HomeMy WebLinkAbout0249 MOCKINGBIRD LANE - Health n
249.Mockingbird:`Lane
A 029 017` "
I
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
�p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 249 Mockingbird Lane
Property Address
Matthew Manning t
Owner Owner's Name
information is Marstons Mills Ma 02648 1/25/2021
required for every
page. Cityrrown 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 filling out forms A. Inspector Information Sl 4r (5114 4?
on the computer,
use only the tab Sean M. Jones
key to move your Name of Inspector
cursor-do not S.M.Jones Title V Septic Inspection
use the return Company Name
key.
Co pang A Lane
Co�y mpany Address
Centerville Ma 02632
Cityrrown State Zip Code
774-248-4850 smjonestitle5@gmail.com, S14522
sean@smjonestitle5.com 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-site 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
1/25/2021
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 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 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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:
The property located at 249 Mockingbird Ln Marstons Mills is served by a Title V septic system
consisting of a 1000 gallon septic tank, distribution box and 2 500 gallon precast leach chambers.
Although the system was found to be in proper working condition at the time of inspection this report
does not guarantee future performance under similar or increased usage.
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 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
Commonwealth of Massachusetts
@ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M tl� 249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
c Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y�ye
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owners Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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 %day flow
Required pumping more than 4 times in the last year NOT due to clogged or
El ® 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.]
❑ ® 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 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.
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
f
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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)]
t5insp.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
I.- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flew based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd
Description:
Number of current residents: 1
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
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. 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:
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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
f
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
system repaired 2/9/2010
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1.5feet
Material of construction:
❑cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints in good condition, no leakage, vented through roof.
t5insp.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
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallons
Sludge depth:
5"
Distance from top of sludge to bottom of outlet tee or baffle
3'
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
7"
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? Opened covers and took
measurements
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. water level was even with outlet, tank was not leaking and was structurally sound.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
c Commonwealth of Massachusetts
F Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityfrown 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):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Distribution box was level and in good condition with no rot. Water level was even with outlet invert
with no signs of past backup.
t5insp.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
ew Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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: 2 x 500 gal
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
it
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� p
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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.):
leaching facility was video inspected from vent and was found dry with no stain lines.
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
i,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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
Title 5 Official Inspection Form
j- a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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
0 t
0
3 � 2
v I
�2 Yy'6
132 .S2
/'+3 Ll�r
,3 62-
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
� 249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 1/25/2021
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: 12'+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater was established by accessing town of Barnstable groundwater contour maps.
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
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
249 Mockingbird Lane
Property Address
Matthew Manning
Owner Owner's(dame
information is required for every Marstons Mills Ma 02648 1/25/2021
page. Cityrrown 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 4 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
TOWN OF BARNSTABLE
LOCATION 7-41 m x-L, L„J Lien,— SEWAGE# Zp 10- ®0 5
+ VILLAGE M x,, oni Ni I-ASSESSOR'S MAP&PARCEL 0{7
INSTALLER'S NAME&PHONE NO. N�, --Z -To" 509 7176-7001
SEPTIC TANK CAPACITY IOC)
LEACHING FACILITY:(type) (size) I ?-AZ5
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: I- 9-1 O COMPLIANCE DATE: ? (U
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N/N Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) a/A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) JV lA Feet
FURNISHED BY
2' 44'C" S9 6° NOT
3 Lis 6c{'``� To
Sc1*� )7- 30
5 73 6''
79 ?
38/
A
s
- r
No. d l o^d ' Fee 160
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:��Z
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
OWpl Co.tlon for Vsposal bpstem Construrtion VPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Zy Q M0c1,;1 �t� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel M hR.ST'c"s m i L2 5 ®l Fre ok t Po-me - tQ I
o ii Mcsrs ors s
Installer's Name,Address,and Tel.No. g''16-7oo3 Designer's Nam ,Address,and Tel.No.
Eo.,tL 1, s4a". /Ma,,( 1 To-
P.U. 4ox L1'L'L ()Qn 's r h+� OZC,3
1)rpe of Building:
Dwelling No.of Bedrooms 3 Lot Size 2 00 35 O sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) S3 C3 gpd Design flow provided 3 5-L gpd
Plan Date J_L-18-0q Number of sheets I Revision Date
Title m, L,- _rr r-uA Q f:S t pn m gjek� 1IL;A
Size of Septic Tank 1000 Type of S.A.S.
Description of Soil _$Qe_ test 010- AIt
Nature of Repairs or Alterations(Answer when applicable) - y
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.
Signed Date
Application Approved by �^ Date ^ l y
Application Disapproved by Date
for the following reasons
Permit No. a 0 I o —® 1 -5 Date Issued !— q — D
-- --- --- - - ---- - ---- -
."'•'"i.:-+-.-.- :._.,. •s+i,( .'•....t,s.r....--... . ,+w.rn+^w.-. ..:w�eti- .i.-•w.r. .. _., r•w .
'w-r" ,vi.r.•,+�' .. -'f,;+"o �1 «. ,n +•.+»�..i••.V.Syr•iri*"r"^rwris:«..F.a•..vf«:,r"'"••�..... `..+'f„µ"w:,-+•f 1-•F. Z,• z-
No. 0 10-0 15Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
21pplication for -Misposal bpstent Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Zy 9 M.c k,, _)(j J (_ Owner's Name,Address,and Tel.No.
M ICR-STON L s r J ci i Pacn^c ,,_ S V9_ (
Assessor's Map/Parcelb,;q 0( ck M o L; 6 L,fj r 4A� M���+o�t 1 �
Installer's Name,Address,and Tel.No. `50 S--776-7003 Designer's Name,Address,and Tel.No.
w.u. Nwx 47_2 Dom„ ,%pk j 1"A 07-C,19
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 2.0 35 0 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) IS Q) gpd Design flow provided ��- gpd
Plan Date r Number of sheets s- Revision Date N»
Title SI, P1.
