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HomeMy WebLinkAbout0025 COMMODORE LANE - Health �,yF� 5 ®rrrdore Lane 'lr�f t Y bwort, � .I 012.-013 006� Meirstons Mills i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Commadore Lane Property Address r 7 Gary&Joanne Anderson r. Owner Owner's Name " information is required for every Marstons Mills Ma 02648 6-20-2018 page. City/Town State Zip Code Date of Inspection O Inspection results must be submitted on this form. Inspection forms may not be altered in,any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation r� Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 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 6-20-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The system was in working order at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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 the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts ssac usetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Commadore Lane Property Address Gary &Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commadore Lane _ Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330/GPD t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s0 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: *****WELL WATER***** Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped 3 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cone.) Approximate age of all components, date installed (if known) and source of information: 1987 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'6"feet Material cf construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100' from well to SASfeet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1'6" Depth belcw grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 5 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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 31" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order:- ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System?Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: innovative/alternative El system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Leaching was 1/2 when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 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 25 Commacore Lane Property Address Gary&Joarne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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 Rear Al-34' 0 131-29' A2-42' 132-41' A3-93' 133.91' co 2 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 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: No GW @ 132" 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: 10-20-87 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 25 Commadore Lane Property Address Gary&Joanne Anderson Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-20-2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE 'LOCATION dMM®�®IS2 Le"\ SSE# Telsp VILLAGE , ; 4S ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO. It_(3cp/I n 1°T) SEPTIC TANK CAPACITY J 000 1 LEACHING FACILITY:(type) P{ (size) 60 NO.OF B OOMS OC OWNER 2Pe PERMIT DATE: C DATE. 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 wetlan ist within 300 feet of leaching facility) Feet FURNISHED BY ' ? I / i r' ! f•? J f 1 4 4 4 \ 4 4 •. •.�\f 4�\�4 .�" \ \ 4 4 \ 4 \ \ 4 4 f \f\f 4f\f\f\f\f\ •.•1'._a \ 4 4 \ \ 4 ♦ \ \ 4 \ 4 4 \ 4 4 \ 4 4 \ 4. 4f\f\f4f\f\f4f\/\/4I 4J � ,t 4 29 42 41 Back Yard 93 91 r, ;f t, , Commonwealth of Massachusetts w Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is Marstons Mills MA 02648 August 18, 2011 required for every page. CityfTown 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: A. General Information When filling out / forms on the �� computer,use 1. Inspector: I �(� only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name r� 189 Cammett Road IL Company Address Marstons Mills MA 02648 Ion City/Town State Zip Code 508-428-1779 S112855 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000): The system: 22 ® Passes ❑ Conditionally Passes ❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority W t _ August 18, 2011 Job#l11-140 I spector's Signature Date �-? 