HomeMy WebLinkAbout0402 PHINNEY'S LANE - Health 402 Phinney's Lane
Centerville
A=230-207
K S M E A D*
No.2-153LOR
UPC 12534
�uoMwwmictw
SH �„ '
N
TOWN OF B NSTABLE
LOCATION k ^ SEWAGE# 1(OS
VILLAGE 1 1 JeA/SSESSOR'S P&PAR10EL
` INSTALLERS'NAME&PHONE NO. v o✓ 7
SEPTIC TANK CAPACITY / Q dO
LEACHING FACILITY: (type) LekcL ¢., (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: 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
0
tA
f
Fee
Noa 'C9
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,4,MASSACHUSETTS Yes
Zipplication for TMpo5al *p5tem Con5trurttott permit
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components
Lo�on Ad� s�r Lot No. � t� Nn � �� � Ow e,Addre�Tel.No.
2 nIK--
A�s or's 4ap�atc�e'f
Inst ller's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. �
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures /� �J
Design Flow(min.required) ?'V gpd Design flow provided � � T gpd
Plan Date Number of sheets Revision Date
Title f
Size of Septic Tank r 4/1( t 5t7 (lam Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable
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 f Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued b is Boa d of Healt .
Si ned Date
r, k
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. "�. �"� �� Date Issued
Fee
v � Entered in com uteri
THE COMMONVIVEALTH OF MASSACHUSETTS p -
PUBLIC HEALTH DIVISION - TOWN OF BARNSTA�B'LE*MASSACHUSETTS Yes
.r T ,y
ZippYication for Ot5po!5al gpp!tem Cow6truction Permit
Application for a Permit to Construct(:) Repair O Upgrade A Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. I Vd OIS Name,Address,and Tel.No.
Ass"essois ao
I <
Installer's Name,,Address,and Tel.No. Designer's Name,Address and Tel.No. �
P&CAS PO.01* )551, an.n S` c 5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
v
Other Type of Building 4No.of Persons Showers( ) Cafeteria( )
Other Fixtures
r-
Design Flow(min.required) .-�Cv 7Q god Design flow provided �T T gpd
` Plan Date Number of sheets Revision Date
Title r
Size of Septic Tank (�S t-t nG Type of S.A.S.
Description of Soil I
I
Nature of Repairs or Alterations(Answer when applicable
Date last inspected:
Agreement: t-
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions Qf Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si ned I �~ Date
Application Approved by �l `' J Date (D�
Application Disapproved by: Date
for the following reasons '
Permit No. �2�'• a 6 5 - Date Issued
: -- —'— - - -- - —
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CEy�J�IFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abanndo/ned( )by L.o Q.V+-5 C 1-h-�
t /-/-O� �1 t�}f� S �a �p� y I (1L.__ has been constructed in accordance Yl� u 1,51�
t p - o ,, p"1 y 4 —c�-� dated b .
with the r�ovis�ionrs of Title 5'
-an(dlhe�fbr-:Dis osa S�Construction Permit No.
Installer 1 Y/)t Q-L ( 1 t_X�l/l.Y/ Designer
#bedrooms Approved design flow gpd
The issu//anal of th' pne it shall not be construed as z g��arantee that the system wiL func. gn-d.
Date (p AMU Inspector
� r ,
———————————/——————————————————————————— V——/�}————
No. �` i�J Fee /C)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS
&!gpo.5al �&pgtem Construction vermtt
Permission is hereby gran,t//ed to Construct ( ) Repair ( ) Upgrade (. ) Abandon ( )
System located at '7 0 fh t I S
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: Construction lu//st be completed within three years of the date� thif is permit.
Date / b _ Approved b
Town of Barnstable
OF1HE lam, Regulatory Services
�O
Thomas F. Geiler,Director
• BARNSTABLE,
9�A MAn Public Health Division
rFD ,�A Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date:
Designer: Shay Environmental Services, Inc. Installer: �o �s
Address: P.O. Box 627 Address: VM
East Falmouth, MA 02536
On was issued a permit to install a
(date) (installer)
septic system at a 5 �� based on a design drawn by
(add
Shay Environmental Services, Inc. dated
(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.
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.
IN OF MASS
q A
C. e
CARMEN
( s a er E. -A
SHAY
No. 1181
0
'P�GrS7ER�
, S KiA
PN
gner's ignature (Affix Des> p Here)
1
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
C' !
