Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0692 MISTIC DRIVE - Health
692 MISTIC DRIVE MARSTONS MILLS -- - - - A = 079 076 - - --- - - -- - -- - TOWN OF BARNSTABLE C� LOCATION l9 11\L-tX1 vie SEWAGE # VII.LA,tGE 1m&r5 �l 4k/::) - ASSESSOR'S MAP/&+�L�OT U19- ® �(1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I2!5J-D LEACHING FACILITY: (*) (size) NO.OF BEDROOMS , . L �t� ut BUILDER O O R sh PERMITDATE: 11 COMPLIANCE DATE: r a 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 ;fP 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 :rx -- � Lk A - i '751 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V- v� 692 Mistic Dr. Property Address Amy Mesirow ; Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date'of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information n filling out forms p �/# r(�vaO on the computer, + use only the tab Douglas Brown key to move your Name of Inspector cursor-do not Cape Cod Septic Services Inc. use the return Company Name key. 350 Main St. Company Address West Yarmouth MA 02673 City/Town State Zip Code rsrvrr 508-775-2825 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on- to sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails � j _ 7/31/2019 Ins or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: System in working conditon. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Y+. Commonwealth of Massachusetts 1= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 692 Mistic Dr. v� Property Address Amy Mesirow Owner Owner's Name information is squired for every Marstons Mils MA 02648 7/22/2019 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: .5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form u � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 -.5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v �I 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 water supply 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.] El ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 CA. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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)] E5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x4= 440gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017=277gpd 9 ( Y 9 (gp )) 2018= 302gpd Detail: Note irrigation system in use on property. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J� 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 pGge. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form 1a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system El 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): Approximate age of all components, date installed (if known) and source of information: 2001 Per BOH Records Were sewage odors detected when arriving at the site? ❑ Yes. ® No 5. Building Sewer(locate on site plan): Depth below grade: 41" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line was checked with sewer camera and found to be clean, properly pitched with no sign of root intrusion. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 30"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: 1250Ga, Sludge depth: 4-6 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2-3 11 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1250Gal tank in good condition. PVC tees in place. Tank at normal operating level. Inlet cover 12" below grade with outlet 30" below grade t5insp.doc-rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 692 Mistic Dr. u- Property Address Amy Mesirow Owner Owner's Name information is squired for every Marstons Mils MA 02648 7/22/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments.(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. . Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day it5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Ii4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): 0.. 