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0137 DEBBIES LANE - Health (2)
Ej Debbies Lane corutx' i A= 027-129 t �a 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 137 Debbie's Lane Property Address �"o Greg Testa =� Owner Owner's Name information is MA 02563 4-26-17 required for every Marstons Mills�n•h„�'' page. City/Town State Zip Code Date of Inspection 9 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 llnlngout forms A. General Information o the computer, ```p ,,\I Of tMgs� l �aa ` use only the tab 1. Ins ector: y ke to move our p O; G cursor-do not James D.Sears ,: DAMES m use the return Name of Inspector �� —SEAf4 key. Capewide Enterprises �_'••c+� 4o.'a*= Company Name '�� �F 5 IN SP��' 153 Commercial Street �'�Jag.......110 - Company Address reore Mashpee MA 02649 City[Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-29-17 spector'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 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. I t5lns.doe rev.6116 Title 5 Official Mapection Form:Subsurface Sewage Disposal System-Page 1 of 17 Lt)y�� v-S 6 a6ed 6 666ti£S809 ueW uolcadsui ayl wlr ££:ZZ L l OZ 06 udf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 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: The system is a 1000 Gal. Tank D Box and four flows. 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.doc•rev.6f16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Z a6ed 6 666bE5805 ueW uojcadsul at{L wif EE:ZZ L 1.0Z 06 udy i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name required on is Marstons Mills MA 02563 4-26-17 required for every Page. City/Town state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Heath)' ❑ 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 CHAR 16.303(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.doc.•rev.6116 Title 5 Official Inspedcn Form Subsurface Sewage Disposal System•Page 3 of 17 'I £ a6ed 6 666tb£5805 ueW uoj�adsuI aLL wlf££:ZZ L 60Z 0£ ud`d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is Marstons Mills MA 02563 4-26-17 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply, ❑ The system has a septic tank and SAS and tho SAS is within a Zone 1 of a public water su pply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supplywell. ❑ 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 asses if the well water n y p analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in ISO" is less than 6" below invert or available volume is less than day flow t E#Cg jN t5ins.doc-rev.61"6 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syalem-Page 4 of 17 b a6ed 61.66bE5809 ueW uoloadsui aU wir EE:ZZ L L02 OE ud' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for � Y Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owners Name information is Marstons Millsrefuired for every MA 02563 4-26-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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 in either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5its.doC-rev.6/'6 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 5 or 17 g @lied 6 666ti£5805 uew uolDedsuI ayl wlr ££:22 L l,0Z 0£ udf Commonwealth of Massachusetts Title 5 official Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is MarstOns Millsrequired for every MA 02563 4-26-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the.following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? If the were not ® ❑ available note as NIA) ( y ® ❑ 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.doc•rev.6/16 Tale 5 Official Inspection Form:Subsurface Se age Disposal System-Page 6 of 17 9 a5ed 6666b£5805 uew uoloadsui ayl wlr t,6:ZZ L602 06 udV Commonweakh of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 page. CitylTown State Zlp Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and four flows. 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No meter readings, if available last 2 ears usage d 2015-29,000Gals Water g ( Y 9 (9P )) 2016-34,000GaIs Detail.- Sump pump? ❑ Yes ® No NA Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gPd) Basis of desilgn flow(seats/personslsq.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: tbins.cloc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L a5ed 6666b£9809 ueW uolDedsul a41 wlr b£ZZ LI,0Z 06 add Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: NA Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.W'6 Title 5 Official Impaction Form Subsurface Sewage Disposal System•Page B of 17 9 abed 6 666bE580S ueW joloadsuI aqj wlr SEZZ L 60Z 06 udV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa - Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 page. City/Town State Zip Cade Date of Inspection D. System Information (cons.) Approximate age of all components, date installed (if known) and source of information: Tank and three flows permit#85-8961 one flow permit#88 -203. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: 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.): Pipeing is 4" PVC SCH 40 — Septic Tank(locate on site plan): 101, 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 1000 Gal. Precast H-10 Dimensions: 1" Sludge depth: t5ins.cloc-rev.WiS Tine 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 6 a6ed 6 666VE5809 ueW uotoadsuI ayl wlf SEZZ L l,OZ OE udy Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information Is required for every Marstons Mills MA 02563 4-26-17 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 29 Scum thickness Distance from top of scum to top of outlet tee or baffle 12' Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape- Plan Sludge Judge Comments(,on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 10" below grade. Inlet tee. outlet baffle. No sign of leakage or over loading. 