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HomeMy WebLinkAbout0086 COBBLE STONE ROAD - Health 86 Cobblestone Rd. Barnstable A= 316 062 o , TOWN OF BARNSTABLE LL CATION �� CU L �U%V� ��� SEWAGE# 2G IF - 23 'VILLAGE 94'�ST"Li ASSESSOR'S MAP&PARCEL 316162 S?�3 2 INSTALLER'S NAME&PHONE NO. ;SpE'(I/V ( C L'�`Ii/� LLC S�. ;ZS SEPTIC TANK CAPACITY I Soo C LEACHING FACILITY: (type) DP-7ti k—LLJ (size) NO. OF BEDROOMS Z(-- OWNER SUI-C-1 V41V PERMIT DATE: 730I�'t3 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 wet ist within 300 feet o eac mg a 'ty) Feet FURNISHED BY o "L No. 7AL°/ Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (© Co Jt���5 j'a4�d_ Owner's Name,Address,and Tel.Noi Assessor's Map/Parcel Installer's Name Addres ,and Te..No. Designer's Name,Address,and Tel.No. I1 C71A 411,9} 'i1V L Dig,-, �y t/ l�.11v..i.v i('y < � '�S D��zr✓ f'l�-c.�.ll��<-�y Type of Building: Dwelling No.of Bedrooms �� Lot Size G/ �%'51 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req ' ed) L/� gpd Design flow provided `�`���J gpd Plan Date `Z y Number of sheets Revision Date Title S. )Le p ©r Pee,' o 5 wJ Size of Septic Tank r-0J �.5,%_ Type of S.A.S. �j'� '500 60 OL - � r cc,ecr- Description of Soil �!�'�}'� C�� C✓ sv/J Nature of Repairs or Alterations(Answer when applicable) Q 36 XL Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 oDheronnmnental Code and-not to place the system in operation until a Certificate of Compliance has been issued by this BoardS' ed � Date J'J / Application Approved by Date i Application Disapproved by , Date for the following reasons Permit No. ���p ZS6y Date Issued ' V/ No"' r $ Fee Ile- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t" PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes t ftplication for MispftAl4 pstrm Construction Permit Application for a Permit to Construct( ) Repair( �Upga&( ) 'Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.8(::, CU&r3Lo-57-D C7t` Owner's Name,Address,and Tel.No. V Assessor's Map/Parcel 3/(r G-L, 6, Installer's Name Address,and Tel. o. Designer's Name, ddress and Tel No. 5�'�h��-t•J �xt��✓�i-���v c � Type of Building: / Dwelling No.of Bedrooms �/' Lot Size .� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req fired) L>'G/ gpd Design flow provided L f`7 gpd Plan Date � Number of sheets Revision Date Title-5 I7L- /9y9�� or a st: fo Size of Septic Tank /f5 00 1; e of S.A.S. 60 C/4 C j Description of soil . 1 Nature of Repairs or Alterations(Answer when applicable) ' 30 'f �, _ Cr1?t } �� /G✓C-(S 14 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in , accordance with the provisions of Title 5 o the En 'ronmental Code and-not to place the system in operation until a Certificate of • f " Compliance has been issued by this Boad_ of Healt 3", r� Signed Date J r Application Approved by _ Date / I Application Disapproved bytr"" : Date for the following reasons Permit No: /,a/4.9 — G Date Issued - ------------------------------------- - - - j r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �� THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ). Abandoned( )by f'r-- " ' -J le;-/clJ' G C C24 4 g L IL <3/"q `J0 a '' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit-No dated Installer Designer #bedrooms Approved des ow �. �� gpd The issuance of this pe it hall not be construed as a guarantee that the system will function as de is wed. Date t 1 1 1 C� Inspector /-------------------------------------------------=-----------------------------------------------------------/---------------- No. c.