WN hereby certify that the engineered plan signed by me
dated (� 0 2 concerning the property located at
-4�U Z 't c�+� 'S ° + �%�T �`4 A meets. all of the
following criteria:
This failed system is.connected to a residential dwelling only..There.are no.commercial or
business uses.associated with the,dwelling.
t • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes .
per inch. The applicant may use historical data to conclude this fact or.may conduct deep
test holes and percolation tests.at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The.bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) AD o'o
B) G.W. Elevation +adjustment for high G.W.
DIFFERENCE B EN A and B 1j ,
SIGN)rD : DATE:
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
q ASepdc\percexemp.d oc
7
c Commonwealth of Massachusetts
AL a
Executive Office of Environmental Affairs
6
Die, artment of j9`9�
Enironmental Protection( a
ee
Wilco ,« F.Weld Im y e
Argeo Paul Celluccl David B.Struhs
U.cmemor CommWiorw
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
402 Phinney' s Ln
Property Address: Centerville, MA Address of Owner. Donna Lenox
Date of Inspection: 47=7_9 7 (If different) PO Box 1 1 8 4
Name of Inspector. W,E. Robinson SR Hyannis, MA 02601
Company Name,Address and Telephone Number. ( 5 0 8 )7 7 5-8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
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� sews disposal systems. The system:
Gs Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: g . Date:
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:
A) SYS PASSES:
havfound an information which indicates that the m violates any of the failure criteria as defined in 310 CMR 15.303.
I ha a not y
Any failure criteria not evaluated are indicated below.
J
M CONDITIONALLY PASSES:
ne or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
spection.
, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with aponforming septic tank as approved
by the Board of Health.
1/03/95) 1
One Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292-5500
Printed on Recycled Paper
l_
I� Y •
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddresa: 402 Phinney' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4—7—9 7
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($)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled 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
Cl ER 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 the
public health,safety and the environment.
1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
D INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
S AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and 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 is equal to or less than 5 ppm.
3) OTH
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 402 Phinney ' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4—7—9 7
D] SYSTEM FAILS:
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.
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 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 1/2 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 a 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]LARG SYSTEM FAILS:
1
The following criteria apply to large systems in addition to the criteria above:
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
and safety and the environment because one or more of the following conditions exist:
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)
The owner o operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requiremenj�of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 402 Phinney ' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4-7-9 7
Check if the following have been done:
_umpiag information was requested of the owner,occupant, and Board of Health.
_None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
VAs built plans have been obtained and examined. Note if they are not available with N/A.
facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
system components,excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
/approximated by non-intrusive methods.
1/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface P� P P Pe
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 402 Phinney' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4—7—9 7
FLOW CONDITIONS
RESIDENTIAL:
Design flow:,gallons
Number of bedrooms:-3—
Number of current residents:
Garbage grinder(yes or no):_ O
Laundry connected to system(yes or no): YA.°s
Seasonal use(yea or no):_A,0 1 9 9 5 — 1 1 5, 0 0 0 g a 1 s.
Water meter readings,if available:
1996 — 67, 000gals-
Last date of occupancy: g
COMMERCIALANDUSTRIAL-
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 6 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORD and source of information:
s8
System fumped as part of inspection: (yes or no)_
If yes,'volume pumped: gallons
Reason for pumping:
TYPE qP'SYSTEM
f,/ 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)
Other(explain)
APPROXIMATE AGE of all components, date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)LL 6
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 402 Phinney ' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4—7—9 7
SEPTIC TANK t/
(locate on site plan)
i �
Depth below grader , /
Material of construction: eoncrete_metal_FRP_other(ezplain)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baflle:3-2—
Scum thickness: 1 6 ' , . 1
Distance from top of scum to top of outlet tee or baffle: I
Distance from bottom of scum to bottom of outlet tee or baffle:
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.) 1C 1. K T-- y �A, z:: L P C IZ, A i At3f,
(i TRAP:_
(locate o site plan)
Depth ow grade:
Mate ' of construction:_concrete_metal_F1tP_other(e:plain)
Dime ' ns:
Scum .
from top of scum to top of outlet tee or baffle:
Digt—anek from bottom of scam to bottom of outlet tee or baffle:
Cc nts:
( endation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,stnidural integrity,
eviden of leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 402 Phinney' S Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4—7—9 7
TI OR HOLDING TANK:_
(I at"
site plan)
Depth w grade:
Material construction: concrete_metal_FRP_other(explain)
Dimensions:
Capacity: ons
Design flow: ons/day
Alarm level:
Comments:
(condition inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(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.)
PUMP HAMBER_
(locate sit
Pumps
plan)
working orden(yes or no)
Co..