Size of Septic Tank ()O(D an X.'&A19Type of S.A.S.
Description of Soil SQL -�o s1
Nature of Repairs or Alterations(Answer when applicable) jn S 1G11 b"
-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.
Signed -.+.-_--...,.,.. Date ('1 Z 1 0 l
Application Approved by Date /- 1 01 - /D
Application Disapproved by Date
for the following reasons
t
Permit No. a O 1 o — 6•( S Date Issued '—/ 9 -- f 0
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
at ,nn � �S�•�,�oi� l e wy,AAw,,P'i`,S has been constructed in accordance ,Pl�
with the provisions of Tjitle 5 and the for Disposal System Construction Permit No. ri Q/0-01 5 dated
Installer EP-V-'(lnt,S�`�le IY ,Ke- Designer
#bedrooms , Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will func}tiojn�asgqdesigned.�j t� _
Date 1 (j Inspector ,✓G/. 11 ' ter-- '\
! ' C7,
----- --------------- --_
nn - ---- -------------------------------------------------
No. C�U 10 d Fee�5 ..- - - -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS
Misposal *pstem Construction 3permit ,
Permission is hereby granted to Construe Repair( ) Upgrade( ) Abandon( )
System located at
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 "- Q Approved by ijii
Rft STA E CE Cl -
X- = n of H EET I OF Z
APPLICANT: a C o •- ,) CA I>i t-Q<_t Z S
ADDRESS: 2 C AII.W J!'
DESIGN FLOW: _ �(j Gig gpd U
REVIEWED BY: DATE:
GENERAL SEPTIC TANK
Legal boundaries denoted 310 CMR 15.220 4 a ize OK? 310 CMR 15.223 i
Street,Lot,tax parcel number and lot number noted on plan[310 et tee located ten inches below flow line 310 CMR 15.227(6)] i/
CMR 15.220(4)(u utlet tee 14"or 14"+5"per foot for increase ft depth(310 CMR
Locus Provided 310 CMR 15.2204 t 15.227(6)]
Plan proper scale?(V=40'for plot plans,V=VY or fewer for utlet tee with as baffle or approved filter 310 CMR 15.227(4
components)[310 CMR 15.220(4 ote regarding installation on stable compacted base[310 CMR v
Easements shown 310 CMR 15.220(4)(b) N 15.228(1)
System located totally on lot served[310 CMR 15.405(1)(a)for eparation between inlet and outlet tees(no less than liquid
upgrades]-ijnot,a variance is required 310 CMR 15.412(4) th) 310 CMR 15.227(2
Location of impervious surfaces(driveways,parking areas etc.) let/Outlet elevations at least 12"above high groundwater
310 CMR 15.220(4)(d)) except as described 310 CUR 15.227(5))or permitted for
Location all buildings existing and proposed 310 CUR upgrades under LUA 310 CMR 15.405 1
15.220(4)(c Minimum cover 9"(Tanks buried more than 9"must have risers ✓
Location and dimensions of system components and reserve areas. on all openings and on the d-box)[310 CMR 15.2228(1)and 310
310 CMR 1522004 e) CMR 15.232 3
System Calculations[3.10 CMR 15.220(4)(0] e access covers(inlet and outlet must be 20"or greater)-
daily flow middle access at least 8"(b 7/07)[310 CMR 15.228(2))
septic tank capacity(required and rovid / ®O , Access to within 6"of grade -one port for systems<1000gpd,
soil absorptions stem(required and rovided two for terns>1000 d 310 CMR 15.228(2)]
whether system designed for garbage grinder hC t All at-grade covers secured to unauthorized access? [310 CMR
North arrow 310 CMR 15.220(4)(g) 15.228(2)]
Existing and ro osed contours 310 CMR 15.220(4)( )] >10 ft from building foundation 310 CMR 15.21 l(1
Location and log of deep observation holes(existing grade el.on _ Buoyancy calculation R uked/Done 310 CMR 15.221(8))
each test)f 310 CMR 15.220(4)(h) v H-20 Where a ro riatd? 310 CMR 15.226(3)]
Names of soil evaluator and BOH representative[310 CMR Setbacks from resources 310 CMR 15.2111
15.220 4(h)and(i)] Multi-Coin artment Tanks.
Location and date of percolation tests(performed at proper Required when other than single-family dwelling or flow>1000
elevation?)[310 CMR 15.220(4)i V 'gpd 310 CMR 15.223(1
Percolation test results match loading rate? 310 CMR 15.242 First compartment 200%daily flow;Second compartment 1000/.
Certification statement by Soil Evaluator 310 CMR 15.220(4)0)1 dailyflow 310 CMR 15.224(2)and(3
Observed and Adjusted groundwater(method for adjustment "U"pipe through or over baffle,outlet of each compartment with
given or indicated)[310 CMR 15.103(3)and 310 CMR hl� gas baffle or approved filter 310 CMR 15.224(4)]
15.220(4)(n)]
Location of every water supply,public and private,[310 CMR UILDING-SEIVER AND-OTHER PIPING .
