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0030 FLICKER LANE - Health
30 Flicker Lane - --- Marstons Mills A= 013 - 032 I i i TOWN-OF fi LE f t?Cp,' ON Z_ SEWAGE VILLA�fi iq,SSESSoIt'S INST LEA'S NAM&PI OME NO JEC TANKCAPACTT'X LF.�4CHING I�CIII-TT� NO oPtatool�s 3 tart om. PER1VdITD CoP/fi°ti Sep an 6 Wmeerii tbe. MaxlmumAd}ustetl GI-antetlwatet Table to the 9bubm ofUA6ing knit)+ l�lv 4v WAtac Sapply y al9 tal l d e'a uteg Pacyltty t a�►y�el9s cxlst a site do bv1tW wo feet;OfWkchi'14 fttaiulY) . � . i Fclgr:_cyf /e antl auui l.caclitpg>rmatlio{figcue unY wetlands exist Al 300 feet v£leublii►is fuciti` ? �-�- ...---.`.`-= 1~urlgbad 6y-� ? fr 1. QaL� lb _ II Lo� f O � O �a I i � Q'3 D!T 3ay3a'� A 8.3 -36Y o/3 -o3a 5� i a I 7- Commonwealth of Massachusetts :a Title 5 Official Inspection Form I ' ,:-'�-1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright 'P Owner Owner's Name information is required for every Marstons Mills ✓ MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection -� Inspection results must be submitted on this form. Inspection forms may not be altered in an§M way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification 1 . 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 3-2-17 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-PPaage/11 of 17 Commonwealth of Massachusetts , a f� Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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: System is in good working order with no sign of failure. Y 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts �x Title 5 Official Inspection Form !, rtl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_J!✓ 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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 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 wN pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form =' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P.4;!,✓ 30 Flicker Ln t J Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic 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: F . 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form ' I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY �A l;!✓ 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year 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. ❑ z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® -Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form J�j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this"inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the.facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information , f 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 r . t5ins-3/13 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 30 Flicker Lnq Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump?,; ❑ Yes ® No Last date of occupancy: 1-2017Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpa) 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 o 1, Title 5 Official Inspection Form I�.+ I Subsurface Sewage Disposal System Form Not for Voluntary Assessments es; J§! 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town 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--pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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 =1 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �F. J;!✓ 30 Flicker Ln Property Address P Y Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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: 2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 14"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.): Good condition. Septic Tank (locate on site plan): Depth below grade: 6"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: 1000 gal Sludge depth: 8" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts , =1 Title 5 Official Inspection Form lf;�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons,Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 0 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 16" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System•Page 10 of 17 Commonwealth of Massachusetts al Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_�_�;!✓ 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town 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❑ ❑ El fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: ; gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts =1 Title 5 Official Inspection Form ` !f� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments aF. 