HomeMy WebLinkAbout0090 THISTLE DRIVE - Health 90 Thistle Drive
Centerville
A= 148 016
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UPC 12534
.2-153L
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page, Citylrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:when filling out forms A. General Information
on the computer,
keyonly to move your the tab 1• Inspector.
cursor-do not Michael Kellett
use the return Name of Inspector
key.
Aardvark Environmental Inspections
�y Company Name
PO Box 896
Company Address
a� East Dennis MA 02641
City/rown State Zip Code
508-385-7608 S13742
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
rn Title 5(310 CMR 16.000).The system:
Passes ❑ Conditionally Passes ❑ Fails
I;
` ❑= Needs Further Evaluation by the Local Approving Authority
CD C' Y'"di
F-- 06/15/11
Inspe is Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
Ism v s 10 Title 6 Official Inspection Form:Subsurface 4Se-waalSystrnIspoe e • I� a»
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. City/rown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiftration 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):
t5hs•11/10 Title 6 Otfidal Inspecdon Forth:SubsuRaoe Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
brokenpipe(s)are re laced Y N ND(Explain below):
❑ P ❑ ❑ ❑ ( P )
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•11/10 Title 5 Ofidal Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier,if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other.
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than %day flow
t5ins•11l10 Title 6 Official inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
' 90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
Information is required for every Centerville MA 02632 06/14/11
page. City/rown State Zip Code Date of Inspection
B. Certification (cunt.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y< 90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5tns•11/10 11tie 6 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Properly Address
Dolores Piegare
Owner Owner's Name
information Is required for every Centerville MA 02632 06/14/11
page. City/town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
I
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5hs•11/10 Title 5 Official Inspection Forth:Subsurt®oe Sewage Disposal System•Page 8 of V
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
r on is
required for every
Centerville MA 02632 06/14/11
required
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed(if known)and source of information:
04/19/06 per BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 3.0
feet
Material of construction:
❑ cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints,venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 2.3
feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gal
Sludge depth: 211
t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. City/rows Smote Zip Code Date of Inspection
D. System Information (cunt.)
Septic Tank(cunt.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle T'
Distance from bottom of scum to bottom of outlet tee or baffle
15"
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was sound and tight with tees in place and liquid at outlet invert.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Ownees Name
information is required for every Centerville MA 02632 06/14/11
page. cKyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. City/Town State Zip Code Date of inspection
D. System Information (cunt.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert even
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.):
The box was level and tight with no sign of carryover.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
90 Thistle Drive
Properly Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
❑ leaching galleries number:
❑ leachingtrenches number, length:
� 9
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation, etc.):
This system has two 500 gallon drywells surrounded by three feet of stone.,The drywells were empty
with no sign of ponding or failure in the stones.
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
kjTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
C /Town
page. itY State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privylocate on site plan):
( p )
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5tns•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piiegare
0%"Ws Name
Infoffna&M is Centerville 1YlA 026:i2 O6/14h 1
per, c4nom fto Ztp Code Date of tr n
D. System Information (cunt)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to
at least two permanZZ110=
landmarks or benchmarks. Locate all wells within 100 feet Locate
where public water the building.Check one of the boxes below:
hand-sketch in the area below
❑ drawing attacted separately
t
10
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ins•lvto 7&5OftWLnpadmFOWSWXWIM gftqp oMMW&pWM•Pap 15or17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owners Name
information is required for every Centerville MA 02632 06/14/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 9.0feet
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:
I augered to 10.0 feet and found no water.
I adjusted to 9.0 feet.