(note co
tion of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
propertyAddresx 402 Phinney ' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection 4—7—9 7
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan,if possible;excavation not required,but may PP be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching Pits, number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields, number,dimensions:
overflow cesspool,number:
Commee (note coon of soil,s' of hydraghc failure, level of ponding,condition of vegetation etc.) L/ — ,¢ C a 5 )
Y.d G t� e
1p
CESSPOOLS:_
(loca on site plan)
Numbs r and configuration:
Depth-op of liquid to inlet invert:
Depth f solids layer.
De of scum layer:
ns of cesspool:
Ma rials of construction:
tion of groundwater:
inflow(cesspool must be pumped as part of inspection)
Commen : (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
P
(locate o site plan)
Materials f construction: Dimensions:
Depth of lids:
Common :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 402 Phinney' s Ln, Centerville, MA
Owner. Lenox
Date of Inspection: 4-7-9 7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include tier to at least two permanent references landmarks or benchmarks
locate all wells within 100'.
� s
(7 3 ,
� G
s
DEPTH TO GROUNDWATER
I�
Depth to groundwater: 2 feet
method of determination or approximation: 6 (N
(revised 11/03/95) 9
06-1
L0C TION SEWAGE P6Plyil"Fd Z,121.Ir IT NO.
VILLAGE
Cep �fll
I N S T A LIER'S NAME & ADDRESS
C:?L�
Isto
S U I L D E R OR OWNER c
DATE PERMIT ISSUED CjL �
DAT E COMPLIANCE ISSUED
® Q
� s
e 4
°►� $o1
,
A
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEP
Application is �Pe �fade for a Permit to Construct (C—l"or Repair an Individual Sewage Disposal
Location-Adess Lot
1w,r . Address
...... Installer Address
Percolation Test Results Performed byi...� t;�:_Iix ate_ z;./Zn� ...A L-f 4
Test Pit No. 1_1*-;%3........minutes per inch Depth 4"Test Pit Depth_1A ground water.....
TO
--'
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL ITi!Lj 5 of the State Sanitary Code The undersigned further agrees not to place in
operation until a Certificate of Compliance has been ued by the b>jrd of.health.
FSi,gne,d-.-.. ___________ °� ���nn��utk� By------ ----'" '�� —�=�--
/lnol�ut��uD� fort&xfo *� r«uxo�x�.---.,r-'�----------------''�-'-'----------' ---/'--------
------_-----'----------'-----'--------------'------'------------................................... ............................
oat"
Date
No.... �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LT
;t
.......:.. oF.. ... c -----------------------------
tir #inn for Disposal Works Toostrurtion ramit
Application is hereby made for 'a Permit to Construct ( 'r Repair ( ) an Individual Sewage Disposal
System at
� LocationAd s �~
�xr.. (.6. ... - �-----?_ fkZ ---
..... -----. + ------.
Owner Address
a Installer Address
Type of Building Size
Dwelling—No. of Bedrooms___ ; ..................................Expansion Attic " ) Garbage Grinder (�> r
aOther—Type of Building ............................ No. of persons.................._--------- Showers ( ) — Cafeteria
. •----•-----.----•••....--•-•-••--•---•.---------------•••. --------........-------�
Other fixtures -----------------------•---------- -• ^` ---- lons:„�
WDesign Flow....... ..I—', .....................gallons per person per day. Total daily flow...... � ._...•.............. t '
WSeptic Tank—Liquid capacit 1jfi_10..gallons Length_ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing ) --
Percolation Test Results Performed b ........ .. . _. ...... .� ?. ' ate__.. :_ ....
Test Pit No lr' '........minutes per inch Depth o est Pit 7-7 h; ,-_ Depth ground water -
(z, Test Pit No..< `�ri.. --_minutes per inch Depth of Test Pit..: ............ Depth to ground water e
R'1 -------------------
-----------------------------------
. ----
ilr
D Description of Soil ... l �n " A � ! Od
UNature of Repairs or Alterations—Answer when applicable.................:..............................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code=The undersigned further agrees not to place the s stem in
operation until a Certificate of Compliance has been ued by the bo rd of health.
.�:�`-`... `.. .. . ..........................
Signed _..,� � •.
Datj
Application Approved By............... ------- • •-4---------------•- ........
.D to
Application Disapproved for the f o owing reasons: = -•------••-----------------------------
--••-••---•-•-•----------------------•---....---••-••--••-------.........------•-------•--........---.....--------....---•--•--------•--•--•-------•-•-•---------•---•.....--•-•----•--•••.......--•--•.
