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0094 ANSEL HOWLAND ROAD - Health
94 Ansel Howland Road Centerville A = 172 233 v o i 1521/3 ORA 100/0 pg No. /`r' Fee 7�_v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for Bisposal *pstem tonstrULtion Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.W--4AJ5 (. HCI W IAIU Owner's Name,Address,and Tel.No. vtC f`; ALA JC!Ltd& RLlf+,kj Assessor's Map/Parcel1 P7�k �q AA)ssLa -6 wLAk-76 RQP C`kjfcc.5- Installer's Name,Address,and Tel.No. .5,02 17 $$7 7 Designer's Name,Address,and Tel.No. dAP&LOW6 ee,.=Z64PAU&GS LLB N1A �t r �T l`t NPR 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.required) gpd Design flow provided gpd 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) S t ALL 56-01114 t EC Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r- � Si � Date ;L Application Approved by Date Application Disapproved by Date for the following reasons Permit No. c9e/ 77 Date Issued — I i .Fee 75 - --- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for disposal Opst(m Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System 'Individual Components Location Address or Lot No.914-AN56(, MoWiAIJ 1a Owner's Name,Address,and Tel.No. �'v«cC FRa►Uc�NC R�r(r�l Assessor's Map/Parcel 1 I7 a.3 3 A0.ss . a 1 _A.%j6 R(> 0- i J1(_L6- Installer's Name,Address,and Tel.No.Sd a —411 ":9$Z 7 Designer's Name,Address,and Tel.No. CAOEwIaE Clui(�2p�ef�s� .Ml~�C 1�t3C I T M : SE-FPc� N 1A 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.required) gpd Design flow provided gpd 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) Y S LL SAAA T*41" TE 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 Certificate of Compliance has been issued by this Board of Health. Si Date I" a Application Approved by Date '' (� Application Disapproved by Date for the following reasons Permit No. c9e/ 6 — c7`5 77 Date Issued ----------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS SV Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�() Upgraded( ) Abandoned( )by CApC—(0j 1 DC e NTrx[?a1,_5 p7 LC at 54 G[.,_ HQ&J4,A&jb RoAb has been constructed in accordance 1 M with the provisions of Title 5 and the for Disposal System Construction Permit No_gob `-�2$7 dated Installer &—it a 6 E'A)7-E R P fJS ES L L.C,,,,. Designer #bedrooms Approved design flow/`l, gpd The issuance of this permit shall!not be construed as a guarantee that the system willD&��j ion as d signed. Date —7- �j Inspector 01 o i No. �t0 a S Fee 75 __. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Nsposal 6pstem Construction i3Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 9 4 �/U� �� w( p �►. J((.LC 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. i Provided:Construction must be c m leted within three years of the date of this pe it. Date J Approved by 1 commonwealth of Massachusetts F Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Michael Kellett cursor-do not Name of Inspector use the return key_ Aardvark Environmental Inspections Company Name P.O. Box 896 Company Address 02641 East Dennis MA ,euun State Zip Code Cityrrown S 508-385-7608 License cense Number Telephone Number i 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 ' pection`-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 pursuantctoi Section 15.340 of Title 5(310 CMR 15.000).The system: I ® Passes ❑ Conditionally Passes ❑ FaQls ` ' ,r , ❑ Needs Further Evaluation by the Local Approving Authority I � 11/23/07 Inspector s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t5insp•08106 Commonwealth of Massachusetts F ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 i Commonwealth of Massachusetts r - Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 94 Ansel Howland Road Property Address Andreia S Iva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 t5insp•08106 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. ► 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. t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia S Iva Owner Owner's Name information is MA 02632 11/23/07 required for Centerville City/Town !Town State Zip Code Date of Inspection every page. Y 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 now 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? ® El information 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 om ® ❑ 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)] Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 t5insp•08/06 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every page. CitylTown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 4 Number of current residents: — Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Sump pump? ❑ Yes ® No current 