Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0278 HUCKINS NECK ROAD - Health
L278 HUCKINS NECK RD, CENTERVILLE A= 252134 { �llln Aa�'�O�o Nop2®� 15� � HASTINGS,MN 1 +� � No. �� 1 '3 14 Fee � J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitation for Disposal 6pstem (Co stru>ctiou Permit 9i+1 I ) a, Application for a Permit to Constdc Ugr� Ab !doA( ) ❑Complete System ❑Individual Components Location Address or Lot No. Own r' ess anc��'a� o. Assessor'sMap/Parcel ` r1C.YlJ� l�Jl Installer's Nslrrts, o. �' Des'• s ; ss,aATel. Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date (7 Number of sheets Revision Date Title Size of Septic Tank l Type of S.A.S. Description of Soil L��1 Trip Nature f Repairs or w Alterations(Answer when applicable) w � p G Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate o Compliance has been issued by this Boa o Si ed Date 7. 1 Application Approved by Date o- Application Disapproved by Date for the following reasons Permit No. na ID-) Date Issued 3 v1-- ' ,1 a� �'s • v ` K� Y a No. d3 - ° Fee , - THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWNS' `OF BARNSTABLE, MASSACHUSETTS Yes r 4 01pplication for -IS Bat, *pSt>em Construction Permit Application for a Permit to CAM )R�epair t�I rj,df 4AMonq��Lj Complete System ❑Individual Components Location Address or Lot No. �W, � Owner' N e,Address and Tel No. Assessor'sMap/Parcel ) ,�_ ` Installer's Name,Address,and Tel o. Designer's Name,Address,and Tel.No. O 1 _1 Type of Building: r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) l Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date v Number of sheets I Revision Date Title n Size of Septic Tank Type of S.A.S. Z-- D� C�f Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 Qiw Date last inspected: „.. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this HeaJAh Date Application Approved by Date 1 Application Disapproved by Date for the following reasons Permit No. l ,> Date Issued ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 3� (certificate Of Compliance �� THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( . )jj epaired( ) Upgraded Abandoned( )by at � ►�{` Y�)�� has been constructed in accordance with the provisions of Title,5 and the for Disposal System Construction Permit No,0 , —Q 3 4 dated Installer �� �� t1�1 Designer _ �u #bedrooms <j Approved design flow gpd -t The issuance of this permit shall not be construed as a guarantee.that the system wi iffunct�'on6as designe' . Date y 1 Inspector , 1C r� - - - '-- -- - ------- Tee - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at Y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted within three years of the date of this permit.t �. Date /. Approved by S Town of Barnstable �` ' i.� Inspectional Services a� = Public Health Division i6J9%63 �$' Thomas McKean,Director � w A + ° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 4 ZOZ CnI Sewage Permit# - d3 Assessor's MaplParceU� Designer: ��/ Installer: Address: Address: Cad/ 4Y1 �7r� On of 6"Xa ' was issued a permit to install a (da ) (installer) septic system at ;,77f I/ d6� based on a design drawn by (address) 'dam 12, (designer) I certify that the'septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip .out (if required) was inspected and the soils were un satisfactory. qu � '� co e0veo M 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. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe a with the to rms of the IAA approval le ers (if a licable) M,q�s� a DAVID MAS®N1 (Installer's Signature) CO) No.1oGG STF� s�NrTAR� � ne lgna ure) (Affix Des tamp 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. WoMdeptAHEALTMSEWER connedSEPTIODesigner Certification Form Rev 8.14-13.DOC f, t Town of Barnstable Inspectional Services Department "`MASS. Public Health Division 9 MASS. �!. 