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HomeMy WebLinkAbout0130 CRANBERRY LANE - Health 130 Cranberry Lane Bamstable u A= 234—066 — 005 � a ° N a. e " 4 ° Yo" . .A ° e b .. o o r , • a3y-0�6 - Dom r Commonwealth of Massachusetts Title 5 Official. Inspection Form MI Subsurface Sewage Disposal System form -Not for Voluntary Assessments -, 130 Cranberry Ln ►. Property Address Dick& Nancy Knight Owner Owner's Name A information is required for every Centerville MA 02632 1-31-20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Shawn Mcelroy t :_ Name of Inspector Upper Cape Septic Service`s Company Name P.O. Box'73 - ,o Company Address E. Falmouth 5 , , MA . 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty 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 aproper function and maintenance of on-site sewage disposal systems.After conducting this inspection'l have determined that the system: s 1. '® Passes' 2. El Conditionally Passes,__ ; - ,: .+ ; . _ -,4 I. ` s r' ,:r n. ., s ,i, ^•+!. .'lt * 1 ^. r as .. i•. .E,x;. at:: 'i❑,;Needs Further.Evaluation bythe:Local Approving Authority 4. ❑ Fails 1 1-31-20 - Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 ' Commonwealth1of Massachusetts = Title 5 Official I nspection Form �ibl Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments .r_. ? 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is Centerville MA 02632 1-31-20 required for every ' page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all`of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. d i "2)' System.Conditionally Passes* .' ± ❑ One or more system components as described in the "ConditionalPass" section need to be replaced or repaired. The system, upbn 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): y n ,y, t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18' Commonwealth of Massachusetts , ` r > -; ,ca r,ece•�e , ,. Title 5 Official Inspection Fora' . :r 0 Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments --. } a 130 Cranberry Ln tit . t c�t Property Address Dick& Nancy Knight Owner Owner's Name r , information is e required for every Centerville ri; MA 02632 1-31-20`, page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) •t 1 •; 2) System Conditionally Passes (cont.); r ❑ Pump Chamber pumps/alarms_ not operational. System will pass with Board of Health approval if pumps/alarms are repaired. , i I .. „'e;. 'e .""x a r;, , .,iti' f— �• ❑� 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): ' r - t ❑ broken pipe(s)'are replaced , ,' r'''' ❑I Y El l ❑''ND (Explain below): .. obstruction'isrremoved ` ' `' ❑ 'Y ❑N `' ❑ ND (Explain below): ❑ distribution boz is leveied or replaced, ❑Y ' ❑ N ❑ ND (Explain below): ,a.... r•,. F .. a is ❑ 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): 5 3) Further Evaluation is Required by the Board of Health:; ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.- a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts = Title 5 Official Inspection Form ! r4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is required for every Centerville MA 02632 1-31-20 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 systempasses 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: t - 4) System Failure Criteria Applicable to All Systems:* ' You must'indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth & Massachusetts Title 5 Official Inspection Fore s. Ili Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 130 Cranberry Ln Property Address Dick& Nancy Knight - t, v:'• r '-1 Owner Owner's Name ; information is required for every Centerville �' ,'a1. MA 02632 1-31-20 x.:. . page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) .4) System Failure Criteria Applicable,to All Systems: (cont.) Yes. No ' Static liquid level in the distribution box above outlet,invert due to an overloaded ❑ ® or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less El ® rr than''/z day flow, ❑ ® Required pumping more than 4 times in the last,year NOT due to clogged or obstructed pipe(s). Number of times pumped: "t . , ❑ N.,. 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: ` ❑ ®' �`Ariy 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 t of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of,custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- ❑ 10,000 gpd. The system fails. I have determined that one or more of the above failure ❑'' ® ` ' criteria exist as described'in 310 CMR 15.303, therefore the system fails. The �-systemi,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 jt4,questions in Section C.4.-, .r,.. ,, . ., ,•,r , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018• * Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts - 1 Title 5 Official Inspection' Form-; ., - ibi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s_ ,> 130 Cranberry Ln r Property Address Dick& Nancy Knight Owner Owner's Name information is required for every Centerville MA 02632 1-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) v 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 aH inspections: Yes No ® ❑ t 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? ❑ N Have large volume_s 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? ® Wasthe 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)] _ _ o. