 025fi
SUBSUliFACE SEWAGE-DISP:OSAL SYSTEM•INSPECTIO.N
RARTA t = s
�� , a C:ERTIFI;CATION ' � "'� •'" _ ��
} r 0-CT T' 199n ,
Propert+�i4ddress ?6&:WlndingCoveRd MarstonMlUs b Address of,Owner
71
-
torou9a (if different) f F
'Date of Inspection:
Name f I onspectorhn Jo Grad freeman r +
Company Name,Address and Telephone Number ;.4 k f ," u>^ � ,
.41:
CERTIFICATION STATEMENT
I'certifythat I have personally inspected the sewage disposal system'at this address and that the Informs#Ion reported below,is true. accurate
and complete'as of the time of.,Inspection The inspection was.penormed based on my training and experienc !in.the proper function
maintenance of.on-site sewage disposal systems. the system,
x Passes
Conditionally Passes
Needs Further Evaluation By the Local-Approving Authority
Falls
_. 1
lnspectol's"Signature: i`Y� Date; 1011196`
The System Inspector shall submit a copy of this inspection report to the Approving Authority,within thirty(30)days of completing this
inspections. 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 Department:of;Environmental-Protection..
The original should be sent to the system owner and:copies sent to the buyer. if applicable and the approving_authorlty.
INSPECTION SUMMARY:
Check A,8.C. or D..
A] SYSTEM PASSES:
x I have not found any information which indicates.that the system violates any of the failure.critena `
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below:_
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be"replaced or repaired. The system,upon completion ;
of the replacement or repair, passes inspection..
Indicate yes,,no,or not determined(Y, N, or.ND). Describe basis of determination in all instances If "not determined", explain why,not.)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiitration, or tank failure is
imminent. The system will pass inspection if the existing,septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115/95) .
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500_
1. ,
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itERT4FICATION (c.otltlnued�
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Pro•e,y d] -ss
_ s -
out or hi hatatic water lev_e,l observed p theydistnbut�on box i hed BO°d of'Health)1„
saewage.backup.orbreak g_. rovalaf;
temr wiII "ass insp.ection.rf'{with app
} x broken pipes)are replaced r
obst'rucUon is removed
t ' y
distribution boxis leveled
The system required pumping
more than four times a year due to broken or^obstructed pipes) The ^A
system vaill pass inspection if(with approval of the Board of Health) F '
broken pipes)are replaced
d..
s
'obstruction:is removed $ #
}
C] FURTHE!R EVALUATION IS REQUIRED.13Y THE BOARD O.F HEALTH y ,,
a a
Conditions exist which require further evaluation by the Boefd.of Health.in orderf to determine if the
System is failing to protect the public health,safety and the environment:
SYSTEM
T TH
1) SYSTEM WILL PASS UNLESS ALTH DENBOARD OF HEER WH CH WILL PROTECTTERNES
MTIHE PUBLC HEALTH ANDIS
NOT F.UNCTI,ONING IN A MAN
SAFETY AND .THE ENVIRONMENT:`
Cesspool or pnvy 5 within 50 feet of a surface water..
Cesspool or pnvy is ithin'.50 feet of a bordering vegetated wetland or a salt marsh. '-
' TEM WILL FAIL:UNLE.S$THE BOARD OF HEALTH (AND PUB ECT THTE PUBLIC H ALTH AND SAFETYER-SUPPLIER, IF APPROPRIA' EAN DETERMINES
2) SYSTEM . -.
THAT THE SYSTEM-IS"FUNCTIO'NING IN A'MANNER THAT P
ENVIRONMENT
_ The:system has,a septic,tank and soil.absorption system and is within 100 feet to a
surface of.water supply or tributaryao a surface water supply.
The systenhas a septic tank and soil absorption system and,is within a Zone 1 of a public water
-- Supply well.
_ The system has a septic tank and soil absorption system and is within 50 feetof a private water
supply Weil.`
The system has a septic tank and soil absorption sysf o mabacteria volatile.o garoc compounds ndicates that the Se is,
water supply well, unless a well water analysis far cols
free from pollution for thatfaclity.and the presence of ammonia nitrogen and;nitrate nitrogen is equal or less than pp
M.
