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Home My WebLink About1052 CRAIGVILLE BEACH ROAD - Health 1052 Craigville Beach Rd. , Centerville A= 206-135 1 i !i No. 42101/3 ORA 29 0sK ESSELTE 10% (* 0 0 0 0 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, f r ' use only the tab 1. Inspector: key to move your cursor -do not Matthew Gilfo use the return Name of Inspector key. B & B Excavation,lnc. raa Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-12-14 Inspector's Si ature f Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 OffilInspectiV:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water 1 ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200'feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No 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: Summer2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address P Y Alfred & Eileen R mill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 8 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.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 2"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: no sludge t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. Tank not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection d-box appears to be in working condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ - leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure or carryover Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CGM , 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is Centerville Ma 02632 6-10-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill infor Own mation is Owner Owner's Name required for every Centerville Ma 02632 . 6-10-14 page. Cltylrown . State Zip Code Date.,of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,.including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately A 4 r TT PirSk f i oor of hdusa,. V Vent (31- Z3'6" 10, b3 C2 - Sa� t3- 23`6" t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 76" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Nov 6-14 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: Plan on file at BOH showing observed ground water at 76"with ground water 4' below system Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1052 Craigville Beach Rd. Property Address Alfred & Eileen Rymill Owner Owner's Name information is required for every Centerville Ma 02632 6-10-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 'q 7 TOWN, L O /RKS LE LOCATION /� i U� j SEWAGE # ' AME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S (size) ,�1 1� NO.OF BEDROOMS BUILDE R OWNER �/C PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: 6 Maximum Adjusted Groundwater Table and 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 f t of levLc ' g cili Feet Furnished F � - � � <� �� I� .. �� , 130 No. Y Fee � ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Miooal *p$tem Cow5trU.Ctton joCrmtt Application is hereby made for a Permit to Construct( )or Repair(k/0)*an On-site Sewage Disposal System at: Location Address or Loft/No. Owner's Name,Address and Tel.No. e �we4 cew.> 'Illfe /Od"z cr,71414, /e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building /��sJ e1�IGe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I gallons per day. Calculated daily flow �Srt� gallons. Plan Date Number of sheets Revision Date Title 51 Y-e �- fe_4,y q .1/X'Y O-got IO S-7 Graiy��ic d��l�! Description of Soil Nature of Repairs or Alterations(Answer when applicable) DESIGNING ENGINEER MLST SUPERVISE Date last inspected: INSTALLATION AND CERTIFY IN WRITING Agreement: THE SYSTEM WAS FALL®I1M STRICT ACCRRDAbNNE p The undersigned agrees to ensure the construction and maintenance of the afore escrt a on-Tt2 'ge disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this f HoOth. Signed Date Application Approved by Application Disapproved for the following reasons Permit No. Date Issued ——————————————————————————————————————— ��> .,, a, �.r�a ^-•.,. 