4.y It The system inspector shall submit a copy of this inspection report to the Approving Authority(Bog-Rd 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I� 9 t r r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System,Passes: ® 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: Tank was not in need of pumping at time of inspection leaching pit was found at 113 capacity. 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): 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. City/Town 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owners Name information is required for Marstons Mills MA 02648 August 18, 2011 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 the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet°of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. Cityfrown 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. 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is Marstons Mills MA 02648 August 18, 2011 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd'x#of bedrooms): 330 t5ins•11/10 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 25 Commodore Lane Property Address Alexander Pepe - Owner Owner's Name information is Marstons Mills MA 02648 August 18 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System is sized for 3 bedrooms May have been restricted to 2 due to wells. Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No N/A Well Water Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? - ❑ Yes ® No Currently Last date of occupancy: Occupied. Commercial/industrial Flow Conditions: I 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: 15ins-11110 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 25 Commodore Lane Property Address Alexander Pepe - Owner Owner's Name information is required for Marstons Mills MA 02648 August 18 2011 every page. Cityfrown 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: Tank pumped 1-2 years ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 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 w„ 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18 2011 every page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' 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.): Septic Tank(locate on site plan): 1' 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 8.5' long x 5.2'wide- 1000 gal. Dimensions: 0" Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is Marstons Mills MA 02648 August 18, 2011 required for every page. CitylTown 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 0" 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 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank had liquid only, no solids. Liquid level was found at bottom of outlet invert and baffles were intact. 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 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 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.): No solids or high stains present. 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: 15ins•11/10 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 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 4x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit had 10-14"of standing water and a high stain line at 50%capacity. 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 n� Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is Marstons MA 02648 August 18, 2011 required for Mills---_--- -- 9 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below 11 r'Irnminri -mff—k-A r ♦ � � ti ♦ •• � � � � r ♦ r ♦ r r r r r r ♦ ♦ ♦ r ♦ ♦ ♦ ♦ ♦ ♦ r r r r r r r ♦ ♦ r ♦ r ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ r ♦ ♦ ♦ r r ♦ r ♦ r r r r 4 29 42 41 Back Yard 93 91 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe _ Owner Owner's Name information is g required for Marstons Mills MA 02648 August 18, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.45 and topo map shows property at el. 90. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Commodore Lane Property Address Alexander Pepe Owner Owner's Name information is required for Marstons Mills MA 02648 August 18, 2011 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No.------------------- Fee--- '_��—_--------- - BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Vell Con5truct ion Permit Application is hereby ma�de for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ,/4l L C2 r Z - o 13 - 006 -- Location — Address Assessors Map and Parcel Owner Address — Installer — Driller Address Type of B g Dwelling _------------------------------ Other - Type of Building-- ---_-- No. of Persons.-------- Type of Well Aaf°�-1,e ; -— Capacity-------------____---__—__ Purpose of Well--- -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate, of Compliance has been issued by the Board of Health. Signed -- date' Application Approved By ---—— S_ U / - -_ date Application Disapproved for the following reasons: ----------- date Permit No. — Issued--—3 -- -"Zlv ---__-- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTJIIFFY�,/That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--- L�!&-4EI-Z—AA01l�/1 Installer -—--- — ---- — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—__ - Inspector------------- —------ �<�''6t' �4,'�'r�- '+ ''. .�_�' -'�' i•i 1�5f°,i { sc '�,. � '•-i _ t ,_. . h ,l .-� No.-�--?��/ Fee- BOARD OF HEALTH . �J_de TOWN OF BARNSTABLE 2pplicat ion-for Vell �CongtructionPrrmit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair '( )an individual Well at: : —�S e-ell pF /l,/lid _ mil? o i 3 Location — Address Assessors Map and Parcel Owner Address — sc/ --- e----------- —�ISTo _�_/%/��� //� - - —` Installer — Driller Address Type of ui'lding Dwelling Other - Type of Building- No. of Persons-------______—__—_________- Type of Well --- $k Capacity---------- Purpose of Well-- greement: • - - The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The i. Town of Barnstable Board of.Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed / dale -Application Approved.By date tj Application Disapproved'for the following reasons: • I, - ------ --___---------- date I a Permit No. --- Issue& ----- a---- ---- ---------- `"Wate ` iS:� r �#:3- _ tal�'ESr � rBFew"�.�,__:...n�C^x.. _ .-..r �.. a '4.;. �.a33 `"� a _Ltd • e� _ .—° ....z '� '�•` " a�+�e+:::. - "�...4.ra6: s.i s a`,t.-�'�r. ., ... u"'_ BOARD OF HEALTH' TOWN OF BARNSTABLE C ertf irate of Compliance 4 x THIS IS TO CERTIFY, That the Individual Well Constructed ( -)-Altered.Altered ( ), or Repaired (: ) by. ------ —Installer ------------------------ — -- r 3. k; at-��S G O/j ,�iY� ///� i has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----__—___Dated ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - --_ 'n;,Inspector-- =-'-- - - --- -------- BOARD OF HEALTH f TOWN OF BARNSTABLE Zell Construct ion Permit No.-- -- }' Fee- --- Permission is hereby granted ----------- '; to Construct( ),;Alter'(- ,), ,or Repair ( )"an Individual Well at. k �s /yiada,P!" •Cif,F ... •. r street' as shown on the application for a Well Construction Permit rt, No.- 'liU� / - U/G' — --� Dated- , - -- ------------------- �v ~; Boardr,H DATE • x 'k�f'w. ._. •AYt.. TOWN OF BARNSTABLE LOCATION1,/) I'r 61 SEWAGE # VILLAGE)f/Z���1�!>�� /!��/�� ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO.::� ]✓1R C�/��� �(i SEPTIC TANK CAPACITY , /� /✓ f LEACHING FACILITY:(type) � t. i' (` (size)�� '�?I ; .,NO. OF BEDROOMS � �Rh TE WEL OR PUBLIC WATER BUILDER OR OWNER �(1 te rj 69/(ry ol�- �)J�,,t cfig. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No (/f ;u` � � 4 . r ��:' � 1.� .�� �� (� �� �, =� � � �, ��`,r _, � - �� �� ,=-• II � � ,���, _ .. I II � ` / _! ` � I �` �5.. '1 ;� � ' • w G� C r s mil CAE/� i ' f i t I - - _ -- __ - 1 - - - - - - -� __ No... FE:B..