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0303 GLENEAGLE DRIVE - Health
303 Gleneagle ®rive Centerville P A = 192 138 1521/3 ORA 1070 P2 Page 1 of 1 - 77 1 t: t. Cal t1�T1NG iG1d� ttR CrJ i )AJ bo i �I i h+f-n-/h:n:nvtnnm hame+ahla ma nclelratrhael7/1gARq ldld2 ircT �17Fi/J(117 v" FLOORPLAN Borrower: John and Elaine Spiezo File No.: 08100009 Property Address:303 Gleneagle Drive Case No.: City: Centerville State: MA i zip:02632 i Lender:Cape Cod Co-Operative Bank --- — - --- -- -- — .._ -- —..._.- --- t.: i 15.17 First Floor 2.0' 12.0' Patio 1 Family 18.0 7.0' 15.9 i a Bath Bedroom Dining Kitchen 1 Car Garage 24.9 24.0' 26.0 Bedroom F5Bath Living 22.0' 15.U 18.0 i NOT TO SCALE , j ) 4 i I •I I SItETCH CALCU.ATIONS Perimeter Ame i At Al:15.0x12.0= 18H A2:40.0 x 24.0= 960.0 A2 A3:18.0 x 2.0= 36.0 i First Floor 1176.0 Total Living Arm 1176:0 i -- Saben Appraisal Services, PO Box 877,South Yarmouth, MA 02664 i C011\IM0\'«'EALTH OF tiTASS ACH SETTS t,r MWr ExECUTIV-E OFFICE OF A _a R: DEPARTMENT OF ENVIR0-11\7MENT'AL PROTECTIO-\; / 'f��r�e yob TITLE J OFFICIAL INSPECTION FORM—NOT FOR VOLL—TS-TAR-° ASSESSMENTS SUBSURFACE SEN117AGE DISPOSAL: SYSTEM FORAI PART A CERTIFICATION Property Address: ,+eG le- 0/,/yam � e✓'�'� C �4 ea bad Owner's Name: o" H4 '7 h Owner's address: 0 Ooi, ✓14 a 4{-1q a-V4 4A, Date of Inspection: Name of Inspector lease print) GYY /"oIs,li�// Company Name: L-- AIV/ — T G Mailing Address: lJ OJC /ot�as 0& Telephone Number(ra CERTIFICATION STATENIENT t R I certify that I have personally inspected the sewage disposal system at this address and That the info(i a o_ �red,r below is true. accurate and comple`e as of the time of the inspection. The inspection,,-vas perfo=,-d bayed on=s" training and e�_perience in the proper function and maintenance of on site sewage disposal s-,-sTenjsjI am a rpO «_ approved system inspector pursuant to Section 155.340 of Title 5(310 C--NfR 15.000). The cam; rt; t/ Passes 0. Conditionallv Passes _ Needs Further Evaluation by the Local proving _hut rir -- P - <so -t Fails Inspector's Signature: �' Date: The system inspector shall submit a cope of this inspection report to the App o,ing stcthor_ty(Boa-di of:-Ieal_l.o- DEP) within 30 days of completing this inspection. If the s ysteni is a shared s-°stem or has a deslg-flo�- of 10.;-iC srod or greater, the inspector and the system o«her shall submit the report to the apron;-i e r2_ion_l o DEP. The original should be sent to the system owner and copies sent to the buyer; if annlica le. a_ f~e a�r-o - authority. \otes and Comments **"'*This report only describes conditions at the time of inspection and under the conditions of use at th;'i time. This inspection does not address how the system«ill perform in the future under the same or different conditions of use. 1 Title 5 Inspection Form 6/15.2000 page 1 f Pau 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS-TENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM FAIT /CERTIFICATION (con-inued) Property Address: 203 .4/,' 2 ell . 4e oogle_ 46�-t kf, ,I C��► � b3o2 Owner: j�e,►ri^I✓, e� Date of Inspection: // Og Inspection Summan: Cbeck A.B,C,D or E/AL.''N`AYS complete all of Section D A qy 1 Passes: I have not found any information:which indicates that an.-,.-of the failure crite^a descr:- _d in 0 C`•iR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. Svstem Conditionall`.-Passes: One or more system components as described in the"Conditional Pass" section n,-ed to be re-place-or repaired.The s_ysteni upon completion of the replacement or repair, as approved by the Board of Hea17h. 1,a1 pass. Answer yes, no or not determined(Y,: ,N`D)in the for the following statements. If"not deterr_-.ired"nlea__ explain. The septic tank is metal and over 20 years old` or the septic tank(-, hether metal or nof) is s�, ,icnirail.. unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. Svstern -ill pass inspection existire tank is replaced with a complying septic tank as approved by the Board or Health. *A metal septic tan'.t will pass inspection if it is structurally sound;not leaking and if a Cerificate of Co=li1'ance indicatins that the tank is less than 20 years old is available. Ni explain: Obsen-ation of sewage backup or break out or high static water level in the disr-ibution box d.:e r._ bre ve obstructed pipe(s) or due to a broken; settled or uneven distribution box. Svstem v,ill pas_ ins ect or i`r 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 ob s-i pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstraction is removed ND explain: C r_ Page of l 1 OFFICIAL INSPECTION FORM - - OT FOR N"OLUNTARY ASSESS�NIENTS SIi13STlRFACE SFAVAGE T)ISPOS.