Date
PermitNo.--- - g `----•------•-------- IssuedL-------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS' - J
.. BOARD OF HEALTH
-
16
, '"° ...............O F.. t '!``" "?. ...:. .. ....................
TrdifirFa#r of TooiptiFanu
THIS IS TO C. RTIFY, That the Individual Sewage Disposal System constructed (4oloor Repaired ( )
by ... t- i..3. ..... ...-•-•-•------------ •------- ------ ---•- ----------•--•--•.... ..................................
at_...��"_�* . , ' t r # ----=....I l°4�"... ----.�c�"uew/ A
has been installed in accordance with 'ti, provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... .......... dated_.............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GUARANTEE THAT THE
-`'SYSTEM WILL FUNCTION SATISFACTORY.
DATE...............) ...................................... Inspector....---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
............OF.... ....... .. ............... ... �+ »h'•
.J FEE
No .........
�is�r ,��a1.forks t �o�is#r�r�' n rraati� ,
Permission is hereby granted.r....�--`�-�---- -----. ....... ►►.'a t_.��._�_�_-A............................................................................
to Construct ( epair ( ) an Individual ewage_Disposal.Svstem
at.No....... 4 - • 1 , ---- ." I. ....... ./Zf�------•----------•------------•--------•..................................
*,- , Street g -
as shown on the application for Works orks Construction Permit N ................... Date --------- --ZY.......
_ . :
DATE......... `_:�-. '_
...........................................
Boa f�Heal
FORM 1255j F..•M..-SULKIN, INC.. BOSTON 4
(e
c� 4 >y�piEFFI7
ELIilk
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eal
fl.
x `1Y
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43
60
W �' r
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kcf �Y 4 y is Zt t'°•' I�t� _ \_� �S.
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50
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i 1- S\x rt-_k'
i A ca;k
8� ,!^ t:fi..Y ST I-, 7 t.3 J•�' !1 5 .�4 i it -.1 J v/ {
1 � I t�µ .I' ' I�'!ORS
f a i 1 1 V
✓tL;4
LEGEND:
t r,c !7: •x p+ r. - tN_. _"'y-"J"fi•�®i �!
$POT .,ELrEVATION 0,►0 ``}
�w EXISTING, CONTOUR --- 0 — n CERTIFIED PLOT PLAN
� N18NIr0.'8P®T .ELEVATi OW
. C L a T 3 G y s z A tip"
4 p•- o � t M .
RNOTE; The ;location d ,'any ;existins5 under® �„ound sewerage, 1 N
welis,~or, othex .��t3litz's �ho,uin ' as cm tY', tplan. is approx- ,•�s�
`iaiate only 3as,1determined fromt.xecord's' and/or''verbal : �� -S-1 -` 9 � ^'S
fnformation;: 'The 'comracto '' is responsible for.'the , '�"� �.ir,, � sE r
yyexiftcat on of :the .exis'ting l ocations imA,,e field:` ' _ SCALE, /"= 40 / DATE
�0�. DOGE' �'�G5��1ERO G�`G'�°;BN CLIENT- I CERTIFY THAT THE PROPOSED . -
RE�IBTl9�E1D . JQsr,NO.`� O: I ' BUILDING SHOWN ON THIS PLAN
'` {r x �r ::' CIVI6 ": <' , � .� � d,►dAN® °.;� r � � ` CONFORMS TO THE ZONING LAWS'
' OR8Y' O F A R N S TA B L E MASS a �,p �c�r d� • ,
�712.;M A 1 9 S
,NYAIdWlB MA9�., sF4 .; 9HERT� LOF Z E REG. LAND SURVEYOR
ZD FT /�l/N �t/QTE !F THE SEPT/C TA.IK /S MaR&
, 7-HAN /2 INCHES BE-Z GRAOE, A 24
to FT M/1/• INCH D/AMETZ=F' CONC/?E 7, COVER SWAL L
k 4"PYC PIPE ;gE BROUGHT Ta G,CZAOE "�4N EXTRA f/EAYY WP
CDJ,7ZRETE MAN. PITCH CAST IRON COYER_5WALL USEO /F JN
CL �r z_v CD yERs yg"P.ER FT D/71 VC WA Y
(--x FLOIND/FPUSaR ® OR '
EOUI VAL E/V T
• �; �2� M//Y. GRAVE ,GALLEiP%ES I
TO BE CUNNECTEO '���
I L/QU/o L�"VEL SA/VO
4,"PIA-
SGHEDE 4o ' ( 3 7�,/�
UL a d o d c=" C al//2 T� 4 •
`' P.KC. PIPE l U O O GAL —� "' C3 n Q Cl C1 ICJ : p/SGt/A RGE L/NE
i, w• PITCH
,�EPTiC TANK BO.K w: •:• -.:�.:- ��� 3 s- 1
/4,.pER
Q� oo SFr LEAGfftPlG GAL-LEVY S W�S,�+EO STowvE
..•�/� �. :. a _ •,-: MAX•l'�rz tLG.u/ �.rc c
—
•{ SIDE 96 x 2. S = 2¢ o SEC714N OF G?oUf/O`YATL-R7�t®LE ELF 3/.