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH el,91- 013 - ... - 1 1_B.4j5�............. ----_-----1�_UJA).. ...OF....... 5' Appliratiou for Dispaiial Works Tonstrudivit thrutit Application is hereby made for a Permit to Construct X or Repair an Individual Sewage Disposal System at: .......................................................... L 4 ation#Adcd,r s Lot No&O'Zp. Address r Installer Address U Type of Building Size Lot...IHk5_16----Sq. feet Dwelling—No. of Bedrooms___-- .................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons.........._.........._...... Showers Cafeteria Other fixtures Design Flow...........................5.5 .......gallons per erson per day. Total daily flow...............3 .....................gallons. W .0 p 2Y--------------------*-------- 9 Septic Tank—Liquid capacity-J.0.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. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by__..__ Date_. Test Pit No. 1...A41--.minutes per inch Depth of Test Pit.................... epth to ground water____--________---____ Test Pit No. 2................minutes per inch Depth of Test Pit...___......._.._... Depth to ground water-__---_--_----_----___.. a ........../---------------*---------- ......................... .. ............................. . .. ...... 654�........................................*.............................. 0 Description of Soil........... ....f W ............................ ... ...U .................... .. .......54 ...................................................................... ............ --------- ............................................................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the af07edescribed Individual Sewage Disposal S.ystem in accordance with the provisions of A'-1.IL 1_7 5 or the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.......1; ............................. Application Approved By............0��.. ... ..................................... ....................Date ------------ Date Application Disapproved for the following reasons:.............................................................................................................. ....................................................................................................................................................................................................... Date PermitNo. ---------------------- Issued....................................................... Date L No... .. .,Z. . - Flm$........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f oF...... 1 -. .cam-------------- ApplirFa#ion for Dispaiaal Works Tonstrnrtiun Prrutit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at . ..............................................fr 161� ir tw ( I� f ..... L ..... L''Y -_'� ........- Location-Address .i , or Lot No. -�•- a . k.. -f1 1 ? ......................... Installer Address Type of Building Size Lot----- >6 ..Sq. feet Dwelling—No. of Bedrooms___-- ................................Expansion Attic (Lj) Garbage Grinder (141 aOther—Type of Building _________________-_____--- No. of persons............_--------------- Showers ( ) — Cafeteria ( ) --el fixtures --------------- ---•--••-••-----------•--•••-•---•--......-•--•----------••-•-------•---•--•......--•-•----------- W Design Flow.............................5..5.........gallons per person per day. Total daily flow............._._.3 ................_.....gallons. WSeptic Tank—Liquid capacity.IPA...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..........._--------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...... '. ° __. . '`l!.?�_ e <{ ll 'et �FFI� Date........ ............ Test Pit No. 1___ __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........................ D Description of Soil.....................6-..... .��....... W VNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•--------------------------------------------------------------------------•---------•.••.