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: Last date of occupancy/use: Date Other(describe): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments , 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and El maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 5 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 t5insp•08/06 i Commonwealth of Massachusetts tz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia S Iva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Building Sewer(locate on site plan): 2.0 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 1.4 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ---------------------------------------------------- 1000 gal Dimensions: 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 27" 2" Scum thickness 10.1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" measured How were dimensions determined? Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 t5insp•08106 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 94 Ansel Howland Road Property Address Andreia S Iva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. Cityrrown 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.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ 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.): 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 t5insp•06/06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is Centerville MA 02632 11/23/07 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): no box present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•Oa/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): This system has one leaching galley surrounded by three feet of stone. There was no sign of ponding or failure seen in the stone. l5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wMg0 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every page. City/Town State Zip Code Date of Inspection D. System information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 94 Ansel Howland Road Property Address Andreia Sylva Owner Owner's Name information is required for Centerville MA 02632 11/23/07 every page. City/Town State Zip Code Date of Inspection D. System information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �a `t by t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 94 Ansel Howland Road Property Address Andreia S Iva Owner Owners Name information is Centerville MA 02632 11/23/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells 25 Estimated depth to 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: USGS Maps show an elevation of over 25 feet. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 t5insp•08/06 t yg Fee No. C.C./� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppftcatton for Otgpo0ar Opotem Con.4tructton Vermtt Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot Noqq W Owner's Name Iress and Tel.No. Assessor'sMap/Parcel ^ .� qL1 Nyl� Jda1 r Installer's Name,Address,and Tel No � �333 Designer's Name,Ad ressand Tel.N t'JQ Q gNtid S o4/l 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 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) <�' e I1 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 f Title 5 of�thheEnv�iironmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ss a . igned Date Application A rove Date rr rr Application Disapproved for the following reasons Permit No. cD::jQ 5 —010 Date Issued 3 1 b j. Now s /Oi` �' Fee S • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zippli a.tiort for 30igpool *pgteui Conotruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot Nogg Wwg 0 Owner's Nam , dress and Tel.No. Assessor's Map/Parcel a.3 3 \ n 021�32 Installer's Name,Address,and Tel.No. o. Z-106 -m 3$'211 Designer's Name,Address Tel.No. �� Q q►{t S ov1 • c�eX1 �e YYI � 'I Px l`V, re ., � ' 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 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) 'D P A -? , 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 issu Eby and of`' alth. igned Date t Application Approv " Date ��b���`� Application Disapproved for the following reasons Permit No. S —2�G Date Issued .3 / 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 .� , 1) 7 f�(nc I.1�or n,aj rn at rt/P. �ca►n i �+�r5 . �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �c,�Q F,� I�f,nt Designer The issuance of this permit shall not be construed as a guarantee that the ys em wi 1 fti tion as esigned. Date / (o a/0 Inspector _ No. (/`..sir) ^�©9 ------------------------- O Feed—� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS Migpoga1 *pgtem Construction Permit Permission is hereby granted to Construct( )Repair )U grade( )Abandon( )11__ j System located at �ti 1 .