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 0 of 18 Commonwealth of Massachusetts z r;-" ; . ,,; 'It- ry -t r� ;P Title 5 Official Inspection Form. - ? ^NI Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments •'A y ' = 130 Cranberry Ln Property Address •'.a.' ; Dick& Nancy Knight Owner Owner's Name information is i required for every Centerville MA 02632 1-31-20 - , page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for-example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? c :; �• -, ❑ Yes ® No Does residence have a water treatment unit? ,• i , . . . - - 1, r-._ ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? - ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: - Sump pump? ❑ Yes ® No `Last date of-occupancy: °' - f•rx l jo Rom. ti- .; 1-2020Date ;4 i.y. iti t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 ` Commonwealth of Massachusetts = ;_ Title 5 Official Inspection Form ?�i w � Yri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 130 Cranberry Ln Property Address Dick& Nancy Knight ' Owner Owner's Name information is required for every Centerville MA 02632 1.31-20 ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: "' ' Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance __ y t5insp.doc•rev.lrmf2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 � ` •, Commonwealth of Massachusetts Title 5 Official Inspection f6ft' Subsurface Sewage Disposal System Form =Not for,Voluntary Assessments 130 Cranberry Ln Property Address Dick_& Nancy Knight Owner Owner's Name information is required for every Centerville . MA 02632 1-31-20 •- #•• 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/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 •t ❑ Tight tank. Attach a-copy�of-the DEP approval.J - 7f at•` ❑ ,,,. Other(describe): Approximate age of all components, date installed.(if,known) and source of information: 2009 Were sewage-odors detected when arriving at the site? �i, ❑ Yes ® No 5. Building Sewer(locate on site 30"plan): c ,zit ; • t, ,- � :r f{;.. ' µ. ira ; , Depth below'grade: a ' �.-s "''max feet Material of conStructi0n:° ° ' I''s '' u ''' `� r-ti * ` ' '` •' ' - ® cast iron *" ® 40'PVC'. F _ ❑ other(expiain)`. Distance from private water supply well or suction line: feet - Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 d; Commonwealth of Massachusetts r� Title 5 Official Inspection Form I�r� Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments � .✓,,� ' 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is required for every Centerville MA 02632 1-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"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 Sludge depth: 12" Distance from top,of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 15" How were dimensions determined? Tape 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 in good condition with.baffles installed and no sign of leakage • J , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 41 Commonwealth of Massachusetts .; � . J :� -..,; 1•� r ,-f f+ r� Title 5 Official l� spection Foam ,01111 Subsurface Sewage Disposal,System-Form -Not for Voluntary Assessments 130 Cranberry Ln a; J� < Property Address Dick& Nancy Knight Owner Owner's Name information is Centerville. r, ; „ [ required for every MA 02632 1-31-20': . page. City/Town State Zip Code Date of Inspection D. System Information(cont.) 7. Grease Trap (locate on site plan): .'Q!.* 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.): ,. /. 4 �.. $ :t.-_ ,t• "i'�`.'� �r 1: Y!. +"7; C a a'+'i� f fi. "r & Tight or Holding Tank (tank must be pumped at time of i nspecti on)(locate on site plan): Depth below grade: - Material of construction:, ❑ concrete " ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ICI• Title 5 Official Inspection Form ibi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,fa 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name informati for every on is Centerville MA 02632 1-31 required for page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No i Date of last pumping: . Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ,xir_' " r �.� Title 5 Official Inspection Fo'm s i M Subsurface Sewage,Disposal System Form.-Not for,Voluntary Assessments; :r .• ;i.te } N ,a 130 Cranberry Ln Property Address s t N'4 Dick& Nancy Knight ;�c Owner Owner's Name information is " required for every Centerville MA 02632 1-31-20 - page. City/Town f State Zip Code Date of Inspection D. System Information (cont.) r„►;` .:* ., e ; r. : 10. Pump Chamber(locate on site plan): ; sr ,• .'+ .r . . :f•,� *1't...' ", �' Pumps in working order:' t ❑, 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)`u, If SAS not located, explain why: ��M, r�, 6 Type: '_,; f, A. j f",;,l ❑, I aching pits'? number:'. . - ® leaching chambers number: 2-500's El leaching galleries number: -.❑ .- leaching trenches number, length: : ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins .doc•rev.7/26/2018 " Title 5 Official Ins ecton Form:Subsurface Sewage Disposal System•Page 13 of 18 P - P 9 P Ys 8 Commonwealth of Massachusetts r Title 5 Official Inspection Form w. Y�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �• 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is required for every Centerville, MA 02632 1-31-20 page, City/Town State Zip Code Date of Inspection .. D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of.ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and holding 3" of water with no visible stain Ines. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert _ Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): { t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 .� Commonwealth of Massachusetts r� Title 5 Official Inspectioh Fo rm` lel it Subsurface Sewage.Disposal System Form =Not for Voluntary Assessments •- . } 'F 130 Cranberry Ln + Property Address Dick& Nancy Knight - Owner Owner's Name n information is required for every Centerville �•.' MA 02632 1-31-20- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4 13. Privy (locate on site plan): Materials of constn ction: " `' �f4fi �'`*F' #r "� j a - �•� Dimensions Y Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f t _ � t .