-kL SYSTFM TNSPF TTO\ FORV PART A CERTIFICATION(continued) Property Address: o,3 �/f Owner: Date of Inspection:.//) C. Further Evaluation is Required by the Board of Health: Conditions exist,,which require further evaluation by the Board of Healdi in order to f''^e is failing to protect public health,_ safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CNIR 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_r_arsh 2. Svstem will fail unless the Board of Health (and Public NVater Supplier, if any-)determines that the system is functioning in a manner that protects the public health,safety and en«ronment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is ::i'11:n ±00 feet o.a surface water supply or tributary to a surface ,vater supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public .rater sup�l_.. The systeni has a septic tank and SAS and the SAS is within 50 feet of a pri�-at,- a e-sul= 1:v'- . The system:has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or_more t'-om a private water supply well**. Method used to determine distance *"Thi.s system passes if the well water analysis;performed at a DEEP certifed laborato:,-. for ce'ifor : bacteria and volatile organic compounds indicates that the well is free frem pollw-io- _o ,;that`acai z d the presence of ammonia nitrogen and nitrate ninrogen is equal to or less than 5 pnrn. pry ided t"a-nn failure criteria are tricaered. :1 copy of the analysis must be attached ro this for- . 3. Other: Pave 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS-LENTS SLt;SSLrPiFA�'� SF�%VACE D�SPOS_1L S4'S'I'LI�T I\�SPLCT70� i C_�P\T PART A CERTIFICATION(continued) Property Address: 162 Owner: //4V/107e --- Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes No Dackup of sewage into faci'_ity or system component due to overloaded or clogged S?_S or cessnoo ischarge or ponding of effluent to the surface of the ground or surface waters due-o an c e-;•:�a ec c- /logged SAS or cesspool t/ Static liquid level in the distribution box above outlet it,vert due to an m.erloacec c_clOgge SA , cesspool _ iquid depth in cesspool is less than 6"below invert or available vol es_t_an '_. da r/ Required pumping more than 4 times in the last year NOT due to clog or obsi-u-cted p_-e(s). \_': e- of tines pumped Any portion of the SAS; cesspool or pm,-,"is below high ground«a-er eic�aeon. Any portion of cesspool or priory is within 100 feet of a surface water supple or r uta.,°to a sur ac water suplDly. nv portion of a cesspool or privy is within a Zone 1 of a public wei_l. V portion of a cesspool or priv,, is within 50 feet of a private«ater stipple w-11 Any portion of a cesspool or privy is less than 100 feet but greater than =0 feet front a p-iv at � supply well with no acceptable water quality analysis. [This system passes if the well Rater 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 tri<ogered.A copy of the analysis must be attached to this forni.l *49 (Yes/No) The system fails.I have determined that one or more of the above failure c-ite-ia e :at as described in 310 CMR 15.303.therefore the system fails.The system ov.-ner shout:. co~,tact t'.e Soar Of Health to determine what will be necessary to correct the failure. E. Lariye Svstems: To be considered a large system the system must serve a facility with a design flow of 10,000 _pd to 15.0001 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) X— no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a si_-face drinking .vate, supply the system is located in a nitrogen sensitive area (inte.r-.n - e.lihead Pro ectior A--ea- Zone II of a public,vater supply well If you have answered"yes"to any question in Section E the system,is considered a "ves"in Section D above the large system has failed. The owner or operator of aniv lar_e significant threat under Section E or failed under Section D shall upgrade the s.,ste l in deco-, 1 . 