� �W 11! _C CO,�1 t� y 1` 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 rust be completed within three years of the ,ate o:thi�ss�pei . Date: 3 / �b � Approved by DEED RESTRICTION The Barnstable Board of Health has determined that based on State Environmental'Code, Title V; 310 CMR Section 15.203(2) and 15.214, the following restriction(s): - Existing dwelling restricted to 2 Bedrooms be placed on the property located at 94 Ansel Howland Road, Centerville,MA 02632 Map:172 Lot: 233 as property referenced in the Deed File in Book 3350 Page 123 at the Barnstable County Registry of Deeds, as it deems those restrictions necessary to protect public health and safety and the environment per the State Environmental Code, Title V: 310 CMR Section 15.413 (1). 1, James Hogan as owner of the property referenced above acknowledge the deed restriction(s)being placed on the property. a4lt,� G'� 03/11/2005 Ow f s Signature Date The person named above: James Hogan Acknowledges the foregoing instrument to be his/her free act and deed,before me. of ubl c Kar n Janette Boduch My Commission Expires: 09/19/2008 y'6 t n this eleventh day of March, 2005, before me the above signed Notary Public, personally appeared James Hogan, proved to through satisfactory evidence of identification, which was a Massachusetts Driver's License, to be the person whose name is signed on this document in my presence. RANSTABLEREGISTRy OF DEEDS 9/16/03 Notice: This Form Is To Be Used For the Repir Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated concerning the property located at kVUJ LAr4)9 4 AV meets . all .of the following criteria: • This failed system is connected to a residential dwelling only. There are.no commercial or business.uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) J B) G.W.Elevation +adjustment for high G.W. _ DIFFERENCE BETWEEN A and B /klo W i Win- SIGNED : NOTICE Based upon the above information,a repair permit will be issued for Z- bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptictpercexemp.doc Town of Barnstable °F "E Regulatory Services o Thomas F.Geiler,Director IM"Srasr e. 9 MAC' � Public Health Division i659 .0 RTFp Mp;�,, Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ((e, Q Designer: � installer: P Mkc(/P%sa� Address: . 7 Address:. 1 bS J � ��cfoJ�� was issued a permit to install a (date) (installer) system at e7 q A->-?',_-e.-1 kk?Ll" 4 based on a design drawn by (address) bk4u,,,-, M ACAV� dated l j (designer) T.,-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. OF MgSSgcyG DR M �+ taller's Signature) �,� 0 M N 11 0 I o FcisTE�� SANITAR\ (Designer's Signature) x Designer s amp Here) PLEASE RETURN TO B STABLE 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. i a Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE LOCATION ? y A Als el- iln ae L /g AZ ZaEWAGE # VILLAGE C' a w�f-P tf/!!P � ASSESSOR'S MAP & LOT! Z INSTALLER'S NAME&PHONE NO. f SEPTIC TANK CAPACITY LEACHING FACILITY: (type' r /7/, (size) NO.OF BEDROOMS_ . BUILDER OR OWNER . PERKITDATE: COMPLIANCE DATE: Separation'Distance Between the: j: 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 ary wetlands exist within 300 feet of leaching facility) Feet Furnished by d 1 i Q I /,vr ` TOWN OF BARNSTABLE LOCATION ? Y A /1/S PL inn W- /¢&JZ- &aEWAGE # VILLAGE r yI«e ASSESSOR'S MAP & LOT 1 7 Z- 2, INSTALLER'S NAME&PHONE NO. AA 9 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /7,< V Lze� 2L4 (size) NO.OF BEDROOMS x 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 h Furnished by f Q� L�: - `I ` L O CATION S WAGE PERMIT NO. VILLAGE v INSTALLER'S NAME i ADDRESS BUILD R OR OWNS DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 210, sl r e ' 39 66 5� No.............. Fizz.... -�....._........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �- ... OF.................... ...... ....... ---....................._..._.... Appliration for Ditipos tl Workii Tnnitrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systems at.: _..N- -•- Location• ress No • Address -•-- -------•................................ s,0pvn � Installer Address Type of Building Size Lot./�?`•_. !e .-..Sq. feet Dwelling—No. of Bedrooms...............................Expansion Attic ( Garbage Grinder (G aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------•----•-----------•-------- - Design Flow....................7-�_'.__a-•C::,..........gallons per person per day. Total daily flow....... .. 5 gal WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No.... ....... .�Width .........._._.... Total Length............ Total leaching area....................sq. ft. Seepage Pit No.....J._ -- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•••••••••••-----------•--•••-•••••...•••......