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 15ins.doc•rev.6116 Title 5 Olflcial inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 0 6 a5ed 6166t E9909 uew jo;oadsui ayl wlr 9E:ZZ L i oZ OE AV t\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-* page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i 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.): i "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc rev.&16 Title 5 Official Inspection Form:Subsurface Sewage DispOsal System•Page 11 of 17 l.6 a5ed 61.66t,69909 ueW .iogoadsuI aqj wlr 96:EZ L 60Z OE udf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 page City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16" IIT-20" below grade, Box is clean and solid w/two line's out. No sign of over loading or solid carry over. I PumpChamber locate on site plan): { p ) Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins.doc•rev.6116 Title 5 Onklal Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 I 1 Z 6 abed 6 66W5809 ueW johadsuI ate wlr 9£:ZZ L l,OZ 0£ jdy Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is Marstons Mills MA 02563 4-26-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ 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 is four flows_ One set of three w/1'stone. 2'below grade clean and dry. One flow added to sidel'stone 3' below grade clean and dry. No sign in flows of over loading. 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 15ins.doc-row.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 £6 abed 61.66b£9809 uew joloadsui ayl wir 9£:Z2 L60Z 0£ add Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 P Cityrro,nn 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.): Prlvy (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.): 15ins.doc-irev.WS Tige 5 Offidal inspection.Form:Subsurface Sewage Disposal System•Pape 14 of 17 6 a5ed 6666b£5805 ueW uojoadsuI ayl wir L£ZZ Ll,02 0£ AV Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 025Ei3 4-26-17 page. CftylTown State Zip Code Date of Ins pection 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 A 0 0 -3_ 33_, A of -t° s ❑ 3 ado` t5in5.dpG•rev.6l16 Title 5 Official Inspection form:suosurfaoe sewage Disposal system•Page 15 of 17 56 a5ed 6666t,£9809 ueW uoloadsuI ayl wi .r L£ZZ L60Z 0£ udd Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 137 Debbie's Lane Property address Greg Testa Owner Owner's Name informations required for every Marstons Mills MA 02563 4-26-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 104 N� Estimated depth toF-igh ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7-21-81 Date ❑ Observed site(abutting propertylobservation 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: T.H. on design plan 7-21-81 no G.W. at 10'. Bottom of flow 4'-6" below grade. Bottom of flow at 5'- 6"above T H Depth f I Before filing this Inspection Report, please see Report Completeness Checklist on next page. I5ins.doe-rev.U16 Title 5 Official trupeuim Form:Subsurface Sewage Disposal System-Page 16 of 17 g l, a5ed 616W9909 uew joloadsul afll wlr L£ZZ L 60Z 06 jd`d Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 4-26-17 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.dac-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-P"17 of 17 L6 abed 6666V£9809 ueW Joloadsui @LL wlr 8£:ZZ L60Z 0£ 4V Jun 01 1410:52p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Systean Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owners Name Information is Marstons Mills MA 02563 5-29-14 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important otat fo forms A. General Information filling out forms on the computer, ```��w�jN OF rf� °� Ss W use onlythe tab 1 for. Ins 9c►��% key to move your I lL �� ,`o?: •.ti� cursor-dortot =�: JAMES u' use the return James D.Sears _ ke t Name of Inspector SEARS y Y- CapewideEnterprises,LLC �I Company Name I RT10 153 Commercial Street l INS Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I a I certify that I have personally inspected the sewage disposal system at this address,,and thatbe .4 a information reported below is true; accurate and complete as of the time of the inspection.Theinspection was performed based on my training and experience in the proper function and maintenance of on s.@ sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 1&340 off Title 5(310 CMR 15.000). The system: I ® Passes ❑ Conditionally Passes ❑ Fails e� ❑ Needs Further Evaluation by the Local Approving Authority i 5-29-14 nspectoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer;,if applicable, and the approving authority. ""This report only describes conditions,at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Tice 5 Offidel rrBpeai forn Sub sudare Sewage Dispv+al Sysyem•Page 1 of 17 i I ' II � fJun01 1410:52p p.3 Commonwealth of Massachusetts lipTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is reequireduired for every Marstons Mills MA 02563 5-29-14 page, Cityrrown state Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check=A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 the4ollowing 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): i 1 Mr.