G_P,o.
/5 6 �.PD, ,SE1�f A6,6 VISPDSAL SYS7,6M �_ -rABI/-AT/0/� i
arRL CAhAG✓Tyt x D/MEKStOm A 3.4 FT
�SC.4LE.: �4. �! O.. Dl/ye/YslaN B `f FT
wxr nva p E�vS on/ C z4.FT
ti.3I•� lFr 4 F-,- Fr SOIL T v
EST P- s3
SO/L LOG
Dd7"EOFSOIL TE T S
• ' RESVl..TS fYl T/VESSED C3Y�M co tv _n/V
SD/L 7"E3?' #I .. SGIl TEST#2
�Am Affje 38,7
�RCA01-AIK�M�/INC/t n i
PE/2COL�T/oN RATE f/2
DESIG/V
CLE/•iN �v3.5 a t L ,
KuM4ER OF BEpRooal,S
2"LA.YER
UNIT /V 0IV�
o
1 p ' Of �3 •• GARBigrrE D/SPDSAL R of
/ ll 06 o c� ;:; s .9�1/EL757DwE ESTJMA7-A--O 1-1-o11/ . 33 D G,ai[ DAY S
l GpGM/!v�
;. � `s •..• _.=•.:t:=. =�!: S/OELEACNIN!{ AREA SOFT. ,
,S6 e
BOTTOP'l AZACNlNG AR.�A SCJ.FT. .
SrECT�-D/V �C -X TDTAG AREA Z5 Z S4 FT � �L,`3 a.2
a`= RESERVE AREA
SCALE ; �'¢~� -O � Cl /1l0 riRDUMO eVi�T6R Z,,V -REAP y
i GROVNO JV A74—,Z AT EL EY.
1NV=R7 ELC1iATIONS
L O r 3
tit' 4, fTk ���.OF tuq\ /NVXRT AT BUIL.D/A!G 3S L7. Fr
4. BE P. ^T
ALBERT �� /NGET.SEPT/C TANK 38 �,FT, TLsvtSFD S'EPr /2 �S �
1 B. r A. OUTLET.SEPTIC 7-A V y
r Dr'��'ir E .o moRSE - v, G E4VRFDGE4BV6JHEE—R1)VCr Co.,INc,
Nd 19 �' //YLET DfSTId/BuTio/ti!B 3 7,
No.1�951 O 37`� 712 MAIAO"57 HYA^IV/S /�j,45S.
-GIsTERFov0. o� p t5? F:��� DUTLZ�°T.A,CSTJE'/BU,TlOK[3E�7C:. 3 ,3 Ft�. CLLEN'Y"` ,'. r.
/p��l. S oFFss ` y��_ INLET FLOd�VD/FFUSO�' FT ®i4 7`E
CorT.1pI tC d by
H I GH GROUND-WA1 C_R Lf VE L COMPU-I AT I ON
4
S i to Locat i,on: L
�_/�i✓c"1 5' �/1,�-E—
ot No. _
Owner: = J�/zic r Address: Q - -- - -- - • - - _—
Contractor: Address:
Notes: --
STEP l Measure depth t,o. wa ter
,table
to nearest I ft. • • . . . . . . . . . . . . _s/ ��/u`
date.
STEP 2 ' Using Water--Level Range Zone
and Index Well Map )ocate
site and determine:
Gv 230
A) Appropriate index well • ,
B) Water-level range zone- . . .
STEP_ 3 Us-ing monthly' repora"Current
Water Resources .Cond;itions" (�--
determine current depth .to
water level fo.r_ index well
mo yr
STEP 4 Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water=level
zone (STEP 2B) determine l 1
water-level adjustment . . . . . . . . . . . . I /� L/6_... 1
STEP 5 Estinate depth to high water
by subtracting the 'water-
level adjustment (STEP 4.)
from measured depth to water rJ
level ar' site (STEP 1) . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . I t
`---—
I
tCA11 15,(. Ii:}hJrA.l�II! a } 1 I 1 et
OCAT IUCI 10' OS. N'c ns
: t DAME
41
,I fNon-r6fu le) x .