••••--•-•-•--•................•••••...---•--.._...---------•--..........---••-•-••--••-----•---._...-•--•.•.- 0 Description of Soil............................................................•---------------....------------------------------------•-----......------------------------..........•••--- x w ----•--------------------------------------------------------•-------------•----------------------- --------•--------------------------------------------------•-----------------------.......------••- 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 TTTTIE 5 of the State Sanitary Code—The undersigne further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oard health. Ked... .. ................... ,r ?t.... Application Approved By........... •-- -• r`......•..............•--•-------.............:...................-•-•- . .--- �C_ ... �/ate Application Disapproved for a ollowing reasons: .................................... ---•-•--•-••••--••--•---•-•••-•-•••----•......----•-••-••-----••-•••.......-•--••---.........•-----•.......•-•--•-----•••-----••----•------•-----•-••--•••-••........................................... Date PermitNo......................................................... Issued_....................................................... Date No... ': � ; ,. Fes$..... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..........................---............----.------------------------.................... ApplirFa#ion for DhipwiFai Workg- Tomitratrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_--.............................................................................. ....................................................----.......................................... Location-Address or Lot No. ......................__........................................................................ ---••....._................----•----.....------....---........---......••.....................•-•- Owner Address W Installer Address QType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No., of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------•-• "_-- ,�-,. --------• -----•-----•---------------------------------------------------------- .............._.. W Design Flow.........................................gallori�r;person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid cap�acity�i .gallons .' Lerigth................ Width................ Diameter................ Depth....._.......... x Disposal Trench—Noa:.,_...._...............Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------7........ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of-;Test Pit.................... Depth to ground water........................ Gi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•----------•-•-----------------------••-••-•-•-••-•----..................._.......-------•------....-----•----••----••-•------•--•--•••-••••-••-----.--•-- 0 Description of Soil........................................................................................................................................................................ x U ------------------------------•-----......---------••--•-•-----------------•----------------------------...----------------------------------------------------------------------------.........._------ -------------- -----------------------------------------------------------------------------------------------------------------------------------------------------•--------------•-----------...------ 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 T I':Lip 5 of the State Sanitary Code— The undersigned further agrees not to place the system in . operation until a Certificate of Compliance hasJoen issued by the board of health. ....... ..................................................••--------•-----•... ............. . ...... ate ApplicationApproved BY-----------. ....................................................................... .......'..... ............��. ate Application Disapproved for -he oRowing reasons:.........-...................................................................................................... •-•••--------------------•-•••-•---------••--•--•...---------•--•-••--.....-•----•--••-----------------....--•-•-----•----------------------------------------------------------•-------................ Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... TrrtifirFatr of Tontph anre T SIM CERTIFY, That the Individual Sewage Dispo ' System constructed ( .,)116r Repaired ( ) by ------------------------------------ -- ;; '?/..------.,t' ------------------------------------------------------------------------------------ `, r.. estaller - has been installed in accordance with thprovisions of TITLE i L 5 o T e State Sanitary Cod as r>h in the application for Disposal Works Construction Permit i�'o.