15220(4)(k Located at least ten feet from any water line?[310 CMR
within 400 feet of the proposed system location in the case 15.222(2))
of surface water supplies and gravel packed public water supply 0 isposal piping at least 18"below water line(when water and
within 250 feet of the proposed system location in the case 1/' sewer cross,see 310 CMR 15.211 I 1
within 150 feet of the proposed system location in the case Cleanouts required/provided?F310 CMR 15.222(8
of private water su 1 wells LI-1, Thrust blocks specified in force mains?310 CMR 15.221(6)(c)] �-�
Location of all surface waters and wetlands located up to'TOO ft. Slope of sewer line not less than 0.01(1/8"/ft) 0.02 preferable
beyond setbacks listed in 310 CMR 15.211 and any catch basins 1/ 310 CMR 15.222(6)]
located within 50 ft.f310 CMR 15.220 4 1] Proper pitch on all runs?(.005 within gravity-distributed trenches
Water lines and other subsurface utilities located[310 CMR ;� and beds) 310 CMR 15.251(9)and 310 CMR 15.252(2)(c
15.220(4)(m) (if water line cross see 310 CMR 15.211(1)[1 ) Siphonproblem/ eachfield below pump chamber)
Profile of system showing invert elevations of all system Endca s or vent manifoldspecified?
components and the bottom of the SAS 310 CMR15.220 4 o Size and orientation of discharge holes specified?(not smaller
Stamp of designer 310 CMR 15.220 1 .and 310 CUR 15.220(2)] k," than 3/8"not larger than 5/8")[310 CMR 15.251(8)and 310
Stamp of Registered Land Surveyor(required if construction CMR 15.252 2
activities within 5 ft.of lot line 310 CMR 15.220(3)] Materials specified (310 CMR 15.251(5)specifies various pipe
Test Holes adequate(two in each of the primary and reserve types allowed
unless trenches as permitted in 310 CMR 15.102(2)or as
approved for an upgrade under LUA at 310 CMR 15.405 1 DISTRIBUTION BOX
Test hole adequate to demonstrate four feet of suitable material? Stable compacted base[310 CMR 1522](2)and 310 CMR
310 CMR 15.103(4)] 15.232(2)(9)]
Test Holes adequate to confirm adequate groundwater separation? / Splash plate or baffle tee required on inlet/provided?(when
310 CMR 15.103(3)) V pressure sewer to d-box or steep pitch of gravity sewer)[310
Benchmark within 50-75'of system 310 CMR 15.220(4)(g) CMR 15.323 3(a
Materials specifications noted?[various sections of 310 CMR ✓ Riser if deeper than 9"•310 CMR 15232 3
15.000 Inside minimum dimension 12" 310 CMR 15.232(2)(b)] )/
System components not>36"deep(unless Local Upgrade 'gee Minimum sum 6" 310 CMR15.232 3 e
Approval or LUA requested) 310 CMR 15.405 1 ' 0 jti 4-C, 1 Watertight cover if QOOOgpd);waterproof manhole if>2000gpd
310 CMR 15.232(3)(d
j,
� R
O wtO o-� ��v STAB.; CE
APPLICANT:
ADDRESS:
PUMP CHAMBNR$ DID THE PLAN INVOLVE
Capacity(emergency storage above working--design flow)?[310 _
CMR 231(2)1 Pressure Dosed System F Provided pump and piping
Proper setbacks
calculations as r uired 310 CMR 15.220 4 r 310 CMR 15.211 same as se tic tanks �"" Pressure dosin aired on all s Watertight 20-in minium access manhole at least 20"MUST BE g ystems>2000gpd or alternative
TO GRADE F310 CMR 15.231 systems under remedial approval[310 CMR 15.254(2)and UA �—
Service components accessible(not too deep with piping, Remedial Usedpprovalsl
disconnects accessible) If used in graveness system-make sure jet is directed as not to _
Alarm floats-alarm on circuit separate from pumps specifiedT scour soil interface Guidance Document
Exceeds two units must have two pumps operating in lead-lag Inspections once per year(systems<2000 gpd)or quarterly
mode.f3l0 CMR 15.231 6 and 8 ✓ (>2000 dRood to note on Dian 310 CMR 1525 2 d - ..--
Stable Compacted Base 310 CUR 1522: 2 Constrnct/on in fell-Did the plan specify that the fill shall meet
Buo. c calculations needed?Provided?[310 CUR 15.221 8 the spec fication of 310 CMR 15.255 3 7
SOIL ABSORPTION SYSTEMS(SAS)GENERAL Impervious barrier and/or retaining wall? Guidance Document
Calculations correct? Impervious barrier installation must be supervised by
4 feet of naturally occurring material demonstrated?[310 CMR designer 310 CMR 15.255 M2 .
15.240 1 ✓ Retaining wall must be designed by Registered Professional
Required separation togroundwater?f310 CMR 15.212 Engineer F310 CMR 15.255(2)a
Aggregate specified as double washed 310 CMR 15.247(2)] Side slope not exceed 3:1? 310 CMR 15.255(2)1
System Venting required/ rovided? Breakout requirements met?[310 CMR 15.252(2)and
p (system under driveway or `I Guidance Document �
>36"de 310 CMR 15.241 l F'S
Inspection ports specified and within 3"final grade?[310 ChIR At least 5 ft.from impervious barrier to edge of SAS (10 ft.
15.240(13) C �� LCheck
mend 310 CUR 15.255 2 e
Breakout requirements met? /less S sfeue(I/A r/p royal Let/ers]
req (No violation of breakout elevation DEP Approval letters for credits and deli conditions
within 15 ft of SAS unless barrier)[310 CMR 15.211(1)[4]andIf s with pressure dosing do not allow pressure discharge
Guidance Document r soil interface.
GALLERIESMITS,CHAMBERS 310 CMR 15.253...
Chambers and Gal.in trench configurationative Se tic System IZIA A proval Letters]
supplied withuilet Was DEP Approval Letter provided and/or haEyou
eve 20 ft. 310 CMR 15.253 reviewed the letter for conditions?Each structure with one jnspection manhole(if>2000 gpd must Is the technology being properly applied and eet all
be to de 310 CMR 15253 2 DEP A royal Conditions?