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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.): Good condition with water at working level and no sign of back-up from chambers. 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.): y * 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 a Title 5 Official Inspection Form i41 f Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Flicker Ln t J' Property Address ' Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ 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.): Leach chambers in good condition and emtpy at inspection with stain line at 3"off bottom of chamber. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts � Title 5 Official, Inspection Form YSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 8% 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions - Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2.17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Li 1 01Y 8-3 36 � V w■■�wwr■ra� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ,a} Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright Owner Owner's Name information is required for every Marstons Mills MA 02648 3-2-17 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: 124 • 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 hole within 150 feet of SAS ( 9 ) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: S You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 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 4 Commonwealth of Massachusetts al Title 5 Official Inspection Fora I ' 0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Flicker Ln Property Address Jon Wright Owner Owner's Name m. information is required for every Marstons Mills MA 02648 3-2-17 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 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes \� 21pplitation for Dizpozor 6p5tem Cow5truction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. b i Gam► L�r�.Q/�II I er's Name,Address,and Tel.No.Tcxq Assessor's Map/Parcel 131 32, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A6S6G 7 Type of Building: Dwelling No.of Bedrooms Lot Size 7.(0 7�S sq. ft. Garbage Grinder ( ) Other Type of Building L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date (o. t 3 - Z®c7 Number of sheets Revision Date Title '3D ►=1,�...-� Size of Septic Tank �x•�1�-v� LODo 51y Type of S.A.S.QZ) 53o5nt 6-c- 14—to Description of Soil nn 1.J� G � �J • Nature of Repairs or Alterations(Answer when applicable) jC a i�l� 1000 At '7)%4y 7-b A) jW �-40- Date last inspected: Zba Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign J, Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. !7 Date Issued No.�_ Fee 1 Entered in computer: � THE COMMONWEALTH OF MASSACHUSETTS -'L .A PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes �f1j , USETTS 5` � try �• � 2pplication for &005al *p6tem Construction Permit Application for a Permit to Construct O Repair O Upgrade( ) -Abandon O ❑ Complete System ❑Individual Components A. Location Address or Lot Nor. q !i-GkA,1 ("n r%4/ p er's Name,Address,and Tel.No.Ton to vt r Assessor's Map/Parcel 131 3 3 2- Installer's Name,Address,and Tel.No.' s , 10 Designer's Name,Address and Tel.No.l 1 . 1D%"t e 00 G Ou 1(-,3 rw1kl,,•_ rvv la �71�` .S (�"j�f�1 y .,� ►-nGw-e v v(k /�'q y r Type of Building: Dwelling No.of Bedrooms Lot Size�fa ��(� sq. ft. Garbage Grinder ( ) Other Type of Building 11, No.of Persons Showers( ) Cafeteria( ) Other Fixtures J Design Flow(min.required) gpd Design flow provided gpd Plan Date l t7. 1 3 Number of sheets Revision Date Title Size of Septic Tank 1000 C;#f� Type of S.A.S.('Z,) 50t..)5ft J,(. 14— -- Description of Soil D�0-Ac, ` I Nature of Repairs or Alterations(Answer when applicable) _ r �a C, ( "T)4� 7-2? A)qN R Date last inspected: Sbo Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign d „ Date Application Approved by Date vIV— Application Disapproved by: V Date for the following reasons Permit No.. �' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT FY,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( ) Abandoned( )by „ )tJ,Q. Q{a/�✓t��.1 �•L� at t(�t, .� ��rJy�,.,( /'�6a(5k,, g/�,i h been nstruc a in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -- 11Pq dated Installer ��O.A (� D sQ✓r 1 5' Designer ( 5 uL, l.� #bedrooms Approved design flow A 'T(> gpd The issuance of this p� it shall not be construed as a guarantee that the system will u'b /as design .) Date M t) Inspector !