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1786 FALMOUTH ROAD/RTE 28 - Health
1786 Falmouth Road _(Rte 28 Centerville F/R 189 033001 llhi;�Gl[iC ��,aEcvct�o� UPC 12M 0 No.53LOR HASTINGS. MN 1 7 . c � YOU WISH TO OPEN A BUSINESS? " 4tJ�\" 11 tt, �P For Your Information: Business certificates (cost$30.00 for 4 ears). A business certificate.ONLY REGISTERS YOUR.NAME in town (which you must do by M.G.L.-it does not give you.permissio to ope L.,.rate.) Business Certificates are available at the Town Clerk's Office, 1- F 367 Main Street, Hyannis,"MA.02601 [Town Hall) SATE- •�/ p � � �� toe n of Fill in pleases [� V�%/!� 4xr`i' 2 APPLICANTS YOUR NAME. W1 Lp e YOUR HOME ADDRESS: ' /����� W "L v , fig:, TELEPHONE # Home Telephone Number (NAME OF N:EV1!BUSFNESS 2O C S C . NCB TYPE OF BUSINESS: 1S THIS A HOME OCCUPATION? YES IVO. _ 1S9SC �`N�7 .: . Rave you ADDRESS OF BUSINESS © MAP/PARCEL NUMBER When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main 5t; - (corner of Yarmou h Rd. & Main Street), to make sure you have the appropriate permits and licenses.required to legally opere-ylo -ess in this town. 1. BUILDING COMMISSIONER'S OFFICE' This individual has been informed-of any permit requirements that pertain to,this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual h b en inf r ed of the p r it requ' ements that pertain to this type of business. 1417 Authorized Agnature** COMMENTS: 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.* COMMENTS: Hazardous Materials Inventory Sheet Checklist 3 23 D fate Physical Street Address-Check database to ensure it exists �CWorking Phone Number __Actual Amounts-(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) i Storage Information-location of storage,how long Is storage for? If none,note.that. isposal Information-where and who?If none,note that. Applicant Signature-understand what is listed and noted Staff Initial-any questions,know who to ask �j/ Vehicle Washing/Rinsing? -provide a vehicle washing policy and Axpiain it-note that it was given ttach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. Date: a3 /Z3 / p�- TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: �n kf&V`S GAo. CAA Uy a BUSINESS LOCATION: 1.186 EMDO'Et- e0d D INVENTORY MAILING ADDRESS: 11L FALMOa%- ROAD TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CON TACTTELEPHONE NUMBER: soS- ?o MSDS ON SITE? TYPE OF BUSINESS: LA`DSCAPS IUG INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste:7—c,"'n Name of Haulers Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS ' The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) G4tr • Gasoline, Jet fuel, Aviation gas i Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes /. Car waxes and polishes P£xlUpS Fertilizers C a° Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) " NEW USED GM-• Any other products with "poison" labels Paint&varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield washi WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS SOIL n SGnap77c.J GA-f'VYjf R'R C (-1 , - r N !VQ GrQtAM UJTnk./� IJ� MD ' I.! 1'WAS `y` `', e Nt `ter s PROJECT LOCATION 7p�, ASSESSORS MAP7. — 1 `1 LOT APPLICANT ( � PREPARED BY '` A & M Land Services 15 Sunset Drive South Yarmouth, MA 02664 (508) 394-2723 � SCALE l � = ��� DATE.- •SffZtT / OF / I _ 7 _ a k d No. V ' , � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Mtgpogar *pe;tem Construction Permit Application for a Permit to Construct( ) epair pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �, m0 /��� Owner's Name,Address and Tel.No. Assessor's Map/Parcel OL-Q��.