-3113 Tine 5 Oftial InspeWW form:Subsurface Sewage 04osW System•Page 2 of 17 Jun 01 1410:53p p.4 Commonwealth of Massachusetts Title 5 Official jnspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 137 Debbie's Lane Property Address _Greg Testa Owner Owner's Name information is Marstons Mills MA 02563 5.29-14 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken cr 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): i d d ❑ 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-3H3 Title 5 Offidal Inspecdon Fork SubvxUme Sewage Disposal System•Page 3 of 17 Jun 01 1410:53p p.5 Commonwealth of Massachusetts Title 5 Official :Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane I Property Address Greg Testa Owner Owners Name reformationis required for every Marstons Mills MA 02563 5-29-14 page_ City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 wate'r supply well**. Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered_A copy of the analysis must be attached to`this form. 3. Other. • ;: f tf a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"-to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Dischatge 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 is less than 6"below invert or available volume is less ® than day flow �L�rcvS t5ins•3It3 Title 5 Of dd Inspecdon Form Sdbwrtaoe Sewage 01sposal Syslem•Page 0 uU 17 I' Jun 01 1410:53p p.6 Commonwealth of Massachusetts U�a _,� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane r Property Address r Greg Testa Owner Owner's Name information required for every Marstons Mills MA 02563 5-29-14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 must16dicate either°yes°or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—.IWPA) or a mapped Zone 11 of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section'iD 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. 12" 3<1 3 _ - TRIe 5 DYcial Inspection Form:Subsurface Sewage Disposal System•Pdge 5 of 17 Jun 01 1410:54,p u p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa :t Owner Owner's Name infbrmation is required for every Marstons Mills MA 02563 5-29-14 for page. City/Town State Zip Code Data 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 NIA) ,: ® ❑ 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? ElWas the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The sirze'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)1 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 7 t5hr.•3013 Title 5 Official hspection Form:SubsuAaw Sewage 61.posal System•Page 6 of I f s p i n Jun 01 1410:54p p.8 Commonwealth of Massadhusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name informatrequired foon r Marstons Mills MA 02563 5-29-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information' Description: } The system is a 1.000 Gal. Tank D.Box and four flows. i Number of current residents: Does residence have a garbage grinder ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings,if available last 2 ears usage d 2012-23,000Gais g ( y g (9P )) 20124,000Gal's Detail: i Sump pump? ❑ Yes ® No Last date of occupancy: NA Date CommereiaUlndustrial Flow Conditions: Type of Establishment Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seatstpersonslsq.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: 15ins•3M3 Title 5 Olrida$tnepection Fonnr Subsurface Sewage Msposd System•Page 7 of 17 Jun 01 1410:54p p,g Commonwealth of Massachusetts Title 5 Official ."Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02663 5-29-14 page. Cityrrown State Zip Code Date of Inspection D. System Information, (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quant ty 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, i#any) ❑ InnovativelAlternabve 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 Q Tight tank.Attach a copy of the DEP approval. LQ Other(describe): t5ms-3N 3 Title 5 Official Inspecllon Form Subsudace Sewage Disposal System-Page 8 or 17 Jun 01 1410:55p p.10 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 5-29-14 page. Cityrrown State Zip Code Date of Inspection D. System Information.(cont.) Approximate age of all components, date installed lif known)and source of information: Tank and three flows permit #85-896/one flow permit #88-203. Were sewage odors detected'-when arriving at the site? ❑ Yes ® No Building Sewer(locate on site,plan): 29' Depth below grade: 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.): Pipeing is 4" PVC SCH 40. 3 Septic Tank(locate on site pjan): Depth below grade: 1011 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) .I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast Sludge depth: t51ns•3113 ,. Title 5 Official Inspection Fonn:Subwlaoe Sewage Disposal System-Page 9 of 1T Jun 01 1410:55p p.11 Commonwealth of Massachusetts Title 5 official 'inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments P. 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02663 6-29-14 page. Cityfrown state Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1' t Distance from top of scum to.top of outlet tee or baffle 12" i Distance from bottom of scum to bottom of outlet tee or baffle 1 711 i How were dimensions determined? Asbuilt-Tape- Plan Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank and covers at 10"below grade. Inlet tee, outlet baffle. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: S 1 ❑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 (Sins•3113 Title 50Ricial hWadM Form:SubawfaW Sewage Arsposel System-Page 10 of 17 I Jun 01 1410:55p p.12 Commonwealth of Massachusetts Title 5 Official {inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Omer Owner's Name information is required for every Marstons Mills MA 02563 5-29-14 page, Cityrrown State Zip Code Date of Inspection D. System Information; (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i . , Tight or Holding Tank(tank-.must be pumped at time of inspection)(locate on site plan): D 9 Depth below rode: ,F P Material of construction: Y ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): a� Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No r : Alarm level: Alarm in working order. El Yes El Date of last pumping: Date Comments(condition of alarm and float switches, etc.): 3 . "Attach copy of wrrent pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Ofdal Inspection Form:Subsurface Sewage Disposed System•Page 11 of 17 Jun 01 1410:56p p,13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Ownees Name information is Marstons Mills MA 02563 5-29-14 required for every _^ 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 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-20"below grade. Box is clean and solid wltwo line's out No sign of over loading or solid carry over. . Pump Chamber(locate on site.plan): Pumps in working order. ❑ Yes ❑ No* A Alarms in working order. ❑ Yes ❑ No* Comments(note condition of-pump chamber, condition of pumps and appurtenances, etc.): r F If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why_ t5ms-3M3 Tile 5 olrrdal Irspedion Form:Subsurface Sewage D Isposal System•Pape 12 of 17 F Jun 01 14'10:56p p.14 Commonwealth of Massachusetts Title 5 official Inspection Form 4 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 5-29-14 page. Cityflrown State Zlp Code Date of Inspection D. System Information, cont. Type: ❑ leaching pits number ® leaching chambers number. 4 ❑ 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 is four flows, One set of three w/1' stone. 2' below grade clean and dry. One flow added to side 1'stone,3' below grade clean and dry. No sign in flows of over loading. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert i Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction I' Indication of groundwater inflow ❑ Yes ❑ No ►Sins•W3 Title 5 Official inspection Fcrm:Subsurtece Sewage Disposal System y8 Page 13 or 17 i ' Jun 01 1410:56p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Nameinformation i required is Marstons Mills MA 02563 5-29-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition ofsoil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: i Dimensions t+ Depth of solids Comments(note condition of-soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): e 4 t5ins-YU Title 5 Offidal Inspection Form:Subsurface Sewage Disposei System-Page^4 of IT Jun 01 1410:57p p.16 Commonwealth of Massachusetts Title 5 Official. Inspection Form M Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 5-29-14 page. c4rrown Slate Zip Code Date of Inspection D. System Information; (cost.) 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 s 'v Ito ✓�„ R FAR P -a z 13�� " �3 3 .t ❑3 Oc L o>< 7a s s tNns•3-13 Title 5 0111clal hspWion Fame:Su6siareoe Sewage Disposal System-Page 15 or 17 Jun 01 1410:57p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills I` MA 02563 5-29-14 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Site Exam: , I ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NO Estimated depth tcf high ground water: 10' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of Date design plan reviewed: 1 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on design plan 7-21-81 no G.W. at 10'. Bottom of flow 4'-6" below grade. Bottom of flow at 5'-6" above T.H.depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. tbins-3113 Tit'e 5 Official hrspoctfon Form:Subsurface Sewage Disposal System-Pape 16 d 17 I r Jun 01 1410:57p p.18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Debbie's Lane Property Address Greg Testa Owner Owner's Name information is required for every Marstons Mills MA 02563 5-29-14 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r I5kt-Ti 3 Tllle 5 Official Inspection Form;Subsurface SewW Disposal System•Page 17 of 17 G Existing Living Room 'k a 0 12-2 0 _j 0 O Existing Kitchen .a Nd 91.C Job Name Drawing No. 137 Debbies Lane First Floor-proposed DATE DRAWN BY Huxley-Testa Construction Co.�Inc. PO.Bwdfi,ld.MA OM ____ 03/28/15 GREG TESTA mu�anugi smass k, SCALE PAGE Rev A" = V-0.1 1 OF 2 A Existing windows Sty 2 New walls to create closet, new doors Bedroom 2 i 0 New door Existing Linen Closet Existing Bedroom xistsing New non bearing Stairs partition wall 0' o� L 1: a Existing Hall .:J Toilet to remain o Bedroom 3 3 Extend existing Remove door to bath, Existing wall to make reconfigure wall for larger closet Vanity and sinks Walk—in larger closet and to remain Closet double doors 0 0 � nr ;7,j �16- Exisitng slider Job Name Drawing No. 137 Debbies Lane Second Floor-Proposed Hurley-Testa Construction Co.-,Inc. DATE DRAWN BY P,O..Box 615 03/28/15 GREG TESTA Wdfeld,MAQ052 5waas elzo{�I sm-awazou nx ® SCALE PAGE Rev I; Existing Living Room I' f i a Oe 12'-2" O Existing Kitchen Z L J Job Name Drawing No. 137 Debbies Lane First Floor-proposed Huxley-Testa Construction Co.,Inc. DATE DRAWN BY Mntlield, Pal.ld,MsA&U52 03/28/15 GREG TESTA wsamanu Rl 60aa 17Xe 0 SCALE PAGE Rev %a" = T-01, 1 OF 2 A Existing windows qty 2 a New walls to create closet, 3 new doors CL Bedroom 2 0 New door Existing Linen Closet Existing Bedroom xistsing New non bearing partition wall 't o� Existing Hall Toilet to remain s. 0 Bedroom 3 oExtend existing Remove door to bath, wall to make Existing reconfigure wall for larger closet Vanity and sinks Walk—in larger closet and to remain Closet double doors 0 0 16'- 1/2" Exisitng slider Job Name Drawing No. 137 Debbies Lane Second Floor-Proposed Hurley-Testa Construction Co—,Inc. DATE DRAWN BY r P.0..80x616 03/28/15 GREG TESTA W01.1d,NY1MM suacsaizopa