HomeMy WebLinkAbout0013 KNOLLWOOD LANE - Health 13 Knollwood Lane
Marstons Mills P
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LOC!. �.sJ �n0�`I,JCV ��A-L SEWAGE #
VILLAGE ✓VIArsi-on ✓ i))-r ASSESSOR'S MAP & LOT /0/ 0 C)
INSTALLER'S NAME&PHONE NO. Z-G 6
SEPTIC TANK CAPACITY U�LEACHING FACILITY: (type) ( f n
I (size) /On G41-
NO. OF BEDROOMS 3
BUILDER OR OWNER C��l E �)S
PERMITDATE: COMPLIANCE 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 wetlands exist
within 300 feet of lea chin facility) Jl Feet
Furnished by 'I' S/1 G i,�t
a ao a5
TITLE.5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSES
SIJBSU YACE SEWAGE DISPOSAL SYSTEM FORM
PART A
C MTIFICATION
Property Adde :_13 knoliwood hL Marston mills
Owner's Name: Sandra Therrien
Owner's Address: 13 knollwood tit.
-Marston wills, !bass.OUn
Date of Inspection:�111VO9 ------- I
..j h
Name of Inspector:(please print)_Joe.Smith
Company Name:_E.Stevens Construction,to _
Wailing Address:_,i'O.Box 71 _ _
Marston mills,mass, IlIh�l8
Telephone Number:,,(`0)776.905
CERTIFICATION STATEMI LENT
I oQr0i&tea I have pcfsoaally inspected the sewage disposal system at this:address and that the inflomation
reported below is true.,a aurae and completc as of the tine of tb€inspection,The.isr4,ajort w:.s
perforated based on my t«ining and expo -rice in tJ p-o v_-i emr nr;d:3 :a�,4w:t
t IAR 15.000). The systc m:
Passes
Pao�ss
u0n€huonaliy basses
1p.spectn 'e Signature: Rs t : ..IfI11l4 9,
is ut5p t _ i. r��- _33 f
lde alih or DE,i j within_io days of tompjai ig.I ,*pcciit�.��€ sysi�m is�s°aa��i syvi�3t�ltas a
a'.sF f l_�WG•'%a 11 0T Mat-M,��t�uts ectur d-ftc s"st &Gwm iu hw :su F`hi rm"'Or •, th
appropriate regi€tnal offer of the DES.Fne,mnoal shoadd he sm to the sy5r€m ow r a l cop s-sent tEv
the buyer,if apocal ie;ao the atipritving aoiltc)My.
C
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Notes and Comments Sys) is sound and woddng correctly at time,of insp"tion
to �
in c1-r
-"*its,r-epw only dKeI s-ordi 5 at the time of ins loon navil under ft '=_- -of r--:a# ;
t➢tal time.This lanpectlov doss not a d'dress how tic system win perform In the Tatar`tm the saw cn
or different eondltirons of ose- �
C)
OFFICIAL MKICTION FORM— NOT 0R V4 UNTAR , ASSESS
DISPOSAL SYS`I VI INIM10"FORM
{ �A A
Cl�s�RT MI CA N(wai ed)
� � v
Property Address: 13 knollwood in.
Owner._Sandra Therrien
Date of Inspection:_1/11/09
Inspection Summary: Check A,%C,D or E/ALWAYS complete all of Section D
A. System Passes:
_X I have not found any information which indicates that any of the failure criteria described in 310
CMR 55.303 or in 3I0 CMR I5-304 exist.Any failure criteria not evaluated are indicated below.
C ents:_-.-System passes title V Inspection.Tank should he pumped now and every 2 yrs.
there after.Riser should be:In stalled on pit to bring to within 12"of finish grade.
lk System Conditionally Passer.
One or more system components as described in the"Conditional,conditional Pass?section need to be replaced
or repaired.The system,upon completion of the replacement or repair,as approve€l by the Soard of Ham;
will pass.
Answer yes,no or not determined(Y N NI3)m the for the following statements.If"not determinedr
please explain.