3) . OTHER
D] SYSTEM FAILS:
ng failure
have determined that the systemfor his determ nation s identified beloefine
follow violates one or more of thew. The Board of Health should be
31,0 CMR 15.303. The basis
contacted to determine what,will be necessary to correct the failure.
_ Backup of'sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.. -
SAS is in hydraulic failure:
(revised 11115195)
r -
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OF
Property Address ZfrBUdlndingCoveRd�MarstomMills ` -* 7 ^
L ids
S*!3 E FAILS(can:ttnuad7 m ,;•#
r ,{
r'h --s- Staticasquld 1ev„el in the:.distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . !
Liquid depth mcesspool is less than 6 'below inuert or.available:'volume is less than 1/2 day flow;
Required ptimping more than,4 times iriahe last year AIOT due to:clagged or,obstructed pipes)
Numbers of times pumped!1'
" Any'portion of the Soil Absorption System cesspool or privy is below the-high groundwater elevation
_ Any portion of a:ce'sspooI or privy is within 100ifeet of a surface water supply or tributary to a surface wafer supply.
s
Any portion of cesspool or privy is within a Zone 1 of a public,well +
_ Any portion of a cesspool or privy is within 50 feet of apnvate eater supply Nell.;;
Any-portion of a cesspool or privy is-tess than 100 feet;but greater than 50 feet f[om a private water supply well:with no {
acceptable water quality analysis ' If.the�well`has been'analy=ed to be acceptable:attach copy of well water analysis for
coliform bacteria,volatile organic-compounds,:ammonia nitrogen and nitrate nitrogen
E] L'ARGE SYSTEM FAILS:;.,:
The following criteria apply to large systems in addition to the criteria
The system serves a facility with a design flow of 10:000 gpd or greater(Large System)and the system is a significant.threat to ,
public health and safety and the environment because one or more of.the ':following conditions exist:
the system is within 400 feet of;a.surface drinking water supply
the system is within 200 feet'of-"a tributary to a surface.drinl.ing'.water. supply
the.system'is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA)or a mapped Zone.11 of a
public water supply well]
The owner or operator of any such system-shall bring the,s ystemand facility into fulV compliance with the groundwater treatment program"
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional,office of the Department for further:information:
(revised 11115195)
3::
•,
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�� �'�'r'�' �"'� �` -�=�- S.tl$SURFP;GE SEWAGE:DISPOSAL SYS+TEM tNSPECT10fJ FORM
,. - .at `� t e "".-"'—"�^a -ram.•• �` �
400 002 1 N,
R1
Property Address 268 WlndingiCove Rd Marston Mills
r Freeman L --
Owner_
p 14101196
4 :
gi;in
�:t}eCt�lf3ttle OWing _ —� y e
� Y
fo�mation was*requestedof t#ie.awner occupant and Board of Health y M•s$ _ ;�
y irs '_' 3•a, .f -r
X None of the system components have been pumped+for at Least two,'weeks and the and the system has been recewmg normal
faow rates'during>that period Large volumes of water have not been'introduced into the system recently or as.part of this
inspections'
X As built=plans have been obtained and examined Note if they are not available with N/A ;
b
X The facility or dwelUng was inspected for signs of'sewage`back up r`
X .:The system does not receive non §anitary,or industrial waste flow
e
X The.site was inspected foraigns-of,breakout
J ;
X All-system components ecluding the S oil:Absorption System have been':located onthe site:
X The septic tank manholeswere uncovered,opened and the interior of the septic tank was inspected .
q of sludge,4depth of scum.'
for condition of baffles or tees, material of construction;dimensions, depth of h uid;depth
x The size:and_location of tfie Soil'Absorption System on the'site has been determined_based on existing information or
approximated by non-intrusive,methods,
x ..The facility owner(and occupants;if different fromowner)wfere provided=with information on the proper maintenance of Sub-
Surface Disposal System:,
I
(revised 11115195).