DDRE.SS �� �F� TELEPHONE NO
NGxNEk'R: TEL:�F,I�''"[0NE _NO.�
ATE::-SCP DU1:AF;1.>
(Applicant' s ' signature )-
000 , . . . . .' 04. o . .,.. . . .. . .... . . . .. . . . . o . . . o -
t
SOIL®.LOG_
U{ nIVISION Nt�ME'^ A7; DATE _7'1M - - _
XPANS.SON AREA: 'YES NO
P =:�elcrl,r.:�: : .
OWN, WA�fER ' Pf IVA'1'E: WELL, _ , BOARD OE ,.HE"F,"[,`t'H
_.
KETCH (St refit "n<�a�e ,e -r -,dimensions ,of lot,. 'exact. location_ of te:�;t hole-; arid
percolation tests, _locate ` wetlands in proximity to test holes )
NOTES :
, IN� C�IS N�. ,
77
7 3 �.
3 6
PINES
VtZ
el
1)°
�+ h pI„I: Se �� ,
r
CDT 3�
ERCOLATION RATE:
v��
ESQ' HOhE:' NO: / ELEVATION: TEST HOLE NO: E CtF V' ( rr N
2
n 3 3
•i ,�
Z_ 5
6 a 6
a -
7 -�
� �•. 8 8 r ` ---
__�_
1.0ir
10 -----
kj y
.t I .t 1 1 iii 11 1
y qq+
12 _12 --
R
{ 13 131-5
r Ye
r4 �. 16 1 ' . 16
,
,S I -ABI,F FOR, .SUB-SURFACE SEWAGE ; , TEACHING FI.E;LD_✓_LEACHING PI'I'S`�
�
.EACHING TRENCHES
t S1 TABLE FOR SUB-SURFACE ZEWAOE
�t + i
NGINEERINCr PLANS MUST $E�OWIsr KaEtt. ASSIGNED ON PE.RO TEST APPLICATION
CQ$tPLETFIle
D TN'''EN 3 P ANP REJURSED TO BOAF.D OF HEALTH
4 t>4.>"r 5:t:l 9* a-r!T. ^ZT!.�• .t. F., .�+
2-18• DIAM. ACCESS MANHOLES
10 min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ,
house to septic tank f"
Existing Foundation s
Septic tank coven must be 7in
BOX cover must be .•+, , +„ .�
within 8 in. of finished grade 6 in. of finished grade Finished grade over System- 98.00 'o' •,1:J'•4�.ta"."••w; '�'' i *tt xe ' f
Grade over Septic - 98.50
Grade over D-Box- 08.00
S 0.02 THE ACCESS COVERS FOR THE SEPTIC TANK.
INLET ( DISTRIBUTION BOX AND LEACHING COMPONENT
DIST. BOX S-.008 TOP OF SYSTEM = 96.00
8 HOLE H-10 41k f
g 10' EXIST. S-0.01 or Greater ",. `J `� iY OU T SET DEEPER THAN 8 INCHES BELOW FINISHED ;? �-0� e�q �2 VY
Er1Sr. PIa1 - N 1,000 GAL. p 4•Parlai ted P.V.C.Obtrbutbn Lines. Y-1/8•-,/2'Washed Stone jl GRADE SHALL BE RAISED TO WITHIN 8' OF
rn SEPTIC TANK ,A '� s- 0.01' per foot (- ;. + FINISHED GRADE.
FROM FOUNDATION ,. • s�
o, 2";r. _
SLAB/CRAWL FOUNOATIO H-10 0.sass. g 0D 5' 3 4-1 washed Stone '1 Bottom 0 Facility X.35 INSTALL 1UF-TITE GAS BAFFLES OR EQUALS
��tt •i.,. STEEL REINFORCED
i"� PRECAST CONCRETE
6 In.of 3/4•-1 ,/2" u II •;y.:
SYSTEM PROFILE compacted stone v�i 5' STRIPOUT ALL-AROUND 6.0' PROVIDED PLAN VIEW
Not to Scale - 7G u7 Bottom of Test Hob 1 ION - 88.80 3-24" REMOVABLE COVERS iD00Dlh aslreaaiit R �..�^..`,y
Ad sled ESHWT ELEVATION 88.80 Iti
� °' >u f � � Iona n,�ussy s �2aas►+tAArreq -�^� _��
--------- --------------------------
6 In.of 3/4'-1 1/2• y •Obs. Groundwater - Test Hole 1 Elev.- 87.50 (Adj. Per CAPE COD COMMISSION ELEV. 88.80) ` •` 4'' ' "• 4• ' ' GENERAL NOTES
composted stone •PROJECT ADJ. Groundwater = ELEV. 88.80 3•min, alearonae •' ,t3' „r ,
LEACH FIELD CROSS-SECTION w INLET ` B min j2_min. inlet to outlet e.mr, :< T
- - OUTLET 1. Contractor is responsible for Digsafe notification
NOTE: ALL PIPES ARE TO BE CAPPED AT ENDS. o•min • ? and protection of all underground utilities and pipes.