'f` .g; �. '� _ - Fee 4), THE COMMONWEALTH OF MASSACHUSETTS 4 PUBLIC HEALTH)DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZlppYtcatfon for Migpool 6pgtem Construction permit Application is hereby made for a Permit to Construct( )or Repair(�n On-site Sewage:6isposal�System at: t Location Address or Lot' o. Owner's Name,Address and Tel.No. crv/�y�i�P�b�c��! z cra/ i C-ow,4e `vi Ws Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7- Type of Building: Dwelling No.of Bedrooms Garbage Grinder(140 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ila gallons per day. Calculated daily flow S�S'-d ' gallons. Plan Date Z 9 Number of sheets / _Revision Date Title Sf.'71c )1-Jre"1 001 �/v# o-i /0_5`77 G1g/y�r/T Description of Soil . p ,Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' Agreement: F The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system �,4 in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this ao f e lth. / Signed d Date �l� -! TV Application Approved by Application Disapproved'for the following reasons Permit No. R Date Issued { ——�---�..— .— .— is—. _—__ ___—-----_—______�__ THE COMMONWEALTH OF MASSACHUSETTS 7 C�'& PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certifirate of Compha�nce THIS IS TO C RTIFY,that the Qn-site Sewage Disposal System installed( )or repaired/replaced(✓)on by Ot dLlJ I L D1157 \ for 'el e k as /QSZ C/'CI'r �4G �' has beek constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Jated Use of this system is conditioned on compliance with the provisions set forth elo Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, IPA EIEEIS MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING G, TH YSTEM. AS INSTALLED W STRICT Migooal *p!tem Congtruchoac aTo PLAN. Permission is hereby granted der f--ol'o# > 4D-Y5, ` to construct( )repair( L an On-site Sewage System located at /05 Z C'/'Di4✓%ii� /"� 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. All constructio st b leted within two years of the date below. D e Date: Approved by v i i TOWN OF BARNSTABLE r � LOCATION,,,-A0 GrO !vi SEWAGE # VILLAGE_ C�� ''y�`l ASSESSOR'S MAP & LOT,240 i ,1,95' INSTAL_.;'i.,S NAME&PHONE NO. SEPTIC TANK CAPACITY cj A L _ y. LEACHRIG FACILITY: (type) _�7 t.l ct (size)�%',ma � ye NO.OF BEDROOMS 5 ` BUILDER OR OWNER PERMITDATE: �4?, COMPLIANCE DATE:� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site c�i within 200 feet of leaching facility) Feet Edge of Weuand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by O CrOv�� OIF FAO•'SC r 3,a _ iza a �+3 - )4 3 3 ~ ' APR-11-96 THU 13 :09 DOWN CAPE E GINEERI _, 508 362 9980 P. 01 t 362•4541 Ip(608)362.WO 939 min strQot rt 64 'gym 0287` down cape egi4ter/04 civil engineers& land atirveVM Ame Oilia PE..P.L.S. st►Nctural design why H.COye4 P.L.S. April 11, 1996 oa�nac.muiln,P.�. land court survey& site planning Ed Barry, Health Agent Town of Barnstable 367 Main Street sewage system Hyannis, MA 02601 designs Dear Mr. Barry: inspections on April. 11, 1996, Down Cape Engineering, Inc. inspected the septic system ithat the system as installedlisaeach Road.in substantialis is to �mpliance certify that the y permits pith the approved plan. Yours truly i Arne H. jala, PE, PLS Dovn Cape Engineering, Inc. cc: R. Small FTHEr TOWN OF BARNSTABLE �. OFFICE OF DAUSTM i BOARD OF HEALTH NAM 0o i639' 367 MAIN STREET MAY k HYANNIS, MASS.02601 February 16, 1996 Richard Small Box 823 Middlebury, CT 06762 Dear Mr. Small: You are granted variances to install an onsite sewage disposal system at 1052 Craigville Beach Road, Centerville. The variances granted are: 310 CMR 15.405(1) (a): To reduce the separation distance between the septic tank and the property line to five (5) feet in lieu of the required ten(10) feet. 310 CMR 15.405 (1) (a): To reduce the separation distance between the soil absorption system and the property line to five (5) feet in lieu of the required ten(10) feet. 310 CMR 15.405 (i): To reduce the vertical separation distance between the bottom of the soil absorption system and the groundwater table to four(4) feet in lieu of the required five (5) feet. The variances are granted with the following conditions: (1) The engineer or approved soil evaluator shall certify that the high groundwater table shown on the plan was observed during high tide. (2) The septic system shall be installed in strict accordance with the submitted plans. (3) The septic tank shall be water-tight. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and certify in writing to the Board that the system was installed in strict accordance with the submitted plans. rsmall The variances were granted because the existing cesspool is located behind the docking closer to the wetlands and is in all probability, sitting in the groundwater. The replacement septic system will be located in front of the dwelling 123 feet away from any wetlands, and four (4) feet above the groundwater. Therefore, the replacement septic system may alleviate a source of pollution to the wetlands. Sincerely yours, Susan G. Rask, R.S. Chairman Board of Health Town of Barnstable SGR/bcs rsmall 1%. R SENDE : o I also wish to receive the y • Complete items 1 and/or 2 for additional services. ® • Complete items 3,and 4a&b. following services (for an extra m V rn • Print your name and address on the reverse of this form so that we can fee): ` return this card to you. ry 0 . Attach this form to the front of the mailpiece,or on the back if space 1. ElAddressee's Address N does not permit. •+ m • Write"Return Receipt Requested"on the mailpiece below the article number. 2 ❑ Restricted Delivery a L • The Return Receipt will show to whom the article was delivered and the date delivered. r Consult postmaster for fee. ® 3. Article Addressed to: dp, 4a. Article Number 4) a 't C 4b. Service Type m E °C c ❑ Registered ❑ Insured �I 0 Certified ❑ COD y W / ❑ Express Mail ❑ Return Merchand Re is for `I p / 1 7. Date of Del, ery 4- o I 5. Signature (Ad esseel 8. Address e's A dress(Only if requested,g and fee is pai 1 w� L Signa 1 eIftl ~� i PS Form 38 , December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT I UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 E] Print your name, address and ZIP Code here Health Department Town of Barnstable P 0.Box 534 Hyannis,Massachusetts fax(508)775-3344 Rare!04 71" Z 348 63❑ 560 Receipt for Certified Mail ® No Insurance Coverage Provided MTEU STATES Do not use for International Mail POSTAL SEW CE (See Reverser M i O Sent m Street, o. � y co P. e d ZIP o O OClo Postage 1 / t'9 a Certified Fee / O LL Special Delivery Fee �R,Ulricted lDCIiLeryiFeermReceipt'SHowing l I to Whom&Date Delivered /;l Return Receipt Showing to Whom, Date,and Addressee' dress"' TOTAL Postage &Fees r �� tit Postmark or®at 28 f� K,rL9 J f STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AWD CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address Lo leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. L 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3611,and attach it to the front of the article by means of the gummed (a ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. co 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, co endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3611. co rl 6. Save this receipt and present it if you make inquiry. 105603-93-13-0218 Town of Barnstable = Department of Health, Safety, and Environmental Services B"39. Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 25, 1995 Richard Small P.O. Box 823 Middlebury, CT 06762 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 1052 Craigville Beach Road, Centerville was inspected on August 24, 1995 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Liquid level in cesspool 6" below invert overflow pipe from cesspool going into marsh You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH mas A. McKean, R.S., C.H.O. Agent of the Board of Health f - - �- WW Z—t� [Installer letter] / Sl TO: -'9 (Date) ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at /G' qo"Y4was inspected on 8�� —` �`�bY ��- �� rd a Massa husetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: C3 r4lz e,w You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable ��, _nor BORTOLOTTI CONSTRUCTION, INC. -Vlf r ' )� rE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop �� --- - �+ -- - ----- - -� �ECf a0 P - v Date of Ins ------ ------------pec �Mapo� 7�7 _ J3 CHECK IF THE FOLLOWING HAVE BEEN DONE: PART A — CHECKLIST _116PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND-BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO / THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. v AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. - THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. i/ ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. !/THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. 4- THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. e PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS � - No of Bedrooms -No of Curren Residents Garbage Grinder Laundry Connected to System 7-- Seasonal Use NON RESIDENTIAL: --- — Calculated flow WATER METER READINGS,IF AVAILABLE: _P Ing Records and Source of Information: GALLONS a -43 l � SYSTEM PUMPED AS PART OF INSPECTION? / Il & IF YES,VOLUME PUMPED = - ALS Reason for Pumping: - TYPE OF SYSTEM: — --------------— - I Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes,attach previous inspection records, if any) Other(explain) Appr Amate age Z4elz.