04. The system. owner should contact the appropriate rezional office of the Depar-r":n . Page ; of 11 OFFICI:4.L INSPECTION FORM-NOT FOR NT OLUNT ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE,NJ INSPECTION FORA PART B CHECKLIST Property-Address: !73 4C--55 4r,4., O,vvner:gC4Y✓'i n Date of Inspection: _ Check if the following have been done. You must indicate "yes"or"no"as to each of the -,oilo,:v: _: Yes \o/ Pumping information 1;vas provided by the o«mer,occupant. or Board of 1-Iea't71 - /Were ary of the system components pumped out in the previous mo,;weeks Zas the system received normal flogs in the pre�rious tivo week period? V Haye lar ae volumes of-:eater been introduced to the system recent)-,-or as part of t is inspection '' Were as built plans of the system.obtained and examined? (If they R.ere not availa`Dle note as N'A? Was the facili-- or dwelling inspected for signs of se�eage back up Was the site inspected for signs of break cut? Were all system components, excluding the SAS,located on site `> Were the sept-ic tank manholes uncovered; opened. and the interior of tie tanh ir_s~ect_ cc_d;. or: of the./baffles or tees; material of cons action- dimensions. dept,of liquid,depth of_ludze and d_pth cf !/ Was the facility owner(and occupants if different from m Ter)provided«nth information on i' e prere; maintenance of subsurface se«-age disposal systems? The size and location of the Soil absorption System(SAS)on the s.i;e has been Bete-mdne based or:: Yes no xisting information. For example, a plan at the Board of Health. Dete fined in the field if any ofthe failure criteria related to Par.C is at iss�.e — rnu ( -. is unacceptable) [310 CMR i 5.302(3)(b)J i Pa?.-6 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY _-SSESSIIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I\SPECTIOo FORM PA FEZ' C SYSTEM INFOR'VIATIO Property address: '?O ��2vr �Cvo✓% ��l1�1� Owner:_ n n o&n Date of Inspection: FLOW CONDITIONS RESIDE\TTIAL \umber of bedrooms (design): Off— Number of bedrooms(actual): c;�— DESIGN flow based on 310 CNIR 15.203 (for example: 110 gpd x_ofbedroorrs): aa-c \umber of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewatre system yes or no):/� (if yes separateirspzction regi iredj Laundry system inspected yes or no): Seasonal use: yes or no : b Water meter readings, if available (last 2 years usage(gpd)): Sump pump(yes or no): Ai4 Last date of occupancy: CO'NIITERCIAL/INDUSTRIAL Type of establishment: Design flow(based on-1 10 Ci8Tiq 15.20_): gpd Basis of design flow(seats/persons/sgft;etc.): 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 readinzs. if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Vdas system purnped as part of the inspection(yes or no): --- if yes, volume pumped: gallons --How N;-as quantity pumped determined? Reason for pumping: T Y OF S1'STEa� Septic tan'.c; distribution box, soil absorption system _Single cesspool_ _Overflow cesspool _Privv _Shared system lyes or no) (if yes. attach previous inspection records; if an v i _innovative/alternative teclxmology. Attach a copy of the current operation and _,- obtained from system owner) Tight tank __Attach a copy of the DEP approval Other(describe): Approximate age of all compone rs;d^tz istalleA(if kr.o andsource of ir_ o:rna-:iyii� Were sewage odors detected when arriving at the site(yes or no): //1V Page % of 11 OFFICI.AL INSPECTION FOR1.l7—NOT FOR N OLU'-'N-TARY ASSESS-XIM TS SUBSURFACE SEWAGE DISPOSAL SYSTF`T I SPF('TTn Fn-p v PART C SYSTEPNI I 'FOR-MATION(conLinued) Property Address: 3a� 5xev) Owner: /44 m o I4ij Date of inspection: _ BL ILDING SEwER(locate on site plan) Depth below grade: �� Materials of constriction: vast son _4v 0 PVC other(explain): 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) Depth oelo-k grade: l0 Material of construction: _ oncrete_metal_fiberglass__polyethylene other(explain) _ _ _ If tank is metal list age: Is age confn-med by a Certificate of Compliance(ves or no): _(attach a cop_ of. certificate) Dimensions: Sludge depth: 01 Distance from top of sludge to bottom of outlet tee or baffle:c> Scum thickness: _a ?/ / Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bolt Pf�f outlet te-or baffle: How were dimensions determined:YNe of ef//Ge Comme7ts (on pumping recommendations, inlet and out':et tee or baffle condition,snmcrsal itegrit<°. iicaic le.els aglated to outlet invert evidence w►���1"►. HOC �-�Ho— lekage,.etc.): 170 , 44 4P f- 4-AI.0 Awls, TG-► Iv- arc/ 7'eeS GREASE TRAP locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass_polyethylene_oher (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: Corn_ments (on pumping recommendations. inlet and outlet tee or baffle condition,strCicr., as related to outlet invert. evidence of leakage, etc.): I Paae 8 of OFFTCIAL I\'SPECT'IO FORM—NOT FOR VOLT) TARY _ASSESSMENTS. SUBSURFACE SEWAGE DTSPOSAL :SYSTEIT TNSPECTIC:N .FOP—M I'yRl' C SYSTEAZ INFORAIATION(con.:inued Property-address: C.