Aggregate I'minimum-4'maximum. 310 CMR 15.253 1 ) Is there a note on the Ian regarding the
2'sidewall credit maximum 310 CMR 15253 1 a) p g g requirement for
In bed con6 lion,inlet eve 40 .ft. 310 CMR 15.253( etua2 maintenance a ement?
TRENCHES 310 CMR15.251 I An alarms involv6d on s arate circuits
Width 2'minimum T maximum 310 CMR 15251 1 Did the applicant submit an operation and maintenance
100 feet-maximum length 310 CMR 15.251 1 (a I manual?
Minimum separation 2x effective depth or width whichever Has licant submitted a co of a maintenance /
eater 3x if teserve between trenches 310 CMR 251(1 d} ^ Yarinaces
Situated along contours 310 CMR 15.251(2)] Are the variances listed on the plan 7[310 CMR 15.220
Breakout OK? 310 CMR 15.211 1 4 and Guidance Document 4
BED SAS(Maximum size of bed or field 5000 gpd), — RLS Stamp necessary on plan if a component is within five
f 3 CMR 15 4
minimum 2 distribution lines(310 CMR 15.252 2 a — feet o ro erty line 10 .412 New construction or increased flow proposed ro -
Maximum separation between lines 6' 310 CM R15.252 2 d CMR 15.4141p p [Refer to 310
Maximum separation between lines and outside ofbed 4'[310
CMR 15252 2)(e Nitrogen Sensitive Areas" \
Aggregate depth below discharge pipes 6"minimum,12" Is the system in a Designated Nitrogen Sensitive Area("Lone 11 for
+ maximum. 310 CMR 15.252 2 a.Tublic supply well)?(310 CMR 15.214,310 CMR 15.215 and
Separation between beds 10'minimum. 310 CMR,15252 2 — 310 CMR 15.216-also refer to Policy regarding upgrades of such 6F
Bottom area used in calculations only 310 CMR 15.252 2 r existing systems]
Is the system proposed on the same lot as served by private well?
310 CMR 15.2142 hd
Are the nitrogen loads proposed in compliance?[310CMR
15.216 1 Ui we
Miscellaneous
jPumping to septic tank? 310 CMR 15.229
Shared System F310 CMR 15.290
I
0
Town of Barnstable
Regulatory Services
* Thomas F. Geiler,Director
• BARNSfABLE,
MASS. Public Health Division
1639. �0
iOrFn `'�° Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 2- / /0
Designer: !� ��J, �A� Installer: Mld4el T/9-,��Q6/
Address: R®, 0x zys Address: 3 DAY 402,
V Y ! ti
rn �Z6 73
On �D /'/> / '/a,h was issued a permit to install a
date (installer)
septic system at based on a design drawn by
(address �sjtis �
(' jE�_Sdated /2 �� ��Z�✓�
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
�A OFMgs
RONALD �G
�7— JAMES N ..
Installer's Signature o CADILLAC y
C 0 1060 Q
/s-T
S'AtITAR P
(Designer' S ture (Affix Designer's Stamp Here)
PLEASE RET TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
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:Health/Septic/Desiper Certification Form
Town of Barnstable P#
Departilnent of Regulatory Services
Public Health Division Date 11 y
6 ��s� 200 Main Street,Hyannis MA 02601 -
Date Scheduled. oL Time Fee Pd.-0
Soal Suitabi lit `
.,
. :r. Sewnage is al
sessment l
Performed By: RjOAXId D/U_4e• ✓ Witnessed By:
LOCATION& GENERAL INFORMATION i
Location Address 2 /dC d//�L Owner's Name Ire�� jam, 7
/'Ski -5 l& Address 27�
Assessor's Map/Parcel: �Z D6 7 Engineer's Name
47` J•64bl .
NEW CONSTRUCTION / REPAIR Telephone
Land Use W� Slopes( _ W,Surface Stones <..
Distances from: ''Open.Water Body * ft : Possible Wet ATea—!!t)Aft • Drinking Water Well ft`.�,_)
Drainage Way ft .Property,Line� t - - ft Other $ ft�
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proxitiv'ty to holes)
C i�r�JG �J ti�'Cl L X Mi
r�A 106V
ti(9U1�
T -��--�
�1.
i .
(3
;zS 1 - ��r USGS QUA
Parent material(geologic) )WA h 2[ J O/ / �4fir� �P�c�/s-Depth to Bedrock Pr
Depth to Groundwater. Standing Water in Hole: y1 Weeping from Pit Face
Estimated Seasonal High Groundwater LOW82 Ja
DETERMINATION FOr,SEASONAL HIGH WATER TABL
Method Used: T,V-2 (�%S p✓�S r iA y- $-6 ' 14,be oe �� ��v�.a tv�
Depth Observed standing in obs.hole: in, Depth to soil mottles: h in.
Depth to weeping from side of obs.hole: Al% in. Groundwater Adjustment ft.
Index PJcll#� Reading Date: Index Well level Adl,Factor, m� Adj,Groundwater Level
PERCOLATION TEST Date /Z 7 a%hne_,&A
Observation
Hole# / Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ 10•-Z7 _ Time(9"•6")
End Pre-soak 10:7S / p
Rate Min./Inch C.Z 24 / • /�7"t5
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ,V
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency,% vel
0 -5 6.