+. J •. Via' rr, , .R t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts "a g r ,0 Title 5 Official Inspection Form wa Czi Subsurface Sewage Disposal System Form Not for Vol u ntary'Assessme nts0. r r 1 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is required for every Centerville" MA 02632 1-31-20i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _ p 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 a f ti t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,f Title 5 Official l.hspectioni :Foam 4ti A i it Subsurface Sewage Disposal System Form -Not,for Voluntary Assessments �• - r� 130 Cranberry Ln Property Address Dick& Nancy Knight ,, f• Owner Owner's Name `�- information is - n required for every Centerville; MA 02632 1-31-20 page. City/Town State Zip Code Date of Inspection ,. D. System Information (cont.). 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells r� F Estimated depth to high ground water: : ` 'r i` feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record ; ,t *�;• If checked, date,of design plan reviewed:. Date ' ® Observed siW(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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8• r r Title 5 Official Inspection_Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection'. Form �i i Subsurface Sewage Disposal System Form -Noffor Voluntary Assessments , 130 Cranberry Ln Property Address Dick& Nancy Knight Owner Owner's Name information is Centerville MA 02632 1-31-20 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: - ® A. Inspector Information: Complete all fields in this section. M ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D.:System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depMto high groundwater included y t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 down cape engineering, inc. SIEVE SOILS ANALYSIS BSC 130 Cranberry Ln Cville.xlsx DATE OF REPORT: 9-25-09 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 130 CRANBERRY LANE, CENTERVILLE, MA LOCATION: BSC Testhole SIEVE ANALYSIS Weight Sample(Grams): 297.8 SIZE :WEIGHT RETAINED % RETAINED ; % PASSED ------- — — — -- - - ---(sum-)-- --- — --------------r - --— — 1" 0.0: 0.0%: 100.0% -------------=---------------------•-- ---------------.0%:--------- 100, % ....................... 0A-----------0 0%0`---- -100.0% -------------= ----------------------------------- 3/8" 0.0 0.0%; 100.0% _____________r'__•_-..._........-....... ----_------------- --__-----------_-- #4 0.0: 0.0%: 100.0% # ___1_0_________ -----------------------2.4:----______------0.8%:--_-__,----------- 99.2% #20 10 2�-----------3 4Z: 96.6% #40 36.0: 12.1%: 87.9% .--------------%---•-----------------..._•Y------------------1----------- #50 83.4; 28.0%; 72.0% #80 214.0: 71.9%: 28.1 ------------=---................. ------_------------------------------------- #100 241.5: ___81_1%: ___ _18.9% --------------�------------------------------------------------- #200 281 9;_ 94.7% ___-___---__5.3 0 ....................... ---------------- PAN: 297.8: 100.0% 0.0% ------ SAMPLE: 297.8: NOTE: TEST ON PASSING#4 ONLY. 1% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR, COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK ()f�,P;l E LA. r SAMPLE MEETS TITLE 5 FILL SPECIFICATION /, o.i LA !, 'vo,4550,";' if RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MIN./IN. MATERIAL o y%� NONCOMPACTED AL SOIL DESCRIPTION: MED/FINE SAND, 0.74 GPD/SF MATERIAL W { TOWN OF BARNSTABLE LC;CATION ATION CrAAJber L. SEWAGE# d 33 VILLAGE _ / /A�SESSO�R'S MAP&PARCEL�Z j -D( —U Oo� INSTALLER'S NAME&PHONE NO. SEPTIC TANK-CAPACITY Ext5Tc� 7 LEACHING FACILITY:(type) �' S ��� /We(�S (size) S X 3 x;; NO. OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: J® 'J 0 -G 7 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 L-aching Facility(if any wetlands exist within 300 feet of Imching:facili ). feet FURNISHED BY , 31 3iv � �ra�t of I�ousE aI� 30 533 No. Ooq f 331r I Fee ®0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPlication for �Biq onl $tem Construction permit Application for a Permit to Construct O Repair(Upgrade Abandon O ❑Complete System ❑Individual Components 13o crzx�►b�t�ri.) L� I� Gctr:��b�i�. I 2 Location Address Lot No. r er's Name,Address;and Te1Io � Assessor s Map/Parcel 6 Oc6 _ 3CCZ_ 92ot Installer's Name,Address,and Tel.No.�G�On����s Bier Designer's Name,Address and Tel.No. �� �ROUIp 35D wtcca R 5t- u-)--4c&&*%ovl'H 3L-1IJ� Z* Zg, UVI t F- ct-7gi--(1Z3_ 402VVL Type of Building: Dwelling ._a No,ofiBedrooms Lot Size 2,, '2 j sq. ft. Garbage.Grinder ( ) Other Type"of Building No.of Persons Showers( ) Cafeteria( ) .4 r Other Fixtures Design Flow(min.required) 1 1 D gpd Design flow provided 3 k® , gpd Plan Date SeQAe,, 2C(. `2oo-� Number of sheets L Revision Date Title �`eL4N 7((4,4 �r S QoSu� aQ 19%w_ Size of.Septic Tank j bUC� Type of S.A.S. �e`((� L•ew� t.-� ��'�— Description of Soil C;'4`o i` ll 1`.'li a 1311 4-o 2511 I&Q-1 Sci.-wA Zg"4-o 41 i� C I (f6vtS-f Su-vJ ks yiz- 114, Ll I"4ro i rb C Z w m g Sam -c Nature.of Repairs or Alterations(Answer when applicable)VA05-s. tic i54t&,n c I®©d 4;;tti et 5cd t f(c c'A ties PQ`S` 1�-ID CZ� ,ro® ��ltv � N-2y l,zuct„ &a'_Ab..0 W.,411 4 ' 15tcA, GII arzu� 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 o ' le 5 of the Enviro ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by his oard of Hea ° Signed ate 1 Application Approved by O & ate Application Disapproved by: Date for the following reasons lei I Permit No. Date Is sued ——————————— ————— —————— ——— — — ————— - No. - '� 5 r" Fee �DU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -..TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mi�;pdM 4§pptem Con0truction Permit , Application for a Permit to Construct O Repair(+�/Upgrade( ) Abandon O ❑.Complete System ❑Individual Components nti�►la��.a�l c.0 r C �b42�.Location Address or Lot No. � Owner's Name,Address and Tel.No. I� ( { sm Assessors Map/Parcel 3ceZ.