�v� -IQ 1?q D 3 3a oo !/ - Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SS j,Lli'�1�C E'r_10, VA--7780, J J l5 S11 nSp$ 4), eum D k:f 4 4 94h- f)-Zole Type of Building: 5 D?`3q 4-- Zrl,7,3 Dwelling C/' No.of Bedrooms Lot Size r Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 3® gallons per day. Calculated daily flow gallons. Plan Date '7 - /!M© 5r Number of sheets > Revision Date Title Size of Septic Tank / .s O© Type of S.A.S. .5?5 /Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) /.fie.- k 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 issue nthr Bard of Health. Signed A- Date 7 s�1,0 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued /" I / -� j7}�•T !t/ram No. Fee'` t a' Entered in comp THE COMMONWEALTH OF MASSACHUSETTS uYes -PUBLIC HEALTH DIVISION -TOWN OFjBARNSTABLE., MASSACHUSETTS �; t Ztppliation for ]0i9;po15al stem Construction Permit Application for a Permit to Construct( . ) epUpgrade( Abandon( ) ❑Complete System ❑Individual Components -Location Address or Lot No.. OwneesNN me,Address and Tel.No. ,. Assessor's Map/Parcel r V ��r �'11 < <' 0) 18q 0 3 3, oo J Installer's Name,Address,and Tel.No. Designer's Name,-Address and Tel.No. l i -t, LQ,A_W S/1V �5t>-(..+�Y,,�(��J Sf, �J, tam. 5a�•- ��/-'7�io Sv• Qumv�lh Wf�- OZ(oG�/ Type of.Building: J �5 Dt- 3r-7 4-- 2r1 7-,?5 Dwelling d' No.of Bedrooms Lot Size f S� ' cftcc.Q Garbage Grinder Other Type of Building No.of Persons Showers O Cafeteria( ) Other Fixtures �! r Design Flo w �� �a . . ' gallons per day. Calculated daily flow gallons. Plan Date "I Z/0YO 0- Number of sheets / Revision Date Title t Size of Septic Tank / S O© Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: F � � Agreement: The undersigned agrees to ensure the construction and maint Hance of the afore described on-site sewage disposal system in-accordance with the provisions of Title 5 of the Environmental Code and nbVto place the system in operation until a Certifi- cate of Compliance has been issued by th' Board of Health. Signed /�/ A Date 7,-, !' Application Approved by _ / Date 7A& oci Application Disapproved for the following reasons 1 Permit No. 'Date Issued THE COMMONWEALTH OF MASSACHUSETTS Y BARNSTABLE, MASSACHUSETTS /j Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired( )Upgraded Abandoned( )by at 1719 — has been constructed iri accordance with the pro vi tons of Title 5 and the for Disposal System Construction Permit No. iiw-I- �70 dated I Installer /'+-SSb t q AJOE f_,6A,4 V> I��l� Designer /� t /fF Nc( SD.bV I c tG The issuance of this permit shall not be construed as a guarantee that the sy tem il1PfunctioA, s designed. Date ? d`f Inspector f_ r K No. Q /� Fee THE COMMONWEALTH OF MASSACHUSETTS ` i PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mif poga[ *pgtem Conztruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 0�& k0d 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 condCbyy Provided:Construction must be completed within three years of the d permit. 