The septic tank is metal and over 20 years old*or the septic tank(wbefficr metal or not)is
sU fichinlly unsowncL cxhibit3 substantial infilt tion-or exMtration or tank failure is imminent.System will
pass inspection if the existing tame is replaced'with a complying,septic tank as approved by the Ertl of
Health.
aA_3-.as s�aptic tank will lass:inspection if it is st aurally so d„not leaking and if a Ctitificate of
rA110.iahlcC "d"Cat tlfit the tank is less than 20 years told is available.
t4D expl :
Cbservafion of sewage bac k or break out or high stay water level h the distribution box due to
broken o,,obstructed pipe(s)-oi°due to;a bi oken,,settled oi°uucvcn distaibudon box.Systen:will pass
insm—d m if ap p vd of Board of ea ):
broker pipe(s)W replaced
obstruction ismmoveid
d sb ibutian box is leveled erreplaced
ND explain.
_ Tbc_system T-_quired pumpmirg,more ihan 4 tars a year due�Ln broker oT obsttructed pi fs) 'rhe
system WA pass inspection if(with apprflval of the Board of ealth):
broken pipe(q)are-replaced
obMcgi sn is removed
ND explain_
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CIERTMCATION(contintred)
Property Address: 13 Knoll wood In.
Owner:_Sandra Therrien
Date of linspection:—ill1109
C. Farther Evaluation is Required by the Board of Health:
Conditions eyjw-t which esquire further evaluation by the Board of Health in order to determine if the
system is failing to protect public health,safety or the enwonmeni
1. System will pass unless Board of Health determines is accordance with 310 C W;q_3(1, )
that the system is not functioning in a manner which wig protect ptabllc health,sater;y and th-e
environment:
T Cesspool er 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
I System will fail unless the Board of Realth<aftd Public Water Supplier,if any)determines
that the
system is functioning in a manner that protects the public health,safety and eavir-otsme€tt
_ T
I he system has a septic tank and soil absorption system{SAS)and the SAS is-within 100 feet
of surface water supply or tributary to a surthce water supply:
_ The system has:a sephe tank and,SAS and the SAS is within a Zone l of a public water supply.
The.systm 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 9AS and the SAS is less than too fcct but 50 feet or m€tre
tiom a private water supply well".Method used to detcrmitw etimnee
$ i his system passes if the well water analysis,perfe med at a l3l p certified iaboratory,for
coliform bacteria and volatile organic compounds indicates that the well is free from:p€slhition ltom
that facility and the presence ofaiumnmii nitrogen and nitrate.nitrogcn is c tz�t eE,«r 1 ,rhr6u
ppm,.provided that no olber failum miterh are tigge-md A cDpy of the analysis mustbezaacbedto
this forin"
3. Other.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_13 lmollwood hL
Owner:_Sandra Therrien
Date of Inspection:_1/11/09
D. System Failure Criteria applicable to all systems:
You mast 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 efffiuent 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 8'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 ofa surface water supply or tributary to a
— — surface water supply.
xe_ Any portion ofa cesspool or privy is within a Zone 1 ofa public well.
_x— Any portion of cesspool or privy is within 50 feet of a private water supply well
x Any portion ofa cesspool or privy is less than 100 feet but greater than 50 feet fxom a private
— —water supply well with no acceptable water quality anatysis:.jTh&system passes if the we#
seater analysis,performed at a DES'urtifred laboratory,for.00liform bacteria and
volatiic ottanie vbt a units Indicates that the ws i is fr;e lr°ottr pollution from that Ia�ty
and the presence of am nitrogen,and t[ttrate n1troge t its equal to of Less tha _4 ppm,
provided that no other failure critetia,are trigge 1.A copy of the•analysis taunt tic
allayed to this f'orarr.]
NO (Yes/No)The system fails 1 have deterred that one or more of the ?ve failure criteria
exist as desenbed in 310 CMA 15.303,therefore the system fails.The system:owner should
contact the Board cif Health to deterznine what will be necessary to-correct the failure.
I
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 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant
threat,or answered`ye '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 CNIR 15.304.The system owner should contact the appropriate regional office of the
Department_
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSU9FACV SEW ACE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address- 131knollwood hL
Owner- Sandra Therrien-
Date of Inspection: VI I/09
Check if the following have been done.You must indicate`des"or`no"as to each of the following:
Yes No
x _ Pumping information was provided by the owner,occult,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
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?