° S-101 TrtiSonRt�,�25 In filler's Name, ddress,and Tel.No. DDesig�is_Name,Address and Tel.No.�Q� �RDu P y✓Xt 4 �9" W•�4Jt:lnpvtW qlb- U13- W. gCLtL ov` " A.t SOS--7'7�96- 96ri101 Type of Building: i Dwelling No.of Bedrooms Lot Size Z 1 t Z Z$' sq. ft. .Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) l i gpd Design flow provided "3?0 gpd Plan Date 15e06-61'L , 24oy Number of sheetsl Revision Date �r Title 5'ew Qy�c D r S P050 a e 10at'2 Size of.Septic Tank ' I bvo Type of S.A.S. �e J(e. teat k. --I i9l r- Description of Soil 0+0 (�,t rVil 1311 'b 251, Jou r''y Sk Ha( Zs�t �o 141" C I CovtS'C k�) 194ve l 141 4-() 1 V6 C 2- Nature of Repairs or Alterations(Answer when applicable) (4V5_Q_ S�1L -�, ID0c-1 qu�(d� SCQI�,C '�c�Y�'-• _ (I � New pQ, S t�-ID 1!Z� S-O6 io-A N-ty l�«�►.,•� .'£+�tw•Tb��: w��-11 Date last inspected: Agreement: The undersigned agrees to enure the construction and maintenance of the afore described"bn-site sewage disposal system in accordance with the provisions offTitle 5 of the Env on ntal Code and not to place the system in operation until a,Certificate of p J Compliance has been issued b'y hiis Board of�Heaalitfi Signed ��r� ' r�o_ ' f r • ate j Application Approved by ( / L�/ Date t � r A lication Disa roved b \ - Date rN rr Y for the following reasons Permit No. V►/ �/ `�- , / Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired V Upgraded Y g P Y ( ) p ( ) Pg ( ) Abandoned( )by Ike W"i-(L fzo�.e&(, at 13o C 2G`^b�2R�� 1U has ,been uin accordance with the rovisions of Title 5 and the for Disposal System Construction Permit No. 4 v �.J_ dated Installer u5`.'v` 009�6i.d5 GJQk t)uje� rx. Designer B-'Z_ �tjL.OUp #bedrooms 3 Approved design,floWN 3t<;p© gpd The issuance of this ypermit shall not be construed as a guarantee that the system will �u,ctidnT as designed. Date I J 1 U Inspector ✓ ' t No. a ✓ ` Fee HE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 5 )bi.po.al 4y5tem Con4truction Permit- Permission is hereby granted to Constructl( ) Repair ( ) rade Andon ( ) System located at i 3'U ��QrZRN 1E 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: Constructio M st1be cc'o'm`leted within three years of the date of this perm t. Date �I� / XW Approved by / 1 Town of Barnstable 4 QFTNE rok, Regulatory Services ti c� Thomas F. Geiler, Director * Public Health Division 9 nss. MASS. g 039. ArEp�.�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 10/3 0/2 0 0 9 Sewage Permit# Assessor's Map/Parcel 2 3 4/0 6 6-0 0 5 Installer& Designer Certification Form Designer: BSC GROUP, INC. Installer: \�rc*OA ] o as _IVkUA� Address: 349 Route 28, Unit D Address: 3S'0 KI(A-',A $'f W. Yarmouth, MA 02673 ���� On ` a � IJV`- (?����dla)permit to install a (date)- (installer) septic system at 130 Cranberry Lane, Centerville based on a design drawn by (address) 9/29/2009 BSC GROUP, INC. dated 'rev. 10/17/2009 (designer) X 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. Stripout (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. Stripout (if required) was inspected and the soils were d satisfactory. OF 4f4 OWN G I sta is e ¢YE,RGATIAN ( CIVIL "CA NO•,6206 40 90A �Q18 T6'0 01 ,Ss Eat signe i ature)' (Affix De mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc P :a Town of Barnstable P# U >�T Department of Regulatory Services Q� n spRP1sTABLE, : Public Health Division Date O G� MASS. rV' � 1639. 200 Main Street,Hyannis MA 02601 Date Scheduled I Time Fee Pd. $100.00 Soil Suitability Assessment for Sewage Disposal Performed By: Brian G.Yergatian, PE, LEED AP Witnessed By:l&/ LOCATION & GENERAL INFORMATION Location Address 130 Cranberry Lane Owner's Name Richard H. & Nancy A. Knight Centerville, MA 02632 Address 130 Cranberry Lane Assessor'sMap/Parcel: 234/066/005 Engineer's Name BSC Group, Inc. NEW CONSTRUCTION REPAIR X Telephone# (508)778-8919 Land Use Residential Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 234086002 234060006 p 128 - - 234018 BOB 234006067. p0 - 234066005 0 122 4 130 ; �234068008 i 1 GRq f�$ fiRy tNAB `. o too Feet 2013088004 234066002 =_ �20 66003 p 119 234068001 3 k 111 Parent material(geologic) ouTt+a14S1.1 Depth to Bedrock A Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face N a A Estimated Seasonal High Groundwater 5`5'.4 3 F-T DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date 9-17 ogTirge 161.30 Observation rp .gyp Hole# ' `—a I r "3 Time at 9" 01. 38.`5 Depth of Pere 9 t t O "`��1 Time at 6" d 7 Start Pre-soak Time @ 0,60 Time(9"-6") 45 End Pre-soak 0 : I vRA4 SAMPt Rate Min./Inch 15 tint SIEVE ANaX.` 5 0 (SEE ATTAGHEp) Site Suitability Assessment: Site Passed�_ Site Failed: Additional Testing Needed(Y/N) N 0 Original: Public Health Division := Observation Hole Data To Be Completed on Back----------- r ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# TP- 1 Depth from Soil Horizon Soil Texture T n Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven 0-16 FILL SANn r LOAM 16 Y R a/1 at -0A9 sw LOAMY 5AN0 10 KR 4/6 W1 c4eaLraS al - 63 G 1 G .SAND w) 61MIL GOBBLES a .S If 6/I} 13 - 130 Ca SANDY LWA 5Y S/4 NO WA-TVK OF, KEDOX. 0155F-RVED DEEP OBSERVATION HOLE LOG Hole# - f'—a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven _0-I3 FILL l 3 - of 5 Is w LoAMy SMn �o YK s/� a 6 - 41 G 1 G . 