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HomeMy WebLinkAbout0213 MOCKINGBIRD LANE - Health 213 MOCKINGBIRD LANE, M.MILLS , A= OoZ-?- 0A b �k(( to +l f ly� F� Y �F TOWN OF BARNSTABLE LOCATION �-l3 �`�cSG�!i tzl� 1 I.f SEWAGE# �I�r�LI VILLAGE �� 2 -,—�tP i�� ASSESSOR'S MAP&PARCEL �lrj INSTALLER'S NAME&PHONE NO. �. -525r, -77 t-!J3J!!J SEPTIC TANK CAPACITY �ftj{e (CM-,,tL / �® LEACHING FACILITY: (type) (size) 23•5--y-1�- NO.OF BEDROOMS 3 -6'q- 3cay OWNER .^- PERMIT DATE: � �-16) 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 leaching facility) Feet FURNISHED BY 0!/pwJ C ®� :• ��s9rr.r�,••o,•�t Q Q No. o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RppYitatiou for bisposaf *pstem Construction permit Application for a Permit to Construct( ) Repair(,,�Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.a 13 /' Owner's Name Address,and Tel.No. _ D_?� — YK�r�toy�Vui Assessor's Map/Parcel �/�v +tirurs t I5 .Installer's Name,Address,and Tel.No. J5_ -a f $—Sg;;,(o Designer's Name,Address,and Tel.No. 37/ Type of Building: Dwelling No.of Bedrooms Lot Size a�� 'S� -- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �� and Plan Date Mlk a� 9 1 C) Number of sheets 1 Revision Date V, 21-01 Title 5� 3 �N' All Size of Septic Tank (fX)Stj' Type of S.A.S. 3- a. e 5 33. [,/19 � 4a2Q Description of Soil p l Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmenta a and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. b Si ed Date ct Application Approved by Date Application Disapproved by Date for the following reasons Permit No. as I Date Issued No. 0 � Fee ! C/ c�"')� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - s PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS application for Mispio8al 60stetn Construction Permit y Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System dividual Components Location Address or Lot No.a 13 ► ;V +��� Owner's Name,Address,and Tel.No. � Nice_ ZC b- / Assessor's Map/Parcel q Yam'Arst�i 1'Glr��S � '� � >3 Niar1�(,' qy/�I d t 1 e A R C- Installer's Name,Address,and Tel.No. 11 _t[a g5_�q a(� Designer's Name,Address,land Tel.No. Qoin%k r'uc-t4o'l,Tin `1$_rv)4,4 y-y "n OV�S 9 r 6t•-1at4l St' Type of Building: Dwelling No.of Bedrooms Lot Size /, 5'YJ fi sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(miri.required) j /) gpd Design flow provided y 5-S gpd Plan Date A44,, �'301�/ Number of sheets 1 Revision Date Q,, c/ ��l� r f X�v.0 Title I'd > ; Size of Septic Tank e1Y J'5 l.r nc / V Type of S.A.S. 3. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of } Compliance has been issued by this Board of Health' Si e n /' Z Date It 4 JApplication Approved by 'Date a, Application Disapproved by Date for the following reasons Permit No. �; / Date Issued G, 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Co pliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X Upgraded( ) Abandoned( )by A,,4,,(, 0 , „ �- at , ; �,�U J^;r. I 6,G ' LC •%liras been constructed in accordance with the provisions of Tine 5 and the for Disposal System Construction Permit No. dated / Installer( ( 1C_ Designer „ #bedrooms , Approved design flow 9 12 A gpd The issuance of this permit shall not be construed as a guarantee that the system i I functi ed. Date Inspector, �""'�.., --------------------------------------------------------------------------------------------------------------------------------------- No. 0 f Fees THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstetn Construction permit Permission is hereby granted to Construct( ) Repair,( Upgrade( ) Abandon( ) System located at {tea ,�k fib, �`.a � Y 2/ i^ and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit. Date I Approved by I JUL-12-2019 00:34 From: To:15097906304 Pa9e:1/1 _..... _................_._.�...--- ��- [2-S Town of Barnstable Regulatory Services "; 4 Thomas F.Geiler,Director NAM X. Public Health Division i �w Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-962-4644 Fax: 506-790-6304 Installer&Desiener Certification Form Date: 7 10 Sewage Permit# Assessor's MaplParcel , Designer: IOLJK\ @- Installer: &,4tO� 0y✓4Y7-uGfiI,0, Address: Address: 6 oX 70 7 Ya-vwo tt4k- PoJ M'(& On av g `G was issued a permit to install a o un (date) (installer)septic system at `� M l)c% UI+�'n 1—"10- based on a design drawn by (ad&z ss) am\1 e.,I 1q- _ J. PE P!s dated Md, aol 9 ALI 0 Aoi9 (desi er) IJ - X l certify that the septic system referenced above was installed substantially according to 'the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS'or any vertical relocation of any component of the septic syateA but in accordance with State&Local Regulations. Plan revision or