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.
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)]
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_13 Knollwood In.
Owner:_Sandra Therrien
Date of Inspection:_1/11/09
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_3_ Number of bedrooms(actual):_3_
DESIGN flow based on 310 CMR 55.203(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):year round_
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): no
Last date of occupancy:_present
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): and
Basis of design flow(seats/persons/sgketc.):
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
Source of information: homeowner
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: System was
installed in September of 1984
Were sewage odors detected when arriving at the site(yes or no): no
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 13 Knollwood hz
Owner._Sandra Therrien
Date of Inspection:_1111/09
BUILDING SEWER(locate on site plan)
Depth below grade: 22"
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,): No leaks,mortar in
place
SEPTIC TANK: X (locate on site plan)
r
Depth below grade:_24"
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:_1000 gal.
Sludge depth:_20"
Distance from top of sludge to bottom of outlet tee or baffle: 25"
Scum thickness:_2"
Distance from top of scum to top of outlet tee or baffle:_7"
Distance from bottom of scum to bottom of outlet tee or baffle: 13"
How were dimensions determined:_measured with sludge
judge
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid
levels as related to outlet invert,evidence of leakage,etc.): Tank is sound with T's present.
Reccommend pumping now and every two years there after.
GREASE TRAP: (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.):
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 13 Knoltwood hL
Owner:_Sandra Therrien
Date of Inspection:_1/I1/09
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/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:_X (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.): Box is level and working correctly.
PUMP CHAMBER: (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.):
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_13 knollwood In.
Owner:_Sandra Therrien
Date of Inspection:_1/I1/09
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number:—(1) 1000 gal._
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.):_Pit is sound.Was half full at time of inspection with no sign of staining or hydraulic
failure.
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_13 Knollwood in.
P
Owner:_Sandra Therrien
Date of Inspection:_1/11/09
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.
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_13 Knollwood In.
Owner:_Sandra Therrien
Date of Inspection:_1/11/09
SITE EXAM
Slope X
Surface water X
Check cellar X
Shallow wells X
Estimated depth to ground water 212 feet
Please indicate(check)all methods used to determine the high ground water elevation:
X Obtained from system design plans on record-If checked,date of design plan reviewed: 03/84
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)
X Accessed USGS database-explain:_Internet
You must describe how you established the high ground water elevation: Perc test from original
install plans shows no water encounterd at 12'.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
OCT 2 4 2002
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION 1 `,ts
Property Address: 13 Knollwood Lane,
Marston Mills. AL4 02648
Owner's Name: Charles Ellis
Owner's Address: Same
Date of Inspection: October 2, 2002
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford Map: 101
Mailing Address: P.O.Box 49 Parcel: 070
Osterpille,MA 02655-0049 Lot:8
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
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
Needs Further Evaluation by the Local Approving Authority
Fail
Inspector's Signature: Date: October 7, 2002
The system inspector shall sub i 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
****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.
Title 5 Inspection Form 6/15/2000 page 1
r
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 13 Knollwood Lane
Marston Mills. MA
Owner: Charles Ellis
.Date of Inspection: October 2, 2002
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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 13 Knollwood Lane
Marston Mills, MA
Owner: Charles Ellis
Date of Inspection: October 2, 2002
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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 13 Knollwood Lane
Marstons Mills. MA
Owner: Charles Ellis
Date of Inspection: October 2. 2002
D. System Failure Criteria applicable to all systems:
You must indicate either"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 '/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ 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 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.]
No (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 System:
To be considered.a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
11d•
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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 13 Knollwood Lane
Marston Mills. MA
Owner: Charles Ellis
Date of Inspection: October 2, 2002
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:
Yes No
✓ 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 i,nacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 13 Knollwood Lane
Marston Mills, MA
Owner: Charles Ellis
Date of Inspection: October 2. 2002
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: 2
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): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
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/sqft,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
Source of information: Pumped 2 years aQo -per owner
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
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:
Sept. 27184-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13 Knollwood Lane
Marston Mills, MA
Owner: Charles Ellis
Date of Inspection: October 2, 2002
BUILDING SEWER(locate on site plan)
Depth below grade: Approx. 32"
Materials of construction: _cast iron ✓ 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: ✓ ('locate on site plan)
Depth below grade: Approx. 20"
Material of construction: ✓ 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: 1000 gal. (W--10)
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 4"
Distance from top of scum to top of outlet tee or baffle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no sign ofleakage. The inlet side of the tank
was under the end of a driveway. Recommend not parking above the tank.
