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HomeMy WebLinkAbout0140 PERCIVAL DRIVE - Health 140 Percival Drive W. Barnstable P IIMM"Mmq A = 110 001028 Jul 019 2019 12:10 HP Fax page 1 //0 - Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4; f n l' 140 Percival Drive 4 v Property Address , Dawn McElaney Owner Owner's Name ' Information is West Barnstable MA 02668 6-28-19 required for every C'* 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. ```ttUN1 I t U U l UIU���i Important:out When A. Inspector Information 64 s39g3 ��� s fillip out forms � �.��••' •'•.9cs% on the computer, �= JAMES . G use only the tab James D.Sears 3 b `n key to move your Name of Inspector = OtAK6 —r cursor-do not s co use one return Capewide Enterprise ,.•o_ key. Company Name 4y 153 Commercial Street ��iqu15 INSP�``������ Q Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that; I am a DEP approved system inspector In full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true,accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-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 6-29-19 pector'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.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Jul 01 2019 12:10 HP Fax page 2 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owners Name information is required for every West Barnstable MA 02668 6-28-19 page. city/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3, or 5 and all of 4 and 6. 1) System Passes: ®: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below, Comments: The system is a 1500 Gal. Tank D Box and two pits. 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): tBinsp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurfaoe Sewage Disposal System Page 2 or 18 Jul 01 2019 12:10 HP Fax page 3 Commonwealth of Massachusetts kvip Title 5 official Inspection Form ,�' J` - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owners Name information is required for every West Barnstable MA 02668 6-28-19 page. City/Town 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.eoc•rev.712612010 Title 5 Official Inspection Form;subsurface sewage Disposal system•Page 3 of 18 Jul 01 2019 12:10 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form tQ� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 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.doo•rev.7/26/2018 Title 5 Officiel Inspection Forn:Subsurfaos Sewage Disposal System-Page 4 at 1S Jul 01 2019 12:10 HP Fax page 5 Commonwealth of Massachusetts (P Title 5 Official Inspection Form '. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. CitylTown 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 is less than 6"below invert or available volume is less than%day flow Pi S ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s), Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. 1 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:Subsurrace Sewage Disposal System•Page 5 of 18 Jul 01 2019 12:10 HP Fax page 6 'y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s � 140 Percival Drive Propery Address Dawn McElaney Owner Owners Name information is required for every West Barnstable MA 02668 6-28-19 page. City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered 'yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5nsp.doc•rev.716=18 Title 5 Official inspection Form;Subsurface Sewage Disposal System•Page 6 of 18 Jul 01 2019 12:11 HP Fax page 7 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. City/Town State Zip Code Date of Inspection D. System Information 1, Residential now,Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal.Tank D Box and two pit's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water 9 ( Y 9 (gP })� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2018 Title 5 Cfficial Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Jul 01 2019 12:11 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments U 140 Percival Drive `J Property Address Dawn McElaney Owner Owner's Name information is West Barnstable MA 02668 6-28-19 required for every page. Cityrrown 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 occupancyluse: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.712612018 Title 5 Olrwiel Inspection Form:Subsurface Sewage nlsposal System•Page 8 of 18 I Jul 01 2019 12:12 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. City/Town 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/Aftemative 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 IlA 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: 1987 Permit # 87-440. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 30" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): i Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. 15insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of I8 Jul 01 2019 12:12 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney - -- Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 21❑ Depth below grade: 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 1500 Gal, Precast H-10 Dimensions: 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 21" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 17" AsbuHow were dimensions determined? Sludge -Tape Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. In and outlet tee's, Tank and cover's at 21" below grade. No sign of leakage or over loading t5insp_doc rev,71261208 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 10 of 1 a Jul 01 2019 12:12 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments v � 140 Percival Drive Property Address Dawn McElaney Corner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. City/Town 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.726/20le Title 5 Official Inspectlon form:Subsurface Sewage Disposal System•Page 11 of 16 Jul 01 2019 12:13 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive `J Property Address Dawn,McElaney Owner Owner's Name information is required for every Test Barnstable MA 02668 6-28-19 page. Citylrown 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.): r *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.): D Box Is 30"xl6"-32"below grade wltwo lines.,Box is clean and solid. No sign of over loading or solid carry over. t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 19 Jul 01 2019 12:13 HP Fax page 13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney owner Owners Name Information is . West.Barnstable MA 02668 6-28-19, required for every page. City/Town 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: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5in5p•doc•rev.712MG18 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 13 of 18 I Jul 01 2019 12:13 HP Fax page 14 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 140 Percival Drive V Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page. City(Town slate Zip Code Date of Inspection D. System Information (cunt.) 11. Soil Absorption System (SAS)(cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is two 1000 Gal. Pits will'stone. One pit at 28" below grade w/cover at 10". One pit at 46" below grade w/cover at 12 Both pit's have 20"water. No high stain line. No sign of over loading or solid carry over. 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.): 151nsp,doc-rev.7/2612DI8 Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 14 or 18 Jul 01 2019 12:13 HP Fax page 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 140 Percival Drive Property Address Dawn.McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction; Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, 15insp.doc•rev.712612018 Tllle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Jul 01 2019 12:13 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owners Name information equire t for is West Barnstable MA 02668 6-28-19 required fw every page. Cityrrown State Zlp 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 Dfc1c P°t`Y /� 14 M 38=8 A�f_ 5%6wl D Q A S= 63� 9y Wnsp.doc•rev.712612018 Title 5 official inspection Foam:Subsurface Sewage Oieposal System-Page 16 or 18 Jul 01 2019 12:13 HP Fax page 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every West Barnstable MA 02668 6-28-19 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: 16'+ 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: 10-8-86 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: T.H.on Design plan 10-8-86. No G.W. at 16'+. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc-rev.71262016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Jul 01 2019 12:14 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 140 Percival Drive Properly Address Dawn McElaney Owner Owner's Name information is required West Barnstable MA 02668 6-28-19 ge. for every CitylTown State Zip Code Date or 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 Z D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 18 or attached For 15: Explanation of estimated depth to high groundwater included GRAD f 7N (01 P1r b, t5insp.doc•rev.712612018 Titis 5 Offloial Inspeclan Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Bamstable MA 02668 5-15-13 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. General Information ���►umnrpy�i on the computer, htgsso,,�� use only the tab 1. Inspector: M - �C .``� '•?O�'�. key to move your o?�••• •'•yG cursor-do not James D. Sears �� =j; JAM ES •,m=_ use the return Name of Inspector key. *: :v�iii CapewideEnterprises,LLC Company Name 153 Commercial Street INS Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 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 5-18-13 spectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3M 3 Title 5 OHi Inspection Form Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ID Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Barnstable MA 02668 5-15-13 page. citffrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name kv information is required for every W.Bamstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every yV Bamstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, If any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has 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. 