certified sabuilt designer to follow. tA OF MAS� DANIELA, N OJAI,A (Installer's Signature) CIVIL H No.4eso2 e 1 ` Cam•^� /ONALc (Designer's Signature) (Affix Designer's Stamp Here) PLEAS4 RETURN TO BARNSTABLE PUBLIC JUALTH DIVISION. _ CERTWCATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Peelth/Scpk/Dcaigner Certification Fon7n 3-26-04.doe Commonwealth of Massachusetts Title 5 Official Inspection Fr v;rF Not for Voluntary Assessments Subsurface Sewage Disposal System Form 2.51115 JU 17 A14 9: '17)4 Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000. Inspection forms may not be altered in any way-- A. Certification UVIbILIN Important,:When filling 7 �� out forms on the 1. Property Information: computer,use only the tab key to move your 213 Mockingbird Lane cursor-do not use the Property Address return key. Jason Bell Owner's Name 45� 213 Mockingbird Lane INA Marstons Mills MA 02648 Zip Code Date of Inspection: April 27, 2005Date 2. Inspector: Michael Kellett Name of Inspector Aardvark Environmental Inspections Company Name P.O. Box 896 Company Address East Dennis . MA 02641 City/Town State Zip Code 508-385-7608 Telephone Number 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority April 27, 2005 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments >� Subsurface Sewage Disposal System Form M yea A. Certification (cont.) 213 Mockingbird Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Jason Bell April 27 Owners Name Date of Ins005pection 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: 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification Cont. 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrown Cityrrown Cityrrown Jason Bell Jason Bell Owner's Name Owner's Name B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ 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: 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 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh A. Certification (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/Town Cityrrown Cityrrown Jason Bell Jason Bell Owner's Name Owner's Name C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/Town City/Town City/Town Jason Bell Jason Bell Owner's Name Owner's Name D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ ® 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.] 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. 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/Town City/Town City/Town Jason!Bell Jason Bell Owner's Name Owner's Name E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrown Cityrrown Cityrrown Jason Bell Jason Bell Owner's Name Owner's Name Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/Town City/Town City/Town Jason Bell Jason Bell Owners Name Owner's Name Residential Flow Conditions: Number of bedrooms 4 Number of bedrooms(actual): 4 (design): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of 440 bedrooms): Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection ❑ Yes ® No required] Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current Date 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 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 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Other(describe): C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrcwn City/Town Cityrrown Jason Bell Jason Bell Owner's Name Owner's Name General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 6/11/83 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/Town Cityrrown City/Town Jason Bell Jason Bell Owner's Name Owner's Name Building Sewer(locate on site plan): Depth below grade: 28 inches feet Material of construction: ❑ cast ®40 PVC iron ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth aelow grade: 18 inches feet Material of construction: ® con;rete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1000 gal. Sludge depth: 1 inch Distance from top of sludge to bottom of outlet tee or 8 inches baffle Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 7 inches Distance from bottom of scum to bottom of outlet tee or 15 inches baffle 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M How were dimensions determined? measured C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrown Cityrrown Cityrrown Jason Bell Jason Bell Owner's Name Owner's Name Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): THE TANK WAS SOUND AND TIGHT WITH TEES IN PLACE AND LIQUID AT OUTLET INVERT Grease Trap(locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass El polyethylene El 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): concrete 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrown Cityrrown City/Town Jason Bell Jason Bell Owner's Name Owner's Name Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm!level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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.): THE BOX WAS LEVEL AND TIGHT WITH NO SIGN OF CARRYOVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills Cityrrown City/Town City/Town Jason Bell Jason Bell Owner's Name Owner's Name Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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.): THE SYSTEM HAS A 6X6 PRECAST PIT THAT IS LINED WITH STONE. THERE WAS 1 FOOT OF LIQUID WITH A STAIN LINE 18 INCHES ABOVE THAT 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form I M C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/rown City/Town City/Town Jason Bell Jason Bell Owners Name Owner's Name 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.): 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.): 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills c1►ITOM cityyrrown City/Town Jason Bell Jason Bell Owner's Name Owner's Name 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. i t '1 i Commonwealth of Massachusetts Aa Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 213 Mockingbird Lane Property Address Marstons Mills Marstons Mills Marstons Mills City/rown City/Town City/Town Jason Bell Jason Bell Owner's Name Owner's Name Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: USGS MAPS SHOW AN ELEVATION OF OVER 20 FEET You must describe how you established the high ground water elevation: L213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 213 Mockingbird Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS z F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M + d DEPARTMENT OF ENVIRONMENTAL PROTECTION ac SOUTHEAST REGIONAL OFFICE c o� SYev 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 JANE SNk-IFT BOB DURAND Governor Secretary LAUREN A.LISS Commissioner April 30, 2002 Edwin C. Gibbs, Jr. RE: BARNSTABLE -- Subsurface 2 Oriole Lane Sewage Disposal -- Title 5 Sandwich, Massachusetts 02563 System Inspection Report Dear Mr. Gibbs: The Department of Environmental Protection has received a complaint concerning a Title 5 system inspection conducted by you for property located at 213 Mockingbird Lane, Marston Mills. A preliminary review by the Department resulted in a decision to investigate this complaint further. The Inspection Report is incomplete with the General Information Section of the report left blank. Also, the inspection describes a single leaching pit, although a failure criterion for cesspool is checked off, and the system is passed. The Department requests that you submit copies of your last twelve (12) Title 5 System Inspection Reports, including copies of any and all correspondence (written or verbal notes)'from the Board of Health that:may relate to any of those reports. Reports should be submitted to John Viveiros at the Department's Southeast Regional Office within two weeks of this letter. Should you have further questions or require additional information, please contact John Viveiros at (508) 946-2859. Sincerely e E. ould % B e u of esource Protection G/JV/cli ' This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper x 2 cc: Thomas A. McKean, Director Barnstable Health Department P.O. Box 534 Hyannis, Massachusetts 02601 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Name of Ow Address of Owner• Date of Inspection: Name of Inspector:(Please Print)���yl���.6�' 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: G486S CESSPOOL SERVICE MaiingAddress: 2�npIQ16 ra ILA N rh Telephone Number CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complets as of the time of inspection. The inspection was performed based an my training and experience.in the proper function and maintenance of on-site sewage disposal systems. The system: _✓Passes — Conditionally Passes — Needs Further Evaluation By the Local Approving Authority Fails Inapectw's Signature: Data: The System inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to 11te system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS A 4. �- � r A �°o ysf ?0p ; a revised 9/2/98 Pageitim V.i Printed on Recycled Pape l ix s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CER T1ON(continued) �tb Date of �o 0 INSPECTION SUMMARY: Check A, B, C, or A. A./ SYSTEM PASSES: V 1 have not found any Information which Indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: : B. SYSTEM CONDITIONALLY PASSES: Cne 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. Indicate yes,no, or not determined(Y. N. or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) _ or due to a broken, settled or uneven distribution box. The System will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • � N-J§bntinued)A ProA O--W Data o nati� DO C. FURTHER EVVALUATION 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENNWRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. s ' 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. .Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 1of11 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property A /� Owner: Date of Inspection: D. SYSTEM FA9: / v You must Indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure., Yes No Backup of sewage into facility,or system component due to an overloaded orclogged-SAS or-cesspool. _L�<'� 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). ' Number of times pumped_. V/ Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. i 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds. - g p ,ammonia nitrogen and nitrate nitrogen. 9 t ogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 r SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECK Property A Owner: Date of Inspection: 31 0 0 Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes. ,_. No Pumping information was provided by the owner,occupant,or Board of Health. L.��None of the system components have been pua►ped:for•atleast two weeks and-the system has been-receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this ,. inspection. _ As built plans have been obtained and examined. Note,if they are not available with NIA. 1� _ The facility or dwelling was inspected for signs of sewage back-up. l--**"' The system does not receive non-unitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System,have been located on the site. The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. ` The size and location of the Soil Absorption System on-the site has been determined based on: Existing information. For example, Plan at B.O.H. Determined in the field(if an of the failure criteria related to Part C is at issue,Y approximation of distance is unacceptable) 115.302(3)(b)) The facility owner(and occupants,if differeo2 from.owner)were.provided.with infounatioa.on.the.propermaintena m ^f Subsurface Disposal Systems. revised 9/2/98 Page sof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORM TION 4operty A Date of `�/� ` v/4—�/ 06 FLOW CONDITIONS RESIDENTIAL: Design flow:3'JI Q g.p.d./bedroom. Number of'bedrooms(design) Number of bedrooms(actual): Total DESIGN flow— Number of current residents: Garbage grinder(yes or no): 6 ;. r/ Laundry(separate system) (yes or no). NI2 If yes,separate inspection required _ Laundry system inspected-jyas or not I Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no):_ Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: apd ( Based on 15.2031, , Basis of design flow 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION g DUMPING RECORDS and source of information: System pumped as part of inspection:(yes or no)_if yes, volume pumped: gallons 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APP XIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site:(yes or no) - 0 - revised 9/2/98 P2ge6of11 II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMVRiFOM ON(continued) roperty Addr '- -Jwner. �3 Date of I on: /BUILDING SEWER. /do (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:/ , Material of construction:_cam oncrete_metal_Fiberglass _Polyethylene_other(explain) r . If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions:/600 G•L ,��b' (.y Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: - 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:�y How dimensions were determined: omments: T (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 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: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 • SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q;ys RMATION(continued) toperty A ! �'DWner: Date of Iru TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: V (locate on site plan) Depth of liquid level above outlet invert: .omments- (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) — PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or Noll Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised- 9/2/98 Pages of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty A o(� w •Owner: Date of Ins _ 7 �U : SOIL ABSORPTI N SYSTEM(SAS):_ (locate on site plan,if possible: excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:_ leaching chambers,number- leaching galleries,number:_ leaching trenches.number,length: leaching fields,number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note eon •'on f soil.signs ofhnydra H failur �Inding. damp soil,condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: l )epth of scum layer: ,-`bimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 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.) revised 9/2/98 Page 9otu SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFOVfAj7N(continued) >roperty A :,q Owner: Date of � G SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �y- y� ' revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMAN�(co.