GREASE TRAP: None (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.):
7
7
Page 8 of 11
v -
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13 Knollwood Lane
Marston Mills, MA
Owner: Charles Ellis
Date of Inspection: October 2, 2002
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
D±mensions:
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: n/a (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUMP CHAMBER: None (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.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13 Knollwood Lane
Marstons Mills. MA
Owner: Charles Ellis
Date of Inspection: October 2, 2002
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 6'x 6'-1000 gal.
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
The leach pit had approximately Y of water on the bottom. The scum line was at the same level. There were no signs of failure.
The cover was approximately 4'below grade. The bottom to grade was approximately 10'.
CESSPOOLS: None (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: None (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.):
9
Page 10 of 11
OFFICIAL.INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13.Knollwood Lane
Marstons Mills. 1,L1
Owner: Charles Ellis
Date of Inspection: October 2, 2002
Map: 101
Parcel:070
Lot:8
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.
C6
10
Page l l of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 13 Knollwood Lane
Marstons Mills. AM
Owner: Charles Ellis
Date of Inspection: October 2. 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30' +/- feet
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: Topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Tne bottom of the leach pit to grade was approximately 10'. Using the Barnstable topographic map and the Cape Cod
Commission water contours maps, the maps were showing approximately 30'+/-to ground water at this site
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees,either expressed, written or implied, relating to the system, the inspection and/or this report.
11
f
No...... y..a:�. FE$...... . .............
Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town FBarnstabl e
................. ... ....................o ......................................... .............
Applirtttiuit for Uiupwitt1 Works Tuuutrurtiun ramit .
Application is hereby made for a Permit to ConstructX( ) or,Repair ( ) an Individual Sewage Disposal
System at:
L ot #8 - Knollwood Lane, Narstons Mills ;, MIA
................ ................................................................................ ................................•••-•---•--........................----•-....---•••......••-••....
Capricorn Rekty-t� st 765 Falmouth Roffe.t tyannis
.......----•--•------................... ............................................... ................................_.._........•---•---•....---•--•................................_. i
W Steve L e b el .......Owner Address
Installer — Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms3..........................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of BuildinjFanCh_________________ No. of persons............................. Showers?{ ) — Cafeteria ( ) f
C4Other fixtures ..............................................................• I
Design Flow..... 5..................... ............gallons per person Ver day. Total daily flow......339................ ........._..P'allons.
W �,000 �-6�------ Wid4i@AP n Diameter--------•---.._. De . $�< <
R: Septic Tank—Liqutd capaci ._._...:....gallons Leng�h Wi p ................
W Disposal Tren h—No..................... Wi th..._..............:. Total Length..... Total leaching area _.........sq. ft.
x go 6i-.... .... 26b
Seepage Pit 1�..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosit} nk ( ) r,
.-� re g. Engineering 11-25-81
Percolation Test Results Performed bY........................................................... Date._-.....-...._._.............--._-----..
` e
,-I Test Pit No. 2'.0......_..minutes per inch Depth of Test P'itlr2-�...... Depth to ground wat {?i encounter-
44 Test Pit NoPA.:..........minutes per inch Depth of Test F1�Y-.A............... Depth to ground water. ................
cl �
...........................................................................................................................................•-••••-•.....----
O Description of Soil-----•0 1, - 2' loam &. topsoi1.............................................................................................
x p 2'- - 10 ....... -6-ilium yellow_ sand
w ........ 6-I--------I-Z .....-mea-----while sarid�' r ces_of. gravel/rio.wa-Eer at---12
- e I
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------------------------------••---•--•--..................._..-•----•--.......---.............-•---•----------.........----------------•--------------------------••-••-•----...-- j
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i I'L LE 5 of the State Sanitary Code—,The undersigned further agrees not to place the,system in
operation until a Certificate of Compliance has a issued by the board of lth.