1639. MA'I A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8265 December 15, 2020 WILSON,NORMAN H TR ET AL 278 HUCKINS NECK ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 278 Huckins Neck Road, Centerville, MA was inspected on 11/06/2020 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\278 Huckins Neck Road Centerville.doc t 1 Town of Barnstable • awRrisraBi.e. b 9 ,�� Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of driveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc d,6-9 3Y c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name / information is required for every Centerville V Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information S/ /5VS-0 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co Company Address Centerville Ma 02632 Cityrrown State Zip Code ,sue 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 11/6/2020 Inspector's Signatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal-septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ;p Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/aWrris riot operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every __._Centerville _Ma 02632._._. 11/6/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge orponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville .Ma-- _02632.,.._.... 11/6/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less 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. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed-at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments MM 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMA 15.364.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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 backup? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/2612018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts �e Title 5 Official Inspection Form 90i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. CityrFown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes E No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment:. Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date-of'occUparicy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes Z No 5. Building Sewer(locate on site plan): Depth below grade: 7 feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Unknown condition t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is Centerville Ma 02632 11/6/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons (assumed) 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? Measurements on taken Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Precast septic tank of unknown size has inlet cover on riser. Outlet cover is under walkway. Water level was good. Tank is 6' below grade. t5insp.doc-rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w, 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 if present was not located due to depth t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !n F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Precast leach pit has riser with cover 1.5' below grade. Pit was located and excavated and was found with standing water approx 4" below inlet invert and a stain line slighty higher resulting in a failing inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is Centerville Ma 02632 11/6/2020 required for every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately U A2 Z I �2 3� t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Ww Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 278 Huckins Neck Rd Property Address Norman Wilson Owner Owner's Name information is required for every Centerville Ma 02632 11/6/2020 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 This 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 COMMONWEALTH OF MASSACOUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS € DEPARTMENT OF ENVIRONMENTAL PROTE T`rON pp 1 ONE WINTER STREET. BOSTON. NIA 02108 Fl 7-292-5500 