/ No. t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mwif poq;al �6pftem Construction Permit Permission is hereby granted to Construct ( ) Repair (K) Upgrade ( ) f Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction n)ust/be completed within three years of the date of th'S et. —, Date /� / Approved by I TOWN OF BARNSTABLE Y i1 LOCATION 30 F L'►c Ke,r Qv E SEWAGE# 2-0c�l4 - 2.9—1 VILLAGE Al5f.,1s fli (IS ASSESSOR'S MAP&PARCEL 13 - 3 2 INSTALLER'S NAME&PHONE NO. C`l4Qew;CU SEPTIC TANK CAPACITY LEACHING FACILITY.(type) CZ ) Soo S4-L L.C. (size) 12.9 K 2 5' NO.OF BEDROOMS 3 OWNER UkL i.J2iC�r PERMIT DATE: q-t q. COMPLIANCE DATE: !l -11 Z©o9 Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 170 P 167 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Feet FURNISHED BY (T r_G l� kajwe$' L�� '�1 A Iz. O 3t Z9.6 �. o 2S_ ® � 3 31.o � .29.6 Q� N t• o T Town 4 Barnstable f � > Regulatory Services Thomas F. Geiler,Director Public Health Division ° � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: / - -0!r Sewage Permit# .Z0 2-9 7 Assessor's Map/Parcel 3 Installer.&'Designer Certification Form Designer: JAIL-6 Installer: Address: f 7d e4-o 4,4164,D- . 4 Address: 2�0 -7 On - 6ft)w 1EAzr620k erl was issued a permit to install a (date) (installer) septic system at C k 62- L.4/✓c-- based on a design drawn by (address) _J'.p D yL cSS 6C/ dated f 0Z 4 3.: a — / (designer) i/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i,e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local R ations. Plan revision or certified as-built by designer to-'follow. Stripout(if requ' acted and the soils were found satisfactory. ��� ASc � D R N�y .k�. C (I taller's S' ature) No. 1140 �FGISTS n S4NITAR\� I �� V (Designer's Signature) (Affix DesiONMiarnp Here) PLEASE RETURN TO B %SABLE.PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL Noff BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARF,RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignemer ification form,doc Town of Barnstable P# Department of Regulatory Services .Axwernats, i Public Health Division Date a NABS. 200 Ma' Street,Hyannis MA 02601 Date Scheduled Be I TILMI b- 7ime Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: /9 06)'1_ C— Witnessed By: LOCATION& GENERAL INFORMATION Location Address 0 FL/C f<,6�—,e L,9/IJC Owner's Name -^/ /WJ4—K6//7 /1�igD�7"O/✓S /Q� Address Assessor's Map/Parcel: 1*9tP /Q3 /RRC ,3 Z• Engineer's Name ✓1JOY4 NEW CONSTRUCTION REPAIR ___Z Telephone# SQ 00"vr6 3 /99�4 Land Use Slopes(%) Z 7e Surface Stones /VON 016 4 Distances from: Open Water Body Possible Wet Area L o gg ft Drinking Water Well Drainage Way oB� ft Property Line Z10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) s v /Z8�/y� Parent material(geologic) CO�2SE ��lllQ Depth to Bedrock r ry Depth to Groundwater. Standing Water in Hole: �0 Weeping from Pit Face CBS' _`-. Estimated Seasonal High Groundwater 6 L i y, 5-1 /0r—/L G 6124 /19f}/0� E2 DETERMINATION FOR SEASONAL HIGH WATER TABLE,,1 l u'i � Method Used: E • - Depth Observed standing in obs.hole: in. Depth to soil.mottles:_ ,- Depth to weeping from side of obs.hole: In, Groundwater Adjustment I B'` u Index Well# Reading Date: Index Well level _,- Adj.factor.,__. _ Adj.GroundwaterrLLevel ; PERCOLATION TEST »fate/o/ o nm /o l_ref Observ77—P:—/) Hole# Time at V Depth of Perc �✓r _S� Time at 6" Start Pre-soak Time @ /U.' ZO:U d Time(V-61') End Pre-soak /0!.Z 5-:00 Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istenc % ravel 0- 7-577k :5+AU y co M 7, sy2 G/y C/ 5/L7 ",#rl I o//R YZ cz �o�as� s.��� �ay2 713 /5�o G v DEEP OBSERVATION HOLE LOG Hole# %P` z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface Om) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% LOAM YK 514-7 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: C ' Above 500 year flood boundary No— Yes .y__ 1 ► Within 500 year boundary No—L/ Yes p Within 100 year flood boundary No ✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the 4 area proposed for the soil absorption system? YES p If not,what is the depth of naturally occurring pervious material? �} Certification .. I certify that on /9 q�� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr . ' gg,expertise and experience described in 310 CMR 15.017. G Date Signature A) / Q:\S.EPT1CkPERCFORM.DOC N Ln O v7 Postage $ o p260r Certified Fee ru Postm� C3 Return Receipt Fee CO p (Endorsement Required) He O Restricted Delivery Fee (Endorsement Required) L- co Total Postage&Fees $ yr v rq CO