4
e
e
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a SnJB_5t7FiFkCE SEW—G DISPOSA SYST.E—.INSPECTION-FORM
i
Property Attdcess 258Yvmding Gave Rd MarstonRMius
Owner; - EFeeman
� .`RESIDENTIAL��
Number o7 current residents 2"
-Garbage grinder(-yes;or no)
d t
Na
Laundry connecteo system(yes or no) Yes
: Seasonal use(yes or no) No'` - :r
=Water meter readings,if available. Na
Last-date.of occupancy: n!a 3 s
,,.
z
COMMERCIAL/INDUSTRIAL.
Type.of establishment`.'Na
Design flows 0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present;'(yes.or`no)
Non-sanitary. waste discharged to_the Title 5system (yes or no.)=Na
Water meter readings, if available n!a'
Lastdate.of occupancy; nla -
OTHER`(Describe)-nia
Last.date of occupancy:
GENERAL.IN:FORMATIQN
PUM
PING
P ING RECO
RDS
DS andso
urce of information
i two ears.
d in the last - .
' stem has not been pumpe. . y '
System pumped as part of inspection: (yes'or.no)Yes':
If yes,volume pumped: 1800 _ gallons
-Reason for pumping:.Maintenance,
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)-Of yes, attach previous inspection records, if any)
Other.(explain)
APPROXIMATE AGE of"ail components,date installed(if known)and source information:
Sewage odors detected when arriving at the site:(yes or no)''C?
(revised 11115195)
5
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.lk'.+.�`+�+i�- '""" -� r i. .• � J,w „wr s�� � Cl � 3 -�r�"�.4r� y �vt *ri.?'�' nv'°��;d.
,.,<, c' ✓"` > � y.x. �,-:'s F .. � 7 �..`Yc^ ,.,,.--r, � � h b �. :7""r""c. r 5 e. _"_.._,y^M_"-.
..... FORMS f... .+� •�x ,
ems.....
M r 4
... _ _ .
a_ Property-Addr.ess 2680l6di69CoveRd;MarstonMills
OWtler:: Freeman ¢r'
oca sitelpl ¢
Depth below grade x '
Material of construction x concreate »metal FRP other(explain)
AW
L 8'B• H 5'7"W 4'1tl"
Dimensions: ;
Sludge depth;.1A
Distance from top of sludge to.'bottom of outlet tee or baffle
Scum-.thickness 7
:i Distance,from top of scum to top of outlet tee:or baffle:4
Distance form bottom of scum.to bottom of outlet tee or baffle 1:3
-
4
1
Comments . ;
(recommendation for pumping, condrilon of nletand outlet tees or baffles depth-ofi ligwdael ev imrelatiori to outlet invert structural;'integrity,
evidence of leakage;etc.)
Septic tank and all components are structurally souridAecommend pumping•system every year for maintenance.
GREASE TRAP:
(locate on site plan) i
Depth below grade; Ne z
Material of'construction: ._concrete metal FIR P_other(explain)
Dimensions: nla. :r
Scum thickness:n1a
Distance from top of Sic to top of outlet tee or baffle:n1a
Distance from bottom of.scum to bottom of outlet tee or baffle:'nfa -
Comments: :
(recommendation for pumping,.condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert,structural integnty;
evidence of leakage, etc.)
Na
(revised 11f15195)
'-' -S v T•�a.
�,yru-.'l`i'.v.� .-.. oe. `""�, .�-.�-.w,,.�`ek :'"`v` ,�; � 3r-t--.•,_ter`.�..'q�d_g,� � `�,y'g"�� ',�,t-...-s ems. r� -� � ,��"-,.
r -
} r♦1` �,� �. Y 2 r Y : +, Aft
—`~ T-T 4 SUT3lltF' PQSAL 5`GSTEM INSPECTIC?N:FORPA {
�:.,- .....:- ,--.• ,. .' ...r`" may .. . r.
-rProperty Add re`ss Z6a';Windingrcove Rd Marston IYiills y - Y
-`Owner:.- Freeman`_.. --
e gRTSpSpti o n
Vt
;TIGHT ORrhlt7L'DING TANIZ
aeo s4
777
;� .Material of eonstructiort<_conere#e metal FR,P other(explain) 'k
—Tensions:
Capacity Na . gallons
Design flow n1a gallons/day;"
-',Alarm-level: n16
Comments
{condition of inlet tee,conditio6 of alarm and'flo`at switches etc)
5:
D#STR#BUTTON BOX:.X
(locate on site plan)
:
s -
'Depth_of"liquid level above outlet invert: L1461d level with bottom of pipg
Comments:
,note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
D-box is strueturaity sound.