71 Date:_ Approve r a i own ol< tsarnstaate FtHE r Regulatory Services O� • Thomas F. Geiler,Director 9� 1KA 6 9. Public Health Division ,er�D �A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Designer: Installer: Address: " SC G�/ ��� QV-, Address: �V �ZP6�- On r was issued a permit to install a (date (installer) septic system at 7�� �` based on a design drawn by (ad s) dated i e I certify that th%sep c 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. t OF a� (Inst is Signa e) o M. V"XZ/- �'OFFpRD A ��1363 O�F��O'�STERtiO (Designers Si wro (Affix Des p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form • TOWN OF BARNSTABLE c• 's4. LOCATION V?810 ��YiiO9:11 241 SEWAGE#�DO`I— 3rI® .VELLAGE ASSESSOR'S MAP&LOT I�!" INSTALLER'S NAME&PHONE NO. A ' SEPTIC TANK CAPACITY 5D� 17"7l '74-1 Dn Goo at LEACHING FACILITY: (type) e49 . (size) �x 15 NO.OF BEDROOMS BUILDER OR OWNER b5 PERMIT DATE: 4—SOMPLLANCE DATE: Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NA Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) .vA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NA Feet Furnished by ,l��S!/,�s90�/L'� �a®��9/A/✓ ��C. N 15 14001 °0-2 AdL 1' � 3g 3 . t--- -� p_( � UTi L1TY S w 3-0 o y 0y Olt. Cl TOWN OF BARNSTABLE �C LOCATION V7 WI L /14 ; SEWAGE#j0oq— 3`1® VILLAGE C`e.,Ict I y l�e ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. ��'►� u k C✓f��YI� it SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) `.7 D (size) NO.OF BEDROOMS__ BUILDER OR OWNER 85 t= L DATE: DA : + PERMTTDATE: .. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N� Feet Private Water Supply Well and.Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) NQ Feet Edge of Wetland and Leaching Facility(If any wetlands exist AM Feet within 300 feet of leaching facility) Furnished by d1 rc;.D �� �.O.sp�/dam Iry G -et Search forts/Parcels 189033001 I p Towunof Barnstable For Pa el N rribe� 189033001 � 3 Business Name ZonesofsContnbution(Y/N) Area,n Numbers a 6p Contaminant`Re{Y/N Phone r Fuel3torage Ta k Permit h y Card On F,il � . �' �� a � Disposal Works �j Percy�est' 11►ell Perrin ° Construction `az i v Flie/Permlt No i �x 2004370 Issuance Date ag 07/26/20 08/12/2004 � Comp etron Datate• Size of Septic Type/Size of SAS (2)500g CHAMBERS �/ iTank Frr i 1500 �i a f Comments h z2 " 3 BED NEED ENGS LETTER&ASBUILT ASSURANCE mapparl 189033001 Owners ROSE EVELYN E& �rproploc 1786 FALMOUTH ROAD/RTE 28 nMW ��& - - InnovatrvelAlternatrve Technol g Septic Systems Single or tl t4 ����.;: <�wGlustered I/A Type 'IlA Servicwt ype s e z w t l r � CD o "Z9 w r co m 0001, COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Y ASSESSORS MAP NO; PARCEL NO. 0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION FA J cD ,NSPE Property Address: 1796 !�1 ma a k A.,4 4 ���®� C-e-A�er ✓,lla Owner's Name: aal Owner's Address: fen{erg,/�2 Date of Inspection: ce//s/o q Name of Inspector:(please print) 71/';"o M4 ,f 4o Je d Company Name: /%.2•m A Y �¢ 4 o vie,// Mailing Address: 4e /6,x zo E l Telephone Number: 77y'- V5g- 9a?q, CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority _X Fails Inspector's Signature: — Date: �/z, 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. Notes and Comments y� Qom, bills ****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. I ' Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: f 7 f3G i AL4101A4 ko4 d Can l e,-sP Af e Owner: R;l f /205� Date of Inspection: 611 s/ 1�/ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: .y1�1 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:. I114 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 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: r ' Page 3 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I786, kcj4d, Owner: hjI R sg- Date of Inspection: 611-rl C. Further Evaluation is Required by the Board of Health:r--V 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. 