998 OCT =�1 11�ILLIAM F.NVELD 350 MAIN STREET TOWr10FBABNSTABLETRUDY C(9XE Governor WESTYARMOUTH,MA HEALTHDEPT. \Pcfccan ARGEO PAUL CELLUCCI & � 508-775-2800 DAV1,D�1 STRUIIS Lt.Govcmor C mmissioncr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Z PART A CERTIFICATION MAP 252 PAR 134 PROPERTY ADDRESS: 278 HUCKINS NECK ROAD,CENTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: SEPTEMBER 23, 1998 JOHN BEGGS NAME OF INSPECTOR: JAMES D.SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: _ DATE: SEPTEMBER 25, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check;A, B, C,or D: AI SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: SITE OVER ALL PASSES, INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. 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 b the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:hftp://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23, 1998 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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 and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23,1998 D]SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than''V2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. c (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23,1998 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No N/A Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23,1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): YES Laundry connected to system(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): 1996 79,000/1997 96,000 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) YES If yes, volume pumped: 1,500 gallons Reason for pumping DUE FOR PUMPING TYPE OF SYSTEM X 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information:, 1984 PERMIT#84-145 Sewage odors detected when arriving at the site:(yes or no) NO (revised 04/25/97) Page 5 of 10 SUBSURFACE SEVVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23,1998 BUILDING SEWER: NIA (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK:X (Locate on site plan) Depth below grade: 62" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: N/A** Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: N/A** Distance from bottom of scum to bottom of outlet tee or baffle: N/A** How dimensions were determined _ AS BUILT&TAPE **NOTE:OUTLET COVER NOT RAISED 62"BELOW GRADE. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) TANK AT WORKING LEVEL,INLET TEE,INLET COVER RAISED 8"BELOW GRADE.NOTE TANK PUMPED AFTER THE INSPECTION. GREASE TRAP:NIA (locate 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23, 1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass Polyethylene _ other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: _ Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) NOTE: D-BOX NOT OPENED BOX OVER 5'BELOW GRADE.BOX NOTED ON AS BUILT. PUMP CHAMBER: N/A (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.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23, 1998 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number: 1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number, alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ONE 4'PRE CAST PIT,PIT 4 1/2'BELOW GRADE,COVER 22"BELOW GRADE,NO HIGH WATER MARK. CESSPOOLS: NIA (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: _ Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) s' GPRp� 's 0 3S (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 278 HUCKINS NECK ROAD,CENTERVILLE Owner: BEGGS,JOHN Date of Inspection: SEPTEMBER 23, 1998 Depth to groundwater feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) NOTE:LOT HIGH GROUND HARD AND ROCK (revised 04/25/97) Page 10 of 10 TOWN OF BARNSSTTABLE ,�� LOCATION ' 'SEWAGE# 1—W—03� VILLAGE ASSESSOR'S MAP&PARCELZ52- INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY X- GJI LEACHING FACILITY: (type)` ze) Z► t� NO.OF BEDROOMS } OWNER r i ( 0/1 PERMIT DATE: '2 ?7 Z®Z COMPLIANCE DATE: Separation Distance Be een the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on g� site or within 200 feet of leaching facility) �" I Feet Edge of Wetland and Leaching.Facility Of any wetlands exist within 300 feet of leaching facility) 'Feet FURNISHED BY -a 7� d �fr J c No....