Bottom of leaching is at 6.5 feet.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-11/10 Titre 6 ORidal Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
90 Thistle Drive
Property Address
Dolores Piegare
Owner Owner's Name
information is required for every Centerville MA 02632 06/14/11
page, Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
tSins•11N0 Title 6 Oft el Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
ifIGH GROUND-WATER LEVEL COMPUTATION
Date:
Ste Location: O 1 Vl l SA-Le emit:
Owner: Phone:
Cot•. Phone:
Notes:
STEP 1 Measure depth to-water table
to neatest 1/10 ft. by/',
(depth Is In feet below lat d rf }; Date: 0 6 �.-C) 0
mm/dd/yy feet below
s
STEP 2 Using Water-Level Range Zone and lc Well
Map locate site and detonMne: ;
A)Appropriate Index well Wa3
B) Wafer- range zone C
,
ST�3 Using montWuCtffrent Water Resouoes
Conditions'determine ctwrent depth water
-level for Index well. 05 K 70
` { mm/yy
- - d
STEP 4 ling Table of Potential Water Level for
Index well (STEP 2A), cement depth towater
level fbr index well (STEP 3),and water-level
zone(STEP 28)determine water-level 0
acUusbTmnL
STEP 5 =
Estimate depth to high water by sutmacting the
water-lever adjustment(STEP 4)ftorrm ` O 0 .
meastired doh to water level at site(STEP i).
NOTE* Tables 1-9"Pot w*M Wat w-tarot Mew am aid as lMhaefis to thb 01.
monthly index well data: www.®peaodaommisslon.org/welLs.htmt
TOWN OF BARNSTABLE
LOCATION t D TWSILA� It`�
nI, C- SEWAGE #
VILLAGE l��I l-t ASSESSOR'S MAP &,LOT/ —O b
INSTALLER'S NAME&PHONE N0. T I WELLe `i► �^�11~ j
SEPTIC TANK CAPACITY 641 1
LEACHING FACILITY: (type) ; (size) 3 Y L3
NO.OF BEDROOMS 3 CMS
BUILDER OR OWNER I)OLo W60-E
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by sSQVW S&i� M ;55pyn .
�7.
Vi
�b
No. o� ( 7 2, r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Application for �3igo$at *pztem Cow6truction Permit
Application for a Permit to Construct( . )Repair(6 Upgrade( )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No. /0 '7,�& lC,p��� r,LAk Owner's Name,Address and Tel,No.
Assessor's Map/Parcel K 3'-1 1 i I V,, �.
Installer's Name,Address,and Tel.No. 77Y- Y5ti-qL?S Designer's Name,Address and Tel.No.
56 C6A''rrrrnpe sl.<+p iL«d ;t
/R,Yh�ri w.
Type of Building:
Dwelling No.of Bedrooms -� Lot Size /L 3 7 sq.ft. Garbage Grinder(yo)
Other Type of Building No. of Persons Z Showers( ) Cafeteria( )
Other Fixtures I
ti
Design Flow 3 3o gallons per day. Calculated daily flow 3o gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /v."e ea f Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �- S ccw CA-(12.. t3 y
tf U� S�Cy✓.
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 Enviroipental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss ed`F oard 24_1*
`Signed Date /I /m
Application Approved by Date 1A
Application Disapproved the following reas s
Permit No. 2 bU 1 _7d— Date Issued G
` No. I! [A- 1 a4 a 1 Fee ITLei�-
.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓�'/
Yes
s PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLES MASSACHUSETTS
' ZIpprication for Mi5po!6ar *p.5tem Cony truction Permit
Application for a Permit to Construct( )Repair(/`'�)Upgrade( )Abandon( ) ElComplete System ElIndividual Components
tde dr,�
Location Address or Lot No. Owner's Name,Address and Tel.No.
76 `�l�sf �
Assessor's Map/Parcel
U t/J IC�`{1 11l� Aul !r
Installer's Name,Address,and Tel.'No- 77y- ySy_92 '77 Designer's Name,Address and Tel.IVo.
5c4�- :54,&k 5Ac 15�0 c 1
C 56 r'ArrA9e st,<+,p ytc.Rd M �
{.