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i_ Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /786 AW&gW "d Owner: a,, j &5, Date of Inspection: 6/� /a 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 k Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool --A/k— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool GC' Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow �t Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped k Any portion of the SAS,cesspool or privy is below high ground water elevation. _ _X_ 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. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. e Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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:.1VA To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ 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. r Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17?6 /5�j ,ftgA IL d 6ka kr J-j u- �Js4 Owner: / ,/10.S y- Date of Inspection: y/5 A 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 wne 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) i 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? 6e- _ 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: Yes no _ Existing information.For example,a plan at the Board of Health.A21r1 acv>u, _ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] r _ Page 6 of l l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: &of Cam.-.Apev.,Ay Owner: a l ( /2D.e•-e. Date of Inspection: e fiS/a FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): Z— DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Z- Does residence have a garbage grinder(yes or no):.vo Is laundry on a separate sewage system(yes or no):.2J [if yes separate inspection required] Laundry system inspected(yes or no):eZi9 Seasonal use:(yes or no): &D Water meter readings,if available(last 2 years usage(gpd)): 2 ��) ti/W Sump pump(yes or no): AYV Last date of occupancy:) ,,�- COMMERCIAIANDUSTRIAL/l//e Type of establishment: Design flow(based on 310 CMR 15.203): -pd Basis of design flow(seats/persons/sgtetc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ncc)aX� Was system pumped as part of the inspection(yes or no):— If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system C Single,cesspool S-e- 0 4 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) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 40 �y Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /7,96 Gzn-lerYg%f•.Z. n1A Owner: i5 l ✓ns-g— Date of Inspection: G BUILDING SEWER(locate on site plan) #-3 3c Depth below grade: v Materials of construction:_cast iron _40 PVC_other(explain): or�, . 2 ,did e4A,4 Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) . A-S h vi It Depth below grade: ce 't�,i�•ti C sR�¢z '-'e J cis l Material of construction:_concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:�U, ,«>> i �x t3k.,,k z �,r $E c ass i 3 •tdr�31uc k b:� �! 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:7. ^0ate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): y Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:.X�K Owner: 40 I ko s-lz- Date of Inspection: 6 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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.): PUMP CHAMBER: . (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7M AAvc✓Ji 12GAd cf.;e 1 k-dt Owner: fl 2c s z. Date of Inspection: 6 �0-4 SOIL ABSORPTION SYSTEM(SAS):A, (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: zo,e 2u Al d - overflow cesspool,number innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: r Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:*0ocate 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.): r Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17F6 12c4d (4f.k-,,,114- r�•� Owner: igai �oJ� Date of Inspection: 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. 