-Ile P-! V�ioa 6.>- Owner el mq Date of Inspection: TIGHT or HOLD Io G TAINK:/(tank must be pump=d at time of inspec on)(locate on site plat:i Depth below grade: _ Material of construction: __concrete metal fiberglass_ polyethylene o,he:(expLir_I Dimensions: __ Capacity: _gal i ons Design Flow: C�allonsidav Alarm present(ves or no): Alarm level:_ Alarm in working order(yes or no): Date of last pumnpir_g: Comments(condition of alarm and float sxvitches, etc.): C/ ..DISTRIBUTION BOX: (if present must be orened)(locate on site plank Depth of liquid level above outlet invert: nolmat,,.— Comments (note if box is level and distribution to outlets equal; any evidence of solids ca-.-ov er. ark° �v-: nr of leakage intiA or out of box„etc /V — 4 / _— ----- PUMP CH ATBER:/1✓ (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.): Page 9 of I I OFFICLAL INSPECTIO'!'FORM—NOT FOR VOLUNTARY ASSESSMENTS SUTRSEiRFACE. SE''AGE DISPOS:aL SVSTEN7 INSPECTIO`: FORAY PART C SYSTEM INFORMATION(cont=nued) Property Address: 30 eo L�j��Q sal Ve-- vi wi lie Owner: 'rfin to Date of Inspection: �elf SOIL ABSORPTION SYSTEM (S:,S): (locate on site plan,excavation not required) If SAS not located explain v:hy: Ts- e p leaclung pits; number:L G leaching chambers, number: leaching galleries,number: leaching trenches;number; length: leachin--fields, number, dimensions: overflo«-cesspool, number: innovative/alternative system Ty pe,'name of technology: Comments(note condition of soil.; signs of hydraulic failure,level of ponding, damp soil, condi ion of v ecera:ian. etc.): � / // � // Imc4f� 6YI e1G G� �� A — CESSPOOLS: 41(cesspool must be pumped as pain of inspection)(locate on site plan) Number and confhuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum'laver: Dimensions of cesspool: Materials of construction: _ In of groundwater inflow(yes or no): Comments (note condition of soil; signs of hydraulic failure, level of ponding. condi-ion of vfp-a,rior',TC is PRIG Y: /t/ (locate on site plan) Materials of construction: _ Dimensions: Depth of solids: Comments (note condition of soil, signs ofhvdraulic failure, level ofponding. ccrditior. of Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA PART C SYSTEix INFORMATION(continued) Property"address: Owner: il Date of Inspection: SKETCH OF SENVAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least tiro permanent r eference lardy _r'.: o benchmarks. Locate all wells within 100 feet. Locate where public water suppiV er•ters,he b}ildir_14 I x /7/ o Ad-.�. � ``ter J 25 L� GS T;+l. : T o oni; t _.__ G 11 c!,nnn in Patre 11 of i 1 OFFICIAL INSPECTION FOR:N1- ,-NOT FOR N'OLUNT:-kRY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA P A.R-C c SYSTEM INFOR- IATION(con=ued) Property Address: Qh 0SI� Owner:Anm Date of Inspection. SITE EXANI Slope Surface water Check cellar Shallot wells X_ •` Estimated depth to ground water�feet ("' Please indicate(check) all methods used to determine the high ground water elevation: Obtained nn system design plans on record-If checked.date of desiQr_plan re-6e«ed: O _ -ed site (abutting property/observation hole in ij0 fygt SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You st describe h o« you established the high�r and N at r elegy a 'on: , ��®�►� am✓ �-� �i�r TOWN OF BARNSTABLE LOCATION 3 O-3 C -£V £-V ICJ-' -DR SEWAGE # VILLAGE C£A'T ASSESSOR'S MAP & LOT f�'S NAME&PHONE NO. SEPTIC TANK CAPACITY Jr yf� c /ti Y or cT'v LEACHING FACILITY: (type) (size) NO.OF BEDROOMS =1 BUILDER OR OWNER £���'£S �IjAU iP.9 S FDA ��'©� COMPLIANCE DATE: /Ai,SPEc i�� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f, REAR �vN / 3V4 3S� y 0 t 1 ZT 2-� Oa COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b 1 a DEPARTMENT OF ENVIRONMENTAL PROTECTION sue's'+:�1! a y+. 