`"$ �"�, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30isposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:C�p nstruction must be completed within three years of the date of this permit. Date 7/PL 7 GIB! Approved by RECEIVED 11/03/2015 01:47PM 5084325099 SPEAKMAN N0/03/2015/TUE 01:52 PM FAX No. P, 001 'own of Barnstable , Regulatory Services r Richard V.Scali,Interim Director MAM Public Health Division t63q. 1 cta Thomas McKean,Director 200 Main Street,gyan&s,MA 02601 .Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form ' Assessors Ma 1Pareel 3l� & Dater Sewage Permit# 2_ _ p Designer: Ol, �. ' /�!.(�j� stallen Is Address: /; Sp4�i� Address: /�`, _ r w '� ► _ze ;a4as issued a permit to install a (�e) installer} septic system.at ��C '1 �� based on a design drawn by ® (address) lS J t7(" 7 t sated . (designer) V i certifythat the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e_ greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construe_; —,�liance with the terms £the AA appr letters (if applicable) ►` �tl t1FrUfq 0 DAviv e" t G I+lASON (Ins ller lgnature , Ma_1058 0 . � s'1Ml TAA� (Design 's Signature) (Affix Design's Stamp here} PLEASE RETURN TO BARNSTABLE PUBLIC EMALTH DIVIiSIXON. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE SARNSTABLE PUSIIIC HEALTH DIVISION. THANK YOU. QASepticZesignec Urdfication Foam Rev 8-14-13.doe Town of Barnstable ' Barnstable Reg p Regulatory Services Department AFAmedeaCkn � &1RNSTABLE. � 1 MASS9. Public Health Division prFD ,,�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 5503 July 16, 2018 SULLIVAN, THOMAS E TR PO BOX 1121 BARNSTABLE, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 86 Cobblestone Road, Barnstable, MA was inspected on 07/08/2018 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. x The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E:C -- AgentRD OF HEALTH Thomas McKean, R.S.;of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailin \Failed or Needs Further Evaluation Letters\86 Cobblestone Barnstable.doc 'I Town of Barnstable @, t6s9. Regulatory Services Department AtfD�,�a Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360=44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA 71-�tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well . ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ❑ y Repair deadline: ` Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone r t Property Address Tom Sullivan Owner Owner's Name :. information isX. required for every Barnstable Ma 02630 7/8/18 €= page. City/Town State Zip Code Date of Inspection :", ri-11 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 �� �3�� filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain reb Company Name 35 Content Ln Company Address n Cotu It MA 02635 Cityrrown State Zip Code 508-364-9587 SI 13522 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 7/11/18 ,oInspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town 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: System contains a 1500 gallon septic tank. As well as a concrete distribution box and two trenches with infultrators. Infultrators are full. Tank and distribution box both show signs of back up. System is in failure. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 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 (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed Y N F1 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): ,y 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 c w Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•''y 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town 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 cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone �M Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•3/13 'Title 5 Official Inspection