033 avi �1 Vito R 2G i Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /'?86 /&-/4c/ eim4t✓lI� rYJ/1 Owner: Sal l Ru .e Date of Inspection: S1y _ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30.r feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: 5 n cJ �� �, �;,,,,,+;,A �)�� You must describe how you established the high ground water elevation: I L)A8 c7n Ast, 'M z IP[1 Lev 6'9, C4 F+ JUN.10.2004 8:24AM BARNSTABLE BOARD OF HEALTH.. NO.306 P.1/1. TOWN OF BARNSTABLE LOCA71ON SB GB # VILLAGE Centervf l.,l a ASSESSOR'S .MAP O LOT 189 033 .001 Evgl•yn $. Rose (owner) ., INSTALLER'S NAME A PHONE NO. 775=3160 SEPTIC TANK CAPACITY 3 .6 y f nnn each (6 X ;g) 20 X 20 LEACHING FACILI Y34'7 )' + �*�,,,� ($i�)00 X an NO. OF BEDROOMS' .%2 .PRIVATE WELL OR PUBLIC WATER N/A BUILDER OR OWNER Owner ' DATE PERMIT ISSUED: 'DATE COMPLIANCE ISSUED• VARIANCE (3�jT D: Y e • I "�' '3 Ito co .. a No �Cqebhi�JC� c TOWN OF BARNSTABLE d LOCATION 1786 pal molit- 'Road SEWAGE # VILLAGE Centerville ASSESSOR'S MAP & LOT189 033.001 Evelyn, E. Rose (Owner INSTALLER'S NAME & PHONE NO. 775,-3160 SEPTIC TANK CAPACITY 1 1 �AAO each (6 x 8) 20 .X 20 LEACHING FACILITYAtype) (size)20 X 3A NO. OF BEDROOMS '2 PRIVATE WELL OR PUBLIC WATER N/A BUILDER OR OWNER Owner DATE PERMIT ISSUED: DATE COLIPLIANC,E ISSUED: VARIANCE G TED• Yes ►5H--r(� S V W, It�w►r 'rC� r /,.V�o0 P NI *44 yw J r '7 11 L. L1 1 ©0 .. i' I' 310-1 1 r Esting Tanks Existing Existing Tank to be pumped & filled o j� lira ter Line Existing Leachfield to be pumped & filled (as required) �,—? �� #� to be abandoned (as required) .� �p� b " -- Lea I Existing I to be ab ndoned ProposedLT 1500 Gal Ex. 16" Tree PROPOSED LEACH G. FACILITY _ _ _ _ _ , ,� �• w .q Septic Tank pro PR Gal Chambers Two Cone 500 I z\ a L o _ I D=BOX '_8"X 8'_6" :I o j I 24 x 4 or S11ir111c with 4 ' stone around - w w .10 (ct b7 Total. Dim 25 K7) ko 4-1 Test Pit 55,Y Loca tion - I _ I a 83f Acres j —Ex Ct- Shed I Conc Slab G I _ 'ah Existing overhead I I L — — — — — —I 1_ ` J Existing 'L - - - - - - - _ _ _ U,ndergrorrnd \ � � � \ — —yrires _ _ _ I Electrical Line _ _ _ _ � _ _ — _ _ — _ — _ — Existing Existing I Existing Utility D�W j _ _ _ - - - - - - - - - -� DID✓ Pole _ _ _ _ _ - -- - - - C, 4L. _ _ _ - - - - - - J 310E' r I 1_____________,________ _____, , ------,----------------.---.,-------,-,---- ------_________ - � I ___-,-- --.----____________I-__-_---,--------__�____________-__.__,-I-I�____________T_�______- I -----�---------_----.-__---7----___--___.----_,�"_,. ____________ _,_,__._,_____,__________ ___ __ ___ I I . I I I I I � . I I . � � . I � . � I I � I __-_______,-,-------- ------------ ,�`-----__--________-__I�-�_, . � � . 11 I I I I i I I I I I . I I I . . I I I I I I . I I I � ,� I � I I I . . I � I � . 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I , I I I :, I � I . I I� , -el I I I � I � . I I I . I 'i I � I - I . I I I I I., I 11 I I I . � � I I . I . I . . I 11 I I I I , -11, I I . I . I I -- 'I I 11 � I I 11 I I I 11 I - � I I 1� I I I I V Pjeometwss ,,WO MA OK-ORM I'O 'WO 6MR 1§�oW, 7/ . I 11 ''. �,;c,��,,�, I I ,4 I I I . . I I I . I I "I I I I I 1 1 I I I I I . 