350 MAIN STI�,EET WEST YARMOUTH,MA 508-775-2800 JAN 2 0 2005 TOWN OF BA,1NSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION M 192-P 138 Property Address: 303 GLEN EAGLE DRIVE = f AAP CENTERVILLE,MA 02632 Owner's Name: ORCUTT,ARTHUR UfiRCEL Owner's Address: DEI.ORESMAURAS 34 CHARWOOD ROAD L01 � � -,- SONIERVILLE,MA 02144 Date of Inspection JANUARY 3,2005 Name of Inspector:(please print) JAMES D. SEARS _ Company Name: A&B Canco Mailing Address: 350 Ma;?;Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 _ Fails Inspector's Signature: `/ Date: p-�— The system inspector shall subn.;t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of complet;,la his 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 tot he buyer,if applicable,and the approving authority. Notes and Continents a ****This report only describes conditions at the time of inspection and undi° 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 Inspection Form 6/15/2)000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3,2005 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 CUR 15.303 or in 310 CUR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 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 than20 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: Title 5 Inspection Forni 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 C. Further Evaluation is Required by the Board of Health:N/A 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 CNIR 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 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 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: Title 5 Inspection Form 6/15,12000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 D. System Failure Criteria applicable to all systems: N/A 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 If Static liquid ievel in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit is less than 6"below invert or available volume is less than%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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must service 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 is 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. 'w- Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3,2005 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)has been determined based on: Yes No ✓ 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 C..MR 15.302(3xb)] i Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3,2005 FLOW CONDITIONS RESIDENTIAL,( Number of Bedrooms(design): . 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage'system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2002—42,000 GAL/2003—24,000 GAL Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203): Basis of design flow(seats/persons/sgft,etc.): 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: 2002 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1984 PERMIT#84-31 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 303 GLEN EAGLE DRIVE CENIERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 8" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 10" 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: 1000-GALLON PRE CAST Sludge depth: F, Distance from top of sludge to the bottom of outlet tee or baffle: 29" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: AS BUILT,TAPE&PROBE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET TEE—OUTLET BAFFLE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 TIGHT or HOLDING TANK: N/A (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: I ✓ (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.,): D BOX IS 16"X 16"-14"BELOW GRADE,ONE LINE IN—ONE LINE OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15;'2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type •/ leaching pits,number: 1 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.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,PIT IS 52"BELOW GRADE WITH COVER AT 1'PIT IS DRY WITH STAIN LINE AT 30",NO SIGN OF OVERLOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionxlocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3,2005 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. W AA IL �r �u 30 3� 0 �s �� ' I Title.5•Inspection Form 6/15;`2001` Ip Page.1.1 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 303 GLEN EAGLE DRIVE CENTERVILLE,MA 02632 Owner: ORCUTT,ARTHUR Date of Inspection: JANUARY 3, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated,depth to no groundwater 14 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: �— Observation 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: HAND DUG T.H. 14'NO WATER. T.H. 4' BELOW BOTTOM OF PIT. 10 > y P/7 Title 5 Inspection Form 6/15/2000 l l No.. ..1.... �..... F:m.....