Form: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 �M 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. Cityrrown 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 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 �M 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town State Zip Code Date of Inspection D. System Information Description: System contains a 1500 gallon septic tank. As well as a concrete distribution box and two trenches with infultrators. Infultrators are full. Tank and distribution box both show signs of back up. System is in failure 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 318 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 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 Official 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 °M 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 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: Pumped every 18 Months per home owner 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 Form: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 ,M 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 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: 10/28/05 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 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 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is like new 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. Cityrrown 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 x i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary-Assessments 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and shows signs of carry over and sludge Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(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•3/13 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 �M 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 ❑ 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.): 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 L Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. Cityrrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 _J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. CitylTown 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 t5ins-3M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 l Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,••''� 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable Ma 02630 7/8/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: TBD at time of perk 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 s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 86 Cobble Stone Property Address Tom Sullivan Owner Owner's Name information is Barnstable Ma 02630 7/8/18 required for every page. City/Town 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 P ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I� 7/11/2018 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION %p C_Ahk�Ake_fu SEWAGE MSS-093 VILLAGE!%p Ill ASSESSOR'S MAP&LOT 31(-`2- INSTALLER'S NAME&PHONE N0.fie)_! r 4!2 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 7!!�/flk/j S (size) No.OF BEDROOMS S BUILDER OR OWNER � [ 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 1 V6Ae- I � e G • A-d iS 13 _d-q1 - - .. . ------ http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=316062&seq=1 1/2 Town of Barnstable j I"E o Regulatory Services • ,., . Thomas F. Geller,Director sncnvsT�BM • AS& Public Health Division F0 °�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Nb V. 7 2-vor er: ��lv� e-� Designer: 6-Z&C t gn Z � °� Installer: � 402/aU Address: /.fox .5i Address: On .