Signed................. � .--.•.•• .. .....-----•...Frey..............................
D to
Application Approved BY---- ........................................... ••..`, -l 7` ...............
Date
Application Disapproved for the following reaso :-----•........................................................•-----------.....-----------....._.........--•••-
......................................................-..................................................................................................................................................
Date
PermitNo....................................................... Issued.........................................................
Date
-------------------------
------------------
No........................ a FEs............._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . OF HEALTH
Town Barnstable
...... ............. ....................OF........................................... ..........
Appliratiun f nr -Uiipuiitt1 Workii Tomitrnr#ion amit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.Lot d - Knollwood Lane. Marstons Mills i, MIA "" _...........
................................. ....._.. . ..........._.........-•-- _........... ..
Capricorn RI&&!ftjf'dtftSt 765 Falmouth RdFaTa;°*Hyannis
......................_..............................r...."--•--"...._............._............ ......................................................_...........................................
W Steve Lebel Owner Address
"--- " ............ ------" �...................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type e of Buildingranch"_____________ No. of ersons......................_..... Showers 2
G4 YP P ( ) — Cafeteria ( )
IZ.I Other fixtures -------------------------------- . .�. ..._.F....... ...........................
W Design Flow"-""""..5—5.�.............................. per perso,Il�pgr day. Total Oil pow--"-"--"-33"""----"--------"-....--"- gVgns.
WSeptic Tank—Liquid capacity....._....=.gallons Lengt ................ Width................ Diameter................ Depth..__.........
x Disposal Trench—No. .................... Widt .�_.._......._..._.. Total Length.__..__ y......... Total leaching area sq. ft.
Seepage Pit Nol................... Diameter................. Depth below inlet....6._._...._._. Total leaching area...�.��......sq. ft.
Z Other Distribution box ( ) Dosin k (
EM&dae Engineering 11-25-81
Percolation Test Results Performed by-----------------"----_."-.."--.-"--____-. .-. .. Date........................................
a 2.0 12'" "" ' Inone encountei
,.� Test Pit No. 1... ...........minutes per inch Depth of Test Pit._... .__.._...._.__ Depth to ground Ovate _._..._.._..__..._..__. ea
Test Pit No. ..A_.._.._._minutesper inch Depth of Test Piti�._A._......_._. Depth to ground water._�_.x.............
...
--------------.......
...
... ...............
--•---•....-•-•---••-•-------•---......-•-.........._....
O Description of Soil_........O f — 2 @ loam & topsoil
1
x 2 - 10 T�:e ium ye 'low sand
U --------------•-•---••------------"---.fi0-,----_--12-,-------med- whit-e--saric�/races o f ravelfrio waxer""at"" 12'
------------------------------------•---"--"----------"-....--------------------------""-"------------"-----------.....""--"-----"-""---"-----""-""-"--------"---...--•--...............----------.....
U Nature of Repairs or Alterations—Answer when applicable.-_.............................................................................................
""-------------------"-"----""-"""-•""----""--"-...-""--"----""-"""""...........•---........_._..................-----"-;="-- """-""""-""•-"--•----••---"""•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bipen issued by the board of h th.
.�d Prysr✓ �
... ............t..........._....
Date
ApplicationApproved BY-"--"""-"•....................................................................................... .......................................
Date
Application Disapproved for the following reasons:-----"-"----""""-"-----"---"---"""---"------•-------"--•"--"-"•""-""----"-"-•--•"-...............................
Date
Permit No......................................................... Issued-------•--•-------
Date
t
THE COMMONWEALTH OF MASSACHUSETTS t
BQARD OF HEALTH
........Town.................OF........Barnstable
(Irrfif irtar of Tuntpfittnrr
THIS IS TO CERTIFY That
Leb.el That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
S
by ---------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at... -..Knollwood Lane, 1l�rst Mills . NA
. --•-••--•-•--••----••-- ....--•- ..
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No............................................ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-"•-•-"""-...-"................................................................ Inspector
1� ...-"-""-"--"-""-"---...__.._...._....••--•._......
THE COMMONWEALTH OF MASSACHUSETT
g y- v5 BOWRD OF HEALTH J S
Town Barnstable
.............I.............................O F.........----................. ......_..................................