` "O......._ THE COMMONWEALi'l OF MASSACHUSETTS BOAR® OF HEALTH .............. ......OF...:7�" � ............................................................. Appliration for Diipuaal Works Tontitrnrtiun ramit Application is hereby made for a Permit to Construct (✓� or Repair ( ) an Individual Sewage Disposal System at: ....... ��G �n✓y-�>�, ,. ..... .' -------------------•---...........__ Location.Address or Lot No. ......................L� It1 C� ee w ��/:: :..S` -• ...._........•_. ...._......•-•----•••••-•-••-...-••--•. ................................ Owner Address Installer Address Type of Building Size Lot... ....Sq. feet Dwelling—No. of Bedrooms._� :=__��'_______________________Expansion Attic (��� Garbage Grinder (�)' `4 Other—Type T e of Building .e �'^��%� No. of persons 3................... Showers Ga yP g --------------------------- P ( ) — Cafeteria ( ) a' Other fixtures -----•--•-----------------•----- . W Design Flow........................Il ............gallons per person per day. Total daily flow....... t+_........................gallons. WSeptic Tank—Liquid capacitye.W'5 _.gallons Length�i 6K.". Width.' `� '__:_. Diameter................ Depth.4.__'''...__. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area.................._.sq. ft. Seepage Pit No......... :......... Diameter......../4°_...... Depth below inlet.................... Total leaching area._ _ .....sq. ft. Z Other Distribution box (✓j Dosing tank ( ) .0 Percolation Test Results Performed by.......................................................................... Date._._ __. .._.. ,aa Test Pit No. 1.......... ...minutes per inch Depth of Test Pit...... ._.____ Depth to ground water_,_i,1 o!Lf'__._.-_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_____._---____-__.____ P4 ---•----•---------------------------•----.............-•---•---------..........._-•---••----•-•----......................................................... ® Description of Soil......_....0_`_m3____.._.�:c'`17� " Ste' 3- E'er < x ••••••-........--••--•••••----•-••--•••---•----•---•-•--•--------••-------•-•-•-----•------------------------------•--•••--•-_-•--- (� ___----•-•-------- ••...................= =- -�...-----•/a2� ---.. W UNature 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b= issued by--the boa -ol health. ApplicationApproved By.. -- ••-- _•---.. ------------------------------------------------------------------- - ` ............... Date Application Disapproved' a lowing reasons---------------•------•-•-------------------------------------------------------------------•----...._..--•-•-••- ...................................... ---------------------••••..........-----------•••••-------------• Date Permit No......................................................... .---------- ---------------------•-•-•-•-•------- Date No.L�...........�3�.... ..... ..�............`... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .....................OF... --------------------•--•-----------.........._..._.....-- ApplirFation for 14spasFal Works Toat,itratr#ioat itarAft Application is hereby made for a Permit to Construct (L- ) or Repair ( ) an Individual Sewage Disposal System at: .................................. .......................�...........C> i--•--�1��= - --- Location-Address . or Lot No. C' c? .. .. .-.�.... .a ....._.._...... --------------------------•--------•••- ................................................. ......... .......---....... Owner Address f"tom, rieif�"•idr . it � r.�.��+' � Installer Address Type of Building Size Lot... -5'i.a`"!...Sq. feet Dwelling—No. of Bedrooms__ .............. __-__Expansion Attic ("elf Garbage Grinder Other—Type of Building ,O-!r `1 No. of persons......3.................. Showers — Cafeteria QIOther fixtures ............................-........................................................... W Design Flow........................1ld...........gallons per person per day. Total daily flow.......3-Z.s3'........................gallons. WSeptic Tank—Liquid capacityoeoV __gallons Length_ f Ci_'" Width.'V-'_/6 ,Diameter________________ Depth_!6 x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No__________ _________ Diameter........./_G_.._._ Depth below inlet.................... Total leaching area__..... ......sq. ft. Z Other Distribution box ( —) Dosing tank ( ) f' 'e 'Q ? ~' Percolation Test Results Performed by.......................................................................... Date..... �.a Test Pit No. 1.........!;P�._minutes per inch Depth of Test Pit.......!