5ANb W1 6"we L- ;1.S Y V 4 4 - 1 a% G a F. SAND a .S `� 6/3 Ca 46"it4Fm fr.SAMO wl SOML' 3lLT aTvyN.Armwx . $Su"10011 No w T REDOX . 695TEMED DEEP OBSERVATION HOLE LOG Hole # TQ - 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 0-13 FILL 13 - as CAW L OAMN SANG to YR 5�(0 a S -41 G t G .SA m) w] G.aAVE 1_ d .5 'C V 4 4 t - ta8 C.a. F_ SAN12 a.5 NO WAT ctlZ OK KEPDX, 656199.VeD DEEP OBSERVATION HOLE LOG _ Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate May: Above 500 year flood boundary No_ Yes X Within 500 year boundary No X Yes Within 100 year flood boundary No X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification - I certify that on 10/24/05 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and expe 'ence described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC f . Town of Barnstable '- P# �. gyp` o Department of Regulatory Services ' BARNSr•ABLB, : Public Health Division Date 7u 9� 1639. ,0$ 200 Main Street,Hyannis MA 02601 - ACED MA'S A i Date Scheduled t 0 • Time 11 A, Fee Pd. _ $100.00 Soil Suitability Assessment f ewa,o is 7 Performed By: Brian G.Yergatian, PE, LEED AP witness y: LOCATION & GENERAL INFORMATION Location Address 130 Cranberry Lane Owner's Name Richard H. &Nancy A. Knight Centerville, MA 02632 - Address 130 Cranberry Lane Assessor's Map/Parcel: 234/066/005 Engineer's Name BSC Group, Inc. NEW CONSTRUCTION REPAIR X Telephone# (508)778-8919 Land Use Residential slopes N Surface Stones Distances from: Open Water Body ft Possible Wet Area ft .Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) '.0 234080000 ZT f•,� , `234000006 0128 -234018 B00 34088005 - 234080007 2 710 2 1300 N 122 _ 234066068'' Nil0 :. ...f . ' t y .Q + 1 Feet 4131 D04 .234088002 y�••�, - < N129 003 gI19 2t34088001; >• "- r p129 . y .6LrAC_14,L Parent material(geologic) p JTW H. Depth to Bedrock IC J A) Depth to Groundwater: Standing Water in Hole: N A Weeping from Pit Face N/ A t Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER"TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date I-1 -01 Time 1c�k'�36 Observation 0. - Hole# Time at 9" Depth of Perc 1"f s � � 51 Time at 6" w Start Pre-sbak Time @ S ` S Time(9 -6") End Pre-soak ' Rate Min./Inch Site Suitability Assessment: Site Passed X _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ib sa A s �i at -a9 $w LAAtAV .SAAYE \0 Yf, j UBELDS 9q -63 �� C.SAND. w`6%-\tL & ('r1381Zs .� 4 163-130 C,a o R-BIDON DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) SW ;l_a&A'i SA la,O o o M S Lto l - G ® AT r 09— WEDOX. 062FIP)EID DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling . (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes X Within 500 year boundary No X Yes -. Within 100 year flood boundary.No `X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? a, If not,what is the depth of naturally occurring pervious material? "Certification I certify that•on 10/24/05 (date)I have passed the soil evaluator examination approved by the Departmeni of Environmental Protection and that the above analysis was performed by me.consistent with the required training,expertise and experience described'in 310 CNM 15.017. Signature Date 81 17 dcj Q:\SEPTIC\PERCFORM.DOC No .......<_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .............--.....OF.......... . . .................................... AVOiratillit fur DiiVa'Sal Blorks Tonotrurtion Permit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal system at: ...................... Z_0T r�..................................................................... ................................................................................................ a�t No. ................. ...... I '.......................... Address .......... ......... N-J ............................. ..............Instal.Installer................. ......... ........... .............................................Addres-s............................................ Type of Building r Size Lot.......;....................Sq. feet U Dwelling—No. of Bedrooms------------ Z.....................Expansion Attic Garbage Grinder 04 Other—Type of Building. ............................ No. of persons............................ Showers Cafeteria 04 Other fixture s ....................................................................................................... Design Flow..... ............-.--..-gallons per person pqr d 872;6_­­ ,#y.. Total c4ily 99w................... .......................gallons. Septic Tank—Liquid-capacity.l=.gallons Length..8'.6... Width;5.,.-A.: Diameter.................. Diepth.4.�((514 Disposal Trench—IN ................ Width.................... Total Length..................... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter..........r0... Depth below inlet.......:......... Total leaching area._2?7 .9.sq. ft.' Z Other Distribution box Dosing 9.1251 1.486 1.4 Percolation.Test,Results 2_ Performed by...... . .... .rQ....C. ..P. Date...................................... 2, 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.....(.�0_7 Depth to ground water...._. fir Test Pit No. 2................minutes per inch Depth of Test Pit.............._.._.. Depth to ground water........................ P4 ...........11.................................. ....... .................. .. ...........0— -4 ......... 0 Description of Soil. ..................... ........... 8 n d................................ ..... ............................................ ............................................ U � w - 132 ........................................................................................................................a.......... ­------- .......S4�19... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ................. ................................................................................................... ................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I TL U 5 of th St e Sanitary Code— The undersigned further agrees not to place the system in t t"operafto untpiertificate of lance has been issued by the board of health. SSigned...... Z......... ......................................... ............................... Dli Approved y....,�,pp ........ Appli on Approved By...................D ..............4...I... .....................7..... .. ..._?. v1 �1.......... Date Application Disapproved for the following reasons:.............. ............................................................................................... ....................................................................... ............................................................................................................................. Date Permit No............. . ......LL(R1 Isu .................... 2'- 4/05 . Da.te.............................. EB ... ... ` THE COMMONWEALTH OF MASSACHUSETTS try oBOA:RD OF HEALTH ..... QWj....... ... ...oF.......... 'ifil Tl . .. r , Applirtttion for Disposal Works To' nstrurtion Prrmit ` Application is hereby made for a Permit to Construct (+/ or Repair-( )'an Individual Sewage Disposal System at: 1 ................_ ....__...................................................................... ...............................--.......... ... .................................. ••• R�l� f� �.Location Address\`.A y 6-7 � Owner Addr Installer Address Type of Building Size Lot................ .. ..Sq. feet I; Dwelling—No. of Bedrooms............................................Expansion Attic ( ) -Garbage Grinder.( ) aOther—Type of Building ............................ No. of persons......................... Showers ( ) Cafeteria ( ) Otherfixtures .................................... ..............----•-.......................------. •....................... v Design Flow............................................gallons per person per day. Total dayily flow............. gallons. P q capacity! b'a gt _ Depth. - lt W Se tic Tank—Liquid ca acit 1[`a tn. llons Len h_65°..16'0. Width 4 N Diameter x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area:"*.. .........sq. ft. 3 Seepage Pit No........-.I.......... Diameter..........{a... Depth below inlet.......?......... Total leaching area..z I.d.sq. ft. Z Other Distribution box O Dosing tank ( ) Percolation Test Results Performed by....... _ ... ...._ Date... : ��.�.� .............. Test`P,it No. 1.. ........minutes per inch Depth of Test Pit....1--�J-..?-... N -, p p Depth to ground water...:............... Li Test Pit No. 2---------.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......................--------------------•-•--•...........---_...o...........----- Description of Soil..... �.' t!QGtY?'7 �SUC�SGt 1 /32 - /s J,.. f .gItyla 1 .....------•.............................. ..........._.................-- _ .1 u. �n � r� � r�1fi�C ....- •-- U Nature of Repairs or Alterations—Answer when applicable..........................................:................................................... ...................................•----•-----•-•-•--------•-------...---....-•----..............-----.........-------------•-------...---.....-----•----...............------•----•.................... A Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ` the provisions of LITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until/2-,Certificate of Compliance has been issued by the board of health. ., Signed...... ....................?I.......................................... ...........................�l'.. Application Approved By.... i' CtY� 1 � .- ......—: Date Application Disapproved for the following reasons:.............:......•-••--------•---------------------...........-•----------.....................•--........._ ---•................•---••-----•----•-•---................-•----.........---------•-----...-•-----••----•.........---....................................----......................--•................._ Date PermitNo....................... ...................... Issued.. ........ ....' .............. d' '/ D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... OF..................................................................................... muertif irttte of Tomplitturr TH 4S+S T�kEAT FY, That the Individual Sewage Disposal System constructed ( or Repaired ( . ) a c by..................-..........._---_.:... .............-••--•----•.............---..... . . ........ -• -•---..............................................-- at.... ......�...... 1 t` �/ f� / J v' ,ir�'s��ilkr �l I' �✓ f , 7 ,+ 'llr� �i' :� I". ........ .. .. ........... ......... has been installed in accordance with the provisions of Tl"'LE--,j of The State Sanitary.Code as described in the application for Disposal Works Construction Permit No...!�:�� ......l... I...... dated---........L.J� z-�a.y. f . ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... ''... :...::- c �.----•-•-•----•--.... . Inspector s ,�.t . .•/`_`l._.. ......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No:7...................... Fn......... Diu rrrutti orku Tunstru rtion f rrmit " - i / Permission is hereby granted ..... ....................••. •....�... ... t� Construct (� or Repair ( ) an Individual Sewage Disposal System at No...i UZ---- .......Cx' 1,c/gF-,�A Y 4ivZ7 h y�9 /'�� 13195�57 Street _ / as shown on the application for Disposal Works Construction Permit No k..>>GJ Dated......L o . ..............7...............