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.): H-10 DB-3 with 1 line in and 2 lines out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 1' Below grade. 5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 6-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �y Title 5 Official Inspection Form r iIo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name irf is requireduired for every Marstons Mils MA 02648 7/22/2019 for page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 61nfiltartors with stone in a 9'x45'Trench. No standing effluent in units during during inspection. No sign of overloading or hydraulic failure. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts p Tit le 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is Marstons Mils MA 02648 7/22/2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts r ,gp Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. v Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts r _ Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 692 Mistic Dr. Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +10' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2001 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data per plan on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 692 Mistic Dr. u Property Address Amy Mesirow Owner Owner's Name information is required for every Marstons Mils MA 02648 7/22/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION M(A I� I�`l'1"�� 1J� SEWAGE q ��I 13C VILLAGE 1�_M-')t[JI t-� (Y1i�ls ASSESSOR'S MAP&LOT L1l2 O INSTALLER'S NAME&PHONE NO.�TtV(IL°S 111[.1 4, SEPTIC TANK CAPAcm _ 12'�D LEACHING FACILITY:(the)41l(� ,,R ""T'04"Z's y�$-I 1 V'Lr3D � Osize) '5-1C 11'" NO.OF BEDROOMS_ o;aPk6 BUILDER O O R (PERMITDATE: COMPLIANCE DATE: ` t 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 Welland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by P, ty f A-Z— lb R3-�93,5 i3-6_l lq � I ley �� •,. ?� SUS btc�(}uJ https://townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mapp... 6/19/2019 lee � � �-�� No, f%iLlr//� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYtcatton for �Dtopool *pgtem Con5tructton 3permtt Application for a Permit to Construct( )Repair X Upgrade( )Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot No. ��L—Lr���(', Owner's Name,Address and Tel.No. Assessor's Map/Parcel 6-ir9l�'�'D Installer's Name,Address,and Tel. o. 1�—� Designer's Name,Address and Tel.No. SI � 1 Type o Building: 1 j� Dwelling No.of Bedrooms 1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1 v�- Ci . o t. mMa Description of Soil qp �k Nature of Repairs or Alterations(Answer when applicable) f 1' Y`l U"L��Y1)1 Y_4 Date last inspected: Fp_�D, Qm 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 Certifi- cate of Compliance has beg d iIth Signed Date Application Approved b Date Application Disapproved for the following 'reasons Permit No. Zell Lg 1.1 Z Date Issued "- �D }to °� .Brat 1, /sue,c / Iee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS p Yes�:PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Migpogal 6pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. lr0 a fy;� L r ',-owner's Name,Add�ress and Tel.No. (A t 7Z� �es� s ap/ cca1 J 1 `� '� U Jree Installer's Name,Address,and Al. o. S�y Designer's Name,Address and Tel.No. our � a,i5 mac.: C .