--•--•-•••--•••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... --..............OF.................-...................... -------------........................... Appliration for Digpniia1 Workii Tnntrnrtinn amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...(_C.4K1_,V.`1 19-------------•---------•---- •••.ramcation-Address r Lo No. . 9�11.�}�q ----------------•--._... @!f �• � _Ulk. ••.._ :�.V 1 ..............._ Owner Address ,y 1 _. ......-- <rwt!w__�w�_5�_�.�\ ... 14- -- -----------------------------•---- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______________________________ __ _____Expansion Attic ( ) Garbage Grinder `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures _________________________________ --------------------- -------•------------------ W Design Flow......: 3_fy..........................gallons per person per day. Total.ily flow-----�3_Q'_____._.____________..._.._ - lons. WSeptic Tank—Liquid capacityf$a_�__gallons Length__________ Width.... Diameter................ Depth-• .......... x Disposal Trench—No_____________________ Width.................... Total Length._;_________________ Total leaching area....................sq. ft. Seepage Pit No........J---------- Diameter......'Z---------- Depth below inlet......t........... Total leaching area.Jq.$......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... a' -------------------------------------------------------------------------------------------•••••••-•......................................................... ODescription of Soil...........-----------------------------•-•--..-.•---•-•--•-----•---------------------------------------------------------------------------------------------•--•-•--- W V .......................................••-••-•--•....._....---._.._...........--•---------•-•-•---•-------------------------•---•------•-•----•-------•------........................................... W x ....----•--------------------•-•-•-•----•-----•----••---•-•---•-••-•-•-----•----------•---------•----------------__.__.--•------•••--•---------•--••------------------------------------•-------•-----•- U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ --------•--------------------------------------------------•---•--------------...---•-------._......•---•-------•----------•----••-•-----•-•------•-------•-•--•--•-•-..-------•----------•-•--......_-- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Co ie—The undersigned further agrees not to place the system in open ton un it a to of Compliance has bee issued by the board of healt Sind_ __ Application Approv -------- -------•---••._._...--------._........ D e Application Disapproved or t. a following reasons:__...-••------•---------•--•---•----------------•-••---••------------------.....---------------------...._...._ ........---•-••---------------------------------••-----------...-•-----•-------------....._..-------......_ -------------------------------------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date 1 NoA.Lt................. Fps .. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ....................O F..........................._.......... Appliration for DhiposFal Works Tnnitrurtinn Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................................. •.� .0 " J ............................... ..:....----...... cation-Address or t No. %��qq ---.------- 9'�s 8!H.. . ..... :I!iS�.u_! r......................... w er Address a '. . . =--- ------------------------------------------•----- r: �. . h► _ �._ .... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ") ` a Other—Type T 4 e of Building g ---------•-----•--•-•-••---- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures _... Design 'Flow..... ;;3-0...........................gallons per person per day. Tota4ily flow_-733.0............................ WSeptic Tank—Liquld capacit45.9.6..gallons Length............... Width... _.......... Diameter................ Depth.,.............. x Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------- ----------- Diameter...:. -----...... Depth below inlet.'.-k............ Total leaching area$ql.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY--------------------------------------------------------------------------- Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 P4 •••---•----•----------••----------- ....................................................................................................................... Description of Soil........................................................................................................................................................................ x V -------------•----••.........------•-••-------••.....-----------•-••-•-------......-•--........------------••-----------•----•----•--------•--------••---------••........•------••---------•------------ W x ----••------••-----•-•--------------•••----------•-••-••-•-------•------•-------••••......-•---•••.._..----•-•--•-•----•---•-••-•----••---•--•-•-----•--•-•------------•---•---•-----•-••-------•....•- U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. •------••-------------------•-------•--•--------------•----•--------•---. ----------•---........------•----••------------------------------••--------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLij 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation u til a sate of Compliance has beer issued by the board of h It Signed ApplicationApprove&B '----------•------------•--------•-----...-•-•---------•---•-----------------•----......----- .... � .......... Date Application Disapproved or to following reasons-------------------------•---•----------------------------------------•------------------------------------••---- ......•--•--------•.............•------•----•--••••------•--•-----•.......--------------•••-•-------•---.-------------•---••---•-----••••--•-------•••-----------••-----------••-------•--••--•---.----- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF �rr�if gr�a#le of f�unt�rli�nr�e IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) r by r ------ --------•-•-------------•----.--------------.---.-----------------------------•-.---•- ---- / fy Installer at.. ? �T /� f_. "' ----------- has been installed in accordance with the provisions of _� c$ The State Sanitary Co as s >bg in the application for Disposal Works Construction Permit No.___����______________________ dated-....__.._._.�' _.�` ........... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM WI 1. F CTION SATISFACTORY. DATE--..3 .1 :..+��................................................... Inspector.... ---.. .--------..._....------•---•-•---------•--=---•-----------...-----•-•-- 1 THE COMMONWEALTH OF MASSACHUSETTS r---.aOARD OF HEALTH ..�,/ OF.............................................•--------------......._............... No dr...............� FEE............--........... i �rar its ii Tnntrnr#uan rrntit Permission . hereby granted. ; TI r•-------------------............-- ------------------- { to Constru ,-( o[,Re air ) an lvldu ag� os ,�System Street as shown on the application for Disposal Works Construction Per ................... Dated......................................... ----•-•- .....•----------------- ---------•--. • Board of Health DATE .... -•••--...