saeaaserao r� ® SCALE PAGE Rev Existing windows Sty 2 New walls to create closet, new doors a Bedroom 2 i o I New door Existing Linen i Closet Existing l Bedroom wstsing New non bearing tairs partition wall o� Existing Hall Toilet to remain aa b Bedroom 3 oExtend existing Remove door to bath, wall to make Existing reconfigure wall for larger closet Vanity and sinks Walk—in larger closet and- to remain Closet double doors o 1 �16'- Exisitng slider Job Name Drawing No. 137 Debbies Lane Second Floor-Proposed Hurley-Testa Construction Co. Jnc. DATE DRAWN BY aa BOWS.ld,MA 03/28/15 GREG TESTA McEfieIJ,KNIL�1 6huMvmgj 6.""4m. ® �._.. SCALE PAGE ReV %a" _ V-0" 2 OF 2 A ����� �� � ���� �� �f�l�� �� ���f� � � ��,n� U''�'"� ---, !, ��i�-- ��i v. jy'�,�e ��,�'�n � � � � � �� �� � cM'`�� �r ���2�� UU��2 '~ � . - - 14, ls 71, I i _z ---------------- fkVA- 4- 13 7 16/3 Fizz �.� THE COMMONWEALTH OF MV ASSACHUSETTS BOAR® OF HEALTH rJ..... OF...... Appliration for, Uiipusal Works Tono rnrtinn jinmit Application is hereby made for a Permit to Construct (�/) or Repair ( ) an Individual Sewage Disposal System at: LO l O 3 �PyPvl f_= L AiU� M Lam, �'I-c7►_yS M I LL�j •---.... ....__... Location�..._•l�7..... ....... � ��r.�� - .o - - Location-Address ���) r Lot �O ?yvpDe •--•------- --Owner Address .. .......- ♦ /___"ti�A__ '�InstallerAddress Building Size Lot.zoo Sq. feet aDwelling—No. of Bedrooms........... .......... ..........Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other tures . ... W Design Flow.....' ......................... .alion�sl T,person per day. Total daily flow....... ........gallons. WSeptic Tank—Liquid'capacity!�-.g`'la Ions ength................ Width................ Diameter................ Depth................ x Disposal Trench—No......I............. Width.....'.._._.... Total Length.....1��........ Total leaching area..�l........sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( )) Percolation Test Results Performed by= •• .---------------•----------------•---------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--_---____-_--_------_- 04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P -----------------------------------•---------------•-------•----------....-----.�... W Description of Soil---------------------•----........-----•----............ U ..........................•----.....---••-••---•-•••••------------.....•---.................--------._...--------------••--•-....--------•-------•----•--------------......-----•.................... W x ------------------------------------------- ------------- -------------------------------------------------------------------------------- ........................................................... U Nature of Repairs or, Iteration Answer when applicable.. p �_ _C _.� -� .................... - I� ... ... L (--- ------------------------•---------------------------------------------•-•-----... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLZ 5 of the State Sanitary Code—The undersigne r er agrees not to place the system in operation until a Certificate of Compliance has en issued y the and • w �/1/f Signed . -- ...... -•-- ........................ .....................------- ApplicationApproved By.............................----....-----•••••-----.....-----••-•...----------••......---....... Date ---------------------------------------- Date Application Disapproved for the following reasons----------------------------------•----------•---------•-----•------------------•---------------------••---••••-- .........................•--------........--••--•--------•-----•-•-----•-------------------•------------•-----•--•------------------------------...----------------------------------------------•-••--- 1 Date Permit No......... • R �-•--•------_.... IssuecL. Ak. wlL/ No ... FE$...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ----------......OF............. Appliratinn for Di"as al Works Toustrudion Prrutit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: ........ .......................................... ...................................... ..•---•----•-••-••••-•-••------•--...---•---------•-......-------••--------•..................•... �^ `/ 1 1� Location-Address r� �, ram-C-- 1 =. 7 -C>is 5 c..,.a.r.>� �M �r K t` �`�l�i AA LC ,, -------------- _ .... ---------------------------•-----------.--•-- --------- _.... ........--..--...-----••. .................. ..... .. r Owner Address M w //(/ ��iu� e1'9 Installer Address U YP g Size Lot............---------------- Sq. feet G/T e of Building Zv, �-, Dwelling No. of Bedrooms..... __ ti �. ��-�.) _.._.Ex anion Attic a g— ---•- ----------- p ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) <� Otherixtures ----••••----•--••••-•--•-•---••-•-•••-••-••••••--•-•-••-••••----••••---•---••--•••-•-•---••---•---•-••-•-•.......•-•--•---....---•-•...•.............. w Design Flow......5.AD............................. allons er person per day. Total daily flow......�_�_d.-----_.__----..............gallons. WSeptic Tank—Liquid capacity!2 !allons ength....._._I - --.:_._ Width................ Diameter----------------Depth................ x Disposal Trench—No..................... Width.....�........... Total Length.....1_____......_._ Total leaching area____--•--_�•-_------sq. ft. Seepage Pit No---------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY................ /A,-------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water___----:-____-__-------- 4A Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -•-••-•-••-------------•.....•--•--•-•-----•-••••---•----•...