1 I � I � I I . 1 2) ,4LL. hvs7A..aAna 'e'S-TAA _TW1&&-1MrNrAL CODE, I - ,� I I I I - � � � I . I I 11 I I . I I , , 1, I 11 I I ,% I I I I � . � I I I . I I I � � I `: I . . I 11 I I � � I I I I -0 ON 15 - I I . I I � � 1 ,� 1� '"' I I I I I . � I I - I I . , I I I � I I- I � 2YYZE 5, AAD JH2, , OF __8A I I � ,�'; I . I . I I I . I � . I I � . I I I � I I -_ SUBSUP1,ACE DISPOSAL REGULATIONS . . I I'll- I I . I 11 I I I I � I I . I I I I I . I I 11 I , I . I I � 111. 11 . I I I I . I I., . I,!, I I I., . I . - I � I I I � � I I I I � . . � � j , , 1 � I ,� � I I � . I I . I I I I I . I . I . I I I I . I I I �,�,,� I I . : I I I I I � I . I I I I I . 1 I I I . I I I . RXNA - . ; 11 . I . I I I . I z I I I I I I 11 � 3) NO DETE TION HAS BEEN 1 MADE A, � D9 COMPMANCE Or, A V,11ZABLE PROPERTY INP ORAIA TION NYTH .hECORDED . I I I _1 I � I I I � � I I I I . I � I � 1. I I . � � DEEDS I 1 . 1 I I I I I I . � . I . I : I 11 I I I I I I I I I I � I I . 11 I . I I . I I I I I I I I I � . 11, _ I I � � I . .1 I I I I - I . I . I I i � . I I I -0 V I I � 1: � I I . I I � I I � � I . � � I i I ,I, I', _ I I I I I I . I I 11 I � � I . ,� . .� I I I I . 11 I I I I - I I I � I I . . � , OR f ING RE6ULArIOYS I I I .1 . . I � .1 : 11 11 : � I I I . I � � � I . I I I I I I I . I I I � I � I I .. 1- 1 . I I I I I I I I . I . I I � . 1. . .� I I I ,11 1� zI I I I I I I I I I I I � 11 I . I I I � I '' I � I I � � 11 1� I I , 1;:� '�' I I I I I I , 11, I I I I I " , I � I I I I I � I I I I I I :- I I . 11 . I . I I I 11 I 11, I I I � I I � I I 1 4) TO W11 - -C PROPARY'r � � I I � I I I I . I I I . - _j ", I � I I . .1 I I � I I I I 11 I I TRYER DOES Mr I . I I - � I 11 I I . � . . ., I SER V E TF�JS � I 11 F I I I I I . � I I . I I 411 I � I I ' 'I 11 I I � � 11 I I I I � � � I I 11 L " 1:� _ _ , I I . I I I I I I � 1. .1 I I I I I - � I I I I I I "I' ; . � � I I � 11 � I I ; I � I , I I I I I I `��", I I I . I , I 1. . I � I I ' 'I I I . . ' ', I I � I I I � � � 1. I - I I I I I . I � I 11 ��'., iI . 11 I I � � I . I I I I , . . I � I I I I . I -G W I . I . I ,�, - . I I I I � I . � �_� I 11 I I I I I I � . � � I 11 I I I I I . 1 5) THERE ARE NO E,UrTIA ZZLS MMN 200' OF ,THE FROPOSiD SOIL'ARSO?PTION SYSTEM 1. I � " _� � tr �� I . I . I I I I I I � I I I � I � I I I I � I I I . . I I I � � I . I , � I , I I I I I I I . I I � I � � , . :� ,;�; � I , I I I I , I I . I 11 I I , I - I ,� - . , . � 11 I I 1. �_ - .11 ,- _v I I � �� I : , � I I I I - I � I � I � . . . I I I � I I I � I I I I � . 1 : 31011 , 1 1 1 11 I I � � I I � , , _ � I I I . I I I � 1, , 2, ,��,,,��ill I I I , � I I . I I I I . I I �, _ �.. I I . I I I I � �I I I I� I I I I � I I I I . 6) ALL COVERS,OF SYSTEM CGAfPON,9NYS-SHALL BE BROUGHT TO A7THIN 6" OF FINISHED GRADE I I I , �� ` �1. � I . I � � � I � � . I � I I I � I . I I I I I � I 11 � I, I . � � 11 I �I I I I I I � . I I I � I I I I � I .1 I ,. 11 I k� ,�� i� . � � - . �, I . — I I . � � � I I � I � I I � : I I - I , 1, "' I I - .1 I I �_ I I I I . - I � I I I I I I I I I I I . I . � 1 ?11 11 I I � I I � I " I I I I � � � . � I I . I I I I I 11 , I 1. 7) ALL SYSTEM I COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION . NO STRUCTURES SHALL BE LOCATED DIRECTLY I I I . , � � , . � I I I I � I � I I I I 1. I I � - I � 1. I I I I I �, - 11 � I I I . I I � I I I 11 I I I 11 I I I - I I . � I � I I � I I .� '��,`�, � I . � I � , I I � i , - I 1, I ; I I I I I I .11 � . � 1 11 I I � I I 11 ,� � I 11 . � I I I I � I I � I � I I I I I I . , I I . 