--- —_ .........................................................._ DATE. M ���?� �a ' v 1 Board of Health z :.....................•-----•-....._ 8�.�iGs— S AB A E5 S L TONN OF l PRki T LE7 55 5QR 34. ___L-OT, 66 59,0 2o'MIn1. 2`I PEASTCs!J€ TOP OF IO'MIN. NG •$MKS NT 30 5 ES 5 �ONI STET? 75 �75 FOUND- - _ _ . -. _.. � _ 5ET FRo to 3 1 REaR l S- - -SEPTIC TANK D15T. BOX. LEAcwl4G FACILI-tY _ ------- l�rtll�t C,aounln covEE -- OPEC © S -- P�E . GAL. a5.37 55,10 4 55.61 000 , r 5532� 55 Or �G r a o s LOTS z- 0 qq,o I o SECTION- SELJACGES I to T. I/ WRSHED STOtJE i; SB _..._ TEST HOLE L065 DE5ICN FOR BE�RaoM �- c$_ _ �-O T 6 TEST 5Y: �9i��3��/1.S �� PERC.RATE< 0MIN./IN. ' 3O P 9 a� 3 � D �. FLOW RPcT DATE : � � L W E I I O GAL./DAY p v I. <I9 S C QL SEPTIC TANK 330 ( S) ,X� �# -REQ'O. SEPTIC TANK 1000 CAS ; F3EWCH M i�K �- .. ���/og m �- � gig 3s► =S6,o LEACHING FACILITY 25r 510F WA�LL� 10 6= 18$.9 (Z.S)=g71.0 G/b 27, EL �18r4`� r — BOTTOM ` ��2 = 78,5 (I.0)= 79,5611) ! 50/G 54,C s 7!�"— — TOTAL 266-" 5F. =549.S G/D wo — ( PIT 1O' EFF DIP.USE L EACNlNG r — C9AYFC — 6 EFF DEPTH � �N NOTES ® ( R ) LP \ >� /. DATUM(HSL)t TAKEN FkOM�YRN(.I I J QUADRANGLE MAP 5147 2. MUNICIPAL WATER IS AVAILABLE V 3. DBStel" LOAO/N!, FOR ALL PRECAST U1JlT5:AAk5No'c/Io-4q 56 0 Q,PIPE JOINTS SHALL BE MADE lJA7Frq T!(�HT, `� 3 -5. CONSTRUCTION.DETAILS TO 8E IN ACCORDANCE wrt40. i C01yM.OF MASS. STATE ENvIRONMEN�AG CODE TIME 7Z 6. TNl5 PLAN FOR PROPOSED MORK ONLY A140 0900LO NOf SE USED FOR PROPERTY: LN. 5TAKING. 1 ` r•• r �� v> . � �MOVL apt: uuSu�sar� M�rt`E�i�l. �ETrtEE�` / Ali 8} El-�V• 55.0 AI-sD <}9.p .roe. I.c, ¢S.rpofao OF G �i KLC-•I PI Q C)V-E pL A� - U,,W-i+ .p .. C✓�P P� 6ENA6E . PLAI�Y I: oJACA .LEGEND: .� down cape engineerir�q i LOCUS : LOT S, c-I;- 6ERRY .LW,I' Hl)PIi qlS civ� �ti ALA , o. 792. CIVIL ENGINEERS CONTOUQS REFERENCE: % 1a- _ 5348 c I (PROP, --o----0-- . �r � FCIS r1STLEs LAND SURVEYORS I - # - . . _ - ® CB PREPARED FOR=_ - 2 . Cole.BouND aA4'sl E �u I N DATE 11 N t JA i� iE` `� .. q2G MalnSt.YQrmouth,Ma TEsr NOL>: `Y Il- J - b �d of health SCA4CE . I - 50 9�2s 86 �oB -6S- 5i6 - S o 00 DATE• / NO APPROVED DATE. / l.ST�I�I-� ,rlA j SOIL TEST PIT DATA P 12689 1 000 GALLON SEPTIC TANK EXISTING (DB-5) RE-VISIONS # ( ) DISTRIBUTION BOX DETAIL 500 GAL. LEACHING CHAMBER �H-20� No. DA DESCRIPTION - -09 NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE 5" DIA. KNOCKOUT (TYP.) 1 10 PARTIAL STRIPOU TEST PIT -#1 TEST PIT #2 TEST PIT _#3 " REMOVABLE 3" - -- NOTES. ADD TP-3 NOTES 65.7 66.1 66.1 RAISE EXISTING COVERS 2 WALLS COVER 0 0 0 � m o o Q Q 1• SYSTEM SHALL ONE E RAISED GRD. EL. GRD. EL GRD. EL. SHGW EL. 54.87 SHGW EL. 55.43 SHGW EL. 55.43 1. INLET AND OUTLET TEES SHALL BE INSTALLED TO WITHIN 6" OF FINISHED e " 3' 0 0 0 TO FINISH GRADE. IN EXISTING TANK GRADE USING SEWER l7TTTl i'7TlT7Tl BRICK AND MORTAR AS 2. TEES SHALL BE SCHEDULE 40 PVC AND SHALL NECESSARY 9-1/2" O O �� �0 C�M 0 2. CHAMBERS SHALL IN GENERAL NOTES: �0 0 0 �C�L� 0� O O 500 GALLON LEACHING FILL FILL FILL BE LOCATED WITHIN 12 INCHES OF TANK WALL. 6" MAX NOTES: DRYWELL, MANUFACTURED " 0 0 0 BY SHOREY OR APPROVED 1. THIS PLAN IN ONLY INTENDED FOR THE Ap 16 Bw 13 Bw 13 . ,• 11-1/2 1. DIST. BOX TO WITHSTAND H-10 LOADING EQUAL DESIGN AND CONSTRUCTION OF THE SANDY LOAM LOAMY SAND LOAMY SAND UNLESS UNDER PAVEMENT, DRIVES OR SEWAGE DISPOSAL FACILITY. 10YR 2/1 „ 10YR 5/6 10YR 5/6 „ TRAVELED WAYS WHEREIN H-20 LOADING I 8'-6" 21 „ 2 BOTTOM ON LEVEL. SHALL APPLY. I" 2. ALL CONSTRUCTION METHODS AND Bw MATERIALS SHALL CONFORM TO 310 CMR LOAMY SAND Cl 2 Cl .•:'' . STABLE BASE 12-36" COMPACTED FILL 10YR 4/6 COARSE SAND COARSE SAND 6" MINIMUM 2. PROVIDE INLET TEE OR BAFFLE WHERE 15.000 AND YARMOUTH BOARD OF 29„ W/ GRAVEL W/ GRAVEL 3/4" TO 1-1/2" SLOPE OF PIPE EXCEEDS 0.08 FT./FT OR LOAM & SEED DISTURBED AREAS HEALTH REGULATIONS. 2.5Y 6/4 „ PRECAST SEPTIC TANK 10• - SECTION VIEW RUSHED STONE IN PUMPED SYSTEM. Cl 2.5Y 6/4 41„ 41 ., 3. THERE ARE NO KNOWN OR PROPOSED COARSE SAND W/ _ 3. FIRST TWO FEET OF PIPE OUT OF DIST. 2• LAYER OF I1W TO PRIVATE WELLS LOCATED WITHIN 150 FT. GRAVEL do COBBLES C2 - - T BOX TO BE LAID LEVEL �0 1/2" DOUBLE WASHED OF THE PROPOSED LEACHING FACILITY. 25Y 6/4 _ _ STONE ABOVE CROWN 4. IF AN OVERDIG IS SPECIFIED, REMOVE ALL C2 - F4. ALL PIPE CONNECTIONS AND CONCRETE 63" WhTM SENSE of FINE SAND GRAB SAMPLE LOCATE • „ CONSTRUCTION SHALL BE WATERTIGHT. 36." 21 / 0 0 � 0 OF PIPE * TOPSOIL, SUBSOIL AND OTHER FINE SAND de SILT 2.5Y 6/3 COLLECTED INLET TEE 90' ELBOW ON (5) 5 DIA. 0 0 M � 1=3 FROM APPROX. UNDER COVER 13" KNOCKOUTS 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. EFFECTIVE � " " UNSUITABLE MATERIALS. C2 „ „ 94 FOR SIEVE OUTLET TEE I Np. I DEPTH O 0 O � 0 3/4 TO 1-1/2 5. IF AN OVERDIG IS SPECIFIED, REPLACE SANDY LOAM 85 -,00 ANALYSIS / DOUBLE WASHED 6. A RISER SHALL BE PROVIDED ON THE 2.5Y 6 3 " " 0 0 0 STONE TO CROWN ALL EXCAVATED MATERIALS WITHIN THE 5Y 5/4 / 90 -100 . . ` • ' !