-•-•••-••••--•-••----•----•---•••-----------•---•---•-••--------•--••--•-•...------------------ 0 Description of Soil...........................................................................................----------•-----------------•-------------------------.... x c, w r— UNature of Repairs o Alteration Answer when applicable.. __ O__.� �' C•�rt -_ ^ -----•-••-••.I...•--A_nP.....••-- -...... -Q.F. . ................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT:: 5 of the State Sanitary Code—The undersignedefilirtlier agrees not to place the system in operation until a Certificate of Compliance has en issued y the and Signed - ------------------------------ -------------------------------- Date ApplicationApproved BY.................................................................................................. Date Application Disapproved for the following reasons________________________________________________________________________ ................... •••-•••------- .................................. ---------------.... ................ ..... ...... ........................................................................................................... •••-----•..--- ^ Date PermitNo........_0........ ----------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / l . .................. (IrrtifirFatr of ToutpliFanrr THIS IS TO CE9 IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired OI by................ ------� .... l--------------------•---------------...---•-•-•--•----------•------------------•----------•-•-•----------------------•-- Installer �a has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... _ _-_ - ............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �` -b Inspector--•----•----•------•---- .: DATE.................... ._-_ ?-- - ----•---•---•--•-••---•-•- a-- ............................•---•-•--•--•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH kJ........ l. ......OF.............!...�"C�-v(r! k1%: .......... ................................ - NO..g... f 0�- FEE... .......... MaposFal Works Tonstrnrttion _ rrntit Permission is hereby granted.......... - - � 4'�c "' to Construct ( ) or Repair ( ) an In ividual Sewage Disposal System at No. Street as shown on the application for Disposal Works Construction Permit No( :k.3. Dated.......................................... ............. ..•-----------........_�-c_n.------......----.....---------------.........--...._ DATE. V Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '4 No.._. _ mac.q L .. — THE COMMONWEALTH OF MASSACHUSETTS -7✓ 4, BOARD, OF HEALTH Ire of......................................................................................... Apphratilin for i Volial Marks Towitrurtion Frrm- Application is hereby made for a Permit to Construct or Repair an Individual age Dispos System at: .............................................................. ............ Location-Address or Lot .. N o.d3 5'new .... ..~..(..... v ............................ . .........................Or.. . ....A 4u- 47e..;2k....... 0,.cr Address . .........I...t ..... .. .......................................................... . ..............................................!................................................... Installer Address Type of Building Size Lot.........ar_i!:)S_Q..Sq. feet Dwelling—No. of Bedrooms..... ........................:.........Expansion Attic ("V) Garbage Grinder (n®) 04 Other—Type of Building ............................ No. of persons......a_.....___.__.___. Showers Cafeteria (no) A4Other fixtures ...................................................................................................................................................... <� Design Flow............................................gallons per person per day. Total daily flow............. 330 ......gallons. W. ------------------------- 94 Septic Tank—Liquid capacity400.gallons Length................ Width._............._ Diameter.........._._._. Depth....._-......... Disposal Trench—No. .................... Width..._........._...... Total Length_..........._._...._ Total leaching area....................sq. ft. "Seepage Pit No..................... Diameter..........:-.__..... Depth below inlet._.....__........... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......X: ......i7—a_,x--6AA&....................... Date....... ................. 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........_..._........... ........................................................................................................ ............................... 0 Description of Soil_ t.-3A ......5 ef k.Me.. ~. ..Id ............... U _'74P t ... --- ----------------/ ..... . .......d .................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ..........................................................................................................................7-------------------------------------------------------..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITLIZe 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Cert to f Co lia s bee�* ed..bby the bboard/d)health. Signed...... ... . ....... - ------- Da t e ApplicationApprove By............ .... .. . .......................................... ............ Date ved for the owing reasons- Application Disapproved sons:.............................................................................................................. ----------------------*----------*.......*--------------*--------------------------------------------"----------------------------------*-----------------------------------------------*--------- Date PermitNo......................... ................ IssuedL........................................................ Date ----------- No....................... Fzic.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH ...........................................OF Apfiration for Disposal Marks Tonstrurtilatt "Frruat Application is hereby made for a Permit to Construct ( or Repair an Individual Sewage Disposal System at: . ......... ............. ............................../....................... ....................... Location-Addr.e or !0. C 'Cl ..... ...... .......4k V.<I�.e................ . ...... Owner Address Installer ................*...... ------------ -----------------A'd*"d'res_s** Type of Building Size Lot..W2_P. ....Sq. feet U Dwelling—No. of Bedrooms.......3.....................................Expansion Attic (no Garbage Grinder (tlo 04 Other—Type of Building ............................ No. of persons....SQ.................... Showers Cafeteria (� P-4 Other fixtures ................................................................................................. .............j..*---------- ...... Design Flow..........................................gallons per person per day. Total daily flow..... ...... .3'.............gallon. 1:4 Septic Tank—Liquid capacity.?T�Vgallons Length................ Width................ Diameter..._............ Dept.h................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) 1.4 Fa7 I,- Percolation Test Results Performed by. Date.........f.......46.................... 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........................ .` ......................................................... ..........i?................................................... ................ ............. Z.......... 0 De4cription of ..... .10.........E.Y. &.11.e5lae...... 0.......................................... ................. ......�A.n ........... ------------------I ----------- U Nature of Repairs or Alterations—Answer when applicable...........................................w................................................... ............................7........................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin 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 Cer t/ef Com.Ilia has be iss ed by the boavd-o7)health. S. Signed.....V41- /.ro.... �-•------------------ --- O.D.Jeo v ►Application Approv2By............... b....... ..... . .. ....... ................................ ............................... ... .4 d Date owing Application Disapproved for the owing reasons:........................................................................................................... ..............................:........................................................................................................................................................................ <�2C Date PermitNo..... s ........... ... Issued .................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A ..........................................OF.................................................I................................... (Intifirate of-Toutpliana Tyl,S IS JO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired 'I b y........ef A/....nl-.ZO....................................................................................... ......... ............. Inll er .............. C sta ..........11........................................................................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ....... dated......[.�2 ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA�N V�T THE SYSTEM WILL FUN TION �SATISFACTORY. DATE. ....... .......... .......... Inspector......... .............. ............................................... ........... . cc ,Py j%rVA-#,t1A/ THE COMMONWEALTH OF MASSACHUSETTS o 'L4AC-tf t P G BOARD OF HEALTH, ......................'OF..................................................................................... 17 No..S-S- VL .................... 1 .0 ....................... Fn....................... io atl Permission j2w iiilerebygrifited........................................................................................................................................ to Constructor an Individual Sewage Dis . osaWt..m 'at N ............................... ..... ............. .... Street as sho wn on the app ligation for Disposal Works Construction Permit No.................... 161ated........iL, . .. ...................... -------------------- BBoard of ealth DATE.--•••-..... ... ..... ........................................ FOR 1255 A Su LKIN, INC., BOSTON y • i w - -- - SECTION - SEWAGE r 1 LOT"/4¢ 7 `f �9 -SEPTIC TANK - - "D"BOX - - LEACH >rNGE� "( i ' ,t ® TOP OF FDN 5 Z, Z, 7z o I d s (MSL)++ 2 'OF 1r8TO 42" WASHED STONE ; N 76 .u 3 I IN• OUT• IN• OUT• IN• )p ff--Ob0 ELEV. 'T I.s TANK 7�rZG s l QO r EPTIC 0 D Oq000 . .9�r \ \e ` �it�/OtV i�o- `1 L.j r y� 1 ELEV. ELEV. ELEV. OOOO e 2� s9.97 69.a e i f I ��C t ELEV. ELEV. Xl n r b7•'ONE 24 OF 3/4"-142" WASHED STONE T� 2 AD.1. WATER FL FV, w_ TEST HOLE LOG 64 No `; 0 o pR� SE ROW 6 r EST BY R.f��A/Rf3ANK 1, F4RD B,D,f/. JU[Y2 6198/ BgRN �� L�E N,D, p 597BEDROOM \ N / 0 $���rr V EST OATS DESIGN ' HOUSE T.H. # 1 T.H. # 2 \m / aye lsZ _ ELEV.-7/•Z ELEV.-f4- NO AND DIS POSER DISPOSER l i PSO L PERC RATE _MIN/IN. 1 30= FLOW RATE 330 (GAL./DAY) 3 30 ® ' Ep/ M S SEPTIC TANK 330 0.5)= 495 \ 1 ��- A/�/ REQ'D SEPTIC.TANK SIZE 100 A S j P/PE I D COARSE ,) /VAt A �� ' LEACH FACILITY I i 4 DEL _ —. \ _ _ ¢- SIDE WALL 2 ?6' (1,5i=O�sf 2 5 225 C/D. 1 `// �......