��tirwed) �ropMy A �1 - Date of ` NRCS Report name Soil Type_ Typical depth to groundwater USGS Date websits visited Observation Wells checked Groundwater depth: Shallow - Moderate Deep 1 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater6OFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Z C— ecked FEMA Maps Checked pumping records Checked local excavators,installers L--*Gsed USGS Data _ Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page 11of11 i° �.wPJ` , E o w sr�4`r CENTERVILLE-OSTERVILLE- SEND PAYMENT TO: MARSTONS MILLS !'ice WATER DEPARTMENT �. C-O,MM WATER DEPT. u WATER n P.O. BOX 369— 1138 MAIN STREET P:o.BOX 369 '. DEPT. OSTERVILLE,MA 9�STONS OSTERVILLE, MASSACHUSETTS 02655 02655-0369 TELEPHONE: (508)428-6691 ;':L:':� 1YIf:?(::I':Cl�lC-;t;.:1:F:L'> I_(•I _ . . SERVICE ADDRESS ACCOUNT NO. 0C:1{., I::.Itit+Jl>RD 7`b •.: 1~: :L:.i l'1(:)(:;I'.:(:I'(I:i;(:;:1:F :(? L..I ► PLEASE PAY THIS AMOUNT•. 1'-I(tI�.`::?T C)I•�I�_:� 1'I11._I...�_) f`1r�t r}:?L,r1t?._.J.•.:?`�C) �R119 a Otir� _- PLEASE MAKE CHECKS PAYABLE TO"C-O-MM WATER DEPT." PLEASE RETURN THIS STUB WITH YOUR PAYMENT.PLEASE PUT YOUR ACCOUNT NO.ON CHECK. This form made of recycled paper RETAIN THIS PORTION FOR YOUR RECORDS SERVICE ADDRESS ,`• ACCOUNT NO. PREVIOUS ;':5 :. 2 BALANCE WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF.ISSUE ARE SUBJECT PAYMENTS TO INTEREST CHARGES,AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE- . OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST TELEPHONE:(508)428-6691. CHARGE PERIOD COVERED PREVIOUS METER CURRENT METER CONSUMPTION CURRENT FROM TO READING,a^ v, READING`:_ 1000's OF GAL. CHARGES CF::'::3 F`f:::F; T( ((at.!`:::.,''Il iC? (.;;::}l...l._(:JI If3 EXCESS CHARGE T'I r."I...'`( 1T11.!'-1.(.1T11J1`I PERIOD COVERED MINIMUM 1 'F•;'--�31_l1�1[:- `0 (CHARGE I'L..l.)f:i(-I a:l•IC F'F (:)(:;f a1P'1 I h1 1: F-F.,E C:T' FJ 1D OF MAY,, ?{::::k:�rl i<:i1:. l•.li'l T I:::F �:l:I:f:iF:a...'i':#?;:>t _;.DATE OF ISSUE �46f {}4%C)i, C?,� ��►MouNT i 0 C A T ION SEWAGE PERMIT NO. Imie- VILLAGE IN T(A LL JR'S N A rE & ADDRESS BUILDER OR OWNER I Le N D A T E PERMIT ISSUED �DAT E COIIAPLIANCE ISSUED /14� i 1 LOCATI01J _ L®""r DATE :L>i i'L fly VILLAGE �TCa it l. AAR•�• � ! APPLI.CNN ��•-. . ��`� D �• Cfa�. FEE AllllRE55 I TELEPHONE NO. (Non-refundable _.�.._.. ENGINEER TELEPHONE N.O DATE SCHEDULED 1�1.• �� Applicant' s signature • • • • • • • • • • • • • • • •-• • O • • • . • • • • • • O • • • • • • • • • • • O • • •.• • • • • • • • • • • • • • • • • • O • • • • • • • • • •.• • • -• SOIL LOG 3 SUB-DIVISION NAME LC*4& PAtito F, S'�_ -DATE TIME q o EXPANSION AREA: YES ENO _,xIC>i-]11.t �a..�.-l3 ENGINEER l TOWN. WATER_j/I'RIVATE WELL _JoHaa J�►rcml3 1 BOARD OF HEALTH EXCAVATOR SKETCH: (Street niime, etc. ,di:mensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) `.�.!4•a..l;�•. ►t NOTES: Pme N4Y 177Ale TFIST 4CD 01 PERCOLAIr�ON RATE: � � AA ]kw►�11-tc-14 TEST HOLE NO: ELEVATION:: TEST HOLE NO: ELEVATION: 3 L4N y 4 4 5 5 6 6 7 7 a + 1 8 10 ®F 10 12 12 . 13 l 3 ' 14 '14 . 15 • 16 16 SUITABLE, FOR SUB-SURFACE SEWAGE::' LEACHING FIELD LEACHING PITS 1 • LEACHING- TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE• REASO}NS s,,� , ; A NOTE: ENGINEERING ;PLANS. MUST .S40 NUMBER ASSIGNED ON P 'PC 'I' ,ST 11['P1.,ICATIUN f►RTGTNAL.'. COM<'LET .D E N T RNC17 T nh121) Of' 111:AI,1111 - ._ .'/alp, w nn• T rT.A?T- •'':':z+p.:, < +;.��° :,. - V OCATION SEWAGE PERMIT NO. z_ 'l� C 4 StL ARq VILLAGE IN T LL R'S NA E & ADDRESS S UILDE R OR OWNER N D A T E PERMIT ISSUED vi 'k© ATE COMPLIANCE ISSUED /� �j s V � �� Fizz... ®................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Allp iratiou for Bhipoiitt1 Work.6 C oulitrur#iuu ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System t r �Location Address y or Lot No. _.... +�'..:.:Sr�r ': !��A .......C.O/Z .... ................. __....... ... ............. Owner _Address a ...................................��4:WIZ......__ �l�s..t�lC...--- Installer Address U. Type of Building Size Lot____ feet Dwelling—No. of Bedrooms.--_.__...�..