••-•.....--•-•-------------••••••--•--•--••-•••-•----------•----•••-•••••••----------••----•-.....--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T'L.:: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ref Signed---••- � 9 _..j �/ 1. %U = 1 Date ApplicationApproved By........... .................' _. . •--....------------------............ ........................................ C�-�,� 1 _' i�ir;. :� ti3 Date Application Disapproved for the following reasons:-------•-••• --------------------------------------•••-----------------------•------------------------------- --•-•------------•--•----------------•--•---------...--------.....---------------•---------•----.........._......_....-----------------------------••--•-------------------------------------•-----_...•. Date Permit No._ & Issued------------------- tj• � -�•- -•----•------•----.... Date----------•-------•---^------- _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f Trrtifiratr of Tuntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed) or Repaired ( ) by --------------=-:--------`.4........ ----- -------------------------•------...---------.......---------------.....--------------....---...- Installer r r..... .. ..E - } has been installed in accordance with the provisions of TILT E 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.&_ t_....;7�c. ..__.__...•.. dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r > N -...� r .................OF..... ....�5 _,"J1J��..... i ��:�:....................... 7 FEE ..... VUlp sal Worhp Tunntra ion amit Permission is hereby granted ...... ........... to Construct (X ) or Repair ( ) an Individual Sewage Disposal System ti Street Vl' � .shown on the application for Disposal Works Constructioion__Permit-1 Dated•........... ................... ....... . t ................. Bo.....---------- // DATE. °• - and of Health......................................._ FORM 1255 HOBBS & WARREN, INC., PU, `LISHERS r Ldg' Number: Bottle' # E4:68 Date: October 28, 1987 OF 13AR.t. z sa BARNSTABLE COUNTYtHEALTH,A,N;DENVIRONMENTAL DEPARTMENT J SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSEiTS 02630 • fi 't-�t-)r.ft ;;;•�.•t„r> ) f.-1„t AtAg9>>`"t `:J;ri! I ;Ir .S� DRINKING WATER LABORATORY ANALYSIS _ PHONE: 362_2511 21II Jf Un a; .rn vc y Alt r • r { jy- t U '(Jillsup VJ811lah2 }f1J )U TUtfJlhfl) (IFS "'rri r nt E%t.337 Cl ient,`• �+.) tltlf�T) ffl7n�itr, I P I>:. ),1 .,, . t.r ., f t 1 tot) I ";? 7!t 92 of nr;' tt si Green briar Develo ment 'Collector. o !! ! ' � )!- P ,rturr ,. ,f F. Clifford zl) t11 ),rl aer!ii1) ul f t'iUtl ,1�Fai 1 i g"Addre' s' ' P. 0. Box 510 ' Afi l'i.a ns a1s7?1 "well dri l l er' n '1iti Ctillf.? i i'.Gft.t `tfr ' ,( rt •(' l5bi3jb U) t+U�'tt )U1 It.�ll (; 1 i Centerville',MA' !02632 Time &'Date of ,J1JwC'o - t o ,,, nt ordr,;?+✓h!'1.0/26/87 ' `4.00 p`,m, ' Telephone.: Type of Supply: well Sampl.e .Location: Lot L Commondore Lane Well Depth: 63' -~ _ Marstons Mills, MA Date of Analysis: 1.0/27/87 9:00 a.m.'.''i ` PARAMETER "'' "' ="' ""' SAMPLPRESULTt'""!' "'li lf)%RECOMMENDED 'LIMITS f 1 131 !.) 13o J Ji.J IIO IJJF;•>P to '!t )111 ._'ttllit. r, Total, Coliform Bacteria/100 ml 0 0 PH--- 5.5 "` _.'to z,9)r� ni atrtllorrtA .nOj! Conductiv t '(micromhos/cm 44)2 ni�t►r,�h�vtnz� h oil Ij JJ!J�!r`?tn !, 500`.0 t .L vmlj INJ(111 JJJ) ') ;),11 k; 3Vf, `(lifrl I•Itf; '7 lF f:f'1") .r r'L t � ,r.(j,!; Iron ( m) <,1 0.3 Nitrate-Nitro en ( m <,1 10.0 I,r,ll Sodium ' m)`''v,�' orli :)rj J :'✓rrri r3tr.:)t 7n ntttrt5.: fo ttoiisttn�,nc ) ni IJIJ;'r? nj nrrft 20.0 '"I — r1"I' r, ,u,.J uftli 71i7I lill",11fffu ti (JJIi'PP JO 23VI ft !�, 1 O ,7Ot)U tllf rhJtfj'U! ( , 1r"J( ! ?:,t .fill, i`31):'h trf 11oU t(i '..t S '." +'� r'r(t�trl if?. rn'fftt Jt 't"3fG fI !lfltll "l-ir"D r `i f.rf-!t to rt,iiir•ttn'...Is , ..,,r ,. ',,i i --- `.. "• ,t ru �t i,e Il,i,i !!Ul( .lint., i 11. )UI I:)J")155 WJ Muldhuj Wit !I- J .fi!'tl;+•.rP ffi"fit r{')'+ I .__L_Water sample meets the recommended limfts for drinking of all above tested parameters. tt;?;,ftrth(i ')ilPti+ti II .'