PUMP"CHAMBER:
(locate on site plan)
Pumps in working order;(yes or no
Comments:
(note condition of pump chamber,condition of:pumps and appurtenances, etc:)
Na
-�-K'-a'� -�. � 7 *-�-_.s" "__2�'r'"'.� _r``..T�s 3� �:� r ,e-,�_ ='mow"y��=�:'' ;•"s"' ����., ,.,... �-s.
s.—�'.�*.w�"'.'^"°,"'�a"' ,. _:-' r:x:'*% _ '^',ra'r""rn..�.'..,. _�su!ur:� s.- xr-��ea`!`.'.•aw. +r mrr�,..- 5 ,:"�". �•
..... ',k
*r'�"'iS�=��"'+i':.'; ._'.'!`,__^.. .r,. ,,�^"_ .- _. .. ._.. r'e -,rt .�..:: ,.- �: n,.,:.,, � Y u r•�a- .� .+y--`;
DtS � YT10T1
-
W
_ 3
nu
.h
t. Property�4ddress 368 Wlnding'Cove Rd.MarstomMllls d __
mo - _ � _
Ng
2
--S�ILA" BSO PTIQN Slt+S<TEAIb;(SAS}
_ffiFtn itexQlain � n
nda
� Type..
- leaching pits; number: t aao gallon teach pit_
leashing'chambers 'number:n!a g
leaching galleries,-,number: rila A
leaching trenches number, length. nla
lea.z ing.fields nutn.er dimensions.
overflow cesspool,:number nra,
ents..{note condition of soil signs�of hydraulic failure level of ponding condition of-vegetat on-
Commetc
The Leach pit v as 34 full at time of the inpection It is structurally sound..
z.
CESSPOOLS:
(locate on'site plan) ; 3 r'
Number and configuration n!a
Depth-top of liquid to inlet-invert; n!a
Depth of solids layer:
Depth of scum layer: n!a
Dimensions of cesspool: n!a
t=
Materials of construction n!a
Indication of groundwater: n!a
inflow(cesspool must be pumped as part ohnspection)_
rda
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.-)
Na
PRIVY:'
(locate on site plan)
Materials of onstruction: n1a Dimensions: rila
Depth of solids: n!a
Comments:(note condition of,soil, signs of hydraulic failure, level of,ponding, condition of vegetation, etc.)
PrivyComments
.--.._'�-•--•--_�'"•---•aa- .•b..s�,:--�....,� -� � --"'ten ...�r.^.�R::«..sc. ^,sue ��— :,..L�,..�,
"ih+.ywi^^,:`c._ _.--_.rn'o �'."a'�.�'�'e,,,,,"`*"t^�-Jcn�'�...--+^^'� _ - _ - ^t^'� : :rw1,n:•....,,�.;+; 1^�u-�!:m„'.i—�'. -w--.-.+i;�` ._r� «ems,.. . ��� ._
_
� �, ,..� ��-�s-..., � +. �-.- -' --'..c'+-sue.- -."" a'"'Tr � ,����.�'-••yr`-^�"K' r7t--^+h'�..v-� FR-:.
-^3" 4��-a..-.• `h.� fie'- ';f' %, •a-
="'e=�� ,.._ �.. 3 3.4- „ is. .y.s� a `� � PX1RT C >�. ti ��. �-4-•';.at�s �t�'-- "��` -
-
-- w r CVCTFpIIN€ 141AIikN{C�ocitlt1119d� k - _ a x
u
. --'- �'4W8={�z-M�FSEOELMIIIS
Owner s reF eman L r
_ mate of Inspectron.1DIU1198
_� - _ - bISP0�,4L-''=S-Y'wTEPA�.=- � � ,��s„ - �"f -�-•,;-r -
t -
_ y
".�,?� Wiz. �'.. .� rt .� � , r �..,-.� .� �-.ems.. ,� ,,.-:.a% a -�+,t � �Y� -r..•-.w-,...--�-e "t'�' - ,�Y.�--
.e..-.=,�..._..--•-•-'--".---•--„ mow- -'f r:a� c� �<a5� z f•.; - - -�.-s.