T
5a s G Z ced Z,S 6 zs
ti 3 rid,4oZ• 6 `
9'
DEEP OBSERVATION HOLE LOG Hole# , Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Grave
�'
S
5=351 /� Z�S ,yp 6
CZ l Z1111 z
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
ter,'
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi en
r`
Flood Insurance Rate Map:
Above 500 year flood boundary No_. Yes
Within 500 year boundary No Yeses
Within 100 year iiood boundary No.___,. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? —AL—
If not,what is the depth of naturally occurring pervious material? _..
Certification
I certify that on -r V,` 1 (date)L.have passed,,the soil evaluator,examination approved by the
Department of Environmental Protection and that the above analysis was'performed by me consistent with .
the required ' mg, pertise pe 'en e ci scri. in 310 CMR 15.017.
Signature
GGc�
Q:\.S.EPT10PERCFORM.DOC
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates.(cost$30.00 for 4 years). A business certificate.ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission t oo op aer te.) Business Certificates are available at the Town Clerk's Office, 1' FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE: 0
' 1�90 Fill in please:
APPLICANT'S YOUR NAME: 1 re e- -
BUSINESS YOUR HOME ADDRESS:
`(z 37 oa onJ. -
�I�� "
TELEPHONE # Home Telephone Number l- g Z3Z
NAME OF NEW BUSINESS fie� vc�. ]tee TYPE OF BUSINES
S u
IS THIS A HOME OCCUPATION?. YES - I NJ O .
Have you been given app=eeimhe wilding div sior� (E6 _ .:NO
ADDRESS OF BUSINESS 'MAP/PARCEL NUMBER a
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the,information you may need. You,MUST GO TO 200 Main St.,- (corner of Yarmouth
Rd'. &Main Street) to make sure.you have the appropriate permits and licenses required to legally opera a your business to is town.
1. BUILDING COMMISSIONER'S OFFI
This individual has b informe o any permit require ents that pertain to this type of business.
�OLLOW HOME
... ATION MULES
` ' Auth rized Sign ure
COMMENTS:
2. BOARD OF HEALTH
This individual has formed of h rmi r u ire nts that pertain to this type of business.
Authorized Signatu a**
COMMENTS: .
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
0' This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
LOCATION SEWAGE PERMIT NO.
VILLAGE
I N S T A LL �'S NAM/EE i ADDRESS
B UILDE R OR OWNER
fir► �'�' l� 61-)?L T I.
17,
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
i
.. J
N
�� �3
2p
jb
��
3 �¢
�No................ .�.......` .. FEs......a.U..... d....
� THE COMMONWEALTH OF MASSACHUSETTS �
BOAR® OF HEALTH
Applira#ion for Uhip a al orkg Tnnitrnrtiun rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_..4T.......................................................... !4.x=- r✓. s-ro► irv�cit s r�A
,......... �. .......................•.............
Locatiorl,Address or Lot No.
................ ...t.P1:!t'!--._ 7 !U...................:............... 7ZsaZ'!>?l-� .,. ffl.::.......... ...................
Owner Address
a ................. '��W ...:......_........... 1'YI- 877DN.S-... !� ,..1�1/ �.........
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...:....... Expansion Attic ( Garbage Grinder (nt)
--------•••-••-•--•••---..
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ..................................... .
W Design Flow............. ......................gallons per person per day. Total daily flow.............�.a..?..0.....................gallons.
WSeptic Tank—Liquid"capacity..QW gallons Length................ Width................ Diameter________-__--__ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..._.__�.......... Diameter.._..6?:............ Depth below inlet....8............ Total leaching area...2..(..�n_sq. ft.
z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Resu is Performed by.t:LD bi-_.. ............. Date.....�-.'-1 Z-.-.6.3............
_-_...._.minutes per inch Depth of Test Pit_.....1.z._.__.. Depth to ground water..RdM�_......
,aa Test Pit No. 1... . � 1
Test Pit No. 2. . ._..minutes per inch Depth of Test Pit...___1.2......_.. Depth to ground water.__II�OIU�r.._.___.
----------------•----.........----••----•----------•----....---•----------...................------•.........................................................
O Description of Soil..----- ;- ---•---• .... ... 11 21-L-••--•-•-• •---•.........
.....r---•.........---•-
. •----••••-•--•--••---•---•-•----•••-------------
..... n,---Soh---- --. ��cs. .o�._. vi:� •-----------------------------------------------
W ........................... "[ 1M E. :.-.�'-N t n' - ----------------
..
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 iITi TLZ 5 of the State Sanitary Code— The undersigned further agrees_not to place the system in
operation until a Certificate of Compliance has been '15sjjieo k the board of
health.
Signed..... /�/ <�d � L.t�% = 3
Date
Application Approved By........... / --------------•-••-----••..... ..-•-------•-•
-----------
-•-----•-•..........................••......Date........Application Disapproved for the following reasons:................:. . ......... ....... t
-••-----•-•----------------------------------- ------------------•-----......------------...--------•----••-•--••---••--•---•••-••---•••---•----•--............•--•••----•••• _
Permit No.....O?.....-:..••�� y----•---------•--... Issued_-------•--
----•-- D
f
No........................ Fss..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............'....✓��'-..---.....oF............f.` r�... _
, plifiration for Uhiposal Yorks Tontrurtion "anti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
I P ' f 3 Cn IVl U6 41"(.L'IJCD t,r��rx�" , rA A�rt�rv� rvl I i.lS , r✓r A .
..... »».....................•-• ....................... .-'-....._......---'---'-"•-'.._.--•....--•••'•-••--•"'-""-'•'-'-'-'--""-''---..............
Location-Address or Lot No.
Fro r_ r� » a �?:JI}lt U L » I = - .....--•-•-•---.._......
.......... .........».._......_............ .."'..j .._•--"..........._........._......
Owner Address
III
a ........................... - . ----•-•••---•-•----'...-••................... ...•-•--..........................