. Based only on results .of the parameters tested for this sample the water is t, `)`t 'su i tabl e'for 'dr�nki rig'but 'may presents-,they robyems"'ch'ecked'-- below fff lfft f;l t! r?')!? lfl 11:),rt ''P`,(f [+!t6 {�)?11`J71i) Jfifarfl nJS) f;lfflortrr101Aorfl9tttJrtt `)?IJfS') VJlfr! ?{)r 1!f,t)r)n•,;t;;. , •' .Ir i, .t11 'v� f ,rl. ,.?. A. Water sample• has' higher than average l'evels'i'ofjrNftPat61"!`'Future 'Mon i tor ing 'is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbiljy,`,,l!t() ' C. rWater may' resent, aesthetic robletns[' taste odor; s'taoih-fh 1) 'diie'!`to r,f' ' rf; rlf rf J+I Jwvn G ^71iJ') fnm runts {).t to 28J7X9 nl 2andsfirl" {°• 1 2�7rJixif nir:l))tact rtn D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human 'consumtion:' t'A. Nigh' Bacteria'ZB no 2"High's N t`rates''' ff' f'""' ` "fi•!I ' k+l tit'1U G )7711(lp'(7ltl){IfS IJItlt r)t I;, „ a r J Z. n+)3'tR otf PP Ag0,3q t! ,rrtuibo? fri'I.1 rrlr;h O r�rfho'):)r,� zf+r!rtc!!rto rct`� -3►tlrzivhr ri •t�tf;w At gpnirrilmn(The Barnstable County lHeplth,and Environmental tatements, REMARKS: .. ,,,, , .:,,.,;�.,,, ..,r.,,. '.;�, , ;raa.•. epa .�, t_. ,; . , interpretations or conclusions made by anyone else concerning these results without written consent. CC: Barnstable Board of Health 1 /7/85 Laboratory Director UluDepartment of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT / /rWELL LOCATION Address�0 d C O r"r"O b D tt£ City/Town MA*L5-tarn 5 M.1 l ( 4 G.S.Quadrangle Map o2. Grid Location — -. Owne[ Crl��i t�QJ'1/sY J £�/��6rONlet�} orr0 C'S Address 0 !VI a WELL USE CONSOLIDATED WELL Domestic K Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones . / Method Drilled 1) From To ►"�G•¢.tr- 2) From To Date Drilled 3) From To - 4) From To ' CASING o1 ,1 Depth to Bedrock Length GO Diameter Type /O✓C UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface(, _ Sand: fine❑ medium❑ coarse Date measured m—/N-g7 Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Yes ❑ No Slot#/length,3from40 tol,3 L� Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Sloth length from to Chemical ❑ Biological [9/ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To M d DRILLER S Cb d Firm Address G 3 City Registration No. perator s ignature Please pant irm y CtIST®MER COPY 15M-2 84-176471 i • ;1 C:7:77- 7 ; 20 FT. MIN. TOP OF FOUND. SOIL TEST EL. _ 10 FT. MIN. DATE OF SOIL TEST CONCRETE CLEAN SAND WITNESSED BY G _ COVERS $„ SCH. 40 P,YC PIPE PERCOLATION RATE � , MIN. I! NCH MIN PITCH !/8 PER FT. OBSERVATION HOLE I OBSERVATION HOLE 2 CONCR T RS 2" LAYER OF ELEV. : ELEV.= 7 / 4" CAST IR N PIPE ( 12 y C I":I {OR EQUAL MIN. ! A �" ' ' 1/B"- !/2" WASHED ______.. PITCH €/4 PER FT STONE -rap cam, T,.l E' Sut4t. T� r' 34 FLOW LINE _" )v�" ., L)�r A ELx .. 5- MIN, 74, 7 E� _ �. �� , D LE E'L --__ --- , _ r � _ � 11 74, � Lj ELz EL = 7i L74 � 74 / 6isTL_____._ BOXY ' • • w _ WATER AT EL= ` .Z MUtl'ER AT E L.= " _ �,. r � k 3/4 - 1112 0 •v o ; GALLON WASHED STONE , o°n ° U. o° Mir o�' , DESIGN CALCULATIONS ` SEPTIC TANK < m EL. PRECAST LEACHNG NUMBER OF BEDROOMS S BASIN OR EQUIV. , C,ARt3A6E DISPOSAL UNIT `r 6' OIAAA, TOTAL ESTIMATED FLOW f GAL./BR./DAY x _ BR. 6 .�OIMY ; SEWAGE DISPOSAL SYSTEM PROFILE REQUIRED SEPTIC TANK CAPACITY }` GAL. k NOT TO SCALE ACTUAL SIZE OF SEPTIC TANK " GAL. (kk--Gf�%'kl ' -- LEACHING AREA REQUIREMENTS / BOTTOM OF TEST HOLE -fW--t S65- PiR6RA8tf- lEfi-i-ABLE--fii - SIDEWALL AREA ;AL./S.F ` u OBSERVED WATER TABLE / / ? EL.= I _ BOTTOM AREA _ GALF './S. ! - - .-�" LEACHINGCAPACITY { BOTTOM♦fSIDEWALL) ;,;,;�. GAL. LEGEND ' ATi RESERVE LEACHING CAPACITY 69,. GAL EXISTING SPOT ELEVATION OOxO { EXISTING CONTOUR _ _ _ Oa._ i F€NAL SPOT ELEVATION 500c. NOTES FINAL CONTOUR — ! I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. SOIL TEST LOCATION TITLE 5 AND THE TOWN OF _ RULES AND x UTILITY POLE REGULATIONS F0* THk Stl l~}HFAC;E (345 . LW *A GF- r TOWN WATER W ,:` W 2, ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT' TO r- r —A L CATCH BASIN t` ® ) -• e -� ''" ��,��- _- _��, L� WITHIN €2' OF FINISHED GRADE C V 3. EXISTING AND FINAL GRADES StitSi..L REMAIN THE 4. ALL COMPONENTS OF T HE SANITARY SYS'rEm SHALL 13E CAPABLE: OF WITHSTANDING N- la L3.Af?