� /Yla/'/N was issued a permit to install a (date) (installer) septic system at C; g_<k UV P44 5/a-2V. based on a design drawn by (address) 5 •� dated (designer) d/ I certify that the septic'system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. a (Irus -Y�r's Signature) �1 Gf 7c7`11'ARD ti ��� STET 01H E. JELLEY (Deems r�s . •atur� fix e�gr a�n er ) EVAL3P�� PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH ` I CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form ✓ 'Town of Barnstable P C�) Department of Regulatory Services _ / t)F 7NE T Public Hcalth Division Date ! 2Z 2 200 Main Street,Hyannis MA 02601 r BARNSrABLE, 7 MABa. jl Date Scheduled "� U1Z Time ��l+ �l�'�f� Fee Pd. Soil Suitability Assessment for Sewage Dispo"sal Performed By: qE-TE: GU LLB V/4l ICJ Witnessed By: ►.lo r2 G LPoxo titSttI P 1t-, : !v,, ::�I:r.61!51�:.Y:. 'di:45dti:!�'!i:�'L -." ,!;!":a;v` •Ln _:!!� . ! � ::9:': "I r. hll�I LI 14..d li4!Sajj:',I !.I' I: ,.! ' �"�"i'•: 4' :. ,I y :,n.".II �_. I� �I :I.� N aa!1 r': I: 'h :qr;t; I. ' r I :1�.. :r.: : . rJ ..u ..II�:: ,.I ula.:: :.t� II : I"l.":. IT:p:(.11 I:':I: 51 !i I: ! I�. E:j:,j i i IYtiI':I•I.I I�h(Ir'tll�fin'14.,d!:.::,i.._II:! ..4,;..hf"..FaP tll I��I;d�.Il:h;q�!� k5�1:: h Ll:,.n:l I II �I � I Location Address 00ce,6013846 STb✓L XO. Owner's Name 7 0/V! StJ//w-n/ Address /Z0 <508g1-t- -)rW6 M4> Assessor's Map/Parcel: 3 l(p /G Z Engineer's Name Sv(1(I/ NEW CONSTRUCTION V/ ' REPAIR Telephone# �J�vg 2g 3 3yy Land Use c5 1 D•e"NTt 6r.:L— Slopes(%) 311/0 Surface Stones ) Distances from: Open Water Body 1l,�1A, ft Possible Wet Area�_ft Drinking Water Well tiJ�A ft } Drainage Way ft Property Line ft Other N 1A- ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) _ c I LOI A[ (1•.::_C21.•_,L,(2 1 0 I..0 ^y�l i hour I � il._`_ ,..--•=F'. "'.._..- - !` , ll i L7 "i Vic' If ^ �t7j�h)1ASL4 DeplhloBedrock Cz%a- Tr-2 Ti`- t al0� Parent material(geologic) Depth to Groundwater: Standing Water in Hole -140 _. Weeping from Pit Face I�C) _ •.�,._caG:..,.,,.--...�-._.._...ter:_. ~ - Estimated Seasonal High Groundwater 1Z jJ�IAA 5�F C G WW SUtZ 1C-41Clc r,.. s+c+mr I� :nr' I•!! - !9•m!p:nl ni:!:;,y,4;,a:,:,L,•rtv !.:nr,:rn•r.:!, :!!r.:: "!,,:mn.,•I Ir:!!:::IIIYn,!::,r.;a,I•!":m^�.�!•':.:'L.::L!::c!�c!nl e'a,'!,91ur; .'I mr!• mlg�rltr'q-:;:4:.1?. �7Fi.".':i•hl�l�(I;LN�'�II�II I m h� :d'I I u I n�!1!n:.:.m�, �y.- t. !Ia ��:,I _. ..I ! IA IJ 1 :�.k: I Ih !:�.::,:..oe,.:d:::-_:I061AuIlan�II�:,Ahl�>.'tIIIrILI�?A Method Used: lbwrU of _AZ(USi),IaLC. 2cauroPwa, Depth Observed standing in obs.hole: AI E in. Depth to soil mottles: qCA)C in. Depth to weeping from side of obs.hole: lU n in. Groundwater Adjustment I�rl1 ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level ... ::: :: :: :.....: � .::: ..:::: :s..�.. .�� :u.:. .:.......:: �.::.t::r J:"e��-;, :;:i'!I'i�'I"!" :!18"I:Iti'r!!�"I.t•:! :ll;! !.I ^..!..y .!rru!:!'!a!!:Ln::.Iln.,.l4!!u�a�e.114.1,!::.dslll:I I:L. .: !,I,ul. .a:.0:.:.::.!:':L:dl l....::. ,,.,.•:::...I::a::.!.: ..-! .: I:I '1: y�I.{i�llmd��!l I,.,L.I.41. li la!a.!.,.LL.t!A..:..r.!:! .'L. .!.� I:,. L I�,.:.IN .! Y !II.�w!.I Id. ..1:"Id^,.,h��li i..Ydl..l: II I I n' 'II'!I I' ;,!: :�Ir !II,, •�..y� I,J.I!.alSh. ,nl�4:. :�I":�,r r' L.I, 'j'L: ..�:: ::,.,!:�.l.la o�I II,• :'i "�:.. ,4:� I : ,A .I V: Id!II -.!', �,flt�Fi'3 :�! .: �I n�Id I !:wu4:IS!' 1 rL�Y.d:�fa-aivr, d�,:!Itl!�!P!!lall�,,:4 ;!�;Nsll�a�,l I�::�':h r .�I!�J',b:Irl..,Jt!�.�.�M...o::l:-:T..�:-.ai�l�..��.....-�,..,.:I+a,,:,� :�::1: la. I u Observation 10_ l L_ FG Hole# t Time at 9" s' Depth of Pere Time at 6" �' 2, Start Pre-soak Time Qa Time(9"-6'1 End Pre-soak ID',SZ Rate Min./Inch 2 F-EL L K-,C �-,�1 l Site Suitability Assessment: Site Passed ��_ Site Failed: l Ac) Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-----�--- Depth from Soil Horizon Soil Texture Soil Color Soii Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. , 1 e 2 —G e. try�w�( fir✓e��S t -f S/� -.t•v C> -- A e Gft,,,C5 RYAT........ Depth from Soil Horizon Soil Texture. soft Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 Q-O u -Aj . 3 ti- 12.1p Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.0 �` i ly C— S z � V ��71r✓S C��� � �yQ F'��u-t✓�=ars �S�o ��v 2�5 -co C (DW : :::::......»:>:<:::::;:::>:»::»: . t 1.: �. <::';. ':: : .. . ...::: .. :....:. . ..G.:.:.:::.:......:.::;..:Hale:#.:.................:..>:.;;;:.:;..::::. ..::::::.:.:: :.:: ::::::.:;:;.;;:.:::.:.:.: ITT,��'<,0 ) RVr ' . N.H.�I, :.; ::.:.:::>:::.::.:.:;. ;::::>:.:::::<::.:::::.;:.:.:.»..,.w»... ................................... Depth from Soil Horizon Soil Texture Soil Color Soil Olhcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. rntsislcncv_"/o Gravel) Flood Insurance date Map• Above 500 year flood boundary No Yes Within 500 year boundary No d1 Yes Within 100 year Qood boundary No tl�, Yes 17euth of Naturally ccurring Pervious Material �. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? "� e s_ If not,what is the depth of naturally occurring pervious material? Certification I certify that on AM,-i(— }j (date)I have passed the soil evaluator examination approved by the Department of Environmental Proff ctycn-nod that the above analysis Was performe me consi�t W'tl �t the required training, expertise and experience described in 310 CMR 15.017. � �. J . TOWN OF BBARNSTABLE e,WfATION A, CA fd SEWAGE #f-AX5 'Og3 VILLAGE ASSESSOR'S MAP & LOT 2L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1.5-'60 LEACHING FACILITY: (type) - 7� (size) NO. OF BEDROOMS BUILDER OR OWNER U( t /v PERMITDATE: � COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Q Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ct r � e 44 G 13 --r- 35- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yication for Mig ozar * ptem Cottgtructiott Vennit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. S �°� (4) Owner's Name,Address and Tel.No. S U$'3&0�— \�1 / Assessor's Map/Pazcel (�yU1 ,J lA I !1/�Y1 -� �! adr ir2 F'/'!K LG3 Installer's Name,Address,and Tet.No. Designer's Name,Address and Tel.No. '1Y mopelpq Type of Building: Dwelling No.of Bedrooms `� Lot Size Lf7 ?1 3 sq.ft. Garbage Grinder(I'9 Other Type of Building No. of Persons Showers( Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow - gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure onstruction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions o itle 5 o the Environm al Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this of He Sign � — Date Application Approved by ® Date Application Disapproved for the following r s s Permit No. Date Issued - - rl No. c _PAe �4� yyTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: < Yes PUBLIC-HEALTH VVISION•-TOWN'OF BARNSTABLE,MASSACHUSETTS ` RnIfcation for Zioogar *potent Congtructfon Permit t Application fo'r a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. ? A Owner's Name,Address and Tel.No.`s` SU�-360�' Assessor's Map/Parcel 0M SU _ �v 1-90 /I Z l vrr��o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t Type of Building: :.... f� , , t Dwelling No.of Bedrooms J pYz'si e L/ 913 sq.ft. Garbage Grinder(NQ Other Type of Building ' No.of Persons Showers(4) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. - * _ 6 Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) �� L Date last inspected: Agreement: = -The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B)oafd of He th. Sign I' Date Application Approved by /y/ Date. Application Disapproved for the following r so s Permit No. _ ^ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) .,,-Abandoned( )by t. at has been constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit N . -' dated Installer j'12e r—i/ \ Designer The issuance of this permit shall not be construed as a guarantee that the ern will c 'on s designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Dfgpoof 6pgtem Congtruction Permit Permission is hereby granted to Construct(,,_ - ep ra r( )U de( Abandon( ) System located at Z and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted within three years of the da`e of this e i Date: ��/ 1 Approved by _ & - .