3. Other: 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 awqM is less than 6°below invert or available volume is less than %day flow 41r7 l t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner owner's Name information is required for every W Barnstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-3M 3 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner owner's Flame information is required for every W Bamstable MA 02668 5-15-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Bamstable MA 02668 5-15-13 page. Citylrown State Zip Code Date of Inspedion D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Presant 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: t5ins-3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 0 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W gamstable MA 02668 5-15-13 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Barnstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1987 Permit#87-440 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 21"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: 1500 Gal.Precast Sludge depth: 1" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner owner's Name information is required for every W Bamstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2911,, Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level,in and outlet tee's. Tank and cover's at 21" below grade. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Tide 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W gamstable MA 02668 5-15-13 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Uo 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Bamstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.)Y ( 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.): D Box is 30"x16"-32"Below grade w/two lines. Box is clean and solid. No sign of over loading or solid carry over. 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. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner owners Name information is required for eve W Barnstable MA 02668 5-15-13 page. every Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): Leaching is two 1000 Gal. Pits w/1'stone. One pit at 28"below grade w/cover at 10". One pit at 46"below grade w/cover at 12". Both pits have 2'-3'water. No high stain line. No sign of over loading or solid carry over. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Tft 5 Official Inspedon Form:Subsurface Sewage Disposal system•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W.Bamstable MA 02668 5-15-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Tide 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owners Name information is required for every W Barnstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately oe 4/ 3 ,a-3 z: ® O 13 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 140 Percival Drive Property Address Dawn McElaney Owner owner's Name information is W Bamstable MA 02668 5-15-13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells o Estimated depth to high ground water: 16+' 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 6 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: T.H.on Design plan 10-8-86. No G.W.at 16'+ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 • • '� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Percival Drive Property Address Dawn McElaney Owner Owner's Name information is required for every W Bamstable MA 02668 5-15-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file II t5ins•3M3 Title 5 Official tnspedon Form Subsurface Sewage Disposal System•Page 17 of 17 E I f TOWN OF BARNSTABLE LCYJ ATION �I O PP Ct �� SEWAGE # VILLAGE U) ` RA a�n (a bU- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. UL� SEPTIC TANK CAPACITY 1 )00 9 " INS LEACHING FACILITY: (type) t (size) NO. OF BEDROOMS Ll BUILDER OR OWNER �bmCA PERMTTDATE: 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 J 'fi ra 1/t. ( q kZ in L - 4L I G qn Ike do o<<k I t a AAIIA R 6?5 Acsiy Va 3 g COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION d o ti` TITLE 5 OFFICIAL INSPECTIONTORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIV:7�+ Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 ` �O Chi b Owner's Name: TOM MADDEN ' MAY 1 'U 2.002 Owner's Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 0266E TOWN OF BAItN'j i i--E: Date of Inspection: 4/22/02 HEALTH DEPT. 'IT 44r Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: " VkO. BOX 2119 TEATICKET, MA. 02536 Telephone Number: 508-564-6813:FAX 508-564-7270 CERTIFICATION STATEMENT 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 systerns. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally P ses _ Needs Furth° valuation by the Local Approving Authority Fails Inspector's Signature: Date: 4/22/02 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec on. If the system is a shared system or has a desig❑ flow of 10,000 gpd or greater,the inspector and the system owner,shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies•sent,to the'buyer, if applicable, and the approving authority. Notes and Comments SYSTEM PASSES TITLE'V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes Conditions nl the Ifllle of holl(`difill illllf 11111ki tilt'(.11111III111114 III tl.o III IIIIII lillih. I hk inspection does not address how the systcul will perform ill the fulare under Ihr same ol. voliflilinlw Ill'oNr. •f . Till,• •� In•:n.