1 I I ,�,,,,,� I I I �e � I I . I I I � I . I I I 1-11 I I� , I I I 11 I I I., I . I I UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, MCH�WO ULD INTERFERE W= THE PERFORMANCE, A CCESS, JX5PECTION I I I I 1.111, I � I I � I I I � . .� � I . I ' . � I I - I I Existing Tank Mdsting Tanks . I R�stizig :� 1- 1� - 1 � I � . I I � . 11 I . I 11 I I . I I .1 I 11, �� ": :i I I ' . I I 11 I I . I I PLfMP,WG OR REPAIR ' I I I I I I . I . I � � � � I � � . I I I . I I � i I Existing Leacbfield I to be pumped & filled , . to be pumped & filled I � I � � I � I I I . . I I . 1 . . . � I I . I . . � .11 I I, I 1 � I , to be abandoned I I I . 11, I I 4;) Water Line . I I I � I I I I I I 11 . 1. I � I I I I � I I1 I I '' 11 I . ' � I - � I I I 1 11� I . I I � - i I .1 I . � (as required) ' . I . I 1 I I "I I .,v�� , I " I 1�I I � I � . 8) NO�DATIIEAAY PARA7NG OR TURNING AREA, OR OTHER LMFER�IOUS AREA SHALL BE LOCAYE0 ,ABOVE A SOIL ABSORPTION - . I I ',�W, � I � � � (as required) , 1 17) � ��,�, � 1, r . I . I � ,111��� � I I I . � I : I . � . I I I I - � % I I . . 1 . I I I 1 1 1 1 1 � I i I � I 1 7 . I I 11 I I 11 I I I . � 1�', I 1�I �,,j iI . I I I � I I I I . I I I I I I I I � . . 1 I I I I I I I . I I 1. � I I 11 I I 1. - I I I., I I I I I 1. � I � :�'111 I 1� , 1 . I . I I I . I I . .1 I . I 11 . I . I� A) 1(0,," I , I � .1 , � . - I I -) I I I I � � I SYSTEM,, E, XCEPT WHEN VENrTVG HAS BEEN PROE1DED . 11 � � I . 11 , 1 _."C'', I, . I I 1 __41�� 1 � I I I I I I � I I 1 W2�._6 1 1 1 1 1 . I I � I I I I I I I I I I - I � I r I 11 '. ,. �� � , . . I I I I � I . I - . I I . . . ( I I I I I I I . I . � I � .; ,��, i I I � I . 1 11 � . I I I I I 1�_ � I 11 I I . I - I � I . � I I 'll , I I' ll I � ' ' I I I 1 9) SEPTIC T"10, CREASE 7RAPS DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE I . � . � I . I . �� ,,,, %, " I I'� � I I I I I I I I I I I � 1 Existing LeackAjold I I � I � . I 1� I �_ II � I I 1, I I I I I I 2� , . . I I � I � I I I � I, � � - , : , I � ,� I I I I I I .F I .I � I I I I I G I Twr �I I I . I I �I TO ENSURE STABILITY AND PR I I . � I I � I I � I . I I �',� �'11��� :- I I I � I � . I I I I I I � I � I I 11 . I I I I I' ll I I -, t� iI . � . I I I � I � I I ___ I I . I I I I I I 11 I . 1 I � � �. I I I I I I � I I 11 I I I ,�', '" : . I I � I �, I I I I I I . I I I I I I I � "I I I I I , . I I- Proposed , I ,to be abandoned I I I 1 '17� 1 1 EVENT SETTLING. , I I � I I I .1 � , L, I 11 - ,.AV-�_ _ I 11 . . I , i . I 1 k; . I I - - - - I . I I 11 I I I I �, i � I I . I I I � .1 I I -. � I I I I . I , � 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MMIMUM OF 7HF FIRST *TWO FEET OF TLWIR LENGTH � . . " I' ll _11"I i � � I . I F � . I I I . I � I � � . . � I I � I I �, I i � I I � I I "I., I � 1 1,500 �Gall, ' I I . I 1 I � I ,Z) � . I , I I � I . I . � 11 ,"� . . � I i I 1,I I I I 1� 11 I � 1W I I I 11 " I Ex. I I I I, 11 . 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF KTHSTAADIXG H-10 LOADING UNLESS THEY ARE UNDER OR #7THIN 10' , I . I �, "I" I . I . I I . I I I � I I I " � . ; � � I - - - - - I �I I . I I I , t . .q - 6" ,Tree , � I . I � I I I I I I ; I � I I I I 1 I " � I I � . ,4 . � � � , Septic , Tank I I I � I . I I . . I 11 'i I � . . I � . �. - I �1, , 11 I � . 1 I � I I I I I � I I I I -,. I I I _H I I I I PROPOSED LEA CHNG I FA C�LITY ,Q� I � I I I OF DRIVE WA YS I I I . "I � i I I I I . I I � 1% 04 4)��0 1 , �� I I � � .