• '' . ' . ,'• .:' L D TO NO LESS THAN 6 p INCHES ND ABELOW LL TFINISHED GRADE. �� OF PIPE LIMIT OF EXCAVATION WITH CLEAN PLAN VIEW - 4'-10" GRANULAR SAND, FREE FROM ORGANIC EL 54.87 130 EL 55.43 s 128 EL 55.43 _ 128 �- ---� GEOTEXTILE FABRIC MATERIAL AND DELETRIOUS SUBSTANCES. „ _ „ _ „ CROSS-SECTION VIEW 21" - 12'-10" MAY BE USED IN LIEU OF DOUBLE WASHED STONE MIXTURES AND LAYERS OF DIFFERENT PLAN VIEW CROSS-SECTION CLASSES OF SOIL SHALL NOT BE USED. NOTES: a FILL SHALL NOT CONTAIN ANY MATERIAL \ LARGER THAN 2 INCHES. A SIEVE 1. NO GROUNDWATER OBSERVED `III TS DESIGN CALCULATIONS 2. NO REDOXIMORPHIC FEATURES OBSERVED ��fCrR ANALYSIS USING A #4 SIEVE SHALL BE 3. ENGINEER TO VERIFY EXISTING SOIL CONDITIONS PRIOR TO INSTALLATION OF LEACHING FIELD. PLAN NOTE: \ It EXISTING FLOOR PLAN PERFORMED ON A REPRESENTATIVE A PARTIAL DIGOUT IS ANTICIPATED DUE TO THE PRESENCE OF UNSUITABLE SOILS (SEE PLAN). \COAj SAMPLE OF FILL. UP TO 45X BY WEIGHT LOCATION AND SIZE OF EXISTING SEPTIC \NY £CIS MAY BE RETAINED ON THE #4 SIEVE. SYSTEM COMPONENTS WAS OBTAINED OPEN SPACE \ \NT SUCH ANALYSES MUST DEMONSTRATE FROM RECORD PLANS ON FILE AT THE DESIGN FLOW: THAT THE MATERIAL MEETS EACH OF THE Q,O.g; SEPTEMBER 17, 2009 _L ESI,MATED \ SEASONAL HIGH BARNSTABLE HEALTH DIVISION. \ 3 BEDROOMS ® 110 GPD/BDRM = 330 GPD FOLLOWING SPECIFICATIONS: TEST BY BSC GROUP, INC. GROUNDWATER DECK10OX MUST PASS #4 SIEVE WITNESSED BY DONALD DESMARAIS, R.S. UNFINISHED FINISHED 10X MUST PASS #50 SIEVE REQUIRED SEPTIC TANK: 0-20X MUST PASS #100 SIEVE PERC. RA < 2 MIN./INgH (SEE SIEVE ANALYSIS) TEST RANGE E ANGEATON N84'03'SO W 56•84' 0-5X MUST PASS #200 SIEVE TE: SOIL EVALUATOR: BRIAN YERGATIAN, P.E. IBATH KITCHEN BED #i 330 GALLONS X 200%b = 660 GALLONS 6. EXISTING UTILITIES WHERE SHOWN ON THE SEPTIC TANK PROVIDED = 1,000 GALLONS PLANS ARE APPROXIMATE. THE ENGINEER SOIL CLASS: CLASS I UNSUITABLE GARAGE I BASEMENT FLOOR DOES NOT GUARANTEE THEIR ACCURACY MATERIALS I OR THAT ALL SUBSURFACE STRUCTURES L.T.A.R.; 0.74 GPD/S.F. (TO BE REMOVED) I FAMILYRODIM LIVINGROOM BATH SIZE OF LEACHING FACILITY REQUIRED: ARE SHOWN. CONTRACTOR SHALL VERIFY LOT 5 THE SIZE,N� � LOCATION AND ELEVATION OF INVERTS OF UTILITIES AND STRUCTURES, o LOT116 � / DESIGN PERC. RATE: <2 MIN/INCH21',225+ S.F. WITHIN THE LIMIT OF WORK, PRIOR TO THE DATUM 1 7,563+ S.F. / BED #3 BED #2 LONG TERM APPL RATE: 0.74 GPD/S.F. START OF CONSTRUCTION. IF ANY FIRST FLOOR 330 GPD = 0.74 GPD/SF = 446 S.F. DISCREPANCIES ARE DISCOVERED OR FIELD CHANGES REQUIRED, THE CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY. VERTICAL DATUM: ASSUMED \ SIZE OF LEACHING FACILITY PROVIDED: 7. THE CONTRACTOR SHALL BE RESPONSIBLE #130 EXISTING 3 BEDROOM DWELLING SECOND FLOOR FOR PROPERLY COORDINATING THE ? / \ \ 1 USE (2) 500 GALLON CONCRETE CHAMBERS PROPOSED CONSTRUCTION ACTIVITIES WITH BENCH MARK SET: HYDRANT TAG BOLT, ELEVATION 68.64f MSL SIDEWALL AREA = 2(25' + 12.83') X 2 = 151 S.F. DIG-SAFE AND THE APPLICABLE UTILITY 1 f COMPANIES, AND SHALL COMPLETE THE Cog SHED `--67 �� \ BOTTOM AREA = 25' X 12.83' = 320 I PROPOSED WORK WITHOUT ANY �" �� N 6� ` + 4" PVC 471 S.F. INTERUPTIONS IN SERVICE. ° STEM PROFILE GOOSENECK ZL -%;0N'iRA'-'T(* is �QUIRLI) TO Nuq '.' 471 S.F. X 0.74 GPD/S.F. = 348 GPD tP -� \� DIG-SAFE, PER MASS. STATUTE CHAPTER NOT TO SCALE i� \w 82, SECTION 40 (1-888-344-7233) A MINIMUM OF 72 HOURS PRIOR TO THE �p. PVC 3' FIRST PIPE LENGTH TOP FOUNDATION FINISH GRADE START OF CONSTRUCTION. �-A \ s7---� ` 1 VENT STACK (MIN.) 9. THIS SYSTEM IS NOT DESIGNED FOR THE ,/� CONCRETE COVERS TO WITHIN TO BE SET LEVEL \ \ -- \ USE OF A GARBAGE GRINDER. &EL 67 6" OF FINISHED GRADE FOR MIN. 2' FINISH GRADE t °� / \ INSTALLATION OR USE OF A GARBAGE =g _ 7 \ < �8\ \ GRINDER AT THIS PROPERTY IS NOT 4" PVC SCH 40 DECK 3' ALLOWED PER 310 CMR 15.240(4). ;*5:t C (MIN.) LOCUS INFORMATION 4" PVC SCH 40 \ � /�/ 711 0000000000 \ / #128 =B I=D I=G o000000000 ( EXISTING 3B I= LLON E I=F H i ` / / 1 SEPTIC TANK ANK 2&4 D OWNER: RI HARD & NANCY KNIGHT BSC GROUP I=C 5 OUTLET I OUT -63.76 CURRENT0 E C DIST. BOX 5.81' SEPARATION ( )= \ 1 GARAGE TO LEACHING PIPES 349 Route 28, Unit D SEPTIC TANK J \ , / l \ TITLE REFERENCE. DEED BOOK 7271, 252 W.Yarmouth, Massachusetts EST. HIGH GROUNDWATER � �, � DECK PLAN REFERENCE: BOOK 426, PAGE 8 02673 TYPICAL VENT SYSTEM 5087788919 1-1 F ASSESSORS MAP: 234 EXISTING NOT TO SCALE PARCEL:- 066005 Q 2009 BSC Group. Inc. SCHEDULE OF ELEVATIONS 11,000 SEPT1CATANK PROPOSED c F � i(OUT)=65.30 \\ ZONING DISTRICT: RF-1 _6 SETBACKS: FRONT 30' PROJECT TITLE: \ (2 500 GAL #130 EXISTING \ --- SIDE 15 N \ LEACHING 3 BEDROOM % , REAR 15' AMBERS DWELLING DESIGN FOR TOP OF FOUNDATION 69.30 A a / _- •� � 4" INVERT AT BUILDING UNKNOWN `� �� \ ��e. �� ci ' MINIMUM LOT SIZE: 43,560 S.F. „ t SEWAGE DISPOSAL \ ` PROPOSED EXISTING TOTAL LOT AREA: 21,225t S.F. 4 INVERT AT SEPTIC TANK (IN) 64.01 C (EXISTING) � _ , \ o \ D BOX �\ NITROGEN SENSITIVE SYSTEM REPAIR 4" INVERT AT SEPTIC TANK (OUT) 63.76 D GARAGE /\` \� �� �` \ ZONE: ZONE II 4 INVERT AT DIST. BOX (IN) 63.65 E Zy ?�` ,....: .,o• 5 F FEMA FLOOD 4" INVERT AT DIST. BOX OUT 63.48 F / ` n,_3 ZONE DISTRICT: 25 DATED 8/19/85 #130 INVERTS AT LEACHING FACILITY: \s t 10.01 EDGE OF °o �. �� ss OVERLAY DISTRICT: GP CRANBERRY LANE S \. -,� _ STONE y. �., \ 22.1 --,. TP 1 4" INV. AT LEACHING CHAMBER 63.24 G (BREAKOUT 63.74) ' '" ' PORT _ / CENTERVILLE �•••� ��� ���� PORT -_ _ � � LOCUS C U S MAP P ELEVATION AT BOTTOM OF CHAMBER 61.24 H CONSTRUCTION NOTES: -\ `VT MASSACHUSETTS SEASONAL HIGH GROUNDWATER 55.43 J 1. CONTRACTOR SHALL REMOVE EXISTING Ns '29"E 113.81' �� NOT TO SCALE DISTRIBUTION BOX AND LEACHING PIT ANTICCIPA D BENCHMARK HYDRANT IN ACCORDANCE WITH TITLE 5. LIMIT FOR REMOVAL OF TAGEL 8 6 t MSS / UNSUITABLES/OVERDIG ,a �' ♦ N .65 _ N, LOCUS PREPARED FOR: CPENSPA C ,32 BLUEWATER HLD f C4 350 ROUTE 28 � � 6 J � R H� WEST YARMOUTH, MA 02673 N B E� L'WW OF M TOWN OF BARNSTABLE REQUIRES AS-BUILT R (508) 775 2800 4S rtf' Sq , cy CRAIG a 50 �p o� CERTIFICATION. SOIL EVALUATOR TO wide LANE BRIAN G. _ FIELD �, e � YE GAIAN No.38039 INSPECT BOTTOM OF EXCAVATION PRIOR CONCRETE p HE�ND Ry� DATE: SEPTEMBER 29, 2009 ,9 No.46o TO ANY INSTALLATION AND ALSO PRIOR 'I'F �o� COMP. DESIGN: B. YERGATIAN 01 . TO FINAL BACKFILLING. CHECK: K. HEALY ��FSS/ON � lNrD � CONCRETE HELD ND �� -� PLAN VIEW a-7 DRAWN: P. HAGIST t Q ` `� _ �9 CONCRETE BOUND �J FIELD: P. HAGIST SCALE: i" = 20 FEET FOUND & HELD FILE NO. 4944600-SEP.DWG DWG NO. 5968-01 0 10 20 40 FT. JOB N0. 4-9446.00 SHEET 1 of 1