Y � d
v?_
1 11 I v
`h\ 5
�,+r ,
_- DEPTH TO GROUNDWATER
_ 459 ,-
��p�21-0 QfOUrIf�W8t66: 12 � fEP�,� rV-%� ' r ; `a'� ;.�,�. � �:."� •.- _ r�' _
method of determination or'appro�i
u n.
lSGS Maps and,Charts,
�.- `
n
a, _ � �1- pw,•ez�=c — «,ram- ,..: crs� _ l,,rt ,s..
_--Vc- _ '. � r _ �� �_ ���r+x_� .-...tea-+�� �--_-•- .° � -"Z' ,.+tR .
�€x�—-m^ c�-=.�-...+.a-•�`->=t"ct.-s:� �-'�_ .r,T •.s, sv 7rraa.".r� .ht.,s �.,xcn'�`Q'----.-:3
>''?z�4•�-- �_-' -'�-- �-`-.,�-.r`t ._ `� _ � "2 � ...",� :_..._. � -fir_
�-^�v�^"avy. '�a r�xz-q y-.�..� �`% ,,.::. �n -`t �' ,'.'�l'�-�r.^ -�"s. -. ' � c...'.��ss�"""� �`� 'f•'�'fi _'��si`�:
0.5 7 - o 4-3 1✓
LOCATION SEWAGE PERMIT NO.
`a-e6
VILLAGE ti� rD�N � C®tee 04) .
INSTALLER'S NAME A ADDRESS
nOS T .
R U I L D E R OR OWNER
T, v 1 12H ►Z lopoloK
DATE PERMIT ISSUED � 14194
DATE COMPLIANCE ISSUED
LOT NO. : ADDRESS :_ ��,�:,�� A
OIJNERS NMIE :
SEWAGE PERMIT NO. : �' I NEW: �-1 -REPAIR:
DATE ISSUED:_ DATE INSTALLED:,/0-14`- F ,
T_r]STALLERS NAME:INSTALLATION OF:
WATER TABLE : FI.NA.L INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE :
I JNe�
y1.a� i 06--
r
it
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........, tC W.LJ............OF......���*i .►�1.s.T. .V�L'1 ............................
Appliratiun for Disposal Works Tonstrttrtiun Prrutit
Application is hereby made for a Permit to Construct (k-11"or Repair ( ) an Individual Sewage Disposal
System at:
--....» 11�.?r1111 - _..... �tT....----•- -----____ -... -
Location-Address -or Lot No. -- -- ----
9-
p� A.iZ
� S C+��eL ress �� .............
r Ads _.._...
a ELL a) Tt S`��,,.c71 ni 7—T W 1 L.L1�rns 1Zp w LY,v ja L\rnu.,?lk rn..........................................................................._._..........._..._.... .........._____.___..___..__..:..._._..___I......................................
Installer Address
Type of Building Size Lot---`Z4._t!Z. __...Sq. feet
�-. Dwelling—No. of Bedrooms...... ...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ....................._....... No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures -------------••--------..._._._...------....------•--•-------------•----.._..---•-•-••-•--•--........._.._•--•.......--••-_..
W Design Flow....................... ....__"gallons per person per day. Total daily flow.......... ................gallons.
WSeptic Tank—Liquid capacity_[O.O(Iallons Length.....S...... Width:__._...__ Diameter________________ Depth...q!A _.
x Disposal Trench—No_______ ________ Width.,____ti..--.----_.. Total Length.•_-__...__..�.__.. Total leaching area--------------------sq. ft.
3 Seepage Pit No.....A-------------- Diameter____.___....... Depth below inlet_.__.!c ....._... Total leaching area..20!;;�._.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by......
.i. .l ..: 1 ..�:.i......__-------------_ Date..... /1k-/'�_Cj........