---••-- i FORM 1255 A. M. SULKIN, INC.. BOSTON f TOWN OF BARNSTABLE LOCATION 2 7 7 /1U Or/A"S N£C/r R) SEWAGE # V Y-"I Y-5— VILLAGE (� £ NT' ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. A-Sr•B-2 0 ; 5-'oz^-& SEPTIC TANK CAPACITY D 14e LEACHING FACILITY:(type) /T (size) S� 1 NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER �46 4f S �Tofi�N DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ` ��,' , �/� s� ---- ��d�d� S� s� y�o�,� LOCATION UC � SEWAGE PERMIT NO. �VILLACE I� �INSTALLAR'S NAME i ADDRESS "" BUILDER OR OWN ER Ilk --T�J Act-Lj:l �70 -7,-A DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �,/ a�' a �-•--- - i[ ��"� i --- 3 �5 ,. �� � ,. .. .----..., :.•rm.r++;a�:w•��.ar--w-arx.,�c: -_,....� .v.c-a.a z..-..-.n..t.r•:_-:••,�,� . ..-_ .. ....:.^,axr.•acs:. ......r-.,�.o,->-._•' �.:'aa;.,y;:a.,ae;rfr.ri';r..ue«.+,na:-r+..w.,T..r...,. �a+uu.,w, :;:f6`�i�S.L�iii.,y,C�d:f....-W -.?.rT.},,...;��.-'.,...-.'". :_: -.yr+�lYiiw!.'-+C .YN.1✓3. ... .. a�MM^1�1M1 M4+:=JR..•!]WY'ul^9.1.'vC Y'4t tiYtf+6s....._�-... _...,_ -�.-:3iMly�,,...:.r.....+r-_....-Nv-..._d-aKai.c-���Y.::..." ._..s.rl��X ..._ �...++.v�3^ni,..• +...✓-r.-.__�aa�-F+-•,.•--... ..'^`.'•'.."T.•. _.._._..�?p.. ..__. f f M'•MONM311rd' .� •. .. .. .. r r. j� t......+.. ..i e.� 'G✓' ,tom'` _` 3 ._.._ ' iil.StaiP2' ''+-' t `?t i , _ );: + �t';a t + Town 0t 1 -2rtt of Health Kr-a1 f per/'' AL'{') - 521: Ci aTl, 3.`:' t. !:gin 0 w ' , .� ix - ` ;Sr?C(* t? �n1i[P•.I��i Y(J/ {\f/`! � / 5'i'. ') . iie? r:5 i. t() . s Y�Y('��''�� .: � ��'L'J"�1 � � � �� }�jy�'r- /f_f'1 •�- flr'J:'.J t�fiCir'i:lr:t} i�, ::._ ^° Yr?14i� r•.nk tf'a rlLtp," - # •-----a----� � _� (iariait, .'fy +I s ,. � . ,i: .r;• f= j C IST(r7}; rpti, +�� s 1. 4++1 t ,.�.W-- t�U �.� Sl1tA _ ITl�ii c.. be h u1 4G PVC ai s;' i ;, < e v... :` r cC 3 V t► I !'� 1 �`"6 distribution bm, W!?..f) �i`_? levpi. 111� (':)r''tflf'fttT?r15 to ( r� t���/ f r" t.. siF,}tli_design uix, tt= i ,.P! for property fin ' -. t. i 1i iiny t?'>'!r u l� aths:er th 1 ti ystr?rr; jElcta!I�tin+`. '.•'`�,i' v ut ' E1 �171 �O ° I• Ic'�� C77trzr.�.yyv - t�ti.... ter �(3�;-t�K o`:#:IIT'.�i. r' .....:::.L__�:.a. .aio-.:�s35.c`=f 1 l �._.• '� J]t P' i ��v `9-.e�vra.,rccart�t.w:^c.:ar.®.bx.:•s-.:-.. /1Q't � � �►f '� -. king shall be 3. i�t,i1 , .. _ 1+ .ftrr�}�L1 T1C r�T4 {.�1°•t.'f .. �1 ���0 ioC~i(j ed. t { I,#ry .x � � ,? �• �-" ;� � t � existing ie ,ng }+ n cEt{f ar?C tt' ':�:'' • :Pr 7-jt c- `' JCr)i=p I n3chil d cess oc?45: and t 7111rti3;C(� 'Jltltl1111 (1P jt'icsed S-AS!;h.7�li be iaced}.with r!L-a Sri:5L.1 op.,- .ifie t tt:srlElC?t:cT1.S. =t TTlji iri7lc a co r h pr+ / ��•.',`f+/�} ` 1�`(i ii+ ';c1 r>...Tl•'ICC'ti. £`. i(','i_ I?C�; :;1� a WdtF'f / :ieeu-lci :+riih 3T; ?�i ;�cil}Ie 40 PVC with, / ii the Steeve.. R}� Th� �' i' _Hp.` . Jr Ir Y to tile lhle ✓n_` —. _ � �, W �1(.✓ d �+�� � i .., i:r7Tf}8gE gi li1dPf ex: 1 .• •� '...' �?::, it iS to be •'2;T4C1t 'stet') iS i1Gt B ,. / f \ ��,/ ��.••1 !T^T, iS?t7c!'( iC'% a(:t'ryP'T1Pllr; `� y t j !/LET „ }, /s,,,.•......�+"' J ..�i„, ,.,,,,,:.,. •lf?(,�.ir�ti?�St�.�_rl. �-Lt_..� )��?UI.rP'f ri�f% :i .j. ,• 1..��.-• r} _.l t': �J-- P:G•1 _i'IV rC'N°i'�c;t� - - ':'StE'!:?Can be1`15i�?: r�-. `y`;i11�E+Z'T11? f�Ltr"� t•� ( `'r'!^l fib f tjilj F xf property owner 'terja tc aFratJyrt' t''` } ti.: n:.'• Cif hetil D�t?!S r?f+i T) . inn flow. E;,st�l#a,"sr tens t7S Tr7f'J(1ri5Ls� a ; ;� a i;, nent for i#fie de44 ! �. \ be CN't11P(j rt+^ !'6tt:'fll by the proper+'4 ,� a;i+' L S1¢. j i I \ ` 1 'r'✓'✓�(..rT r Y'�e't �( *1J =' t y� . . 1'si,;Sj(5/Cf(tf1i5iie! ., ;'�i t}`!P(?XI:113I!C111 i t1 1.+' I' , , ..''ir, l'1f'.Ti11;I I pan or the :alidil. , t. . x lit jt'1 r� (./ 'LC.-T'% �i:.• ! �C�ii..�W^ t � plan 1_ r i;'X!}l1'(��)T tl ' %? T, -'' ' c i+.' f r(.+(Ti I.}:Iit il!- 7/' iy�_ +,• .r { �✓// ..> ,-�, 't f.- -� - - _�f:'t e .l-:,`' ,d - i ii .. a a_t; ;:eU TO} ,�✓;. Pali%%�ii ri ':t: (`• , X Z`o _x 2—)( , = / 1 ' - ! 7 DAVID 9Ln B. ZE MASON t„ o No.1066 co C' lfl r d ; Ti 1 s / � , , I (, �: 6 � rN-T��' T 4 kll-l� ;�.