Type of Building:
Dwelling No. of Bedrooms t Lot Size i;. 7 sq.ft. Garbage Grinder(,vo)
Other Type of Building No. of Persons 7 Showers( ) Cafeteria( )
Other Fixtures
Design Flow *3 3ri'- gallons per day, Calculated daily flow 27v gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank i� ,gam, / Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 l-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance-w tS the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued-by Board of H a1th
F Signed �! %/ / Date
Application Approved by. Date /g d b
f' Application Disapproved for the following rea "ns
l�
Permit No. 7 n�. ! �� Date Issued U /
------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Comptiance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired(K Upgraded( )
Abandoned( )by S S. � �, S '
at `9 6 -�.�, �/0 A n .� f��PFLr�1� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ��� 1 7,2 dated i (//
Installer Designer Ilt✓_�a
r,.
The issuanc of thf permit shall not be construed as a guarantee that the sys et m will function as designed.
Date �Xb Inspector
No.Oho 6i , I- 2 Fee /tiG
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
liopoaf *pgtem Con5truction Permit
Permission is hereby granted to Construct�( )Repair(1/)Upgrade( )Abandon( )
System located at Qn .' Y-i_n✓1 _�� .A �����
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Constru`don must be completed within three years of the date of phis pe it.
Date: � / hb Approved by 1 .
t
Town of Barnstable
Repleto>ry Services
Thomas F.Geller,Director
Public Health Division
Tbonias McKaaa,Director
2,00 Mains Street,HyannK MA 02601
Offiwc: UW-862-4644 Fax: 3080W6304
lsstt&t& Dtsitrier Q ag °�For®
Date: 1 46(° Sewage Permit# 760(, 7 Z Assessor's 11Sap1!'ueel 1
-oi;�
Designer: _ N n9�` t�hJ62-( -Iestatler: � sSh�r.e 5� e S �"C
On was issued a permit to install a
(date) (installer)
septic system at �o Tbvti 5 �.e lac-+ Cep u`y���-� based on a desip drawri by
(address)
(designer► dated
—�--
_ I certify,that the septic: system referenced above"was installed substantially accordinji to
atlas design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
r
I certify that the septic system referenced above was installed with major ebanges (i.e,
grmater than 10' lateral relocation of the W or any vertical relocation of any component
of the septic system)but in accordance with State dt Local Regulations, Phut revision or
cert0 s-built designer to follow.
Of W�SI'c
PETE14
(In$teller'4 Slgnatutre) o MCENTEE
v CIVIL
o No,35109
( signer's Signature) (Affix L'esi ere)
MEASE ALnALJQ B&=IaLL_ZW" _UALIJI .DIV361 N. f.L=r.
J:QMZL-1EA.1QMLL6 N121 M MILILD UNTIL JM TWS EORM AND A&MILj CAALAU
MCLIXED By TIC A&M_ITARLS i~UBLSS HL"IN 21136 X "�'�
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Q.Hcairk'Uptir.-TAsiFrner Cerrificuion Form 3.26.04.doe
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Niche: IMb Form Is To Do U For the Repair Of Failed
Septic syglows y
PMCO A27014 TEST IL. &V AI. UA`11 ION It ION FORM
d n&! sy if C4&-M a 4 to a eeidateal d"lling early. Time we as 04MAMoftal,W .._ .
' sa Usin mKiiad W101 ft dwell",
® nn void is chnnAed•a CLASS i wW ft psmolaoma rays to low*w or eqW I*s niwAn
` per dam. MW gpbowt try�W hiowfal dale W concha fts Ut at my p
fat Was cod POW10M 11M at Ow ate a baft ASM Pimt.
a Ybwe is no 'amweem to flow atWer elms in use paposed
Vnianese r"Vewd or .
e The bona of OW prOPOr d low"facility VAR* 19CAW no low 6W five dxM Ow
vWIM tt&4VOd p+oaa ut9a w table slevation. !Adjust OW VWffWhW6W tabffi+4 Ot
Ptoetpm ratad W le)
Plaaas sampleft do$Wkwft.