Test Pit No. 1._!!�. __minutes per inch Depth of Test Pit_..I_'.Z,........ Depth to ground water________________________
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..........................
0 Description of Soil....._•__.-___-____::!�_.-..... oq - --5 4? ._ �.t__
p 1.:::.: ._. - :........... -e �.v;
W .................................•---._..........._..........------......--.-.----------•-----------------------.__...-----•-------------...---....._....••••••--._....... ••..........-••.•-••_...
-------------------------------------------------------------------------------------------••-----•-----------------------•--=-------•-----....----•-----•-•--------._..__...-••-•-••••.._.............
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
..................................................... -.....•-•...........................•......•-------•---------------------------•------ ......••----••----•......
.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LITAU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i sued by th board of health.
Signed_. _..t ./_.."kl .. 1 ��_t � U�............... 9A ...
Application Approved By------- = ��= g_...D to.�7 I
U Date
Application Disapproved for the following reasons_______________________________________________________________________________________ ..........._..
--------------•-••------...---------•---------•------•-•-•---._.__ •--....R..
Date
»
Permit No....F!Z..- 7�
.................•-•-••••--•--••--_..... Issued........................................................
Date
r �
No................ ...... FEs...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........1C3W.N............OF......��:A•R 1.�s. A. 1_� .....................
' . , ppiiration for Disposal Works Tonstrudion Frrut tr
Application is hereby made for a Permit to Construct (j,-,j/or Repair ( ) an Individual Sewage Disposal
System at: ,L,, ,,, - f
Location-Address or Lot No.
Wa ,tc �� i+_$�tr •Zs . Or:,w1n�eHr.s + En �.... nncrh®uv v-ira_
................... ................................... E.s
rros Zt 11 Lift Mji2f) , t;;j......... ......... ....••••-•---•... ...--••-............... ..••.. ------------•• ----•-------••----• ----------------------------
...............
Installer Address
Type of Building ' Size Lot._" .4;_..�a z `+�...Sq. feet
U Dwelling—No. of Bedrooms.....:- ?...........................Expansion Attic ( �)�-� Garbage Grinder ( )
p, Other—Type of Building � ............. No. of persons<.:_.....__._.._. \)Showers ( ) — Cafeteria ( )
04 Other fixtures ./
d .....•--......--•-•------•--�--�'---••--------••............•--•-•..............•...........................................
WW Design Flow....................... ...........gallons per person per day.. Total daily flow.........3.3_4..................gallons.
C� Septic Tank—Liquid capacity.11XMiallons Length..... Width_. ........ Diameter................ Depth...`.-:..
Disposal Trench—No. .................... Widthf...... ..... Total Length......._........_.. Total leaching area....................sq. ft.
�
3 Seepage Pit No...............:.... Diameter........._ ..,._.....Depth below inlet...... ......._. Total leaching area.. d._sq. ft.
Z Other Distribution box ( ) Dosing tank`( )1C'..
Percolation Test Results Performed by...... ..t ......A-X-.":f1E__?. ........................... Date..... ....Ln
........
a Test Pit No. L.A..Z .minutes per inch Depth of Test Pit...!.-Z...�-...... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .�f_...... L ...... ......... .........
Description of Soil..........................z t• 1�..... s�_L• •. -.-
W ----------•---•--•--------•-•-- .....-•--......%!. ---------.• ------- -------------•-------..... ------------ ------------------.... --- .......
........
x --••-------------------------------•--------•---•••---•- •------------••••-....._........•------•-•-•---------••-•--••----.....•-••--••--•.................-----•............._..............-•-••.....
UNature of Repairs or Alterations—Answer when applicable...............................:................................................................
4
..-•---•-..._•..........................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i sue Ubythnbo rd of health.
LA Signed.._._.(^. ._._... ♦ I Q tko,,s rS I
'1 Gu .................. ......-- ........... ....
D e
Application Approved By........ -.�� "
Date
Application Disapproved for.the following reasons:................................................................................................................
' •----•--••--••...................•-------....._.....----•-......••..............._._ ..............•-'--------.......•------•--••--...----•......................_....."._-=---- f._'...........�
....
Permit No...Z C/ 71A''......