� 1, 1 \NVI _ I � J s�+ -- � D rr �� � � - _ _ ,� .��jl� -_I� t5_FPEe�► . C/ ,tea K �d_.�,..�. c.x.��. . .� � - ,,�..�.�.� ..�...C.�. .. , +I - , j �-` �{ ► ..._. i r AA t� __+•j < i• S_.r'C.✓ �/l- Y y'•}/�t2i d 'UV-J 1,4 L I '!�? 11 - PC /D --,c Of— Z' � y ».. �l SOC t � f (i '' a° 'K '""{ir'•� '�C'�'` . ._.,�''T�"'rL.�+l i�-°/t�`�...-- ' , r �1 • � . F �{�rW i =•=�io.7^t:Y..::.wNa:t w!w.-v.:tR' -..'.c' S/Q w9• P � w✓d^a'• K - "iflt M -�OfOrmin '.-.:"":.q�M:w�.r..;�.i..,_,.....r.rtiw.r+r�rwprsr,m �r r--+xs.•t,�.+. a'm t-1 T"F. f_..iaf.m[3nf}7.1r3s'-'�ws_v^. C�—T .._ -� s-,...F:F.iC�7ElPR.-{'it't r:,e:r;(.r•>;;,=t,. .. .. •yr,... .-. ...., .., ' - flfl 4L L E L f.V 15 t-�w>,1 AFC'6� M Fc o w.t SE�► �"�v'E�.. r cj} � � _ _ _ - �L�� �_. _- � 6i►�.+c°O CI.J �..aC�G7 5 C7�►T L,� A ...-�,c: ViJL� •1 ^LL L.I►JF_S 1+ ►tiv,rnu c7f- 1r, 1 , i .S~J -f..' - ; -- - 1 � / - ��_ (( U►-!1.t `+'• O I►-IL ICE+ �1�E ��'"k G�F l k•'U - \ r./ �;} /ALL W1fV , To .AwID o.J TH(c :,Y ,,It;l✓`, ��.Aky :;G--i£':.'` J I �+ - -?`�- _ '7 h � � 1 1 bt G.wST IQ4►J t3dU�� A P _ X r+ O , 0) �1/ �.1 l� A F PT K TA"iC 5 P,' T 2,fSJT�G.J 'flz�,[ A r t� n �t � I �l l 1 E�+C►�,.JC� F�rc'� �r�a.LL 7..E LaE��S�..JED Lt�i�. ~ -- ---- -- - - ` ' a © `I (J, �G �.) �J tit 20 v�.iEEI_ ♦pi.C. .JCS '.�1ak ►J .Jr _C f,,lL 1 -- - - rrll � L - kE►�.-�✓E A.� u..�s.�,rA3...E MA.rE21t" dE.JE.aTti C (Qi t� �� = �E i"✓Eer E1-ESA--10--VS of �Ec c►+� Jew vn5 Fri. :,T — !. �� �9 C) C > �� A e�a�s ,c. �e,.►o E�c+��LL .��,rF, c��y � � �� �Y � ) � t \J 11 Q) Q j �J `� ��ti: 13f�i�/✓s�i�C*[�' F� :.....:.C7 c�= r+ti:.a�T�, ►.-�u,r M � I � I i � J.l �� nn r rf� /��`` l l'k r�i'11 if-.tT� w►��,..r r-►�t �y�.rE.M 1`., rye Ak_ rH - iLh-- � �.� -'C' L-I � \ J / v �) �� 11 ` `; / � W li tC�e�► 'i. t_1-�[1nJ A._�G PC'_,oG` TC) �►ex�,l-L,u� --{r r � � \� v i .F.. � r �c,� 0--- V►�i_ c5�; O Tl-+E�f� .. ,�,E_ t ,nY k=C�, A L.�. :,Y S T E�1 h i , r � � ____.., � .�„ I () (� ( ) � � �. � Q� �v.-tPb�lE►.r!'� s►.t.,�-�. �' E I..,st-F.`...co ,�.1 !� 7,vPICAL DI�T�II�L�TIG►-J VQGA.,1� 1T1+ r i TLE � c-tc (ti " �rc �TgTE - - - s--= - -- -- -- 1 � ) ( 'i !act Cza�' iE JOT T,O ScAt E+ _ -- - -�__� • ! �l�1ILr1 MAN I►R�1i .l,7TTc 1`„_rl ,�rrir. l 160r I�siv Y4- T f'1L/►L �S lJ u+..L $tcJ�'T/E. TrJk. _� l I�.IAI� l��r!4S.F! t.� � k7IT Od E,v yAT/GN - -- F'/T5 t;E,...� . iccL• 5trr : T ..._,►a py �tr,G...J IS'i=c r,�,r �loT Ra ScA4� ►.roT Tc __. _ ...._.. SC.►. 6 vE.Q coL A rio.V ,�'.a Ttr = Z/inn �����j ��•�L O yv /..C7rE : T n►.►K S 1Z��.�FcccE G t wi n,�..o,, i w,Tld E<.I,•�k'�•... ruE�C�O �uii� w�Tl-1 OBSECV�T/OitlS t3y: T ter--.- �<7� 2A - It' iMBHhOED S1EEL k0��'i •1 AJOTG' AGGEYf M�nIF/OLC� TO BOA e&q OF 4W,1 L -Mr dor orb. Cek+C. 16 4t700 Pu t�',T SGvT,e TA,A[ ^ND l CAt Ney6 Pilg Ta 1341ILT UP TO DA7L" O„T-7ii ' _.., '`� TOI FIwN C.�TIO.. LOr_v '!- j IJ.jI tt.4 C. ¢n of (:"Jar 7 F r IS►4 6cIOC f. u�E ,�/ISH 6 ��►L S H GCn LE >i air Ts►,c K r c I;EA G H,N G -t- _ 4 1►J tQ T . W �� t5 fiG b.� IHN. CI 1G O a O « p 4,,1L A�Q ``f CeuJFocGc D Co.�c pIST 13Gy( © .O 4 (000 t F ; SCPTIe. TAIVMG . i mO � O0 P►-r TVP1CAL aE%u..6f 5vSTEM /O- 40 NeT T o mac..*.L OE L-E�cN I nI C� p rT \ i DES 16,v C,,E'/TE,e1 4 --- 46— PROPOSCD DUEL.. L. 1 KIG LOCAT I C) MdE� r OF eEo ¢�.+�s 4 k�4 PROPOSED SEWAGF— D15PoSA1._ 'y C/, . / _�o, 1 �Ersa�✓s �F,c a�v�oo,+� L = . t'.�a�. .;.or�� i GROSS N loT / , l 6./LL GLU'S Aye irCp.X•�✓ -o"o.4 Y -?�c- � \ LE.4�.�•�/N6 ,a.e�a �eE4��t� _;. ��►� � ae sE.c��rv.� o r. � p i z � � , G'E/1rrE-.t?1/lLl�' /`•�i=��'.5�. , Z6Aeyl,,/6 Ae,--4 ,cvov,,P&.o FlkGOPO5F- ) L.:ALNINL- piT /F ONAI .Q,PPLIc.e.A1�r Ew1G1►�F Q'. /l14N/V LS Mr4. '. - -2 b /07- Q.D. StEk.lER 10E5 G1..1 L 0 ,7 ' L- / \ S'/T:Capf1LG A�6A.'(L :t8 SSG).2•s =Irzo f,- P v. ;e NOAMAN GROSSMAN 78 SG ALE GATE sMEET �� I �,C p�� 12�1vZ )0 AS ►JOTS <9-E, -83 �Q Sl�IS Z�Vc- % OpAWN 9Y CHKD 6v APPD or PLAN NO.