�Crlal omponents. Date installed,if known. Source of information. S SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: - Depth below grade: Dimensions: Material of construction: Concrete Metal FRP Other} Sludge Depth Distance from top of sludge to bottom of outlet tee or baffle 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 Comments: ----- ---- ---- — - DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMPCHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: Comments: CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scu lay r Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) C ments: , i �j hr / /` Q 1�01R Materials of c nstruction Dimensions Depth of solids Comments SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: s Ala SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters?, Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the*last year? Number of times pumped �— Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? / Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? ( Within 50 feet of a surface water? VWithin 100 feet of a surface water supply or tributary to a surface water supply? /V Within a Zone I of a public well? Within 50 feet of a private water supply well? /v Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for col form bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT.I:HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE;MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS �TATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. V I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY PAR Real Estate System - General Property inquiry Help Devel Lots 47 Lot Size! . 14 Acres Current Own : SMALL, RICHARD S & PENELOPE State ClassH 10:1. Deed Date: 011083 Reference: C90699 Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 04190) Land Reviewed ByN Date: 0000 Bldgs Reviewed By9 Dates 000C.) Tax Title: Account: Taken: Account Status: Hold Status: � Cancel Press XMT for more data Next screen PAR Action Owners Name Road Index Road Name Parcel Number 206 136 � � � � ` -,r 7 �-1 1.��1.l)%,m, .7 V, T. TT 7, 7. TEST H01J,' 11'( T� �x It Jk t I 14101 ',AAI) -------!�k, At4j,,, AtA.k ENGINEE.R:.. .,_,4, *WiN n' (0 HN G")k MINIMUM it A*k ()Vt X t'llit t.A',I t;lOtpf. Wiflit(Lu (NLK sysltm V� WI I NESS: lituot 11K i LVE1 WASt*J) ►I-TASTOht 5.5 f OR itwil 21 DATL:- A? PRO11111SE11) 1500 oolfiiii,ts to t* J/fr 1cl 51er �1111P 11 (A I Ot4 sk:1111c. PE RC. RATE 4 UT.4 a,7: 1 Az CIA SOILS _j t , ss P# (,Tjo Wo,'JILD '�110111. Ok 04t.(JiMilUAll .4' A)VIIA00AN (1') �21 [.11) 3,/er to i 11z" LKiuwf wAsiTow sroNE f0 --itIttl. I IL to opt L Nj Ell ()tpllti + �jIULS ANo t10110161 OF I-LACII MERWE P) Bt SCARWILL) RUN 1 1-1 " 1 -7-1 'L. __ - " — f LOCATION MAP vOlLil ULP10 t4.7t'","c 1-4 L-C T 4/4 JAN 4! 0' 7,, Im ASSESSORS MAP PARCEL -3 53 ( \�` I LACHIN"' IT OUNI)AI ION 1441% 0* 80X IT ACI 1.1 1'r 5- 7-1. ex� FLOOD ZONE At. A-10 '114 i BUILDING ZuNE SEC 7 y < \ �� , . 7 z 0 SET8ACKS. /a -Ix- FRONT SIDF -7 REAR ................I.......... a-A- PLAN REFERENCE: _____ Q�a (ii;maiiia msmbLk I'S' ousloN f ! ow: �5_ t3F_uN00m:T> ( hl.--� GM) GPD N 0'r F T +-I / US( A GPD Df.",IGN fLUW 4. L?lj g.i. I l-1 br it, FANir,, GALLONS 1. DATUM IS ;A! ION TANK MUNICIPAL WATER IS 3. MINIMUM P!TGITI TO BE 1/8" PER FCT01`_ 4. DESIGN LOADING FOR ALL PRECAr-"r UNITS TO �!V I%ASHO-H '14 -0 BE MARL WATERTIGHT. Gill) 5. PIPE JOINTS 1 -t!0WSTrRLCT1tGU QErAl"S 1[0 -2L IN ACCORDANk"V WITH MASS. ENVIRONMENTAL CODE TITI,E V. A`z. I TIAIS PLAN IS !_OR PROPOSED WORK ONLY AND N_)T TO fjL 4 US! FOR L 01 t INE STAKING, 8. PIPE FOR SEPTIC SYSTLM 10 ISCH. 40-47 PVC. r-4 A,lTT.Ti,(_i_- 9. EXISTING (,�*SSPOOQ T()" BE PUMPED AND WITH CLEAN SAND CA 1EL rt F Nt 10, COMPONE-NTS NOT TO 93E BACKFILLED OR CONGEALED WITHOUT INSpECITION 9Y ROARD 0!" HrALTH AN�f) PERMISSION 08TAINf-D v MG- FPOV BOARD Of'T IiLAL,rH,- & E-A' t F,2,1V10rk_ " At A,- To w 14, r-4 C L 6L 1, -AZ ' 0 W- 'LT-i 1�5 F iLi v! TACT 7, If 1-11,4-itLAk -TIP -TV F&.ICA 1"i Nk W-1 7 TF tj a O-L0- L 46- `iT`4-#--t iL A�s 10 ' A.�%��e->.t_C_V� 11"ITE AND ShWA( P�' 1-1 T N OF ) .1 . BOARD UP' HFALTH IN THE. TOWN OF- APPROVED DATE MA PREPAI&D FOR. za Amp %_0 Feet SCAIX: DATE %ki Of --ape cligineermAr, 11 c(10 wn c AANE ( A V I I N G IN RS 0,A1 A N F) 'S R V EA( R S CIV14. .,A f"*ft Y116 362-4ml FAX bbs W-4w, NO. No, -Tl� r T� wai-n st. yanno ith , ma Jim OJA L.S. RA TE 0 B li