................................... Issued_..................•••--....-••••-•.••••..Date ••---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..
y ' ' CIrrtif irate of Toutphaurr
THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( '{) or Repaired ( )
by.....14'dr1 •-•C t"I
/r t f Installer ,
at...............•• -`J-..._.....V/,._...?irk. ............------............ -------- ----••-•-•-...---•--••.........•--------.........---•--........----••..............--•-••-•----
has been installed,in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..__��1'.._.7C
................... dated.... ..._r"_`�:. �� ...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. /
1 ' 'i2
....... � Inspector •- ------------- --------••--------••......-•--••-•••---•••...... .
Y THE COMMONWEALTH OF MASSACHUSETTS
x�j.
BOARD OF- HEALTH
. Gk`'!c .....OF..--•--....*AP./rb+S r<14,.,.e �.. da
�!- 7� ........... ........ d
No......................... FzE............ ---..
Mapasal Works Tonstructiort Itrrmit
Permission. is hereby granted__....... GL 1........ham. ..1. .
. -----•----•-. --•-•..._...-•--•-•-•.................................••••.---•-
to Construct ( �) or Repair ( ) an Individual Sewage Disposal System
at No. r `3 ht%k �i - C o
U .. - �J.....
A- Street
as shown on tLle apphcat>on for D'rposal �\orls Construction x Permit No......•............. Dated...
,C ..... �Xt.
4 !t j� f r d .., Board of It
l�
DATE. --....... --- I
-
�d ' EC.:" N �•'SE:WAGE
—SEPTIC.TANK — — "D"Box — � U — LEACH
+ s a TOP OF FDN �.. '
1
,: ���n- (MSt)•►' "2..OF 118TO 4="
WASHED STONE
4 .. . ..
IN• OUT- 1N• OUT• t- --•
`` ♦ SEPTIC \ ��,
t gi7+�• ✓:' l.4Ei'.� nTA'NK \�1+�- d. / \ t � ,d,... .e. ,•�...
-E EV, E'LEV. ELEV. E LEV.4 c.
t ELEV. ELEV. r • $ _i J — #� LC-,T -5
t4 ;5 ( G V ky L U- •L4>•E, l —1-VA A�P3 9� OF�. 1 14. ' �1z
.f `Ll. " "'M• .:M C�V•6ZC'? c�RrA 1�. *JI C_ �tr�V. WASHEOSTONE
Q•, ; •' ' i. i .��' is.�47 • _ ,�..�, ```•_� � �• ,..w,.. �� ^''�"— o _ '\�� ` U� _
l"� TEST BY .� , —•` 4�
TEST Oki S .' WITNESS DESIGN HOUSE �; o N� v Y 4i g
�* { T:H ,# I .T.H. 0 `2 G. �gz 6 Q, �8, 1 `
k4 :. .... r `I,q V 494=' ELEV. �• �,�,,3g• et Y •� �
DISPOSER DISPOSER S nw. ee! ..,•mow �3 ry�� +: rA ii �'
Pe RC RATE z' MIN./IN.
FLOW RATE •33CocGAL./DAY I 33C� n «• y e o. q?.