�.. �- BOTTOM 24) -- ( I 1+ G/D. 1 ff AM TOTAL 23�f,5 = 361 G o \ 1 i lq"- lvA7ER-6/7 .vo J ZT cvc, 1' 13'3 '-57� ! \1 Al O/ W � 6 l Za AN USE L3)q�x8l SLOW p;FF LEACHING T T1;EIJ�� ! ®/ S 114�1 STONE: Z_4 ><b�,c l'S EFF.- hEPTH _ © 4 O Q 1 WATER ENCOUNTERED -14W NOTES: (UNLESS OTHERWISE NOTED) '6 LOT /02 \ 7® 1. DATUM(MSL)+TAKEN FRO G oTv rT' __._.__.QUADRANGLE MAP 2.MUNICIPAL WATER Lt hO ___AVAILABLE � 3. PIPE PITCH:1k"PER FOOT =lO t SN OF 44,, 4.DESIGN LOADING FOR ALL PRECAST UNITS: AASHO- 44 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. �O RI( HARD DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT G 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. O R �^ BY CERTIFY THAT THE BUI SITED P N STATE ENVIRONMENTAL CODE TITLE 5 F I SHOWN ON T N IS LOCAT HE a� 02 �ILOCUS: LOT 103 EBB/ ANA- GROUND AS SHOWN THAT IT CONFORM TOT ING S OF THE. G(A16F,BY ESTATES"MARSTONS M/L LS -- TOWN REG. AQN�, INFER WM CONSTRUCTED. DATE PB Z72 - P 92 I REF: � , r 'y L ESLJ'E AAGIVES BRrANT IJ�OW/! cape e�gineel ing PREPARED FOR: CIVIL ENGINEERS Rte /49 MAFRSTONS AM, 02,648 BOARD OF HEALTH LAND SURVEYORS ----------- - CONTOURSEXISTING)------------- REG.LAND SURVEYOR 1//_,3 '2S-BO' ( r• � SCALE II3 - . (PROPOSED) O-0-O-O- APPROVED DATE fie' : MA Yarmouth MA p DATE S3-ZO7 _"^"'ry�.,���•°,. J;tom„=` ,a""tw'Ic- 'T' , k �, rt... . >:5K✓f'i`�.'3_ MP,5+13 "�'L�t'S+x�a�t��x�'� ., r. Sl TE PLAN A�l - � Sy • •`f PL�\,1��•�`f�{f y� 'F��' �`x�•��^ '� { � �. � �TIr•S"G�t ..�IT � l s '� �,�' ��r Y,,P =�1'���'�g�'1+��,,��4 4��� � � yy, �� � r i • i1 •Y'}"' 1���.� /5 P ✓ •'Y� � t a d � aKFrS"t' •S.f- - ': r— i _ d M1 S r +•ir '.k ra.TTq�t1x t k. r '� i 14 ,: �„i��+7i t�;,✓',�a� � �� r;' aka t; t / im 10WW7 P , Q / /'. �O ..���5 I �,�/�._�.•�-L.l....P���•� 6�1?E .� �1 ��.. Wit. ,:,�.� � ,f``f �_�..�-' _15c�`_c��: r_c.ow�C H A Mac -�•��� ������� ,�. �•: O r�, 1 V! �:�E s ��':e� ""t` ITR- t O , « i .3L k /;'F. 1^4 3 z d !S h� 1+• ,r.A^Cr' ' ` ct, G��IC.'1 f�?tc I►..��+- / ��V',�.:�' �, rF r �O,S� �'�"t�-`'����� �c ���`"�'�����'++ ¢' Noni Y f f,J A ,p +f•P 4'�y - r ._ • �. �.� ,•t. ,� '..d � � Ito ,,.t/�,�''�}s�Y,ti,�xy}"'�"'iJ1���„ry� � rF �, S •a.F � ,a i#'nWrg��,KM,�/ll f S�•.a„`� c 1 ,�..n• " { 35: kaaJY,tx ��p4 . yt '� W ,•l M1 Y F eft }`"�.. A3r�J.. ��,_'GP cS✓,�xy9. (�"qk yy `HH y 1 ',� z �-P�•�+.tx t't i,.Tm,'t,.2�'c�'•- t-+ ! � � H,, t O 1 v 't5-.y �� 4Q jX S•s! y r+'��. -Pit yr ti,•! ``„ �' �1 ;1 >�' i ,Y r'•r' 1`7. }4"`f*. s.s„�� _ Y f x '+ .r a •�'k� ?' r f +7 t ,' a st 'P (vh tXsf P'AO ra OR �4.'�''�E,,Y3F"F nC`1�1' �.• Q :-'i l� ..... W�..� yi �, {tp v .� x+rr x"i .a - 1✓rq''t-+ `d� �. of+�., r7 9'' H LC 11 ! :4 t lo. v6'1 r I ` ��.. ^'C r��; ;`'�.' m #� 1 a� y. 7,}�✓ ,� a*�'F4 hF c _ PREP �FQt, Af� -An��`- � WILLIAM yG��� �1�yF k�� Jfs�r s� ��F4 Tv/���f � 1 WARWICP( __._�j.... .. 6s . ;SHY yF '"' f � r ,�� fcrsr�P• ,, / L:-C/Q/L�.�..J G—..__, ._.._. _..__... �,_._.. � .�� '� ,F - f %'; _.�.:_��*a,��'s��`���� � •i No. 7urrI Alt sN k FOR REG/STEREO LAND SURVEYOR , v ZONE kF,M=iL.t~ tin ,o °"`� PLAN REF -74 ' --; DATE 6 ler� t , BENCH MARK DATUM � �� �• '� ' r WA RW/CK�BAxSSOC. /NC. k ��x� �� '�3" �'° DOMESTIC WATER SOURCE W �-L 'W } � �BOX, 80/ N0., fi VfA L MO•.UTN FL00D ZONE. ,m, -D MASS. O255.E,��rrEC=3 26 A •,7 3b h,,.!� -: G R;: P r st rtn � yp }w3" `' v� ,sue ti e 1. D I MY,A 't. Rm � ' co S.. All 4 114 SECTION - SEWAGE t SEPTIC TANK — _ "D" BOX — — LEACH- TOP- F FDN (MS L� /O/IRp✓!V 2 '2 i 2 "OF"�8T0 4z r^ ut 1 • ;&. WASHED STONE `�L` � � f• 1 IN OUT IN 7Q OUT, , w O D 'a a IN t s s (�o c7d G u t \ r a°Ift+ i fr ' 1 y `,�. ' II _ / , SEPTIC II Z'�I ter+ rR ✓ TANK ` � ELEV. ELEV. ELEV. , ELEV. ' a \ 1•_ a v.\ �+ 44. ELEV. ELEV. 0 * +�'i�' , — s �\ f OF31."-11F2• ,�o ' WASHED STONE' Y\ y _ '/ ` .• m �., ' TEST HOLE LOG �7/j�C"�lti {JiYIT7a jt I I(! { ' � tM 'M'��� p�'/� s` RON . l^iy •1f�A SwF. :�. 1 I l / TEST S t'��.S Vy �S 1 •. . 7 C3 JUG J Z"l /981 �,ql' ' � N ` a� 597 DFioOM you r TEST DATE • rdfr � DESIGN c r T.F . # 1 T.H. # Z ELEVI' �. ELEV.7It'f' Nt? / _,/ �, at pA` �* S L3. }� 'F Y DISPOSER DISPOSER '; 9� t F`M :•� :_' .Ik 4, y �: '� PERC RATE �...__-•. -MIN/IN. / �',S0 L 495 \Owl FLOW RATE 33cd tGAL,ic�AY y 3 l _ r •, °: r t r SEPTIC TANK �I.a�= REO'D SEPTIC TANK SIZE I I LEACH FACILITY. i.5�=�tJ1 �`? 2' G/D.I V SIDE WALL 2 i w 3 � ....�. BOTTOM .. � '_�' j. Q l K .�,� G ID. " TOTAL � _.�_,r "GIP t lt7ki'AI �Q-6t7 1,yv�T ,4 4IfL� Y � A/ff USE �4)18' FLEW 017F' _LEACHING !* .! 7J 1 Zp I k S5`'1OWE 2-4"x6!x,1"s ECG C3EF''�"� --- j� � t � s . 1 q — - 1 t WATER ENCOUNTERED / ;A . X OT NOTES: (UN: SS OTHERWISE NOTED) 4O f vI ' r 1. DATUM(MSL):L- KEN FR©M : - -----r•-----VAILASLEADRANGLE MAP 4 2. MUNICIPAL WAT La :_S' —`— ....AVAILABLE l�' l�► ~ . yy 3.'PIPE PITCH: V I P FOOT Kt 4,t7ESIGN LOADt i> OR ALL P,RE=CAST.UNITS: AASHO - 44 'L' "P�: N p i —{�---'-�DISTANCE AS,CERTIFIEO 5.MIN.GROUNOttOVER OVER ALL SEWAGE FACILITIES: (1) FT. � :R►GRARD � ?,•' `', f 6. PIPE JOtNT.S,$1 �4LL BE MADE WATERTIGHT pAN 7.CONSTRUCTI WDETAIL5 TO BE ACCORDANCE WITH COMM.OF MASS. - "tir• v CERTIFY THAT THE BUI [� r -. yj SHOWN ON f N IS LQCAT ME STATE ENVfRC1NM>=NTAL CODE TITLE 5 I ) -e ,✓ ; GROUNb/i'S SHOWN THAT1T / I f "�l OCWS: i'p CONFORM TO ING S OF THE' /'/+^I ( , ' ' TOWN ��y�}[r: �^ +�' *�' r ! 1rJ�I/i i Csl .7 R G REC. �P � tNEE S i CONSTRUCTED. DATE { REF: / Jam. 1'" do yn Gape enlineerin PRL'A fi.EQ FOR: cl V Ik EIVGINEERs. . � LA (J SURVEYORS A BgARi'p;Ql ky�RLTH AREG.LAND SURVEYOR (! ✓ /f« ,.F r , t SCALE.. ATE ;t (EXISTING) :_:, `- 'A} 31� �+«+ IMA , C T UR5 D _DATe . _ _ -�,-- t�+ Yarmouth QN. APPROVE h 1VIAAT M1 y .. v ` • �: - f