________________________________Expansion Attic ( Garbage Grinder ( b PL4Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures _________________________________ W Design Flow________________,__ ................gallons per person per day. Total daily flow.........M_l(-.....................gallons. WSeptic Tank—Liquid capacityl,04t?_gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet_______.._.._._.____ Total leaching area..................sq. ft. Z Other Distribution box O Dosing tank ( ) ~' Percolation Test Results Performed by.......................6_ze...: ....... �t__- Date.............,.4�zlej Test Pit No. L._.4._f.s minutes per inch Depth of Test Pit_.__-_.l_: Depth ground water.....P P ` � to P 0 . Test Pit No. 2......- 14-`hiinutes per inch Depth of Test Pit.................... Depth to ground water...... 1j o -•-•••---------•- -- � � .S.o!Z"-•-••-•I3-.� �-�--•.�- W.Y............................ ' -----•-...•••-•--•••---....-•••---••-•.._....--•••-.._._�__-_-M............... :z�= ------ -'�1 - : ---------------------------------- W -------------------- UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the,aforedescribed Individual Sewa e isposal System in accordance with the provisions of iIT?.i: 5 of the State Sanitary Code— The undersigned u her agrees not to place the system in operation until a Certificate of Compliance as been issu by the bo of h. igne --•------••--•- • -• •--------••-•-•••••••••---• �jp�................. <7/ / ® 4te ApplicationApproved By -•---.----••-•-- --------------•••-- .............................................. l-----------------'-Date•----------'-- Application Disapprove or t following reasons:-------•---------------------------•------------------•---------------.----------------------...----------._..._ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date J Fn$..,e._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .c- : OF...............15. ►t rV...... Appliratiou for Uhiposal Workii Corm rurtinn Vantit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: � ................_•---............--=-` .. .-. .`..G :.r�...... ; .. .. =----------.. .. � }: -_J Location-Address or Lot No. /f {'_�1%G c.s-T.•... ...........................7-U. . •....--••-•....... Owner }} " Address a ..1�i.;' 5 .. , s C.� r........• ?^c,.,� .4 Installer Address d Type of Building Size Lot..... '.'' ...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ^9 Garbage Grinder ( �) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------•-•----•......•. . W Design Flow................. ..`_.__.._.___._._..._gallons per person per day. Total daily flow......................?......................gallons. WSeptic Tank—Liquid capacity/...c..0_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.......................�....�.. '_...... "y ... Date...._.__...../ .... ..... Test Pit No. 1___--�:'s=.minutes per inch Depth of Test Pit...... �..n..... Depth to ground water-___.. +_.JW_ ''.f=, Test Pit No. 2......._"'minutes per inch Depth of Test Pit.............____.. Depth to ground water------ :�..f.:_�.: ,• ... i* O Description of Soil.................. ... !} t , ? - /S '� / tr --------------• ----•• . .................................. ........................................... -•-........•-•---•••-•-------•--•-----••••••-----------•--•-----•......--•-----•---••-•-.....•• ..... •••••... W -------------------------------------------------------------------------------------------------•---••--••••••-_._.._....----...•--•----•--••......•------•••••••••-•••••••-••••---•-•-.............. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•---•------•-----------------------•-------•--------...............-----••-----------------------------------------------------------------•---••-•----.........--.--••- Agreement: ,.... The undersigned agrees to install the aforedescribed Individual Sewage iosal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned u 1,eif'a`grees not to place the system in operation until a Certificate of Compliance has been issued by the bo• ,.of th ig � f necLXn.-- ............................... .. ='-' Date Application Approved By..-'- :::':'_. .: ' {' ` /?�_.f' r .. ------•--•---••-----------------------•-------- 3 Application Disapproved, or t� following reasons:-------------------------------•------------......----��--------------------...--------- Date---........--- •................:••••............••• ..... ••----............---•-----••..........--•--.....••-••----•------------------------• .............................................. r ,^ PermitNo......................................................... Issued....................................................... 