No......................... FEE........................
Dioposal Works Tungtrttr#Ilan rrntit
Permission is hereby granted S teve-L be1
-"""---•"-..........."".---•-""-"-""""--"-"•-""""--•--""-"-•"----"-"-"""--""""""-"...............................•.....
to Construct r• or Repair (( ) an Individual Sewage Disposal System
at No......T oZ 3 - Knollwood"Lane, Marstons Mills , ir,A
. . . . . -----------------------------------------•-------
Stre
as shown on the ap icatio for Disposal Works Construction Permi o...�.............. Dated..........................................
--"""""-"......................""""-•""""----•-----"-------•"""""""-"""-""-..--•---............•-•.------
'�� �/ Board of Health
DATE-------------------- --------/-•--•-------.....--------••-•---------------..... -
FORM 1255 A. M. SULKIN, INC., BOSTON
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CERTIFIED L
EX,I8TIN.® --BPOT ELEVATION'S
ED PLOT PLAN
EXISTING "CONTOUR --- 0
?FINISHED., SPOT ELEVATION_:. o r ROSRT; ep
FINISHED CONTOUR 0. y; �
. y IN
'`APPROVED i BOARD. OF HEALNSTAJILA AA
TH s`
F Y
A RENT 9CALE.� ./" .3 DATE
4 .REDBE ENSINEERIN6 CQ AR.�RJ;�.
1a F a s ei� a
CLIINTa,,•�--, 1 CERTIFY ��'MAT THE PR'0Pbl�ED.
x EOISTERE RE®ISTEREO 'r ,37�'� a� t® ILDINg . MOWN. ON THIS PLAN
,.. J01l,�HO.
f.rC�ViL LAND , �,x �` E z CONR4RM8 TO .THE. ZONfN® LAWS
EN0 N ER SURVEY It DR•01�' x� `} OF BARNSTANL MAS
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SJNALL S.F ,S/POcAX qT TO.4V.TAP&w;. .dXT,F
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co#V��E t/E.4Yy CAST/VoW CO✓ER SN.4LL BE USED
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BOX o � • e • • .• •oo . a •
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DEP/tI y .. WASlLED STDN`E.
O • • • • • ••• 1 e o •
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om_n zT SEPTIC Ti�NK
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/N,CET D/STRl4!/T/ON. BOX AFT. • - SECTlG 4 `GR •
OOTLETD/STR/OtITION BOX S3 g FT
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LEACHING P/:T ME* a o . I�l
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SCAE0/ .
DES/6/V CR/7'ERIA D/fl es+vs�o/V $ FT
N4VAf&&01f OF BEGrROOM.S 3 "DIMENSION G FT M�w.
GARQAGEO/SPOS/IL 4f'Vj7- i✓oNC-- SOIL. LOG SOIL TEST
TsaTAL EJT1NKTEG FLOK/ 3 3 v G.4L.1GLOY SOIL TEST ! SOIL TEST2.
/UlJ/NBER Ow 40ACMIAAG PITS 1 f`.ECEY. 77:6 ELEY �4TE OF SOlL TEST _�'� � �
S/OAF .CACH/NG PRR P/T SYt Pri RES[/LTS 11/ITNESSED A. 7P � `JAca•$I,;
OOTTOM LE�IG'N/NG PER P/T $Q. PT. - Z AERCOLAT/ON RATE./ zC'SS MIIV•IJIVCX
2�Y - ° L�� FlElf"1�4T/ON RATE AZ -Trt.4••!MIN. lNCfr
TOTAL LEACHING AREA .S(.�. FT. j
S,d�✓SO/L 2�O
RESERVE LEACN//V6 AREA �`f SQ. FT.
ra�P QScR7 `�� ��?�t .��T`�' R, � r-i n/F .Sr, /f� �/1- R S'Ti)�•..,..�� �'l�L L.S
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/qYANAl/9. MASS.
SL't�;vim FSc�ONA1 �� ® ND GROUND ;41,4 rER ENCOUNT1rRE0 CL/ENT r iP� �/c.c� DATE 4 //. '
-� G1 OF GRO[J/1/O kV..�►TER AT E=4HV Z
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