Sent To Lj �U Street Apt.No.; or PO Box No. City State,ZIP 4 w" ---—�-- I -... ui vi f KY �b2a �1 Certified Mail Provides: 3v 9 C_Ur" Lcj r_�_ s A mailing receipt Mr1r\ a A unique identifier for your mailpiece IN A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. m Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider,Insured or Registered Mail. ■ For an additional fee,a Return Receipt maybe requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT, Save this receipt and present it when making an inquiry. PS Form 3600,August 2006(Reverse)PSN 7530-02-000-9047 SECTIONSENDER: COMPLETE THIS SECTION: COMPLETE THIS . ■ Complete items 1,2,and 3.Also complete A. n a)u re item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse 5" 1 t I 4�X ❑Addressee so that we can return the card to you. B. Received by(Printed N1 e) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ _o �105 i� Ni 11 Ra(i �.� xY yo2f�-s � L- 1 ����(�1 Ky 3. ervice Type Certified Mail ❑Express Mail 9 �///////❑''Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 ArticleiNumber (transfer fromI sery ce label III'/I [17 0 Q 8' ,18`3 Pit PI PP 2 0 5t®0 8'S 7p 4 r t�t ) „ �y, k a d u ,� to 9� ft'l�It�d f PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 1 I UNITED STATES POSTAL SERVICE. First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Health Division RARN5rARLE, MASS. 200 Main-Street. r� '639 prE'D MAyp Hyannis, 0 MA 2160I -t Town of Barnstable Barnstable Regulatory Services Department j m1e8 P BARNsrASM 1NAM 6 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 07 7/09 � C 0 Jon and Linda Wright 905 Elm Hill Place Louisville, KY 40295 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at3 Flicker Lane, Marston Mills,MA was last inspected on 8/1/2007, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "System is in Hydraulic Failure-Backup of sewage into facility or system component due to overloaded or clogged SAS" The deadline for repair has past. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health OF rNET x*cPm t 4 ✓-t^ X'^+. '^p ✓ 3a':. -Jr d �d,'ii ?-k a 4- rs� Town of Barnstable 9 i.Y4 (� �1. a stable �- E CC"'r' r, Public Health Division ,200 Main Street 3 -17A 00 � � -� ''��''` a ��Wiz• Hyannis, MA 02601 �tt Eo Mnr 02 1A $ 05.210 7007 0710 0005 5820 7564 0004606238 JAN03 2008 MAILED FROM ZIP CODE 02601 C VAOlt ICD let MIX IF_ 029 DO I RETURN TO SENDER NO MAIL RECEPTACLE 1 { UNABLE TO FORWARD " me: 02601400200 *25s"''m".2-•1876E6-03-09 801@400.2 J4 r -ice' s COMPLETE •N . COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature - Item 4 if Restricted Delivery is desired. ❑Agent E Print your name and address on the reverse Addressee so that we X ❑can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. I I I D. Is delivery address different from item 1? ❑Yes 1 1. Article Addressed to: If YES,enter delivery address below: ❑ No I I � w' 3. Service Type KW 6z u\Aq ®certified Mail ❑Express Mail � i I ❑Registered W Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes i 2. Article Number - - 1 ffimnsfer from service label) 7 0 0 7 0 710 0005 5820 7 5 6 4 1 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 Town of Barnstable Barnstable �ppSHF Tpw y�P Regulatory Services Department AN-Ame"aC hy (� BARNSTABLE, Public Health Division �p ON i639 679 �� ArFb MAC A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 2, 2008 Jon Wright 30 Flicker Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 30 Flicker Lane, Marstons Mills MA was inspected on August 1, 2007 by Patrick O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. rtillrr PER O OF E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\30 Flicker Lane.doc Town of Barnstable Barnstable �OFTHF TO �° fty �'�� Regulatory Services Department I micac J.F * BARNSTAULE, ' I t`90 "ASs. Public Health Division O i6S9' �� Arf0 MAt p' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 2, 2008 Jon Wright 30 Flicker Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 30 Flicker Lane, Marstons Mills MA was inspected on August 1, 2007 by Patrick O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P R O OF E BOARD OF HEALTH 7007 0710 0005 5820 7564 Thomas McKean, R.S., CHO �. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\30 Flicker Lane.doc 7007 0710 0005 5820 7564 I - r ' COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d ? DEPARTMENT OF ENVIRONMENTAL PROTECTION Y M A� t Sy• TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Flicker Lane Marstons Mills MA 02648 Owner's Name: Jon Wright Owner's Address: Same Date of Inspection: August 1,2007 Job#07-168 ` Q o 3 0 32 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number-: 508-428-1779 CERTIFICATION STATEMENT y 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 r-; approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:,) Passesh Conditionally Passes Needs Further Evaluation by the Local Approving Authority X i •• Inspector's Signature: Date: 8/1/07 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. Notes and Comments: Liquid level in leaching pit is at top of structure,pit is in hydraulic failure.Septic tank was found to be structurally sound and can be used with a new leaching system. ****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. Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: f Page 3 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more'than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) Yes (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Flicker Lane, Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _ _X Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site _X_ _ 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? _X_ _ 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: Yes no _X_ Existing information. For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:3 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 25 years old Were sewage odors detected when arriving at the site(yes or no): No I Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Flicker Lane, Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5'long x 5.8'wide—1500 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:28" 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: 10" How were dimensions determined: STICK WITH HINGE FLAP. 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 mreviously been full to tom observed solids on top of outlet tee Liquid level currently at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Flicker Lane, Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): Previously full to top one outlet pine PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number:One 6x6 pit. _leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: _overflow cesspool,number: _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Liquid level in leaching ppit is at top of structure pit has no effective leaching CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Flicker Lane,Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Flicker Lane 33 48 53 108 � r Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Flicker Lane, Marstons Mills Owner: Jon Wright Date of Inspection: August 1,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: N/A Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked 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: -s • ��ip ,r S < n � b Nfigilill., E J - --------------- Z - ---------------------- ol ---------------------- exwrru,rouyv�rEou gag. I r - -------- ----------- —� —1 c s ,.•. 0 0 a o �f !9i r•2 o GJLPI6: I -4 fn ORA-PIG TYPE: rWndAF'w�PIAn SHER—Ink, OO o � 0 . o 1113 �1 1 i S u.. il�-•.ear p C � J •• '�� f el R v o r i i g 8 e T. 5 '> $ o fill till P-19--Vr i'L-00(-PLAN - ouwwc nrt: hLnla: 1/4"- 1'-O" �r..h rlom►I." Slllli NUMllli: A 2 OO E 15� ,oMm,nwr�. .M A.plul..h'mgL Ya m.Yeh � • ' i h•r.l.pp.r t O �/II"MArwf.d.p.w.fi'M GILr.L.a'I r"oe. }1� O"HO.InwLtnnp.so � ••(///CC. AyMW.A'syL f.m..A. II� ' 1/t"nryw.UfypJ \ � .J J f GM-iw•u.4y.dy liti G'tli.y Js' •160 .'1 a^r'r ex t_GM-mu,u.¢P.d,y _ � � � 1._•t P'n..Yim.s nrf.h Q I r_•s P.i..r-.n..mM4. Z T.14.W.bs.rd iw 46 uJly - : GMlwaw.oNM v.M ~I OI P.T....psJ.rrwpr.J iYv.F^bu..wrp fttl ♦/.°APAr...d T.14,Wflm' •f/t"NO.MJ.frn p.lh +„ � 2 ' I..wlw.rod•!1•.� r4 o �{ .e P.T..bl.f.•Ir..s. •ba-i... ..a _ P.r.s.a.mua Ji w/rmy.on.n — ..� 2�a.$.. rl/•'r4.n.i4rnn.p,aJs s/t C ..� O..`-O"Pmu'.J.n.w.f.ioWwi'nn t •. .' b mY.ply v.por bwrr'w. - - �A�f�UIL1711yGhCGTIJJ1.1 lB�y�•� ° 3 tit p E `ta ' OMWING TYPE: !NETT NIIM AA00 0 all S d { 1J r____________________________T-1 it I I , I , I I Q I i f 33 r-- - --- --- ------------------ --- ---------------------------------------- --------------- tLol.(r eL-eyAT-ld2N d -7 41 L hcnI 1/4"- -OI N { .-$ A a."o. �� i I i i ' i Y �• �.�.i g.C L I 1 ----- r-----------r-- --- ----------- - a qµ f+ I -------------- 1 F—IGHT M-CVATI67N --f` - i�'ZbJ o ------------------------------------------------------- i ' o T 0 I r---------- -------------------------------------- [l F?