i 1
MJ•l�lo � .> r _ _ SEPTIC TANK 33o R•S)= •
R.EO'D SEPTIC TANK SIZE ,caoq
LEACH FACILITY
r SIDE WALL
BOTTOM gz 50.3 f S6 G/D,
A- TOTAL ZlJ I •► n
• ." USE: � ►..)s~•- LEACHING �� T_ - �,, � �_ � ���� ��*�'I;;:,, �, ,��, ,rGE��•. :�ai��-'I'.�;• :4r
. _•WATER ENCOUNTERED
• _NOTES:, (UNLESS OTHERWISE NOTED)
" y ',l. DAT0M•(MSL)±-TAKEN FROM Cam? w� _.. QUADRANGLE MAP
I~ s 2.MUNICIPAL WATER _ .. _AVA1tA8LE' a\� aF Mi
2 r 3:PIPE PITCH 44"PER FC'OT
4.QESIGNLOADI:NG,FOR ALL PRE-CAST UNITS:AASHO C.Z•44 . % -
S.MIN.GROUNC?COVER OVER ALL 5EW61GE FACILITIES (1) FT. �ti`� 'f wRl DISTANCE AS CERTIFIEp
o RICW
6:PIPEJOINTS SHALL,"BE MADE WATERTIGHT R. K ;-A SITEPLAN
r7.CON$TRUCTION DETAILS TO BE ACCORDANCE WITH'COMM,OF MASS. a
' '"STATE ENVIRONMENTAL CODE TITLE 5 04
�s ,. LOCUS: �� i (I IJ DI L1C. COdE
'Am
+ EG.P.` f=a3� L�t EER
x - REF: H 1.�} � z'(Z 'F' 4' 'it`:`e
8 F P1atc PSGt��
n
7 down Cdp f f7j ,�e/ld�' PREPARED OR. ��,
CIVIL •.ENGINEERS, — -- !Z Sr•Sil.t t'- +. �C AtZFt'eiv'111 a.{�,
LAND$(JRVEVOR$, -• DREG LAND SURVEYOR
BOARD OF HEALTH• >Il 'main 84. �+ 40# 0�(,,
SCALE
(EXIST:ING)_-•.`.._ _ •- - -
CO.NTOUAS"` APPROVED ._�DATE
'PROPOSED)-O-O<d=0 a MA Y I D w DATE
s
ASSESSORS MAP :
--- T E S T H O L, � LOGS
NOTES:
PARCEL '
�? FLOOD ZONE: SO I L EVALUATOR:'17)400 iF 1) The installation shall comply with Title V and Town of Board of
REFERENCE: W I THE S S : � 1'Dwn'I '4S, Health Regulations.
� C'�/L77F/�� Z DATE: �G7D8t`'�2. � Zol/ 2) The installer shall verify the location of utilities, sewer inverts and septic
PERCOLATION RA1 E: -� ZN'1/
/c., , components prior to installation and setting base elevations.
,�j yJe- \w, 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
' '' " '� � '' two feet out of the d-box to the leaching shall be level.
Q TH- 1 TH-2 4) This plan is not to be utilized for property line determination nor any other
.Lo4�1 " Y> purpose other than the proposed system installation.
i /° i�3 / I a)' �� I 5) All septic components must meet Title V specifications.
6) Parking shall not be constructed over H10 septic components.
�AL4 5 l a �6 8 7) The property is bounded by property corners and property lines.
LOCATION MAP 3� ��� / 13� 8) The property owner shall review design considerations to approve of total
� _ � 3
design flow and number of bedrooms to be considered for design. Receipt
S►�1� of payment for the plan and installation based on the plan shall be deemed
2- 1 - C approval of the design flow 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
k/O� D �� ��� Title V specs.
1 10)System components to be 10 feet from water line. Sewer lines crossing the
7' \ ��j - - - water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
SEPTIC SYSTEM ' DESIGN 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
FLOW ESTIMATE owner to ensure such.
Z
� 12)The installer is to take caution in excavation around the gas line if such
exists.
SD B�:DROOMS AT GAL/DAY/BEDROOM GAL/DAY 13)The installer shall verify the location,quantity and elevation of the sewer
T- wTo o lines exiting the dwelling prior to the installation.
SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting
' Title V requirements.
SAL/DAY x 2 DAYS GAL
!2 -�I USE I GALLON SEPT I C TANK £XI ► ILC� ��Dkl�b`
-";A�'�-T`�
TL `BSORPTION- SYSTEM DVID
1 1'.r / lI ,ONO y� �,O A qy�
i SIDE AREA: X yJ_ '2,x v1
BOTTOM AREA: 1 2,08
Zor/
o� PTIC SYSTEMSECTION
'01W vim w
�Lr
-
Ox
�, o�eo 5 1 � � qs 5�''�h✓'
GAL
— - — — — — -- — — — SEPTIC TANK X 3�S �---
i.
ii,--t;T Hm,-C, "-. 3-71 ET
SITE AND SEWAGE PLAN
LOCAT I ON :
`
PREPARED FOR : 'j F"\jgn
SCALE: 10
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DAV I D B . MASON R`.-) DATE:Io 1 zbl
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