• li .n I�.u'ni i.'I ,/'llllll - 1_ Page 2 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t, PART A CERTIFICATION (continued) Property Address: 140 PERCIVAL'DR WEST BARNSTABLE,MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.' B. System Conditionally Passes: _ One or more system"components'a'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 state mer' s. If"not determined"please explain. n/a The septic tank is metal and over 261years old* or the septic tank(whether meta{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: n/a n/a Observation of sewage backup or break buf or high static water level in the disiribution 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 obsiru`ction.is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more.than'4,times a year due to broken or obstr icted 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN G Date of Inspection: 4/22/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further,Avaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the envirgnment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50�feet of a bordering vegetated wetland or a salt marsh ..1 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning i'n 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. v _ 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 det,mine distance n/a "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: n/a h .y . t 9 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A II CERTIFICATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow _ X Required pumping more,than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped P[1MPFD 6 MONTHS AGO BORTOLOTT1 BY OWNER. X Any portion of the SAS,cesspool or privy is below high ground water el--vation. X Any portion of cesspool or privy:is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.I (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the.system;must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X 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 urge system considered a significant threat under Section E or failed under Section 1)Shall uppyade lilt!syslcni in accurdLuur will) I I II 1'Mlt 1, 0.1 I Ilr ll1'l,lrul 11wili'I should contact the appropriate regional office of the Deparllnenl. Page 5 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 140 PERCIVAL"DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system comppnerats pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period '? X Have large volumes of water been introduced to the system recently or as hart of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum 9 X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`?, The size and location of the Soil Absorption System(SAS)on the site has bcen determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] . , Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 140 PERCIVAL DR WEST BARNSTABLE,MA 02668 Owner: TOM MADDEN ' ` Date of Inspection: 4/22/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of cut-rent residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system.(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last2 yeas usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL . Type of establishment:n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the,Tifie 5.system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: PUMPED 6 MONTHS AGO BORTOLOTTI BY OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box',soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes".attach previous inspection records, if any) _Innovative/Alternative technology.,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _"fight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components;date installed(if known)and source of information: 15 YEARS BY OWNER Were sewage odors detccicd when,uriviul{`;tl 11w Illy(ywi to no) NI Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN Date of inspection: 4/22/02 ti. BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron,X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): WELL WATER SEPTIC TANK: X(locate on site plan; Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6"'W 5' 8"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): " SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. j; GREASE TRAP: _(locate on site.plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a ti ,6v Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE,MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locatf,on site plan) Depth below grade: n/a Material of construction:_concrete_metal_f berglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if presbnt must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenar.e: etc.): n/a � R Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovativelalternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. LIQUID LEVEL IN PITS WAS I' OF TIME OF INSPECTION. BOTTOM OF PITS IS AT 101. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a .ry Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a wpage 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 PERCIVAL DR WEST BARNSTABLE, MA 02668 Owner: TOM MADDEN Date of Inspection: 4/22/02 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. k. U ,i II 4A s c a Ab e3 Li 6) 4° S p in Page I I of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 PERCIVAL'DR WEST BARNSTABLE, MA 02668 p Y Owner: TOM MADDEN Date of Inspection: 4/22/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked, date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavafors,'i'listallers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+ FT. p. l LtLo n ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 • 449 Me. 130 Sandwch, MA 02563 508(888-6460) 1-800-339-6460 FAX(508)888-6446 CLIENT. Paula Markiewicz LOCATION: 140 Percival Dr ADDRESS: Century 21 - Cape Sails W Barnstable MA 02668 133 Route 6A (Thomas Madden ) Sandwich MA 02563 COLLECTED BY. Meehan Well Drilling SAMPLE DATE. 4/22/2002 SAMPLE TIME. N/A WATER SAMPLE TYPE: Existing Well DATE RECEIVED: 4/22/2002 LAB I.D. #: 0204402 RESULTS OFANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 4/20/2002 pH pH units 6.5-8.5 6.62 4500 H+ 4/22/2002 Conductance umhos/cm 500 97 120.1 4/22/2002 Nitrate-N mg/L 10.0 0.41 300.0 4/22/2002 Sodium mg/L 28.0 9.1 200.7 4/22/2002 Iron mg/L 0.3 < 0.1 200.7 4/22/2002 Manganese mg/L 0.05 < 0.008 200.7 4/22/2002 W COMMENTS: WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date*s 2 >=greater than onald J. Saari TNTC=too numerous to count Laboratory Dir r lt/® -71 TOWN OF BARNSTABI.E T!'!OCATI()N L ®� Sf Wig- 7�S_..__.._SEWAGE # VI?LAGEk GVh S"f��l�C ASSUTASOR'S MAP & LO`I'_ IN'STA LLER"S NAME & PHONE No. ��'�(V� 1 �' � 3 93 06 SEPTIC TANK CAPACITY^)S60__ LEACHING FAC ILITY:(tgpea.� ^ � � � Pt TS (size)__ _ NO. OF BEDROOMS�i-PRIVATE W f.!:LL OR PUBLIC WATER rrtVc, G DATE PERMIT ISSI)EI): i ` . F g �• -- DAZ�E I�C.0 Issu._I . H� -- C;OLiI LIA ___ — �.�� VARIANCE GRANTED.- Yes _ ___I`1�*�y _T •t >. .. c. h P���� � � �{ i�°� �� o � ��'"� d •� f e s '° ®TFTE POMMONWEALT) H OF MASSACHUSETTS BOAR® OF HEALTH ...._.. --.ZCTnN. . ..............OF........... !'ABLE ......................................... Allp irativaa for Bhgp ual Works Tonstrurtiutt ramit 1A cation is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal em at Lot #51 Percival Drive, Barnstable 51 ................_........-...................................................................... --.._.....---------...........---•----._...--•-----------------------................---•-------•. Drake Hm es��rico:-Address i r i N�o. ...... - __._--------------- J... ............................................... .......----------------------.......----------............------------•-------------•-•-...------ O er SAS dr s e Installer Address 3514� Q Type of Building Size Lot________,______..............Sq. feet Dwelling—No. of Bedrooms...................4 ......................... Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------•---•--------------------------•------------------------ -------------------------------------•••---•-•-•---••-------- d W Design Flow......... ...............................gallons per person per day. Total daily flow__._......_..........................gallons. R: Septic Tank—Liquid capacity_.1 ...gallons Length Width..... Diameter----_ ___.__ Depth._.5!7"_.... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-___-_-1.......... Diameter.........61......... Depth below inlet_..____8�......._. Total leaching area...tir1........sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Percolation Test Results Performed by......... ...... Date....... .8r1 ___.. Test Pit No. 1.....1 ts/.2....minutes per inch Depth of Test Pit........14�._..___ Depth to ground water------------------------ w Test Pit No. 2.......< .......minutes per inch Depth of Test Pit-------- ...... Depth to ground water._______—___.__..___. .Aa D Description of Soil......0 .. 30" T::p & s-tsoil,30" 144" Fine silty sand & gravel,1441 168" Mediun-sand ............ ..... v " &s i1,..30" - 731 . _9i1t ._&_ �t l._]. 2!'__-192" 1�.�mard W E;-N 1,NG ENGINEER Iyt Y OUI x ;T.ALLATiON ANC CEfi 1 Ylo v U Nature of Repairs or Alterations—Answer when applicable______________._-_____-_.-____ ___ ir= SY6YYENIs.-�'-�•�u�+'-•T--A---'- r- ..................................................................................................................................................... :..r_.t Agreement: ;i.;- Y it Y a The undersigned agrees to install the aforedescribed I Sewage Disposal System in accordance with the provisions ofi'iLa:p `}of the State SanitCro he undersi ned further agrees not to place the system in operation until a Certificate of Compliance has e by the rd of health. Signed-- ------ - -- --•-- . -•--....