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...........J................ .....Expansion Attic (f10 Garbage Grinder (nt)
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ----------------------------------••••• • > >
W Design Flow.............`?._�._.........._...._..__..gallons per person per day. Total daily flow..............._:U_....................gallons.
e4 Septic Tank—Liquid'capacity.f.(40gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No..................... Width...._............... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........... Diameter.._...n----------- Depth below inlet....::>............ Total leaching area....:. ......_sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.-i_ Du..I:',1;`__. I116(iU .............................. Date......L:"-M_2......63............
Test Pit No. 1.�..._`--...minutes per inch `� Depth of Test Pit......1.L........ Depth to ground water..! vtA ......
Test Pit No. 2..'_'��...Z-....minutes per inch Depth of Test Pit......1 7. Depth to ground water_-__"
--••• • •-•---•••. ...............................................•-•--...-•"'.........---"'.......................--•-.'--•-
ODescription of Soil.......v--•Z-' 4)t4_W1 J �11("_�_ <) 1 I•r--------------------------•--------------------•-------------------------------...........-----
UZ_._ ........ = 1= 'n � 1/...7_k_.�it,t=' 0�� CeAVj,]
W --------------------------------------2' 12.'...... w I ti•rat Sty V n
UNature 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^:yT s,
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue/dby the board of health.
Signed f�.-%i...!11-./y.-C-
Date
Application Approved BY ......................................... .. : ........:.....
fit j Date
Application Disapproved for th following reasons------------- ---•- . -----------------------------------••----------•-•-•------....---.»
--------•-•---•---.......--•---------•--...--•-------------------------•-----------------......--•----------••••-•---••• -••••--••-•-••---•-----•••••-•••---•-•-•---•...-----••-•-•••----•.......-•---
Date
...»
Permit No..... x�............................................. Issued.......................................................
Date
k �
E COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH f`
CJ GJ/ Gt r�v
Trrtffiratr of TontpItnnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (, ) or Repaired'( )
by.......... ..........:.. ..................--•••-•---•-.
sialler
at...................................................;r JY) ..
has been installed in accordance with the provisions of T=r j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No r °`
-----•••. dated
THE ISSrF
NC OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE
SYSTEM W CTION SATISFACTORY. t-
DATE..... ---------------•..-...__........ ----------------- Inspector... .._
.. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF-HEALTH
76- � )......OF...:'....
.. , ....................... ... .
No....�...............:.... FEE...:......
-
Permission is hereby granted.........................
C�w ...-f__.___....... _
-----•-•-----••••••-•••••-•---.......••-•••--•...................•..''-
to Construct•(�K) or Repair ( ) an Individual Sewage Disposal System f
at No. '- = �) 1!I I hG��/��h .✓rat .../ +! 77 e j-1�1 �5( %f //�/5 ..21� p .+�.................
Street . /ri5 C +'
as shown on the application for Disposal Works Construction Permit No. .............. Dated.....4 ". '. ..................
Board of Health
••DATE:-•..... .... .... ......... ._. ....
FORA 1255 HOBBS & WARREN. INC.. PUBLISHERS }
,r C-."_XIS'1-i1.1L WEl_t" '• /V1C_rrlt �.:.
�'FtiiFLI�-L.CN=A ��frl1� MAC/ 1 1 ILlY+�I,
AA
I 14
"c-+(_c WELL L.G::-A"i'ICIL-1'
i
o Qo
TOW{ i WATT= � °
Q, ...- _ d-.3
Q -a Abe. �. (� r--1`
aLQ CosP{�a D 3 e� I
'9 IS9.se8f4 q RENT =
RJO EL i 3.5
4N ►srs p v, V '-mot
I
$V�
3st I 7I \
�T�n@ G3 a 77
\ EL=loo.o
�'�Cf,Ttrl esn'Si u — ECC f:bF
- 1=n.tr-1nt.Nr
Mocl�_i"Li QI D f ao WIN— — PL IVA
LdT' 134
- E LA ki E
�.IIF 2—r , .TLAPP r
(--F-5 V jeu_ L y__,7 rxD"
IPAPP
p1)=1 D LOeAM O" A PO I L. 14. lq e/L \
Za�a� �F✓ Lo r ►42
APEA 43..5C--o may.F�, . (VACAIJT)
F- C7trJ'r t1C=.—_ I c), 1
CV 1�Pr 72L .G-E7rhltDf'rh`I'r _c:;-i -1" E
LEGEND : �� CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION 00 a�tHOFM
EXISTGC N T U R O — c - Cx=k_try ) L.r1 t.
FINISH D 0 0 >� y, LnT- ►3Co M
FINISHED SPOT ELEVATION M,4L kA ILLS
FINISHED CONTOUR-0 iR� —" ___ —
IN
366
APPROVED , BOARD OF HEALTH �o.
NA
DATE �N
DATE AGENT SCALE r I "= 50' DATE r
o� srr EH
LOREDGE ENGINEERING CO INO CLIENT ULJLI&AiTE�b I CERTIFY THAT THE PROPOSED
LENGINEE
STERE REGISTERED JOB NO.__S'-'__ BUILDING SHOWN ON THIS PLAN
VIL LAND CONFORMS TO THE ZONING LAWS
R RV DR.BY� OF BARNSTA E, MASS-* cxcCPT
A Z� WcTTEO
712 WA I N S T R E ET. •, CH. By'. os,02.$3 — —�
HYANNISt MASS. I 2 _—L.. . -
SHEET OF DATE ��Et3. LAND SURVEYOR
rJ IYOTF /F E/TNLe'R.,774WA -S PTIC TANK O,Q:
/EACH/NG 0/T ARE -IoRE THAN /2• w
JRAOE�A s?4'O/AM ETER CQNCRET CotiER
swALL &,F amoeiGyT T® -7,TAOF.64N EXTRA
•V�Pvc* PJPE
CO/VC4t&lr& tiE.4Vy CAS`7 IRON G0{/E.W SN,iL L C3E CISEO
M/N. P/TCJ,I. /F!N DRLVEA Y
r=L= I o3.5 COYEJ3S �'oFR FT
s
i 2JJ�GG MIN. CONC.eE•TE
A ,rr CiRAOE CO VE.4 C'L EAN S'A/Y O
sBAC.X,= -
.�t a.