A3 Tqp of CWvwW Bleats Elevatior: Custn$Ol.$ infonvssoonl
44 t for 111*G,�1V.�2 2—
S VATt:
NOTWE
gap"vpm dw abwn asfoty ate, a repo►pstvttat will be i (aor._
waxftmm. No l bads to aueho ud to tits ftwn +ani
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Town , of Bat
2006 Property Assessment Lookup
Home: Departments: Assessors Division: Property Assessment Search Results
New Search
90 THISTLE DRIVE
Owner: 2006 Assessed Values:
PIEGARE, DOLORES Appraised Value Assessed Value
Map/ParceUParcel Extension Building Value: $ 135,600 $135,600
148 /016/ Extra Features: $2,600 $2,600
Outbuildings: $500 $500
Mailing Address Land Value: $149,800 $ 149,800
PIEGARE, DOLORES
Totals $288,500 $288,500
163-41 17TH AVE
WHITESTONE, NY. 11357
2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Community Preservation Act Tax $54.61 Fire District Rates Town
Barnstable- Residential $1.90 $6.31
Barnstable-Commercial $2.51 Commercial
C.O.M.M. FD Tax(Residential) $305.81 C.O.M.M. -All Classes $1.06 $6.54
Cotuit FD-All Classes $1.33 Personal Property
Town Tax(Residential) $ 1,820.44 Hyannis- Residential $1.61 $6.49
Hyannis-Commercial $2.50 Other Rates
W Barnstable-Residential $1.60 Community Preservation A
W Barnstable-Commercial $2.46
Total: $2,180.86
Construction Details
Building
Property Sketch Legend
Building value $135,600 Interior Floors Carpet
Style Ranch Interior Walls Drywall
Model Residential Heat Fuel Gas
Grade Average Plus Heat Type Hot Air
Stories 1 Story AC Type None
Exterior Walls Vinyl Siding Bedrooms 3 Bedrooms
Roof Structure Gable/Hip Bathrooms 1 Full+ 1 H
Roof Cover Asph/F GIs/Cmp living area 1196
Replacement Cost $157634 Year Built 1972
Depreciation 14 Total Rooms 7 Rooms
Land
Lot Size(Acres) 0.35
Appraised Value $ 149,800 i ._X 1 "
Y• i
„ p
Assessed Value $ 149,800
Interactive Property Map: Ma re uires Plu in:
I have visited the maps before First time users
Show Me The Map
-
April 2001 photos available Click Here
Sales History:
Owner: Sale Date Book/Page: Sale Price:
PIEGARE, DOLORES Jun 15 1992 12:OOAM 8045/274 $85,000
BAILEY,JOHN E TRS Mar 15 1992 12:OOAM 7905/316 $1
BAILEY,JOHN E TRS Aug 15 1987 12:OOAM 5863/098 $ 1
BAILEY,JOHN E 1653/56 $0
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
SHED Shed 80 $500 $500
FPL1 Fireplace 1 $2,600 $2,600
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTO Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
Q TOWN OFBARNSTABLE
LOCATION t D �!415.1 ODi�I V SEWAGE #
VILLAGE ASSESSOR'S MAP & LOTagge
I. INSTALLER'S NAME&PHONE NO. p I LA U;'
SEPTIC TANK CAPACITY 1 aDO&AL,
LEACHING FACILITY: (type) LEAW (size) 1-3 X 'L3 .
NO.OF BEDROOMS 3 CA4AJJ9M9
BUILDER OR OWNER 'DOUR ?IE60-E
PERMIT DATE'. Y 5' .--..COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
I
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ak a<c Rd LOCUS dRd
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PROPOSED CONTOUR pr Rd P t Rd o
C AJ 1 ec"ct rec rc p co
s.
7g PROPOSED SPOT GRADE
r p2 re
EXISTING CONTOUR
EXI5TING 5.A.5.