'k Date r" a✓a THE COMMONWEALTH OF MASSACHUSETTS i v � I BOARD OF HEALTH l ..........................................OF.............. 1.f.(,(tG.. ..... ...... .!................................. Trr ifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (--)--or Repaired ( ) b ' .:'..:"._.............---.•..r�!................. ---------------------------.....------------...-----....---------......---•--•---------...... _._ _x. Installer l at C� �'� ..f.._.ft ..+� rs.._ f 11-uap i -•--..•.. ..---••-• -•-••-•----•--•--•.. V_,* 3sc ...... s - has been installed in accordance with the provisions of TITIF; 5 of The State Sanitary Codri_ ed in the application for Disposal Works Construction Permit No.•k-_13,...2.k.1V.......... d-ated_�I J_ .....................: THE ISSIJAN E THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GIJA ANTES THAT THE SYSTEM WILL TON SATISFACTORY. DATE. -�f -•--• ................ Inspector.... . ..........._.:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nq i t'-e•'h- `OF............... ' ........................... FEE .............. . �. Permission is hereby granted................... "._'J.__. _._ .%.' .... -----.....-•-•--.........••••........••••-•...... to Construct (. ) or Repair.. ( ) an Individual Sewage Disposal System Ear ' at No. .................l.., I. r a ... i / Street as shown on the application for Disposal Works Construction Permit Nq,�qfn-,2?; ___ ate ......................................... oard of ealth 1 DATE........ ................................................ FOO 1255 HOBBS & WARREN. INC., PUBLISHERS C �' •lam,�', .: .... .._- _.......-•.._._,�'._._.,,----.--.. l bT�-.Lc�t' 14o wILL 4AvE 10W" Wf� —_ -- -- -- .- ---- L.o r f+41 HAS A rFav�E \,u 1 T O Tnw� � fJUi� Y13M C H-101) W; Lots Iat & f42 `1 �,�,�� � LoI, LCC^7�G�d IJ�oc�iNbf31R-D I:A+.�E e�(A•N6E �3011'.ovrcl2 { f4Cr�//1/rxl3��.D L.gi1/� rJo c 4,: vick_f=1rf�.- f�1h11l WiLET OF ( NyDC�rnaT EL- I63.71 PRlViq ? D'yl///7E 2�;f2� LAf.�t=, 10 1, 2-6 1 1 G� M W 81 ti G W�C3• i' \�e�ce,E TOW W vi ZY814 A i EP- (o C 4'xla'LP1cM, `y: Prr t pbu ° 1 f Q�:SSF f.10TE EY-iSit�l . AA, lol 10 F15SuME'U PP- Mal I1 I a�) (coo r Uwbep.an PGoFa>r Qf 1D ! gy,TEIL LOT 139 �l / Id LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Go 1 EXISTING CONTOUR 0 ���t1oFMlss LOT 13 4,i- �.�alv� - . FINISHED SPOT ELEVATION, /►'I,dR57`6)/1/S j F_INISHED CONTOUR 0 APPROVED BOARD, 6F :HEALTH a "' �? � An IN bAT Eti A OEN1' . r ? ' 'fSs1oNA��`� SCALES dd_ 3t� DATE 4�2-s 8 3 L,OREDGE ENG%NEMVNG Cd IN CLIENT '.�.,.� :� ! CERTIFY THAT .THE PROPOSED STEREOREGI `fER`ED j JOB''NO. =�` BUILDING SHOWN ON THIS PLAN CIVJL t LAND 'u CONFORMS TO THE ZONING LAWS E`NO VEER x VE ,' OR.$Y+ : :O.F BARNSTAB E ARASS. 4 _*:eCPT ,. AEwnO. 712 M A I N :S Tft E Et , + CH.°8Y :. �, .�,�.._. � 3 �.L x : h4 Y A N N I S MASS . :,. ®F A E ( _REG. LAND SURVEYOR /VOTE /F E/TNER THE S�PT/G TANK OR 20 FT. MIN. 7, _EACx/NG P/T ARE MORE TNA.✓ /2 "BEL0J&V 4/r/ =rRA OFF Aa 2C �O/A M E TER CO V C.+P E TE (OVER SJ/ALL E BROuGN.T TO GRADE. _ O CRCT'E i •4 PYC P/PE t,rEgYy C^ ST /RO/Y CO1/4vR SEAL L L3E USES G N M/N. PITCH Eft �' /"^}•'' GOYERS DR/VEl�ti.4Y PFiP FT. _ 2 . i,g iry, CD/V CRZm TE. . co ✓E� CL EA/V S'A/V A:' L/QU/D LEY. 4: 4-CAST� -- _ - �' •� ( G�cC •��. . 2 LAYER J % o •e o en—H i M�=--/ aa : '0 MIGN Al. .P/ G.4L. j • • •. • • • • • ► a e WA5HE0 57VIve %4 .PER r7 SEPT/C TANK D/ST• • s • • tildre: ,ud- P' Eww LAIFLI • • •EFFECT/✓E r ` • • 314 - ►�2" { r • . • • o wASt/ED STONE • `s a•• - HE U'1O 01 ,4•83. � • v • • • • • • s • i p P. . J S I x Z S 3 7 7 -/ • • o • • • • ► o p o PREC,gS 7-SEEPAGE / Y3 y 1•v / 1 y • e. • • • • • . • • • p ••� lNI�ERr ELEVAT/DNS PiT c`PA cr?Y = g qo GpL�Df, , a °. • • • • • • • o o P/T OR ► - e Ar GL INVERT AT B[//LO/NG °Zp Fr. . 61T D/AM. INLET SEPTIC Ti4IVK 101. CCSEE7�iBt/L.4TlON� OUTLET SEPTIC 7-ANK 1O1 FT. //VLEr DISTR/OtI710H BOX 101 .4 FT, s.EC7-/a/V DF GROuND WA7ZR TABLE oc/TLEr,a13rw®uT/oN eox 101,4—FT. .SE;VAG� AVISPOSA L SKS rjW, //VLET LEAC/ llW2 PIT SFr. TABUJLATIDIV LEACH//VG P/T 3 FT. SCALE D/MENS/ON A DES/G/V CRITERIA D/M.FNS/oN `� FT. 9 F ml/v, 0 3 D MENS/aN C T. NtJJNBER OF EEDR OMS GARBA6E•o/SPO5AJ_ uN/r Nor",'- SOIL LOG TOTAL ESTIM/'reD FLOW/ 3 3 O G.AL.IDAy SO/L TEST A/ SO/L TF'ST#2 SD/L TEST NUMBER QF LEActllwG P/rS__1 �ELEY. �D3 _�-EL�Y. >A'TE G. SOIL TEST S/OE LEACH/NG PER P/T l-�l Sot RT. Cron �j _3 RESULTS n//T/VESSED SY JR 9Q rr01w LE,�CN/NCs PER P/r l $Q. FT' L 0 j-iN 4_ PER C,0LAT/ON RATE A�/ L c s`S M/IV•//NChf �b 9 Torsa/c AERCOLAIT/oN RATE AL-2 N MIN. INGH TOTAL LEACH/NG aRE�► SQ. FT. z 2_0 RESERVE LE✓4CM//V6,4.4E�► Z 6 SQ. FT. ,o ZNOF OfA MC'/>fv'��� Lo7 !3 � Mocic;�✓G3i2�� t. nr V. yG� g ALE Y v 7h 4! F �M6 sE �, ELOREDGE ENGINEER/JVG CO,INC. �1`. No.10951 C/ST 7 T 7/2 MAIN S . 