LJ�U/O LEYEL. _ . y . . ,
-"'CASTP� -. GAG • ,• � ' . a® G1F. J/e'-3lg" .
MJN.P/TtJV. D/ST.', s / • a • •r' A •e WA 54HEO 5roN4c.
i :'
szpr/G Ti4NJ?C 1 • • r
• • a s • t e
::. `' = s 0� • � •O0 • f'• • O'er •
a
314
v
EPTif WAS.5tE0 STOrYjop
.
• • Ito
� •.t o e ' s s • • • p. � PRECA.S'T SEWAGE' '
108 5 x .2.5 471 .=/D...
lN!/GR? �lFYA7YO�YS _ _
�8' �i D e T
�•. f R • O
/JYYERT.AT BU/10/NG I o0.5 FT. P,TcAPr�rrl ; 54`i .U/b G�T:IMAM ;
r
IKLET S�PT/C Ti4NX ,jpa,3 FT
!C FT IMAM. C�SFE 7,JVL.,4TJOiV�
D0744ST SEPTIC TANJK%!" 100• I' FT i
INLET 40/57i4IADMY/0/V 80X I70/t/9i FT. OF GRO ATEK TAB1 E
x
' SE`G'
OcJTLETDt3TR/BtlT/ON BOX FT.
SEWAGE L7/.S'P®e5•A L �SY.ST•6I�t 4
/IV46T LZAC,W7NG P/7► dcT. 1 FT r
L EACHANa 0/7 '7AQldC:.4T10�1f
DESIGN CAITERIA scAttE
D/.at.�KS/ON"
= /M NUAfBER OF®EDRQ4MS. 3
CaARQr'1GEDlSPO:SAA. UV17- SOIL LOG:-
TOTA"l EST//yE,�iTEp FLON/ �� G,4L./oA*e. : SO/L .TEST A/ SO/L 71rST02 SAs'.Gf TEST
NUi!r9gFR aF LCAGHJNG PITS_1. I"ELEi! 101. t -ELPa! IOf.Co.. D.4TF OF SOIL TEST. at, t R 83
SJDF LeACHJKG PEft PJT —Sa PT. Latnn Logrn RESIFTS iV/TE ED/VSS BY
aoTTOM L-64c,41NG PER PIT 2$ SQ. PT. s�ago��— ReMCOLAWOM' RATIr,*/ L�—S� ,MJIV1>NCM
TOTAL 1eACHI/Y6 AREA I" SQ- FT. m� o AERCOt.�4T/CN RACE 2 JyJN f INGH .
RESER►�ELEACHtNc3rARE/� t4,ra SQ. FT. i8-(o' srttiD • MED 5AwD 2. o
LMC25 !nF
t3L E G[A ( c OAvEl—
�ZN OF M ,.
' cF G
ZN�F I61 r'... eo LnT t 3(_ - N10C 1%t t\t G�Pit Q (�At.1�
M E_D 14 T
M ) L
RG ;t o SftN.D StkuD
h o.368�0•�� 1 _ k�
EL DREDGE AENG/N ER/NG CA,/MG.
/ONAt 'EL 39. 1 f±L= 819.[a 7/2 Me4I/Y ST. , fi�YA�tIIIviS..M.gSJ,
Np SUR`j�� Ca' NO GRO[JNt7 L{�iQTCeR ENCOUNTERED
Z Ct/EAtT: ��� cry D�ITE= o3•a2•b3
0 U/VO I-V A TE.Q AT EL EN.
_ - JOB NO: 83co E SHEF_T 2:Z OF 2-'
ALWAYS DIG SAFE PRIOR TO CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. JOB NO. B-09-07 \
NOTES Stein.dwg
a HEALTH AGENT NOTE 1. LOCUS IS A.M. 29, PARCEL 017.
d- PROPOSED LEACHING IS 4.1' 29.64 2. ELEVATIONS SHOWN ARE ASSIGNED.
ao BELOW EXISTING GRADE. 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED AUGUST 19, 1985. do
`1' BOTH VENTING AND H-20 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) o.
0 COMPONENTS ARE PROVIDED. 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER.
m IF THIS IS NOT ACCEPTABLE 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. °
z WE PROPOSE ADDING 17 OF 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". wQk b
EXTRA STONE TO TOP AND 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW
a_ LEAVING VENTING. 29.39 D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. ��1F
9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. NOT TO �,�o
COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, 1 ON LEACHING SCALE �e
10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP
28.87 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND,
CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC.