TO BE PUMPED STRIPO?U w�
�T TEST PIT ko�'o c r
2 FILLED 1MTH 5AND o
gj (SEE, ALSO, NOTE 11) 9EE NOTE 1 1 ---- `>Pd EXISTING WATER MAIN o Mer de" ord Cr �or0
BENCHMARK �
A _
OUTER CORNER OF RAMP _ r Roser"ory �O m 8er" Noti�
EL. = I00.00' A55UMED " 19 BENCHMARK
pun
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.119
LOCUS MAP N.T.S.
! f la
x TP-2 EXI5TING 5EPTIC TANK
�9 TOP OF TANK EL: 97.65 GENERAL NOTES:
.� INV.(OUT)EL: 96.30±
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
TP-1 yy
BOARD OF HEALTH AND THE DESIGN ENGINEER.
r� DEC li �q 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS.
(!1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
` 9 / ,r / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
9 7 / ' NO. 90/ / //, // _ o DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
fA 5TY. / e ,�` /� N W j FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
WWD, FRM. / v is ENGINEER BEFORE CONSTRUCTION CONTINUES.
fi/,T.O.F. a 100.25'/ //' 1 C�� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER.
Z IITCN4 1�9 I i 8. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S.
DRWIEWAY
i ��� OF yJASS 9 L AREAS A CONDITIONRBED RING CONSTRUCTION
OWNER AND CONTRAC
TOR.
OR.
1 q
ETER T. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
1 o P
1 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
APN 148-0 I M CIVIEE CONSTRUCTION.
'90) No. 35109 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
AREA — 15,375_ 5FE �k `� 6 IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S.
�4 a FGISAE��9 ' R `�� AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3).
1 { t
,��.... �� � �-. 5Ip t 12. CONTRACTOR SHALL EVALUATE STUCTURAL INTEGRITY OF EXISTING
Q SEPTIC TANK PRIOR TO CONSTRUCTION.
OL 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
c�� I lGf N38°06'20"W - U u �.,� -- --� PROPOSED SEPTIC SYSTEM UPGRADE
90 THISTLE DRIVE CENTERVILLE, MA
THISTLE DRIVE � E.
O P.
91 Prepared for: Dolores Piegare, 16341 17th Ave., Whitestone, NY 11367
190 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
EnglnwdngWorks. HOOD SURVEY GROUP 1"-20' P.T.M. 143-06
12 West Crossfield Road P.O. Box 1724 DATE CHECKED SHEET N0.
Forestdole, MA 02644 Moshpee, MA 02649
j (508) 477-5313 (508) 539-7799 3/24/06 P.T.M. 1 of 2
1
i
' NOTE: TO PREVENT BREAKOUT, THE PROPOSED
TOP OF FOUNDATION F.G. EL: 99.3t FINISH GRADE SHALL NOT BE < EL:96.0
EXISTING I FOR A DISTANCE OF 15' AROUND THE
EXISTING F.G. EL:. 99.5t(EXISTING) F.G. EL: 99.4t(EXISTING) PERIMETER OF THE S.A.S.
MAINTAIN 2% MIN SLOPE OVER S.A.S.
INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 2-500 GALLON LEACHING CHAMBERS INSTALL RISER OVER CHAMBER/S
WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES SHOWN ON PLAN AND SET COVER/S
TO WITHIN 6" OF FINISH GRADE WITHIN 6' OF FINISH GRADE
L =15' L =5'
6 4" SCH 40 PVC i 4" SCH 40 PVC
e 2" LAYER OF 1/8" TO 1/2"
EXISTING a 10 EXISTING 74" ® S= 1% (MIN.) 6 @ S= 1% (MIN.) ®aa�®®a DOUBLE WASHED STONE
0 1000 GALLON INV. ELEV.=96.07 I INV. ELEV.=95.90 2' EFF. DEPTH aja E3Ma
SEPTIC TANK 3/4"-1 1/2"
EXISTING BAFFLES D-BOX WITH 4' 5.ID 4' STONEE WASHED
NV.EL: 96.30t INLET TEE EFFECTIVE WIDTH = 13.2'
INV. ELEV.=95.80
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.=96.6 -BREAKOUT ELEV.=96.3
PIPE INVERTS PRIOR TO CONSTRUCTION.