_ __..___ Depth to ground water_., ®,4-c"_:_..__-_. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._____-__________-_-_. Q+' •---._...._..••-------------••-••--•---••-••----••-----•••••--•--•-•-••.._...........--------...----......................................................... O Description of Soil____.._..._ .":--�........_e'V-1P I? ' �'`U� �' C x ------••-•----••-•---•••-•-----••------------------•--••-------------•-•----•-•--•-----•---••--------•-----•--------•_.. V ....................... .................. ..!-�.---•-•-----/nE'``� `•'2'.^t W UNature 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by-the boa A health. Dyfei Application Approved BY = ,r I Date Application Disapprov lowing reasons--------------------------------------------------------•------•----- ........................................... ....-•----•---•-••--•---•--...•••---•• •--•--••-•-•--•------•-•-••---•-......•-----•------'--••••••-•-•-------•----•------•-------••----•••-•-----•••-•-------------' -----...•_.__. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..`.''.....................O F...... e - ".......... ...'='......`................................... �., Trrtifiratr of T-nutpliFana 'I. TCj RT,!�.That the Individ�46;Sewage Disposal System constructed ( or Repaired ( ) bY, ' .. --...- -•--- --_.. ,.,._....---• `:- -----------............................................................................................. -r Installer ^ �.. at....... •...t'-••-r....`.t ----------•------•- ------------------•-------___------------------"-------------------------------------------- •-•------------- has een installed in accordance with the provisions of TI�rKE �5 of The State Sanitary Cod as cJ sic bed in the application for Disposal Works Construction Permit No--_Ia--�_.`_ ___________________ dated_. 1 __l _/. _•_____.__.._..____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. np DATE.................................................19, � L� ........... Inspector.............................. i- ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No........................ FEE-1•................... Dispofiatl Vorhv T-1a1mitrudiatt "pautit Permission is hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................•---......._....------------------------••------•-----......----•-------•---•--.-----------------------•-•••-•-•----------•------------•----•.l Street / as shown on the application for Disposal Works Construction Permit N .__ Dated z_!,� __d.. ________________________ _--- --•----t---------------------------------------------- Board of Health DATE.....''. 1. ....................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS LOCATION SEWAGE PERMIT NO. VILLAUE INSTALLER'S NAME & ADDRESS ' d U 1 L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r..� ��- �- 3b 3� ��'��� � , �.� �� � � �,S . } 5%WGLC- FAMAO( - :6 BCOQooM IJ� Gi�52BAGE G21NDE2 z/9 D/a1Ly F►-ow s 110 X = 3v G.P, c? ,' f ; 5EP'f1G TP►JK a 33Ox15o% = �9/r" G.P. - 1111759 LJSE . l000 /1'' /Qo,e ��' •� •' 9 v5E Ivo0 GAL. -7— oi5Po5AL_ PIT 28 ti 37 5 6?o I BOTTOM AcLA= . O 1: 5 o S.F.' x I• o � 5 O G.P.o � i� /ao. ; Boa f �.I f.; -T 5 ' (9.P. D. E�ep 1 } t oT A 1-. �E 51 GN s .a-2 IN oTAL DA1LY FLOW - 330(,.PD, �_; 1 f -T S.T. ,�� " MIN oP-LE55 a F.✓a /�/ 1 PE2co�AT(oN RATE I IN 2 91F.7 114 _ �P,vA of Afgs i �1N F PAq l /,� -� syc TN I 3 n /ao•3 /o/ I . o: WILAN LLIAM W. ^. •p ` it a C. w JONES • jo. N Y E �' . 251 I i, c No. 19334 C su A • z'' . `�y1 �F v / 1 I Z7Z7 �;G. -� Y�,y T o P F N D°/6/. ^ ' loco INS. t.. I I� D►ST. SEPTIC INJ. GA►.. , 1000 NY. 6uX II 13 9>q PIT INV. INV. WA LNG D �i 6TvNE ,i G is 2T I r- S 0 P t.wr P L-A-W I; P R U F I LG •� � l.oL4 �I •4 � 1.10 . SGAI.E `jcALE '' yATI'c 79 It GEczT1FY THAT HEREON GOMPI.`(lj WITN"THE SI0lr--1.1W1'c �7 - �� n �� A►.�D SETiaAGK OF 'C1-1� -To W N p �L�iZ tJS'T YL>,•3l A N U 15 I.1�,T' i. ,.j . LOCATED WITNI. T GL-OOp P Ihl i DA-rE C BAXTEtz� IJ`(E INC. .` REG I'S'T f�QE."D'►.A►.t o S u Z.Y TI115 Pl.v.t�! 15 NET' 4t%5Gap o AN OSTE�Z_VILLE - ►55• ` INS-I-RuM6NT Sv9VC-y �'TNE OI-FSET5 6WOUL,, I' NoT (3F- V5E0'TCp Oe7eR/NJ►4G �.oT �_II-lE�j APPt-ICA► I'r ,p.Q✓/I>`4[ILJ,e� i .d