- , I I I OR,PA,WNG OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE- USEV. ' . I I � I ; I � . -I 1- I I , I . I I I � I � I kr� , 1 I - 4 1 � 1, I I . I I I � I � � I . I I - , I I � I I I I� � 11, C�) I I 1� I I I ; . . � � I I I ; :"� � 1 .%, I I I N* � L_." I , I'll I . Prop Two, I Cone .500 Gal Chambers I I I I . 1 - 1114��1 1. . I I 1 ,�4 � — .1� — — 11 I I 1. - I I I , ., I � I . I 'a I I . I . �I 1 ALL INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC I � I I � I . . i I 41� q) -, " )_ - - ).* � ,#I I I . I . I I :: � I'', I I I I - - - - - -, ,- -_ - - I'll I I I I I I I I � I I I I I I � I I . . 1. I � : ,�:�. : I . I I I I I � � 11 .� I , I � I I. , I � I .I . I � I �_/ — — . I I I , -4 O� 11 I �� — — — '\,.�, , 1. I I I I I I — X 7 X - ) or Sim I I . . � 113) THE DEPTH OF THE TOP. OF .ALL SYSTEM COMPONENTS SHALL NOT EXCEED 3,6" UNLESS VENTING HAS BEEN pRo VIDED , I I ,� � 1, - 1� .11 11, 111.1 �.,�� I i 1 1\ I I I . '0 � i I . I i I 1, � . I I 11 I I I I I I I -�� I .I- , . , 11 _�O�_ (24 4 8 �8` 6" flar �, . � I I I I I � I I I 111� .th I I I . . I I 1 . I I I I I I I I � I I I I I n 0, 30�� 1 � 1.11 I I � .1 I I I . . . TW ;4 " ,stone around ' � �� I EXCAVATION, EUSTKNG GRADE5 SHALL BE REESTABLISHED UNLESS . . I i :H � Iri '18' I I I , I I -, 0") I �_ I I I I I I I I . 1. � 14) RV THE AREAS OF NOTED AS PROPOSED CONTOURS. I I I " �, 110", I . I - . I I � I I I i I - - - - - Ci ,� I -- I I I . I , I " "�, I I I I � 11 I T -: I I " . I I � -.: .. * , /__1 , I I I �� . � 11. I I I 11 I � �I 11�1 � ::: : :,:::*::::-,-,7, 1 1 = I I . I I I I I � I , . I � I , I "I" - i I I.. � %,I � . � I I I - I— I ,�, 14" 1 1 _� I �:::: .. .:.: , ..::,.-..- 9, S) ; T6tal Djl2i , 25' x, �12. 6" : 1 ��) I . . . 15) IF S0ff,S ARE ENCOUNTERED DURING THE 'EXCAVATION OF THE SOIL ABSORPTION SYST&M, THAT DIFFER NO TA BL Y FR OM : � . I I � I � I I I � I I . 11 - -, j 0�0k!�) I I .;: . 11�11 . I I I � - I I . I I I I � . I �I ,,,� . I . . � , . . 11 I I I I I � I I � I I I I , : I I � 11 I I . . I 11 � I I ,��,,- . � I I . I I - I a - �' , , . T.:.:: � I . .. I � I I I BEFORE PROCEEDIN I I I I 11 . I . - . '' � I � I - - 11 " I - - -( ) , -� . I . I . :H 11 . THE DEEP ,ORSERVATION HOLE LOG, CONTACT THE ENGMEER I I -� �7� 1 . � I I - I � G. I I I I � ; � I I . � I - . , ' ' . I I Z , I . I � '. � :,�,__ I ��',,' � I I . I - � - I .1 . , :::::. I � . I , , I I I I I � I � .�� . , ,�, ," I I . � I- " I .-:: :: ` "' . , Test Pit . . -4 , . . I �� � -A . 11 . . . & I ::�:' � I , I � �,.'," � I I I I ,I I �, � I-7:-::--:--::*:::::.-:-::--- I I . . 1 16) CONTRACY19R TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES . . I �, �� I I . . . � - --L - - - - - 11 1 55!1- 1 1 __ I I I . . , I I � , , , I L � . I . I I � I . � I I � , I ""�_,-�__ � ______ I Loca tion � I . . � �� I I . �,,,�:�� I . I 0.83_+ *Acres I 11 I I � I � I . I I I .1 I I , � , I I I I � . 1 . I I I � i��,_,. , \ . I I I I I I . - I& I I I I I I I � I I I I I I , � � , � . I I . I I 11. . I . � I I I � I I . I ' 'I I I . i 1 I I t��_V, . . � I � � I I . � I I I I ' ' A !i . I I Ex I � . I . I 1; I -. I I I I . I I � � . I . I _�,;�:,,��,,, I I I � . I I TRAf El, = ,�(2 o. I \ '�_ I j� I I � I . I . I . � 1'1� , - . I � , , �`, I I . 1 I I I . I I I I . .1 � , ��Jl , I I I I � � , i I . � I I I I \ I I I � �_ 11 I I . _� k__� � � I . I I I I � I I � 11 -�,�. I � I I � I I Sbed ' I I� - - - - - . , I I �_ I I � . (� S.q I 11 I I I I I I I I I I I I 111% : I I . 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