€NG UNLESS THEY ARE UNDER OR �. WITHIN €0 FT OF DRIVES OR PARKING AREAS. H-20 LOADING MIN FRONT SETBACK SHALL BE USED UNDER OIL WITHIN €0 FT OF DRIVES OR PARKING. �^t. DEAR SETBACK 5ANY MAS{NVARY UNITS USED TO BRING COVERS TO GRADE MIN. SIDE SETBACK SHALL BE MORTARED IN PLACE. . NO DETERMINATION HAS BEEN MADE AS TO CO MtIPILIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO \ , : LZ __., OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHIORttY. `� ,qc i urn ,�iSaIL.�- E�EV11)iry_ sL„avc' APPROVED : BOARD OF HEALTH 4c-rL1,4t /4s C U1LT Lvc.47-/oiV J/,I." !\-4Z/` I�P-E VIS 10�4 "/ f ,c./ 5jlf w A.S B,)1L ! C..C/�v s Ir,,-L/c- 1C...,"V \ LOTc7� � 7, v LFE L. E. Fi✓. .$ � sit: / — . LOT A4,. DATE AGENT p - "4ATIOW _ 1 Lc% T APPLICANT, -/ A. /I �r [� l,�^•� ryt'/ `t^ ni,_ 1- /L_ L.. J�' ! f `•` � ...J ��..J l\� � till \S; DF Y Levy, Eldredge & Wagner Associates Inc. , En*iem Lcmdwipt Architects P4ws Lmd &xwyors ". 889 West Main Street Centerville Mo. 02632 L;7t:J Al . , LEVY ... -r..�,�...... .� LOCATION MAP ,xe No. : .:. 7 FSHEET OFJ1 ... _. t 20 FT. M IN. TOP OF FOW0. EL. _ _ ' `�` 10 ' FT. SOIL TEST GATE OF SOIL TEST 6ks ' CONCRETE WITm&S$EO BY 2 x 4" SCH 40 PXC PIPE CLEAN SANG G COVERS RAt INCH ` MIN. PITCH 1/8 PER FT. PERCOLATION OBSERVATION HOLE I OBSERVATION HOLE 2 CONatETE �� 12 COVERS 2" LAYER OF ELEV.s 76 G = 77 4 CAST 1 N PIPE Mf N 2 / „ ,� ..� `EL E V. a �FiR EOUALL MIN. G I c�E, —.> I/S — 1/2 WASHED PITCH 1/4 PER F7 STONE- r45, - FLAW LINE Z W u. , ]'I Es L 7S MIN. ,�.• .. ` ,�1� a �? 3 EL_ 74 . 0 EL = 74. t LEVEL L EL.= 7-3 / DIS T EL x BOX N J WATER AT �_ 4 WATER AT % EL ` 1,} EL." Y . ! ~ 4 is y: GALLON WASHED STONE •°00 o oQ� a SEPTIC TANK + ° DESIGN CALCULATIONS 4J a Or EL.= (09,Z PRECAST LlIACHIN6 NUMBER OF BEDROOMS << BASIN CAR EQUIV. t -� ' ,. GARBAGE DISPOSAL UNIT' N r4 4 U 6 DIAM. 14,) TOTAL ESTIMATED FLOW_ 'SEWAGE DISPOSAL SYSTEM PROFILE d _ Rio GAL. x BR.) 3_0 GAL./OAY �iI"C — -- . NOT ?0 SCALE REQUIRED SEPTIC TANK CAPACITY t5_GAS.. f — — ACTUAL SIZE OF SEPTIC TANK G U GAL. L 90TTOM OF TEST HOLE' = try 5 ( #z LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE — ! — / -- EL.= -- SIDEWALL AREA 2.5.: ../S F. BOTTOM AREA / — GAL./SF L D T LEACHING CAPACITY I BOTTOM SlOEw+ALL ` 7 GAL. LEGEND: RESERVE LEACMNG CAPACITY . GAL. EXISTING SPOT ELEVATION O0A0 } EXISTHNG CONTOUR — --- -DO--- FINAL SPOT ELEVATION NOTES ✓~" -- Y FINAL CONTOUR 1. ALL iMaRKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.O.E. 7 SOIL TEST LOCATION TITLE 5 AND THE TOWN OF °' c:4 RULES AND ' UTILITY POLE -0- Y _ REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. _. ` r - TOWN WATER W �W 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO ^�u ,(� • `_ CATCH SAS IN �, GA� -... ��-�.- - �_W,6_tL �./ - WITHIN 12 OF FINISHED GRADE. L3 ', 3•'EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. ` 4 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE �_: // ;yA OF WITHSTANDING H-10 LOADING-UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING t MIN. FRONT SETBACK 3& SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. ' f MIN REAR SETBACK /5 3. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE G E MW. SIDE SETBACK SMALL A J. � MORT RED IN PLACE. 6.'NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. APPROVED BOARD OF HEALTHA �c / OT 8 DATE AGENT PROJECT' I.00ATION� '_ a G l T€ �{,1/,> F i f v l R APPLICANT r LEf4Gr� t {* � WA_<E ey ,�� Levy, Eldredge & Wagner Associates Inc. tclnduo" Architects Plara►ers land S'urnyr a 889 West Main Street 4., Centerville Ma. 02632 LOCUS i i r 1, ., � j _,:�. �� •: ,, � ,.. . ,Ia No. / ` 7 SHEET OF 1 LOCATION MAP 0 _ ..... i...t Lx.... x: . n. T...!..i✓ . r. ,. >Wp+,4.. < ,., _... .. y :#,..... x. ..a. .:... .i'>;'t.. .,A` 3.. . xC.S, .. ..