12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING
IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1
30.00 1 . PUMP AN FILL ANY EXISTING E SP00 EA HPIT. REMOVE ANY C OIL BLOCK
L NO GRADE CHANGES 3 u D A C S L/L C vE N LOGGED SOIL, ,
RID AND STONE IN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH inches1 � 28,56 ( ) ELEV.(feet)
® ARE PROPOSED 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS.NG0 31.0
• 29,1 " 0 layer
0CK S� P NUMBER: 12783 529.65 9.6 TEST HOLE DATE: December 7 20095/8
29.71 3 BENCHMARK-TOP, BACK, CENTER PERFORMED BY- Ron Cadillac, Soil Evaluator B layer 10yr m
' 0" SEPTIC TANK=30.08 ASSIGNED 24" silty clay loam
8 S58125 00' 30.9 (2,01" OFF HOUSE CORN. do 11'5. OFF DECK CORN.) PE RC RATE:BY: David
(CSlayer) C1 layer 2.5Y 6/6
30.4 30.09 SOIL SURVEY(1993): Enfield silt loam
1.5 v0 l 33.24f GEOLOGIC MAP(1986): Mashpee pitted plain deposits 50„ silty clay loam
31. x D A 31.6 C2 layer 2.5Y 6/4
\ < 0:.-; Top Foundation 55" loam coase sand 26.4
F\ x o x 32.0 2 DRY WELLS °
3 .2 Invert 28.73 Invert 26.30 H-20 a�
0 2 Use Gas Baffle .�a
L5 � � Top Conc.=26.9 68
F\ 0 -- ---- -- Proposed Proposed C3 layer 2.5y 6/6
� x 31,9 H-20 Top Peastone=26.6
x 30.8 ,� " med. coarse sand
Existing i S=7/8 /ft S=1/4"/ft r,.✓6 Max. Provide
31.4 32.3 1 1000 Gal. i min.
2,2
i Screened
31.7 '0 :::•••-••••• Septic Tank i
:r. �----------J ---------- Vent "
...........•... 24 144 no water 19.0
x T
30.4
24.1
EXIST. HOUSE 31.3 Invert 26.47 Invert 26.10 of
N0. 249 F)oST. 6" Stone or compact Proposed Proposed 5.2' Bottom TEST HOLE 2
SCREEN '
i
SpORCH ��•-- 31' --� � N E--2--� Bottom TH1=18.9
I 31,2 N/F 9' DEPTH (inches) ELEV.(feet)
------- ==-- , x z DESIGN DATA 0 30.9
X III Exist. rn 0 layer
31,1 ••i w i ALTOONIAN BEDROOMS: 3 5
x 31.7 _� 31,8 Deck __ 31.4 I N o B layer 2.5Y 5/6
GARBAGE GRINDER: No " silty clay loam
X ('g REQUIRED CAPACITY: 330 GPD 35
x 30.5 : EXISTING SEPTIC TANK: 1000 GAL. LEACH AREA
1.4 � BENCH MARK--TOP S.W. CORNER C1 layer 2.5Y 6/6
C4 x 31.3 X BOTTOM LEACHING AREA: 325 SF USE 2 DRY WELLS WITH 4' OF STONE silty clay loam
N X x 30,9 rn A 3 .33 BULKHEAD=32.62 ASSIGNED 50"
30.8 [(25' X 13')] 6
ALL AROUND TO MAKE A 25 BY 13 C2 layer 2.5Y /4
SIDE LEACHING AREA: 152 SF 57" loamy coase sand 26.2
o bo x WIDE BY 2' DEEP LEACH AREA.
.P. L: X _ 30.8 [2(13+ 25)' X 2 DEEP))
O�
m �--X-e- 9-5X `36: BENCH MARK-TOP, BACK, CENTER DESIGN CAPACITY: 352 GPD C3 layer 2.5y 6/6
NSF __ - SEPTIC TANK=30.08 ASSIGNED [(325 SF + 152 SF) X .74 GPD/SF] med. coarse sand
PARAGHAMIAN __► i 1TjH 2 x 30, (24'11" OFF HOUSE CORN. & 11'5' OFF DECK CORN.)
1,11 03
M j �j6 \ LOT J LVRM OPEN TO BELOW
rn i i p INSPECTION SCHEDULE BDRM BDRM 144" no water 18.9
x �,8 20,350±S.F. CALL R.J. CADILLAC TO
TH x 31.1 m 310 1 INSPECT PRIOR TO BACKFILL
�► KITCH DNRM ENC. BDRM
BATH PORCH BATH
25' 300'+ PROP. LEACH TO WELL
x 31.2 1 ST FLOOR PLAN 2ND FLOOR PLAN
01.0 NOT TO SCALE NOT TO SCALE
30.9
x 31.0 SITE PLAN
c 125.00' FOR
R
N a1.49,20" E THIS PLAN IS A VALID COPY ONLY IF IT BEARS
N/F AN ORIGINAL RED STAMP AND SIGNATURE. FREDERICK J. & PAMELA H . STEIN
LEGEND FIN N
�j S INOF41,1 LOT 136, 249 MOCKINGBIRD LANE, MARSTONS MILLS, MA
TH 1 TEST HOLE LOCATION, NUMBER x 31.0 RO Dq ° 0
W WATER LINE MARKINGS DECEM BER 18, 2009 SCALE: 1 "=20'
E OVERHEAD ELECTRIC WIRES (IF SHOWN) CADILLAC -C IL LAC co
G GAS LINE MARKINGS # 1060 #35779
x 9.5 x$,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) ��G1sTZ'F' ti�Fss�°?e
SANITAW,' ° S�R E ° RONALD J. CADILLAC, PLS, RS, P.C.
/-S'� EXISTING CONTOUR
8---- PROPOSED CONTOUR
PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
0 UTILITY POLE (IF SHOWN) P.O. BOX 258
® EXISTING DRAINAGE CATCH BASIN
x - FENCE (IF SHOWN, NOT ALL SHOWN) WEST YARMOUTH, MA 02673
O TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE (508) 775-9700 PAGE 1 OF 1
REV. 1 12 10--P NUMBER, WITNESS, DATE & RESERVE C 2009 BY R.J. CADILLAC