• v I- _ tiv ' 5•- .eA F=w Br Ob ATOP TtJZyyb x3 mvVI o•J&,ng ®Tv Awblj Wl.46011E Wb GOL p/YRA1•.y Qoo AWlSI << T a'/Yb aYY6 Try/8 yL (p GW Sot-B r /sve- /x•.c 6o. oof¢ Fwgd T d4yb - u Y4G E Roo SE D2ootq a U ` / Yb Is IA _ 6 0 45, Ou 1. 7" + a `U p Pw.+rnj rb M m to 13ATZ4 I AV 3/ G/Z IA5 O o qS s°rRe�a_ ,� a• I v r "b f/ae ALL Ora j 7 'y ( bL a" .'7 �mEwP Ae a° ba Tw a®6 ret?v ®w j� 6iDA LTS to• pl a y® . d�b STEP E AANOG,� 4><v PoyTS koo V - s K O '6 k .4 .. r c � O LI/uDC /n! 6AA ws . �Net6�NOo5E a¢ _ M - _c.cPsOve4 6Aaw w.•IDowJ/.Yy80d7 ' TRI 7S/L Td) )yYb . i 11 vLL o �e T.O. a- - S H N-MMr�N ,, W,.u4W Ey16Nf- DOmfu t, LU Ilk V ro - '1 -0" 4 �1� - fEco,uo rtvne P�.rN � vets 8w x 8 r a rl - r bO dW 1. is nncn mac Q --b17 S�Kr _ UP 4 GSILLU-.C3NLK TypE G 9 pbnt P Peoa�Q�_l�L ODE •v _3-d x is &J, 1 i eu 4l 2 m y r IZ 2 3l�xx 30" /moo"�nuc= a O a a u a „ v N _ 7-0v k�2 a 8 p 0 3x8.�T Lsc. 11?DP /d'3DF1s m JE 6PA,VV- ANcdWP�Z,YA_-e cow Y"co.,ut,-yea-5acpra-TD Doody `�i U _ •a 1-09 �,/ •�.fl.♦ ru�wwm�. awaw�n ill II��� P r Q (4 SLOG K Poor /y� A"e, -JoyEA- M!KR)LhNE RAYf£2T/Fj —R La'GDx'PLC/ °T't- -...l.VL-�k ID6E5(SSE CVM 6�R y/}Q-0 SPEGS� _21R1�.+__LOaI.T_�oFFIT yFNT - DR I P 'ED 6$ 1/-EN T£D. - �� ►Q _ _ fFwAe_._�vrL-�� +S.PoyTs ZAK4+- to ax/0 la _rb lb lb (O_ - - a la TyVvk OVEA- �a°'GDX.PLY' 3�xy_aLc .zDP. 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SEPTIC TANK y'Z.S4 6a_ � EL.M. �l . � INVERT M/9 I Zood .,•1 �So.�'.... 6U1L. INVERT DIST. EL. J�o.SB EL. ........... EL 9z "¢�--�Z:.. 80X EL. �.... ? � r,2���t/ CHAMBERS ;wc "'6CRUSHED STONE 14 H/CM CAP• No</E /pH�CL�Z•,. fL /o' 20' --+-� /Z ' 4s.7S G'"NCo V N7 E"7LE7> -. PRO FI LE 0 F ADJ. GROUND WATER E.L........... SEWAGE DISPOSAL SYSTEM SO L LOG �� 04 02. NO SCALE DATE . . .�. : .. . . TI M E .... . .... . .. .... VEGETATIVE TEST HOLE .�..... TEST HOLE . COVERDESIGN DATA ELEV. 94.60•_. ELEV. ..ya. :..... _ i� NUMBER OF BEDROOMS / • -� � ( .I L �• :: F!I✓L /✓L'6"Z)L,(.i .1 ,./ NE.V82'sL!`.S • Z„ EL,9¢.43 Z" __ EZ.94•S s TOTAL ESTIMATED FLOW GALLONS/DAY 4O ,` Lonny �A,uE cv��>y G�g2sE- I ♦ � - _ I SHTO r 3R91 D ZZQ.97 ��' Io ---- �\ —EZ 9fSo ayr24/3 BOTTOM LEACHING AREA SO.FT./TRENCH C�Avi. %. c2Av�z y�AHy toA*^ JgNn � / ssrri n io'/LG, SIDE LEACHING IN G AREA �'. . .... SOFT./TRENCH �/ y 3D" — / / / C /v0�/E O /! Z.�/On 81C"' L//o^, �cT �� �OU�r 5-��� / r-L. �lZ.to gZ-So GARBAGE DISPOSAL t50 /o AREA INCREASE) TOTAL LEACHING AREA .`4u•• ••: SOFT. 4 Z• - �L7�GDI �I�L7 c:—t/LsZV PERCOLATION RATE 4`_3S TN/I� ? H 'Y' PER.INCH LEACHINGN L I��LGG y 4°. � 6 tom' GAT ` LEACHING AREA PER PERCOLATION RATE YZ �6 �Gv' GpD• ADJ. GROUND WATER j7 "L, 8=�;6c lam'' �L.BS•oU /1/o TG-"- L-Z��/iI T1�N s• t`�iGISG�l.� �^/ /�-=.=S c,..-•._-r� T���-v.y �'".. . WATER ENCOUNTERED ..... . GoT 8� ��'/a`•h• /ZG-� �L �/c, 3G � !-'�', ��' WITNESSED BY : • . .... ... .. . .. ./ . . . . . . . ._ ..--- BOARD OF HEALTH .. .... ....... EN GI NEER _ . . PETITIONER . 241-1 lee ik?cel/ 29, K ` J I S 7-: IV PrIc < 7- CL 6t, v e I 47 89 I I 3 -s F/-.i RD . 41 I \ KELLEY Z' No. 26100 I \ / - - - - - - - -- - --- - - -� -- --- - -- - - — - - - - - - '' �A` / f�t '� 47 / STETSONs9cy 1