2'-6" on center 5'-0" on center 5'-0" on center 2'-6" on center 5' -7. �' - 5' -7' 2. The septic tank / distri4L{tion box shall be set
4'-0' min, level on 6" of 3 4 -1 1 2 stone.
s- `' ti• Liquid depth 3. Backfill should be clean sand or gravel with no
Note: Remove soil down to med - coarse sand layer & replace with s stones over 3" in size.
... ...... . .. . . ... ... ... ........... . ................
elev. 95.50 Estimated) "
.............................................................................................. Es mated & r a. ,.,., .,. ,,,. .......................................... ................................................................................................. ( ) replace with clean coarse sand w/perc. ,! 4. This system is subject to inspection during installation
he I
rate less than or equal to 2 min./in. before & after placement •°•r.�••,. '•.ti, ,•, •• : :•• '1 by Carmen E. Shay - Environmental Services, Inc.
i 12"Min' s_o• 4' -10• 5. The contractor shall install this system in accordance
3/4"-11y2" Washed Stone 6 Min. Note: All leach lines to be copped at ends w/PVC caps. with Title V of the Massachusetts state code, the approved plan
CROSS SECTION AND-SECTION and Local Regulations.
Note: 4 PIPES TOTAL (5 FEET APART, 2.5' STONE ON SIDES) 6. If, during installation the contractor encounters any
20 USE EXISTING 1000 GALLON H- 10 SEPTIC TANK fromcthose showns n site
the soil log tions hor at n ore uri'fdesgn
Sch. 40 - 4" perforated P.V.C. pipe installation must halt & immediate notification be
NOT TO SCALE made to Carmen E. Shay - Environmental Services, Inc,
7. No vehicle or heavy machinery shall drive over the
PERCOLATION `TEST septic system unless noted as H-20 septic components.
8. Install Tuf-rite gas baffles or equals on all outlet tee ends.
Date of Percolation Test: JUNE 1, 2006 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
tg-LBedroorn Test Performed By. CARMEN E. SHAY, R.S., C.S.E.Kitchen10. All solid piping, tees & fittings shall be 4" diameter
ww Results Witnessed By. AMY VON HONE ( YARMOUTH B.O.H.)Bedroom Bedroom Excavator: SHAY ENVIRONMENTAL SERVICES, INC. Schedule 40 NSF PVC pipes with water tight joints.
Percolation Rate: Less Than 2 MPI 0 30"
� � � 11. Municipal Water is Available And All Houses Within 150 Feet
Dining DEN Test Hole Test .Hole
are connected to Municipal Water.,
No. 1 No. 2
Stara a Storage DEPTH SOILS ELEV. DEPTH SOILS ELEV.
0 96.00 0 96.00 THE PROPERTY LINES ARE APPROXIMATE AND
Loamy Loamy COMPILED FROM THE. SURVEY PLAN ENTITLED
2nd Floor Sand sand CERTIFIED PLOT PLAN OF LOT #36, PHINNEY'S LANE CENT., MA"
10 YR 3/2 10 YR 3/2 DATED JULY 2, 1985
1 3 BR HOUSE FLOOR SCHEMATIC 1st Floor 0"-10" A. 95.17 o"-1o" A. 95.171 BY ELDRIDGE ENGINNERING OF HYANNIS, MA
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
1 (Description Provided By Owner) Sad �Saand IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
N/F MARY H. HINES 10 YR 5/6 10 YR 5/15 THE SEPTIC SYSTEM INSTALLATION.
1 10"-30 Bs 95.50 10"-30" Be 95.50
1 Q Medium Medium
0 Sand Sand EXISTING SAS TO BE PUMPED DRY &
1\ / 2.5 Y 8/4 2.5 Y 8/4 REMOVED
/ 30•- 86 86. 30 120 86.00l
1 / NOTE: THE STRIPPED OUT SOIL CONTAINING LEACHATE
1 / FROM THE EXISTING SAS TO BE DISPOSED
1
1 f 67.0 f, /// LOT #36 OF AS PER BOARD OF HEALTH SPECIFICATIONS.