-eAF—eLeVAT-1^ onnwHcnre: O at L 0 CATION SEWAGE PERMIT NO. Lot 102 Flicker Lane 83-679 Vtl L AG E/� ---Rn I I/- INSTALLER'S NAME ADDRESS Robert B. Our Co. Inc. Great Western Rd. Honth Harwich, Mass. 02645 BUILDER OR OWNER McKeon Custom Homes DATE PERMIT ISSUED ' �- DAT E COMPLFANCE ISSUED _---'� �/ � � �� , �� 1 i ��5 �� i.�� �Y`� ,n, .. 11 \ � ! 3� ����� (. �� �( 3 - D32 73 / 7 No........................ FEic ......X'-- • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......t.O.W_�.................OF............. . .................... .0Appliattion for Dispaiial Works Tonotrartion rprmit cation is hereby made for a Permit to Construct (V') or Repair an Individual Sewage Disposal 5y s t e m Pa It i: L-i -* 10 ..... ....Ln Mar ...........................?.. ..... . ........................ .......................................................................... Location-Address or No, . . ......... Owner Ad ress nur . ...... ....... ................................ ..... Installer Address Type of Building Size Lot............................Sq. feet U .A- Ce. .......................Expansion Attic (v- )Dwelling—No. of Bedrooms... Garbage Grinder (fj1AA Other—Type of Building .......N/A............. No. of persons......lj./P�............ Showers (o/,*) — Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow._..4,55...........................gallons per person per day. Total daily flow....... ?3Q .............gallons. ..............*'**' 1:4 Septic Tank—Liquid capacity.)APQ..gallons Length.A...�?.".. Width...WAD'!_ Diameter.jO/A...... Depth.5'..5.7. Disposal Trench—No..NAK......... Width....61A........ Total Length...0A........ Total leaching area....V,/ja......sq. f t. > Seepage Pit No.___._..........._... Diameter......X0.1...... Depth below inlet......�.. ...... Total leaching area2%Q&;?.......sq'. f t. Z Other Distribution box (V. ) Dosing tank (NA) Percolation Test Results Performed by....ZAI"�.....Z3.... ........................... Date............................. ........... as Test Pit No. ......minutes per inch Depth of Test Pit....!z......... Depth to ground water..."O N e— .................. Test Pit No. .....minutes per inch Depth of Test Pit....., ......... Depth to ground water...0.0 e-A....... ................................................................................................................................... ..................... 0 Description of Soil... ...ftnA... 8'L-1Z' nZX" -)----- --- ---- .......lsmn.anvct. �4 oqq _0r)(A Sv6sod . VZ ... !�?nay.............7..................................7.............—AZ U ... . ....................................... ......L............. ............................................................................................ ............................................. ..........'r f- 6 jo 14 U Nature of Repairs or Alterations—Answer when applicable- .................................................................................. ..................................................................................................................... Agreement: 14r-A.e,.e-f /-/7- - .I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITA U 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. `�A c-V_ Signe ................................................................. ....rs.. ...... Date Application Approved By........... /�....... .............................................. .............7. -'.1.. Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date --------------------- ------------- ----------- Vr ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................oF............. ... ..................... Apptiration for Disposal Works TonstrnrtiunZ. Appl cation is hereby made for a Permit to Construct (,01 or Repair ( ) an Individual Sewage Disposal System at: } t �' t C�1 r tut e `� N1 ........................ - 1: .. .. . .°�...._.. .�........... ......----------......................_.. -. .. . Location-Addressor le No. aOwner + Ad ress Installer Address d Type of Building Size Lot............................Sq. feet U g— p ( -) Garbage Grinder (N��. Dwelling No. of Bedrooms.__ f..:lf= ........................Ex Expansion Attic 0.`4 Other—Type of Building N '� No. of persons......... Showers t ( ) 1 YP g ------------=-----••----•--• P 5 (�, — Cafeteria f11 Other fixtures •----------•-- -•-•------••••. . W Design Flow... ..<� ...........................gallons per person per day. Total daily flow.........-:��........................gallons. 40 WSeptic Tank—Liquid capacity.3 iX?..gallons Length_. '. r`". Width._ �.