�1,lb r. Ty o wilding: 1 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria(. ) Other Fixtures s� Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Tf Size of Septic Tank s Type of S.A.S. 111 Description of Soil Nature of Repairs or Alterations(Answer when applicable) - 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the-Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Bo ofHealth. ) Signed Date 1 C Application Approved by Date Application Disapprove or the fol owin son Permit No. N Date Issued !7- ot 7;__0�0 �> THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ,r Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by at - has been constructed in accordance with a provis I ons of Ti e 5 and e f�r b isposal ystem ConstructiorJPermit o 4__ 0 ,� dated f Installer E Q Designer f The issuance o this permit shall not be construed as a guarantee that the systeem, will�function as designed./ Date / 1 tf k I Inspector y'/1�� L��r is l� '( --------------------------------------- No. �_ / Fee �7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wigpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair O Upgrade( )Abandon( ) System located at I. G^n „'ink;TH 4 �,- '„E rn' izL nn -w1 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this Pe 't. Date: Approved by r J ' 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL V WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby "erti that the application for disposal works construction permit signed by me dated 3 / concerning the property located at S j (L \ /1L meets all of the following criteria: 4 V This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system .There are no private wells within 150 feet of the proposed septic system ;There is no increase in flow and/or change in use proposed • here are no variances requested or needed. -� The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation..[Adjust the groundwater table using the Frimptor method when applicable] r If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) l L B) G.W. Elevation 7-) +the MAX. High G.W. Adjustment Z DIFFERENCE BETWEEN A and B SIGNED : DATE: 4'r4( O� [Please Sketc roposed plan f system on acl:]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �� �, �` -�r� ? � � � �. �- .�, ,. �� . I • TOWN OF BARNSTABLECJ . =Y; LOCATION SEWAGE # VILLAGE '�Y I(�YL) 'rnl t I ASSESSOR'S MAP & LOT D `Q INSTALLER'S NAME&PHONE NO.W-m 1P-, 6,Y4, SEPTIC TANK CAPACITY LEACHING FACILITY: (tye) b (size) NO. OF BEDROOMS 61tZtJUr.lb i1� � � ,i, . � BUILDER.O 0 Rr' `rl PERMITDATE: r�ilt 1 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) R Feet. Edge of Wetland.and Leaching,Facility(If any wetlands exist ,✓ within 300 feet of leaching facility) i.' Feet Furnished by v I ................_._..._. - — - ;�. 1 N+-tUiZ{��l�S �U c7t►W� dd p� '�� a`7��� l} 2O I t t t 1 1 C �.� ASSESSORS MAP NO: No.... .ir-.L7... PARCEL N0: F>�s..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....................__...................O F.......................................--------------•................................. ApplirFatiun for Diiipuual Works Tongtrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..--D. ---------------------------- ----.---- Location Address or N ........ I. ��i ..l.......grt.�e.n1----------------------------------------------- --lov....7 avr. �i 2'd 4 .7� vJ1' p n 1 owner q' Address al`3Y ---•-------^..----•-------•......................................... _��i' Installer Address Q Type of Building Size Lot............................Sq. feet U U Dwelling—No. of Bedrooms.............._.__._______.___.._.._...Expansion Attic (° ) Garbage Grinder ( ) Other—Type T e of Building ZS,4D.k&f:-e. No. of persons ___________________ Showers Cafeteria a YP g --� P � (0 ) — ( ) a' Other fixtures __________________________________ W Design Flow............,�3AO...............gallons per person per day. Total daily flow.....0.1 A..........................gallons. W`- Septic Tank—Liquid capacity._ 5.V#gallons Length-.......... Width►............. Diameter................ Depth................ x Disposal Trench—No. ........�....... Width.................... Total Length.................... Total leaching area___-__-_-•-_------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..