6 o CL EY � c 6REc,r� ,eiL6 2S �3 su1� SsIONAL�6 ® NO GROUNO Yhi47-eR ENCOC/iYT�,e..0 Cl/EIvT: DRTE / '1\ Q GROU/V0 WATER AT EZ EffV J0a vo S3 U C z SHEET z OF z 4 SYSTEM PROFILE SYSTEMALL MARKED WITH CMAGNETIC TTAPE OR S SHALL BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 3 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 102.8' FILTER FABRIC OVER STONE / Z 2% SLOFW, REQUIRED OVER SYSTEM 101 ' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o'k MINIMUM .75' OF COVER OVER PRECAST �- 5 0 NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST b PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-�( �/ Q Long RISERS (TYP.) PRECAST RISERS a 20 100' 4"�SCH40 PVC MORTAR ALL H-10 / S� Locus and 6" MIN. SUMP PIPES LEVEL 1ST 2' 4' CONPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. Q {� 12 MIN. INT. DI �ENDS 9M. (TYP.) �SIDES 4 5� o„ o Qooa 98.00' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE a{ o 10" **EXISTING 14 y. poo�•e�.o e� ° TEE SEPTIC TANK TEE ° °°°°° °°°°°° WITH 310 CMR 15.000 (TITLE 5.) a aoao ®a®a o�a�- �aao °. \*98.7'± D�a��aaaODa a�a�Do�a�a� `y ooa0000000.0 WATERTEST 'BOX ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE::: 0,00e J ° ° ° ° a�aaooa®olio a�aaaooaaoo ° ° °,_o�o�o 0 0_ FOR LEVELNESS ci ° ° ° o 0 ;00000000 ��D�QQ�D�QQ 0� QQ�0�00��000 ;00000000 NOT TO BE USED FOR LOT LINE STAKING OR ANY ' ° 95.0 OTHER PURPOSE. a� Q 4' LIQ. LEVEL (ACME OR EQUAL) . 97.29 97.12 °°°°°°°° °°°°°°°° L 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �� 4 �� Q H-20 500 GAL. LEACHING;CHAMBER BY ACME PRECAST OR EQUAL. ALL 3/4"-1-1/2"RAROUND DOUBLE WASHED STONE 4' MIN. (3) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR Sur 6" CRUSHED STONE OR MECHANICAL ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF P OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.50' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [21) Pond LO OF HEALTH. a e .P� J 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING AND VERFYNGIGSAFE THE LOCATION OF ALL233)UNDERGROUND & LOCUS MAP 1 (4.5 % SLOPE) ( % SLOPE) 90.0' BOTTOM _NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. SCALE 1"=2000'f FOUNDATION- EXIST SEPTIC TANK 31 D' BOX 12' LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 29 PARCEL 20 FACILITY BE REMOVED BENEATH AND 5' AROUND THE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PROPOSED LEACHING FACILITY. SITE IS LOCATED WITHIN A ZONE II UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 12. EXISTING LEACHING FACILITY SHALL BE PUMPED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 99- EXISTING CONTOUR LEGEND **INSTALLER SHALL CONFIRM MINIMUM SEPTIC RD LANE , TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY MocKINGI FOR RE-USE. REPLACE WITH 1500 GALLON X 99•1 EXIST. SPOT ELEV. SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF, SYSTEM DESIGN. -[991- PROPOSED CONTOUR NOT SUITABLE 82.62 GARBAGE DISPOSER IS NOT ALLOWED 198.41 PROPOSED SPOT EL _ . TH1 p�� EXISTING 3 BEDROOM DWELLING TEST HOLE i� o DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD 2%. SLOPE of GROUND USE A 330 GPD DESIGN FLOW UTILITY POLE � SEPTIC TANK: 330 GPD (2) = 660 BENCHMARK: FIRE HYDRANT I' **RE-U EXISTING Inn f TOP; OF STEP SE 0 CAL. SEPTIC TANK NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING 3 =102.4' NAVD88 � LEACHING: PAVED SIDES: 2(33.5 + 12.83) 2 (.74) = 137 GPD TEST HOLE LOGS DRIVE BOTTOM 33.5 x 12.83 (.74) = 318 GPD lb TOTAL: 615 S.F. 455 GPD ENGINEER: CRAIG J. FERRARI, SE #13871 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITNESS: -DAVID W. STANTON RS �� WITH 4' STONE ALL AROUND DATE: 5-7-2019 T 41119 �o PERC. RATE _ < 2 MIN/INCH Q p' 10.4p O �C, LA CLASS I SOILS PT# 19-13 T Qp �� D DATE • BOARD OF HEALTH MA ELEV. ELEV. ° 77 APPROVE O" 4 101 ' O" 101 ' Q P A q LS LS no �, TITLE 5 SITE PLAN w �10" 8,� 101 10YR 3/2 10YR 3/2 OF B #213 MOCKINGBIRD LANE SL C1 34" 10YR 4/6 98 2, SiL ,� - MARSTONS MILLS, MA 10YR 5/6 PREPARED FOR C1 369' 98, 0 _ _LOT AREA BORTOLOTTI CONSTRUCTION/ SiL 21 ,155 S.F. 4811 1OYR 5/6 97' DAVID SHERMAN PERC DATE: MAY 8, 2019 C2 C2 REV: JUNE 4, 2019 (3 BEDROOM) MS MS 160.52 OFkgS �p�jNOF'"ASsq off 508-362-4541 sycy o�'� DANIEL 0ti fax 508-362-9880 DANIELA. A. sAlu I downcope.com 10YR 7/4 1OYR 7/4 0 OJA IVILL ply OJALA o o.46502 o No.40980P ! down cQt*e e4gi7eeri/!g, 18C. 132„ 90 120 91 , 0, o� Scale: 1"= 20' °� si�sT�N `` sS\ civil engineers NO GROUNDWATER ENCOUNTERED _` �s NAL E G\ _ �' land Surveyors 1-` w J 939 Main Street ( Rte 6A) TI 9 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 LICE # / �- �25 19-125