-----•---------•---••-------•---- ApplicationApproved By--------------------------------•---------------•---..__.......... --------------------------- ate Application Disapproved for the following reasons_____________________________________________•___.__________._____.___.___._______:_.__..___....__.________-_____ ....-•-•-•-----------------•-•-----•--------•----------------...---...--•-------------•--•-•.........---- Date Permit No......9-7_-_...`l�Y©-----------------•--. Issued___ ........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;;CNING ENGINEER MU'T ......... ....................OF...........:......Ali............................T.�hLATiON AND CERT' ' : : SVSTEM WAS INSTA'_L�- Cluntifirtttr of f�umpli atta ,^IDANCE TO PIAN- THIS IS TO ERTIFY,.'Khat the Individual Sewage Disposal System constructed ( -or Repaired ( } by................ • . ----- ........ e-P --------------------___------------•----- ^�Installer ••----•-•---•---...-•-•-•..............•---.......-----••-•--------- at. .`� _a-----/----------------- -- ------------------------------------------------------ has been installed in accordance with the provisions of Ti T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......____.7a_.e/,y.0........ dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................••-•--•---..__...-------------------•-•--..._--•----__---- Inspector..................................................................................... t To... 2:...ova FER.2 ."....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF................................ .... ........ Appliraatioaa for Disposal Works Toaa,'trurtiun ramit Application is hereby made for a Permit to Construct (g ) or Repair ( ) an Individual Sewage Disposal System at: ................_.. ...... ............................................... ......_--••-•---•-•----...-------=-•-----•--�---r•�-•----------•----------------........_•---._...._. , ation-Address W F.0 i ,-� o ...................................... Y4i a es .......-- -----_---- ........................•-----•--- ----....-•-•---.......... Installer Address Type of Building Size Lot..36i140-------------Sq. feet t: U Dwelling—No. of Bedrooms................ ................:.........Expansion Attic ( ) Garbage Grinder ( ) a a p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P 1 Other fixtures ............................................. d - ---- . ---•------------••---••--------------- W Design Flow..... ...............................gallons per person per day. Total daily flow ..:_ !...........................gallons RG w :'Septic Tank—Liquid capacity gallons Length.._._{ .____ Width___-.�.��..._ Diameter___'T'r"___._. Depth.. lZ"...__ W Disposal Trench—No. .................... Width.................... Total Length.......__........_.. Total:leaching area_._.....______.____.sq. ft x 1 6� 8� � 4 : Seepage Pit No________ ___________ Diameter_._.._..._.......... Depth below inlet..........._......_ Total`leaching area ....-....sq. ft. z Other Distribution box (X Dosing tank ( ) '-' Percolation Test Results Performed by.. ...�� / +_,_.Date...... ai __-_ Test Pit No. 1____i minutes per inch Depth of Test Pit ____..............._ Depth t&ground water Test Pit No.-2.... ........minutes per inch Depth:of Test Pit....... ....... Depth.to..ground water __"""......__.___ atir •••--•----•• ................................................. 0 Description of Soil__.._A"..............................................................� �.. � � � M ------------- .. W U ,,Nature of Repairs or Alterations—Answer when applicable................................ '......._._...._.........__......___________.... ......................................................................................................................................... ......................................................... - Agreement: The undersigned agrees to install the. aforedescribed Sewage Disposal System in accordance with the provisions of T i:s.E, 5 of the State Sanitar o he unders' ned further agrees not to place the system in t ';'operation until a Certificate of Compliance haseen u�by th rd of health L Signed =l o I, Application Approved B Dat Application Disapproved for the following reasons:.............................................................................................................. `- --_--.-•--•----•-------------•--------------•-----_---------•-------------_--_-_--________-_----____--------•-••-------••-----------------•----------------------------------------------------•-----•- Date Permit No.....0g - o -- Y�1...7__.._. Issued------••-r Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .....................OF................. i.........................: C.rrtifiraatr of Toutplinurr THIS IS TO.CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( } bY................I ..rti-�^�...........�-- •--- - _ ._ .......................... Installer at -- • t . r _...-- .............77 + _ � has been installed in accordance with the provisions of TIT'E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...................'