---•-----------••---•••-••-•-.........--•--•--------------•-••--•••••... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit___..._aa_.________ Depth to ground water......__.__..._.....___. .9. . j Description of Soil ....... {.-. ....__f.. ................................................ x w -------------------------------------------------------------------------------------------------------•------------•------------------------------•----•--------------------------------...._.__...._. U Nature of Repairs or Alterations—Answer when applicable.__----•-------------------------------------------•_-__-_•._-_----.-_------__-__----_------___. ----------------------------•-------•----------------------------•-------------•---------------------•-•---... ----------------------------------------•--------------•------------------------...----•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T'��: p 5 of the State Sanitary Code—The undersigned fur not t . lace the system in operation until a Certificate of Compliance has be issued by the board of ea Signed.....04A..'Y� -- •- -----------------•• _ .._ ... to Application Approved By............ -----------•- ..... -�""....a. Date Application Disapproved for the following reasons:-------•-------•---------------•----•------------------------•--------- ..........----.......................... .............-....................................................----------------------------•--........_......_....---......._...•--------•-------•......-•-•--•--•--. ............................... Date PermitNo.------ _ ."... ----------------------- Issued....................................................... Date F�$........ ....: ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i } .. .................._OF Appliratiun for Disposal Works C> oustruttiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -------------------------•----•-•- ----......---•--......--------------- ----------.....---------------......-•---- ---- ------------ Location-Address or Lot N , ownerW Addressti ..............................................................7 Installer "" Address Type of Building Size Lot.-__----•-----••-•-•---•--•-Sq. feet Dwelling—No. of Bedrooms..............5.........................Expansion Attic (✓ ) Garbage Grinder ( ) Other—Type of Building ...___ a yp g ����/'.C!.. No. of persons _____________ Showers — Cafeteria di Other fixtures --------------•---------------------------------•-----....---------------------== g �: g P P P Y Y G --••------•-..gallons. W l5esi n Flow........... ......Q_____.______.___._gallons per person per day. Total dail fiow____�� ........._._.__. • R4 Septic Tank—Liquid capacity�.?2G.gallons Length............ Width .............. Diameter................ Depth................ Disposal Trench—NTo. ........ ........ Width.................... Total Length.................... Total leaching area____._..:'_._..._---sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total.,leaching area---................sq. ft. z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......................................................................... Date......... ----_---------_Z...... Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water____ •_.__.__. f3. Test Pit No. 2................minutes per inch Depth of Test Pit ... De th to ground water-- _----- ODescription of Soil----------------------------------------.............................................