►0..._ Diameter..�t)..A..._. Depth.5'_. � x Disposal Trench—No. _i 0.......... Width....41A....... Total Length...OP.._..... Total leaching area..... ,J ......sq. ft. Seepage Pit No........A----------- Diameter......A0......... Depth below inlet......k..` ..._.. Total leaching area-a,-... ......sq. ft. Z Other Distribution box (V) Dosing tank ("M aPercolation Test Results Performed by....P__1V!.5.....Z;3:6g.�1 t.......................... Date........................................ ,_l Test Pit No. I_-,.$v..___.minutesperinch Depth of Test Pit.....1. .......... Depth to ground water.... 44 Test Pit No. 2...A.. _....minutes per inch Depth of Test Pit.....L?...._.... Depth to ground water-__-�0.1`9�...... 9 •-----•--•••-------------- -••-•••••-••--••••••------..............---------••...•••-•---------.............------------........---•----•••-••--..........•. D Description of Soil P -- �A,';. .... ,a.c z +a n e.g�� 5 y 6 `a t .I L}� ° t"��r :+J M $f-jl��„I ......... .......•-•-- ------... M. U Nature of Repairs or Alterations—Answer when applicable............................................................... �7iE....... X�l�c/rI"Ytf ....:.��........ S Agreement:- /U A r: -/ P" The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 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. Signe { ti r;...... rt! K .rK 1" .�fj ! 'hY-1. 0. w' F.4"X Application Approved BY �� ` . --- ---•-- ..j.. kx: r Date Application Disapproved for the f olloiving reasons----------------------------•-••-------------•-----------------•------------------........_...-••--•-----------_ .........-•---•------------------------------•--....---------............----------...-----••--------•--------•-------•----•-•--••-------•--......--------------•-•----- •••-•-••-•----•---.-•--- Date PermitNo......................................................... Issued....................................................... Date THE "COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t ..�gVj ......�....................OF............. ..1.�� ..).��......................... (Irrtif iratr of f ompliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V--O') or Repaired ( ) by....&9 ftf.A••-••.�-�-``�....................•----•--•-......•---------•-•---- ----•------- Installer at....... .._1! - "--- 3 1>fs: 4P_1�------��-_r1%....... ------M i,l. )....... 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 CONST AS A GUARANTEE THAT THE SYSTEM WI FUJACTION SATISFACTORY. DATE._.1......•----- •-------------------------------------••------•--........... Inspector------ •----...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF......... _!Gl` '1 .-----••••...............•••........ No.... .. ..r..7�f FEE........................ Disposal rks 011notrnrtion rrntit Permission is hereby granted....gQ_ J"..........<)N f.....--•------•--•----•-•-----•••----•...................• ......................................... to Construct ( r Repair ( ) an Indivi ual Sei a isposal System�g �( at No...1Q ---�)-!ca--- =�----•1��-----.. �'S.t`:�. �?.��...�V�t-�--�-------------------------•-------•---•------------------------------------•-----...-•-•--- Street as shown on the applicatio for Disposal Works Construction Pe o _...........�� Dated...... 3�.. �.�•--....._............. ; y,; f ..------ - .. --- Board of Health DATE..... ...............-.............................. FORM 1255 A. M. SULKIN, INC., BOSTON _ 7 f I ` 7 Z1n pQO p 0077 10 q s Y. Q � i 2�G. a y,E. eGICC if p l �.©• e:: �. c ti l pE*, Fok WC S�E c nF u Q � 1411 0� n o ti 24m 77 ' P� , t �O '� .. .:...ter. .t3i�;; ✓ ^ t L '��{. :, ��� (�'� ~ �...f q N of �4sL su 9At a Mq O !! Lo" K-F E� yam, (p ��, AQUA ; 43,.�o.s F� p �' MORSE, p No.10951 p 5 S.IST A FSS/pNAL'�N�\ ! �V ASSun+ED P�jECTION' iNC&L ^P-T� LEGEND . :.~ EXISTING SPOT ELEVATION. OxO �'ay1� CERTIFIED PLOT PLAN EXfSTING CONTOUR ——— ® ! o ' . 6 � : L.:o T FINISHED SPOT' -ELEVATION [Q A Y Q MAR s to n/s . Ma �.�s FINISHED CONTOUR \;>' . . IN APPROVED a BOARD OF HEALTH A;I r ♦ w I •� r . .0 ATE AGENT vAcANT.' , • SCALE$ l �' = 30 DATEt F 2 ' LOREDGE ENGINEERING Ca ING i T/fi�i �-✓ CLIEN _. 1 CERTIFY THAT' THE PROPOSED . E013TERE REOISTEREO >� J06:,N0. y�3 '.,BUILDING SHOWN ON THIS PLAN CIVFL LAND "'' OR ' + CONFORMS 'TO THE ZONING L'AW� �� e EN01_NE R sl OF_ 8ARN9TAS E' MAS9. : E�` �-- -� ,A 712 MAIN STREET;f CH, ®Y� �'R ,fit 83 _ -_e-- HYA NN 13MASS gHEET.: OF 'R Or LAND . SURVEYOR • t -•G /GLe ol /1lCfTF :� /� ElTff�R TNL�'S=RT/C TAN?'C. 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