2 D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE I INV. ELEV.=95.80 ®®m"603
aaa®aa®aa
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED Im aaaaaaaa93
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). BOTTOM ELEV.=93.80
3' 2 x 8.5' = 17.0' 3'
3) INSTALL INLET & OUTLET TEES AS NEEDED.
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' MIN. ABOVE BOTTOM OF L EFFECTIVE LENGTH = 23.0'
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. T.P. EXCAVATION OR G.W.
LEACHING SYSTEM SECTION
NO G.W. ENCOUNTERED OF Mq
SEPTIC SYSTEM PROFILE AT OR ABOVE EL: 88.5 P,�� SS9�yG
PETER
(3) 5" DIA.OUTLETS
McENTEE
15.5" 16" 2" N.T.S. o� CIVIL
�� -� DESIGN CRITERIA No. 35109
1 " �
15.5" 0 �; 8 3� ��..1 NUMBER OF BEDROOMS: 3 BEDROOMS
6"
SOIL TYPE: CLASS I /j',1/�-�0 4
H-10 LOADING 2" PROP. �,N DESIGN PERCOLATION RATE: 5 MIN./IN.
�--BOx \ SOIL LOG DAILY FLOW: 330 G.P.D.
DESIGN FLOW: 330 G.P.D
GARBAGE GRINDER: NO
DATE: MARCH 23, 2006
SOIL EVALUATOR: PETER T. MCENTEE P.E. LEACHING AREA REQUIRED: (330) = 445.9 S.F.
16 a �. WITNESS: NO WITNESS-CLASS 1 SOILS .74
Z EXISTING SEPTIC TANK: 1000 GALLON CAPACITY
®®®® O ®®®® Elev. TP- Depth Elev. TP-2 Depth
�®®aaa aa0®® 33•• �_ _�
®®®®®®®®®®®
®e��®®®®®®®® 99 5 A SANDY LOAM p 99 5 A SANDY LOAM D USE 2-500 GALLON LEACHING CHAMBERS IN SERIES
/ 10YR 3/3 10YR 3/3
99.2 B 4 99.0 B 6" SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F.
/ ��f/ / ! / A' Q��✓� . SANDY LOAM SANDY LOAM BOTTOM AREA: 13.2' x 23.0' = 303..6 S.F.
No. `�O�` 96 7 10YR 4/4 32" 10YR 5/8
448.4 S.F.
96.0 42" TOTAL AREA:
4" KNOCKOUT /,/� `` �''///i � �J/ �' _ G,
20" ram. COVER j / v f ��f �' / M0YRS4N6 SILT LOAM
/WD. FIRM. !// / SY 5/3 DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D.
" KNOCKOUT O 4 KNOCKOUT 62" f j T.O.F. = i 00.251/ / ! 92.5 `2>15 GRAVEL 84" 94.5 C2 M-C SAND
60"
///;�� f/ /�'�'' >;10YR 4/6 5 GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE
4' KNOCKOUT /'
MED. SAND
2.5Y5/4 92.5 C3 84" 90 THISTLE DRIVE CENTERVILLE, MA
J MED. SAND
500 GALLON CAPACITY, H-10 LOADING 2.5Y 5/4 Prepared for: Dolores Piegare, 16341 1 7th Ave., Whitestone, NY 11367
88.5 132" 89.5 120" Engineering by: Surveying by: SCALE DRAWN JOB. NO.
CHAMBERS S.A.S. LAYOUT NO GROUNDWATER OBSERVED Engineering Works HOOD SURVEY GROUP NTS P.T.M. 143-06
N.r.s ".vs PERC RATE <2 MIN/IN. (SAND) 12 West Crossfield Rood P.O. Box 1724
Forestdole, MA 02644 Mashpee, MA 02649 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 539-7799 3/24/06 P.T.M. 2 Of 2