- x rJ V 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 TT*" 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the board of health. Signed_._ _ . ,a �---- ate Application Approved By........... J ----•-•---- Dat-ev'' ` - Application Disapproved for the following reasons:................................................................................................................ --------------------------------------------------••-----•--------------------•-•••--•-----•............... -••-•----•-------•-----------•------------------- ------------ Date Permit No......F-I-=_- __7---------------•-------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF.......��f .r,�aa !1.:""f:�.................................... TOrrtifiratr of Tuntpliuna THIS IS TO CERTIFY, fThat the Individual Sewage Disposal System constructed >,-) or Repaired ( } by I&X4.------------------------------------------------------------------------------------------------------------------------------------------ `� .............Install,........ ........ has been installed in accordance with the provisions of T T T'lE. j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------72..._.X'),.......... dated......______________________________________•--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... .. ................................ Inspector---------- .\.J-----•-----------•-------•------•---------•---.---.--- THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH '' .....G...(-a' lyq/.1................OF...... 'K!f' "1.J .................................... N0...0.4 _ I � . SS ...�/.--•--- FEE .`-�................. Disposal Works Tunstr ion rrutit Permission is hereby granted....... „__ . .......P�ea:r _ to Construct ) /o�r Repa' ( ) an Individua Sewage Disposal System atNo................... ��'� �....... .L_ _:5 •-!•X--........... .............................................................. .....•.-• Street // as shown on the application for Disposal Works Construction Permit Now..I......_. Dated.415.._�j:.:_________________i... DATE Board of.,Health ---------- �_._.2. d �. FPRM 1255 HOBBS & WARREN, INC., PUBLISHERS ��,. � of TOWN OF BARNSTABLE a e. VOCATION L& SEWAGE VILLAGE 5 L ASSESSOR'S MAP & LOT 6-79 0-7(. INSTALLER'S NAME PHONE NO. / C/C.. j o �I Zz SEPTIC TANK CAPACITY /Z�p (pcs� LEACHING FACILITY:(type) Z- (size) NO. OF BEDROOMS PRIVATE�WELL OR PUBLIC WATER BUILDER OR OWNER .DATE PERMIT ISSUED: Sr & DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No �../ OR ... _ -.r a . •....a -.-..- ,:•.t....z':C✓.. . 4_ _....r,..:. ••...J..,,...-., :L, >.-.... t....:a♦rtr .rv. All I.—. .r... .rr..•. ... ry:. ..... r.ro ... .,,.r r. .... . r .. .m•fp^..Y.. aar r .r t z.,:.... n t < .n ........... ..... .. .... _...•... ,,.a:,...._ a. .....•-.::a.i r,;.- u,.... . A• •r - 4 J4.tr. I...w.. 4 e,r N4. ..c. ...•a.... ,t. r7]i .e :r .. .. ._. x..... a f.s , ... c. ... nv![v4A S YS TEA,' P OFIL E NOT TO SCALE TOP FDN. _ EL . FINISH GRADE FINISH GRADE' OVER :a.:°"°: FINISH GRADE OVER DIST. BOX FINISH GRADE OVER SEPTIC TANK � L EA CHTNG PIT r VARIES �^ Y / p. .e 3" OF 1/8" — 1/2" 12" MAX U' p Q :o .° •o..o, . e o:4 '0 _°.e:°e;�:'D•p:d•: .o:.d;d';e:p•:;!: '9'' °. 'l ° o' ° • ASHED PEASTONE ea ?.' PRECAST CONC. OR ;-b - A :� .4 o, a.•°• o:°'.p. BRICK 6 MORTAR ,- OUTLET PIPE LEVEL ,:. TO 12" BELOW GRADE .4... .o:; e. 3 u q• o:o.• 4 l^ FOP 2 FT. MIN. °•..e..o::°::o:o: •'Q:.4 :� .o' .. .°, //'^'�� •.O.•• ..o. e.y.b.'o.Qp: :c:a:QO:Ae;;';o.,o 'n �._/O O o: e ' D• L,YJ:lJIJ °' V(1.:rJ ct JJ ?/ , "A:; :s.r .'o. a' _. .'q:o:.Q r'.o,o:p.9: .c of '� n 'p.p: �• °n•';_ `s C. I. OR PVC TEES 8Z. !`� "'e.:p' dd�� s. e• :0: , I BSMT. FLR. o o p :. 250 GALLON � DI TRI U TION BOA'' �.: ,•° �• °•'' o: :o INS TA L ON L EVEL BA SE „ ,• 3 '--7" ; PRECA S T CONCRETE 3/4 TO 1-1/2 Qo PRECAST o. o..•.o c -a WASHED �,v-- l® RE.�"N�"ORCED CONCRETE p. s CRUSHED ' :I ?.c;o• e•o-o•.a•••v:oo,e'.o.e;a.. Q.:a..'o p.e::::.s :;d. 'o.' .STONE s b"o.•o. b:v:"o?.o:o A o,p o.,•o •o• o.o •o,o o:o o.• :o.. o,. o b:°:: �•. d _ e H l0 REINF. SEPTIC TANK �:a:a:' :° - o: INSTALL ON LEVEL BASE "' i ;•:e 'o aP v NOTE.