1 20,534 Square Feet +/-
1 �
1 Perc #1 ZONING - RESIDENTIAL
1 ,- Note: Remove soil down to el. 95.50 & replace with �'98 Depth to Perc: 32 to 50
1 clean coarse sand w/perc. rate less than -or / Perc Rate= Less Than 2 MPI ASSESSORS MAP - 23C PARCEL - 207
AIW230/ZONE B - INDEX = 22.5 for 6/05
- r 1 / or equal to 2 min./in. before & after placement / ADJUSTMENT 1.3 FEET � THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS
rOp, ` 1 / ,OBSERVED H2O Elev. = .102; or 8.5' below Grade OF THE PROPERTY
ADJUSTED H2O EleN, - 7.20 below Grade per Frimpter
DECK
r 1,0T #37
1 ' ALL OUTLET PIPES FROM THE
SET DISTRIBUTION
LEVEL FORLEAST B2 FT. 12• CONCRETE COVER LEGEND
1 0 _ EXIST. EXISTING 1 PROJECT BENCH MARK s - 5• �7 * ` •ti 2'
,...
TOP OF FOUNDATIDN -, �� ' KNOCKOUTS DENOTES PROPOSED
I r -1 GARAGE 3 BEDROOM
\ 1 I HOUSE ELEV. = 100.00 (Assumed) - - 5S' ouTLET -) -�I . ,2• INLET 8X0 SPOT GRADE
\ I EXIST. #402 / r: e• s• ;
/1 /
SAS X 104.46 DENOTES EXISTING
/ _96' 155• ;,,, n 1.75"2 SPOT GRADE
I PLAN-SECTION C PL ROSS SECTION
/ PROPERTY LINE
o 6 HOLE DISTRIBUTION BOX
1 1 o I I EXIST. / NOT TO SCALE PROPOSED CONTOUR
� 70 1 L- - 4� 1 1000 GALLON /
\ = 1 3 I 1 SEPTIC TANK I / 97 - 97 EXISTING CONTOUR
\\ oT 11 I / ( / Gi ® DEEP TEST HOLE &
\ v Design Calculations PERCOLATION TEST LOCATION
\ ✓ 1 I - o' Number of Bedrooms:3 Equivalent to 330 Gal./pay (330 Gal./Day Min. per Title V)
\ I EXIST. I TEST HOLE #1 Number of Bedrooms DESIGN:4 Equivalent to 440 Gal./Day (AT OWNERS REQUEST) FENCE
DRIVEWAY ELEV.= 96.00 f 9� Garbage Grinder: No �---�
\\ 1 I I Leaching Capacity Proposed: 440 Gal./Day
\ 1 I \ ® I I Septic Tank - 2 x 440 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. ''PRIVATE DRINKING WATER WELL
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch
1 I 215' \TEST HOLE #2 1
\ m_ ✓ Proposed Leaching Field Dimensions: 1 0 20' pride by 30' Long. REVISIONS
��\/I I O n I
ELEV.= 96.00 I I 1 \ V I V
1 \ Bottom Area: 0.74 gal/sq. ft. x 600 sq. ft. - 444 gallons
/ I f 40'•00' Sidewall Area: Not Utilized
I14 DT Providing: = 444 gallons NO. DATE: DEFINITION
\\ 11 I \ I I I 1 06 06 06 Changed to 4 R i
\ \ I (15 FOOT EASEMENT) I I I (15 FOOT EASEMENT) _ / _g B Design
4.
\ I �- e PROPOSED
\ I (40 FOOT RIGHT OF WAY) PREPARED ' r- OR -
�\ I SUBSURFACE SEWAGE DISPOSAL SYSTEM
MR . JOSEPH COGSWELL OF
#402 PHINNEY,S LANE
CENTERVILLE, MA
402 P H I N N EY'S LANE PREPARED BY:
C ENTERVI LLE, MA 02 632 ����" ss CA 11 Ey E. SffA Y
A N
ENVIRONMENTAL SERVICES, INC.
0 20 40 50
0. - P.O. BOX 627
cfSTIS EAST FALMOUTH, MA 02536
SgNITARtP�
SCALE: 1"=20' TEL/FAX : 508-548-0796
SCALE: 1"=20' DRAWN BY: CES DATE: JUNE 2, 2006
PROJECT#SD-927 FILENAME: SD927PP.DWG SHEET 1 OF 1