�_...V._4K0..._....... . dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................................•---•--•---•-•-•---•-_-•-_.. Inspector.................................................................................... ~IGN'IJG ENGINEER MUST SU". '\r: THE COMMONWEALTH OF MASSACHUSETTS ALLATION1 AND CERTIFY 1I1 SYSTEM WAS INSTALLED BOARD OF HEALTH PLAN. ....................OF.............................................................................. No. ..�...1�7G FEE........ ... .. Disposal or'ko Tokinstration firrmit Permission is hereby granted. ............................................................... to Construct (� or Repair ( ) an Individua Sewage Di s osa System ,.--7 atiV o.----------.�_ Z.._...5 ----• .._... ----- .._.•---- ---•...............` ...............1 •---•_-.-• ._...___--•-- Street .__ as shown on the application for Disposal Works Construction Permit Nok.2:yl�._' Dated.- ........ ................ Board of Health DATE �L? j. ------------------..........------------------- f. FORM 1255`-ADBBS & WARREN.•. INC., PUBLISHERS r_„ Department of Environmental-Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Addres City/Town G.S.Quadrangle Map Grid Location A-Anti Al RA Owner Address IF /WELL USE CONSOLIDATED WELL Domestic reLyJ( Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled 2) From To Date Drilled 0 j 3) From - To 4) From To CASING Depth to Bedrock Length_Diameter_ Typepydrs UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface_ Sand: fioe❑ medium❑ coarse Date measured Gravel: fine❑ medium❑ coarse e GRAVEL PACK WELL I(m/0/ Screen: Yes ❑ No Slot,;�240 ength from4o--to - Split Screen (or 2nd screen) WATER QUALITY TESTS MACS Slot length from to Chemical ru}�( Biological r�•l/ Depth To Bedrock PUMP TEST i Drawdown _feet after pumping days hours at _GPM. How measured Recovery feet after_hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To , n 01.0 ° DRI ERlb ' Fir ° Address ` o City Regist ation No. Aerator 5 ignature Please pant I firmly CUSTOMER COPY 2SM-10-85-807101 Department of Eryironmental,Management/Division of Water Resources WATER WELL COMPLETION REPORT tWELL L�OyCATION{ Addressl,"/t-' 5,i 1 c City/Town W .R1 Y?117P°� sU f7/�SAS p,/t G.S.Quadrangle Map Grid Location Owner rA_1slAI: t r Address x /WELL USE CONSOLIDATED WELL Domestic® Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To 21 From To Date Drilled 4✓fd! 3) From To 4) From To CASING Depth to Bedrock Length Diameter Type PkG UNCONSOLIDATED WELL STATIC WATER LEVEL • Water-bearing Materials Feet below land surface 'f Sand: fine❑ medium❑ coarse❑ Date measured 16JA , Gravel: fine❑ medium❑ coarse / Screen: GRAVEL PACK WELL1. of Slot#-`�/} length from If ft to� Yes ❑ + No Split Screen (or 2nd"screen) . WATER QUALITY TESTS MADE Slot 4f length from to Chemical ®' Biological ® Depth To Bedrock PUMP TEST Drawdown S feent after pumping—days hours at GPM. How measured 0, Recovery 40ffeet after_hours. s LOG of FORMATIONS COMMENTS: (On well or water) Materials From To o a o Arcat/ m - DRIL ER m n d o Fir �,�^ C Addressjyy IU A ©' Q6 City�'ihV�kn�v � RegistAration No. Operator's ignature Please pant firmly BOARD OF HEALTH COPY 25M•10 s5-so7tot r r n OFFICE LABORATORY HIGH STREET 176'PLYMOUTH STREET BRIDG&ATER, MA 02324 BRIDGEWATER, MA 02324 OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL 8 BACTERIOLOGICAL ANALYSES 697-2650 June 30, 1987 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water - Drilled Well - (6-inch PVC Well) - 90 feet deep - producing 20 gals/min. (static water level 47 feet) . Located on the property of Mr. Kevin Drake - Lot 51 - Weeks Crossing - West Barnstable, Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @35C 1 Color (APC units) 10.0 Sediment slight Turbidity (NTU) 1.10 Odor none Taste satisfactory pH 7.10 Specific Conductance micromhos/cm 70.0 mg /liter Total Alkalinity (CaCO3) 16.0 Free COz 2.50 Total Hardness (CACO,) 20.0 Calcium (Cal 5.60 Magnesium (Mg) 1.46 Sodium (Na) 7.80 Potassium (K) 0.56 Total Iron (Fe) 0.40 Manganese (Mn) L 0.01 Silica (SiO,) 13.4 Sulfate (S00 6.50 Chloride (Cl) 14.0 Nitrogen - Ammonia 0.01 Nitrogen - Nitrite 0.005 Nitrogen - Nitrate 0.39 Copper (Cu) L = less than On site collection made by Mr. L. Wile - 6/27/87 at 9:00 A.M. Sample delivered to laboratory by Mr. L. Wile - 6/27/87 at 11:30 A.M. Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water is high in iron content. All other chemicals tested meet the standards. 4LL ---Tirector 7# , The Standard-Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin (intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water - color should not exceed 15 units. Turbidity — NT Units - Recommended limit not to exceed 5 units. Odor£t Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/I. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. _12tat Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/l. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/l. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/l. OFFICE LABORATORY 1498 HIGH STREET 176 PLYMOUTH STREET � BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324 mill: OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER -WASTEWATER CHEMICAL Et BACTERIOLOGICAL ANALYSES 697-2650 June 30, 1987 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water — Drilled Well — (6—inch PVC Well) — 90 feet deep — producing 20 gals/min. (static water level 47 feet) . Located on the property of Mr. Kevin Drake — Lot 51 — Weeks Crossing — West Barnstable Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @35C 1 Color (APC units) 10.0 Sediment slight Turbidity (NTU) 1.10 Odor none Taste satisfactory pH 7.10 Specific Conductance micromhos/cm 70.0 mg /liter Total Alkalinity (CaCO,) 16.0 Free CO, 2.50 Total Hardness (CACO,) 20.0 Calcium (Cal 5.60 Magnesium (Mg) 1.46 Sodium (Na) 7.80 Potassium (K) 0.56 Total Iron (Fe) 0.40 Manganese (Mn) L 0.01 Silica (SiO,) 13.4 Sulfate (SO,) 6.50 Chloride (CI) 14.0 Nitrogen - Ammonia 0.01 Nitrogen - Nitrite 0.005 Nitrogen - Nitrate 0.39 Copper (Cu) _ L = less than . On site collection made by Mr. L. Wile - 6/27/87 at 9:00 A.M. Sample delivered to laboratory by MR. L. Wile - 6/27/87 at 11:30 A.M. Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water is high iron content. All other chemicals tested meet the standards. A4-Tlr2ect-or ♦ t The Standard-Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, .leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin(intestinal tract)and may be considered as closely associated with disease causing organisms. On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water - color should not exceed 15 units. Turbidity — NT Units- Recommended limit not to exceed 5 units. Odor& Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/l. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/l. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. Total Iron Standard not to exceed 0.3 mg/l. Manganese — Standard not to exceed 0.05 mg/l.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/I. t ' DOYLE ENGINEERING ASSOCIATES, INC. LAND SURVEYORS - CIVIL ENGINEERS P.O. BOX 595 • 530 THOMAS LANDERS RD • WEST FALMOUTH, MA. 02574 JOHN P.DOYLE,R.L.S.- TELEPHONE540-4411 JOHN P.DOYLE III,R.L.S. STEPHEN J.DOYLE July 5,1988 Town Of Barnstble Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Lot #51 Percival Drive,W. Barnstable Dear Mr. Kelly, This is to inform you that our office and field crew have monitored and inspected the installation of the septic system on Lot #51 Percival Drive in Weeks Crossing Subdivision. We find it to be proper and meeting the setbacks. Very truly yours, ,H OF R tDPM10S00v on,P.E. RMD/cdl A No. 24500 a ��F. G�STER tc. FSS�ONAL ENG\ S 0 1 L LOG N 0. 1 N O'� 2 77.4 0 78.7 I T E PLAN 7-6,- -' I Top U6 5 OIL 5 0 z- 2 /yo TE- : _T/V)PE/Z K10 US H,4 7 97R //9 L 3 TO RE IFE/-f 0 YED FOR YO' A RO UN-L) 4 0 " I I , S/ L7-Y 5 5 IZ- 7 001 TOP OF FOUNDATION EL .79 A 5yQ A( D 6 L 7 1?,q YE L- "T"w MIT 8 O. ............ 9 I . 1 10 IN EL 7-5.2 cc VER r �j E L 75-..0 t- 2 COVER 1/8 3/8 WASHED STONE 12 IN EL 7-5.8D' 1ktE,01uH N EL 7,5�57 L '5119 A(D 111-f ED U I N E L 7*�-7 I 1 jq D/ B W/ 6" SUMP 1 1/2 WASHED STONE )VDLIQU10 LEV 3/4 4 EL I NO /01 WAT�59 ENCOU# .4 /0 01 SIL-ry pIpL- • IYO Wq 7-E R ARE r Y qAtOU7 8 ' EFI-, ["PTH .- c4EANou7- / 4 L- C L F:4 -:' /VCC)UM7 PERC TEST RESULTS: -2.7 PRECAST SEPTIC TANK WITH PERC RATE : < 2 MWI /ff C11 - PRECAST LEACHING PITS 7 9 8 W1 Tg OF- 5 7-Off E- WITNESSED BY : -- Hc,CAST IN PLACE INLET AND E L. 6 6-7 N 0.: 2- SIZE : OUTLET T 'S PER TITLE V q L Z- AR 0 U)YD. 3 A R/V 5 7 ,0 3 LE 8 OA R 0 OF HEALTH,r SIZE 15-00 G-1qZ-L0A1-5 EDI UN0 1 A . 5,q IYD. 170 DATE : 0c 7-0 Clcl(� ' LoAr& x 6- 7 DE-7E�A7)- A/o W,4TER E1v'C0U,,YTERED. 72- PROPOSED 74- ELL PROFILE OF PROPOSED SEWAGE, SYSTEM SYSTEM DESIGNED BY THE TOWN OF -- 4,9RA(5TI43LE REGULATIONS AND 6 STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE SCALE 1/4"= 1 ' 0 " 78 N . B . 1 . ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE u 2. ALL PIPES SHALL BE SLOPED 1/4 " PER FOOT EXCEPT FOR U) 77- 3�� THE FIRST 2 FEET OUT OF THE D /8 WHICH SHALL BE LEVEL 3 . DESIGN FLOW 4 BEDROOMS AT 110 GALDAY PER BR . GAL/DAY \�� \ ' lExp SEPTIC TANK SIZE 44-0- X 2- 880 GAL . 1 0, p USE /-5100 GAL. W/ 17-1-1 GARBAGE DISPOSAL > L\ LEACHING SYSTEM : USE (Z) Y, 8 ' 1'9,L-7C1,957- LE,4C141N'6: 1`17-S ,57-OffE qLL 49OWY0 TANK A ry L,p 82 EFFECTIVE AREA : SIDE 2- 7r R A/ 2 7;--(4 8 2- 5- 5-(n 3 0,4 y BOTTOM -77-R 7r(4-) x S-6 GL14L-1 I)lq y 61 TOTAL FLOW 5-s3) x z //04 c-14LIP14 Y TOTAL REQ 'D FLOW 44-6 X c -W/ 17 /-/ GARBAGE DISPOSAL 41 1 RESERVE FLOW 4 4 4- 6 A L D A Y //v R VE 15q 2Z-4-' ij REFERENCE PLANS .........------------- 5 0 09"36 92 so -72 _74- 78 76 APPROVED BY : pRop 051 31'?f NS 7 1,9,5 L-E BOARD OF HEALTH PZ- /9 /V S C 19 L 2E7 DATE PROPERTY OWNER D Rq X E- HOMES k SITE AND SEWAGE PLAN 4 13 MO R 7-lY /"11-9 5 7- FOR : DR A K E R 0 M ES c 0 HAss ET /-liq o202,5 BEDROOM SINGLE FAMILY DWELLING LOT : L 0 T 5/ PE R C 1/'/'?Z- D R J VE DATE . u IVE / 9P987 DOYLE ASSOVATES FALMOUT", MASS .