• EXCAVATE" TO ELEV. 7�o t OR p •o.e. .••a:•;e: • . LOWER TO REMOVE ALL IMPERVIOUS 1J� �.A0 MATERIAL BENEATH THE LEACHING AREA 21-01, 2 '-0" G Q� SG 00 REPL A CE E XCA VA TED MA TERIA L WI TH 6'—0 " S �• CLEAN, CLAY FREE SAND 10 ,_0" / .i EFFEC TI VE DI ME TER GENEPA L NOTES L E•A CHING PIT— INSTALL �k SZ ON LEVEL' BASE 1. ALL EL EVA TIONS SHOWN ARE BASED ON FIELD SURVEY 2. A L L PIPES IN Ti->E S YS TE"M MUS T BE CA S T IRON : A TES HO ,E WAS DUG DURING INSTALL-A'!IO lS� / OR SCI�icDULE 4�; r PVC•` TION ')'' TO CH CK fyROUND WATER ELEVATION . �Z � � O SEP VA. +► �• N P� I S SOIL 44 BEL OW LEAF viN PI T �,� b ` 1-10 0 GALLON 3. THE-BOARD Or- f-IEAL. T,",' ��U�T BE MO TIFI ECJ t , r'RrCA f'T CONCRETE (No GR U/!D A T8"R WAS" SERVE Q - - � � WHEN G"CJN S TR!1 ' "ION IS COMPLETE PRIOR P—S690 SEPT.7C TANK TO BA Cf�,'FIL L ING PEACOL A TION RATE: "r / ��• 4. ANY CHANGE: a,"'+/ THIS PLAN MUST BE APPROVED 2 MIN. /IN. B Y THE BOARD OF HE'A L TH AND CAPE cg ISL ANDS WI TNESSED 8 Y.• SURVEYING CO., INC. T. AfcKEAN 5. MA TERIALS ANO INS TALLA TION SHALL BE _1f•N ^ COMPLIANCE :kdl TH THE S TA TE' SA nl.�TA R Y ._._.BA_f_1LVS. BAD. OF HE TH �..�. DESIGN Did TA f32 \ \ p o\ \ CODE — TI TL E �° — AND LOCAL APPLICABLE DATE., JUG Y�0, 1996 RULES Al'v�7 REGUL A T�IONS >6\ ��„ ,•5- �-�\N PRECAST CONCRETE N� „ NUMBER OF BEDROOMS '4 �• NORTH AAOW 15 FROM RECORD PLANS AND \ r PITS 6. N R A LE ACHING,RING 0 (2 RE©•D.J APo S GA RBA GE DI SPOSA L NO FOP GLAR PU SE�0 IS NOT TO BE USED S TOPSOIL 6 GAL . •� 7 FLOOD HAZARD ZONE C DAILY FLOW 440 M • \ ---- --- --- SUBSOIL �-•^ ' GAL . r 8. WA TER SUPPLY TOWN WA TER 4f3,. SEPTIC TANK REG� D. 1250 z '� �-'-•-•'" y GAL . L O T 7/ SEP TIC TA NK PRO VIDED 1250 \7.48, 500 . F. �- _ `�1 LEACHING REOUIRED 440 GPD. MEDIUM o AFL Il pr-Fivrous OR uNSUITABL� ATERIA SAND SIDEWALL AREA 225 S. F. \ \ � WITH.TP, 10 FT. OF THE LEACHING - Ll `� 225S. F. X 2. 5 G/S. F. — 562GPD .i 1_I TY IS TO BE REMOVED AND REPLACED WITH CLEAN SAND , . BOTTOM AREA — 157S. F. �� •,`'— r` L ECCE1c'D 157S. F. X 1. 0 G/S. F. '� 157 GPD LEACHING PROVIDED = 719 GPD -0- NO GROUNDWA TER PROPOSED ED EL E VA TION 144 CL.2�:J.O ——3 0—-- .'EXISTING CONTOUR ,g,� >� SINGLE FA MIL Y RESIDENCE C RV N PIT OBSE' A TION I H . L7 DISTRIBUTION BOX AS BUIL T SERA GE DISPOSA L S YS TEM "� 1• LEACHING PIT � o PIRR 10 v �. 29s� PREPARED FOR o SEPTIC TANK 1= �sso�ISTERC����F`� N�� CA MME T T CONS TRUC TION (RP t RESERVE P,x of g, LOT 71 MIS TIC DRI VE 4 q .t° ° BA RNS TA BL E — MARS TONS MIL L S — MASS. t DAVID <:� � [ Ll CHARI. S PIPE' INVERT EL EVA TIO r >f'` DA TE.• ocT_ CAPE 6 ISLANDS SURVEYING, INC. PLOT PLAN SCALE AS NOTED SCALE: 1 "= 4-0' V� �'''"'' ^ P. O. BOX 334 . � � lf,. ` _ P ,�-, .r^Y! A h! R;P'^ �n,/`f"'l o-,,• T fi`.,� ..'"..i CG<'!_...,.� fi.r°;9 •'_:`t';' - J w mv w�w-,T_,--wm- X RT7 ... _ww Ivor- NZ, PROF ;&Ul '45 ? TLH-, 41 A, TOP F -ov FINSH� GRADt" �ER _ ' ir �NISH GRADE FIA ISH GRADE', GRA DE 0 YER ars r.1 SEP r ric ANK EA&? VA ST 3" ;,-:TU '12 &EL Oh 0, 6 00 to 1_ -OR PVC—TEES :j T. FL R. EL . TR-t 16-W 7-10AI BOX Ji '050 GA L L'Ohl D TA L L ON L F�IEL -0 3 p 314' PRIFCA S V CONC�7� TE ic s Lb /0 [1 SEF TC TA41K ALI TO P.,,5,f 4 ell dv 8 va L ILK f VEPV4;�_'A �-H L.FA CHING A A -0 o RE-PAL A C�E F XCA VA TOO AfA TERIA� Y.T I OL k-A N, CtA Y FREE' S11 keD 1 'A prT L V. JA r F T'. T. TJ V A DA)7 y FL 0 P 1,7'c T 446 P TIC 7:4 _-C 411k 4 40 0 t�wc jai c S= F.X P, '0 T TON A R 15,1 SAM F. RES X 1 7 6P, L FA CHING PPO Vic 7 19 G'PL) EL E VA TIM y 05 5 ER �4 T1 ON PIT; DISTRIBUTION B0,V YS-' P _GE DIS POSAI L ROPOSED SEPIA L E,4 CHING PI T PREPAPED FOR TIC TANK TIT, CQIYS TRUC �Lo -MIS TIC (Rp I E.11� 7:jl DRI VE A M- A' TONS MILLS A ZIA T E�:PIPE ;INVERT ELEVA'TION T)A -SU VEYI�NG. JSLA DS T PL TE -2f CAP G ,E PL 7�9 0 'SCALE.,,- P E P G . ..........