__ ... .._ dated.. .C.._-__ ._._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE/CONSTRU ® AS A GUARANTEE THAT THE SYSTEM WI FUCTION SATISFACTORY. DATE....� �_..�' Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F.........................................--------.........._.._..._.................. No.. .......y�.'...../ .. Dispos nrkii (Dnnstra ion rrntit Permission is h reb ranted----- :------..... Y g -,s to Construct,( or Repair ( ) a 1v Se is al 5 atNo.........................................a__ ._ .._...... ....._........ `"... . Je Street , as shown on the application for Disposal Works Construction Permit No............. .... ated.._.._._..._.__..........._............... i 1/�, oard of Health DATE..4 . --------f.../ ----------------------•-- f FORM 1255 ORBS & WARREN. INC.. PUBLISHERS C _ J `o1Ad6Lc FAM1L-`! - :3 BEORoON1 {JO :, �RBA6E• GWNDE2 FI-OW a I10 X 3 = SEP�TIG TA*JK = 330x15c>% 1 o o o GAL. jf/GQ�/D o15Po5A1_ PIZ' v5E � �.1�• 150 5.F x �•5 375 G.1?D, 50TTOM AREA= . �0 !�F• `` 5� $.F X I o F eiST/mot/5 - j PE2COLATIoN RATE : 1''IN 2MIN OP-LC--55 i� BICHARD ALAN lei.� BAXTER y o W. Na 2.t�48 70NES I 171 p oA5t00 _ 0 StlRV6 70P, -TV H'P L-� TlQov 5v[3SGi� 0ST• INS rAPT .S3 3 ti �6PT�G I 000 INV. Sa ve/ Gay.. $Z.S 45eAV4-L L�ACN PIT INV. INV. S • yl r WA S%A r D • ���� 6TvNt~ GERT{ FICD PLOT P1'_A1J �z PRUFI L� 4/,0 L o C AZ_I o N GE V-I5k\A U 1E "s P40. 5CAL. : SCALE I P 1...A N REP 62EN GE i T N AT ?N E F��►.{DaTlo� 5l10 4YN Nrr,REo►-I GOMFL' 6 YJITVA S 1 oti=Llt� i AWP S6TreAr1�, �Z.6Ct�►R.EMENY� oF 'TNE- �oT 33 ► -(oWN OI= L-�Ac�-NSTA- -c ANC IS N�T� GEt�TE�VIL��c N16H1.,4ND5`' LOCp.TED WITN W T1-AE GLoaD PLAIN �✓EGTIa.I DAT NYE INC. R.E61 to 6Q6U'1-Aw D 5 u Q.v "T%AI NO-T a�`5F� �� AN OSTE2VILL�- - 5• Iu,5TR•UMENT '5V Y J.-rNE oV-F5ET5 SUou� 1�1„ ! sM No-r DE •V5E.D'TO �ETE.�1^ItiI� Lo'C III-lE�j APP�.ICA►�'r . A L-L.-�lK1G- i p : f 1 i F d7 �I NOTES. 3 � � �• 4 AssEssoRs MAP : TEST HOLE LOGS 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH 3o co a PARCEL : �j�j p Z R.S, CS e S PLAN, 1995 MASSACHUSETTS TITLE V & TOWN O u '� SOIL EVALUATOR : HyF 4 ' I �o 0 bN Zf�'12 S L,C-. BOARD OF HEALTH REGULATIONS. �+ FLOOD ZONE : N �� WITNESS: n � �l�P N OF UTILITIES TNI l �. � DATE: -{? Pt'�R Z THE INSTALLER SHALL VERIFY THE LOCATION ZUO� , 2) , UM REFERENCE: BY-- 335� PERCOLATION RAT : G. �nLJ SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO q r R G INSTALLATION. 4 0 23 s ( w . p c�ass z 5 01�, , 6,� �d Y G f+ o Ri .. FOR SEPTIC SYSTEM INSTALLATION va Fo ,,, u - - 10 TH-2 3) THIS PLAN SHALL BE USED O y o � r,+ O TH I �. . rj ONLY AND SHALL ` NOT BE USED FOR PROPERTY LINE v S DETERMINATION. Ay 3 o .o h yGf �' l6 R �y 0 -- � P�A-�. _ _ `f it �. - rJ D 1/8 / FOOT. UNLESS s ciR tP 4) ALL PIPING TO BE 4 SCHEDULE 40 @ � f (2 Iq WO S SPECIFIED OTHERWISE) rawN�O J �� _ 1 ., L/t a S ( 7 pA't fl r E$_ t_.-:__ S IN I _- `�� _,r--fir -� , l�'f� y 4Z _S3.S0 DESIGN F THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 5) THEO /J1�T - L OCAT I ON MAP C ) � t UJ►�) J GARBAGE DISPOSAL. - r . _ 6 SEPTIC TANKS AND DISTRIBUTION .BOXES (WHEN INSTALLED) , 52.0� MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON S b ABASE OF 6 OF CRUSHED STONE. *2 S-,� 7) t vrvt,o Cf-V/-!F ca a�s�'rz t5o�. wl ot� PAW, hlo i*ovvo PO4u w h p M u 'I). �o wEas w ►n! isv of- t,� .� o � . I o�z� S PTiC� SYSTEM DESIGN - - - - —. _ Nb VA Q►g1vl.�� TLE 1/ 0�?TwrJ5, mm ? op - FLOW E!,T i MATE L�D 6 �'LT14 v —loin �1 t v1 IQ.t.D N \ I Z-BECROOMS AT 110 GAL/DAY/BEDROOM GAL/DAY 1 I ► _ � 2 P� ono R-�ST�c,� I SEPTIC :TANK p i 1 2.2�) GAL/DAY x 2...DAYS 4-4t� GAL I°r f USE GALLON `SEPTIC TANK E. l DU � Q 1 G�U X�Stl� �Iw� � ,S . . CN.OTf 7 �-I 1 r-�r •�`,, SOIL A'�..SORPT 1 bN SYSTEM h �•' L ;� v D+m e ae vyoockz,lzev 41 El VDU 0 �L r fF 5 � lhra R 4 ._ • o 1 x 7 7. 2- � - . 1 DE AREA. 1 � .-� � � I r o _ I O��` AREA.. i(:o ,> k O- E3T1 i'3 x h 3 , y ZZo 6 'D r ; e1 . � � s SEPT-1 SYSTEM SECTION CONct PATIO n t - E i IS T NG E X � N - — EL L �e- DW 1 0 , _ i 1a t Tl 5 3So 1n54� ( N Elk 53.t"o2 2 8 k kJa frit! FNDN o T S Gas �► OF `s_ z v o t TOP +_ .S +c 0 I l EL 57.51 a r�w3, o �, BOX C 3. I m 5 r tIl 1 00o GAL Q ) SEPTIC TANK 1 o Z i bil E E 3 ► � � K lSn Q I �o � 3 � w tl W hc as �12 , U Qo d S� 5 0 r > o 1 _ z a . W w o n .� TP of TEST Noc.� � : cL f t o€ 16 �(N M r 9 � - s � _ � SITE AND SEW AGE PLAN O o R E cr H ; _ _2_al- . LOCAT ION : � � 1> D 1w P NT / F D S N.TR PREPARED FOR 1-9�mc-S 111zK 47t)0o vv SELL AN rI,I b J DARREN M. MEYER R.S. SCALE . 0 i DATE: Z Or 0 P.O.-BOX 981 _ < EAST SANDWICH, MA 02537 W HEALTH AGENT 8 362-2922 DATE HE L H Ph (50 ) j