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Home My WebLink About0157 HAMDEN CIRCLE - Health 157 HAMDEN CIRCLE, HYANNIS A= 309 246 0 1 0 i` t" Town of Barnstable Health Inspector �oFtNe t � Office Hours o Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2.00 • snxivsTna�. 9� MASS. ,0� Public Health Division ATEDMA'�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: 115 7 Map 3QA Parcel Name: L Cl\- / may Phone#: 7 7 I - 7 0 1 3 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? V 1sj If yes, how many? l 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? Z 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please.label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or S If the dwelling is connected to public sewer,skip questions,#4 through-#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATE 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO --------------------------------------- ---------------------------------------------------------------------- - FOR OFFICE USE ONLY r2o'nn The Public Hea th Division has no objection to bedrooms at this property. Special Conditions: PAISigned: a Date: 6' Q;/health/wpfiles/amnestyapp ,z cj- h I J y � L L ro l � r I 7 =Q V L N Q 7 I. N o r � Z l , I Ch i 43 a n u, �a l y C { t •= ( 1105 Town of Barnstable Health Inspector oFtrie Toys, Office Hours Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00-.2:00 * BwRNSTABLE. MASS. 4b° Public Health Division i639• �0 plFn �a Thomas McKean,Director . .200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT--SEPTIC QUESTIONNAIRE . 1. General Information: Size of Property: Address: / 15 7 ('tom✓ C Map " Parcel i/ iO-,7yName: 0 �- fig. Phone#: 7 7 --7 0 / 3 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? V-C-� If yes, how many? , 2c. How many bedrooms total are proposed at this property.(including the amnesty unit)? .Z 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If tl e'dwelling is connected`to public.sewer,slap questions#4 through#9`below:; 4. Location of dwelling is INSIDE or COTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to UBLIC WATER. 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------=-----------------------=------------------------ FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Lw 6 (2 Special Conditions: Signed: Date: 8� O;/health/wpfiles/amnestyapp .j SJ 1 i C v k. MM t{ I Lrr� t � V �. Cl ® `7 i — cr i u q 74 Qj w � C12 I UP iAl n � o -o f t( 4 i �r t C: ABfl\1F1j !%mum AP - �� ram.T It i CL 0 5 G T 'v3 � J� I 1 z 15 NN 23 I I I CLOSC i L`l tZ►-A fe N T, E_k E t ` P L OO R t' � TO �2KJ OF BARNSTABLE LOCATION 1,257 /.4 N2 SEWAGE # VILLAGE A4i,&1WQ/ n ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. �T V l a W2 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) — y° X 2 X �—( she) �•ta.�e (!� NO.OF BEDROOMS tt L BUILDER OR OWNER 1 U � PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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)facili Gee Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) AIWEAfr' Feet Furnished by f. y rn ry) VJ w a )7 L No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Migogal *pgtem Cougtruction permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Addres and Tel.No. Installe f�NameeWAddresst and Tel.No. Designer's Name,Address and Tel.No. 75 S,4I-/_ A �.� Type of Building: Dwelling No.of Bedrooms Z. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title, Description of Soil Nature of Repairs or Alterations(Answer when ap licable) � 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 provision itle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued by is oard 5! Signed �� Date Application Approved by Application Disapproved for the following reasons JI Permit No. I Date Issued 1112 47 - No. Fee THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migpo.5al'*pgtem ctConztruction permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: l Location Address or Lot No. Owner's Name,Addreskd Tel.No. 1 � N4� dery ��;pe_/.c TO4 ry _hry 411Vi �. 3. Ce �� L .w rv-e Installe : Name,Address,and Tel.No. Z 3 0� ;.y Designer's Name,Address and Tel.No." � 2 �U ; � Type of Building: Dwelling No.of Bedrooms �^. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4 Design Flow l gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title x Description of Soil y Nature of Repairs or Alterations(Answer when ap licable) 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 provision 'tle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued by t 's oardg€jHe Signed �' Date �. Application Approved by Application Disapproved fdthe following reasons Permit No. Date Issued F. s 'THE COMMONWEALTH OF MASSACHUSETTS "`�- ---- --•- �___ PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Certificate of Compliance L � T��TO CER�IF_Y at e On-site Sewage Disposal System ins ed( )or repaired/replace �n '�Ld°"�Y �__d �.�..,•r-- for as h constructed i ,accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. «°' dated 41 Use of this system is conditioned on compliance with the provisions set forth bel � v - .. ems:. '^�3.�"_ . No. / Fee ,. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS t� Y potetn Congtructionertnit Permission is hereby granted to / 4Lcl to construct( )repair( fin On-si Sewage System located at 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. 0 All construction mu4t be ompleted within two years of the date below: 0 Date: ! Approved by o I i t� Commonwealth of Massachusetts ` Executive Office of Environmental Affairs Department of �1 f t', Environmental Protection J U N. William F.Weld Gowmow Trudy Coxe U.w EO 0 , David B.Struhs ComrniWoner ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO -r LESSORS MAP lea PART A CERTIFICATION_ OME R Property Address: C Address of Owner: n Date of Inspection. (o 3- _9 Of different) �� .--- Name of Inspector: S' (9 MCA_<eu ` Company Name, Address and Telephone Number: 3 F' M & N sepfi CS CERTIFICATION STATEMEN i 1 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: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Inspector's Signature: Date: The System Inspector shall submit a copy dthis 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: s A] SYSTEM PASSES: 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. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N,or ND). Describe basis of determination in all instances. If"mot 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 a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Whiter Street a Boston,Massachusetts 02106 a FAX(611)SW1049 a Telephone(617)262-UM 0 Printed on Rw dW Paper 4 �. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: f 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): broken pina(s) c-e --ep!,-cd obstruction is removed fi3.tribution box is levelled or replaced The system r i Red a more than four times a year due to broken or obstructed pipe(s). The system will pass Y eR pumping Y P�Pe Y 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: 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 -A;; UNLLJS 2-OARb OF i-I ,kl.Ta G�fERMINES 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 PROTECT THE PUBLIC HEALTH AND SAFETY 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 ha, 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. DJ SYSTEM FAILS: t/<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 o!r cesspool. (revised 6/15/95) 2 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A L CERTIFICATION (continued) Property Address: 1 s7 Owner: k4Ai-r-e,a Date of Inspection: DI SYSTEM FAILS(continued): / 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 e 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] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of System is 10,000 d or greater (Large System) and the system is a significant threat to public health and g Y gP g g Y ) 8 P 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 I 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. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5 Owner: Date of Inspection: � - 3-gam Check if the following have been done: 4,:fllumping information was requested of the owner, occupant, and Board of Health. Cone 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. 44?As built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. �{II system components, excluding the Soil Absorption System, have been located on the site. vThe 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. k-rhe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _--T-he facility o%%ner (and occupants, if different from o�%ner) were provided with information on the proper maintenance of Sub- Surface Disposal System. �s (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of In,p U. � FLOW CONDITIONS RESIDENTIAL: Design flow: j=2)2galIons Number of bedrooms: 'lam Number of current residents: a Garbage grinder(yes or no): A-1 Laundry connected to system (yes orno):-Y-- / Seasonal use (yes or no): N/ (Q Water meter readings, if available: 0L Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Sa Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or Non-sanitary waste discharged to the Title 5 system: (ye o) Water meter readings, if available: Last date of occupancy: OTHER: (Descri Last da ccupancy: GENERAL INFORMATION PUMPING RECORDS and sour a of infor ion: System pumped as part of inspection: (yes or no)yr) �s If yes, volume pumped eallons Reason for pumping: TYPE OF SYSTEM peptic tanlo4iowibukiep-1, oil 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: 9,F/ F Sewage odors detected when arriving at the site: (yes or no) /tiE'J (revised 8/25/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i ' SYSTEM INFORMATION (continued) Property Address: �� -4-4-Ph4e.fU C-/2C. 442 { .4/✓y S Owner: .(•c,q vtJ{-e/` Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: Material of constructi n: 4-6-n-crete _metal FRP other(explain) >< x �- 2- Dimensions: Sludge depth: 2-/o "- Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 3--el Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet t s or baffles, depth of liquid level in relation to outla inv structural integrity, evidence ofjeakage, etc.) -f- GREASE TRAP:_ (locate on site plan) Dept elow grade: ,. Material construction: _concrete _metal _FRP_other(explain) Dimensions: Scum thickness: Distance from top of scum op of outlet tee or baffl Distance from bottom ni 5r orn 1- . om of o ee or baffle: d Comments: (recommendation for pu g, condition of inlet an utlectees or baffles, depth of liquid level in relation to.outlet invert, structural integrity, evidence eakage. etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (5 OA Owner: 4,;�'4nJ+e/Z Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete metal_FRP—other(explain) Dimensions: Capacity: eallons Design flow: aallons/day Alarm level: Comments: (condition of inlet to ondition 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 equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) - Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pu appurtenan etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):L/ (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: ��C40.6 leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note conditi n of s 'I, signs of hydra is failure, level of p riding, ndition of ve"tat' n, c.) V CESSPOOLS: _ (locate on site plan) Numb e nd configuration: Depth-top iquid to inlet invert: Depth of solids r.:. Depth of scum layer: ' Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped a rt of inspection) d Comments: (note condition of soil, signs of hydraulic failure>1ev <nding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensi Depth of solids: Comments: (note condi' of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) !revised 8/15/95) 8 � 4 ` a 't SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j� SYSTEM/INFFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' G, A a ` - O 13 - 17 c ✓ C-7 . � ' DEPTH TO GROUNDWATER Depth to groundwater._L5j__feet O - , method of dete nation or approximation: t (revised 8/15/95) 9 r • comm0,\NVEALTH.OFM4SSACHLSETTS 6 7 -� F1:EC(:TIVE OFFICE OF E?,NIF O��iE�TAL AFF. p o DEPART�IE�T OF EN VIRO'. --NTAL PRO TI �o�t• 0 go �- OBE U'1%*7ER STREET. H0570N. MA O:IOS 611-_9_•`=t't' 1 19 Y CG?— wTLLI��f F.WELD -..v : .V- .�:,: _, ��-. .. _-.y- . - �- vGzic•'�:'• DA`ID B STRUF_- ARGEO P.4L1 CELLL'CCI Commission_ LzGavcmar SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .... ,n 3 PART A O'�Y — O`1 CERTIFICATION 'A(A(o ti+L.C-k-Z.� '000t1.? f O 1 Address owner: -;J.\\L �'��lii►� Property Addrei;- f �� R`m i :(If different) ' Date of Inspection: k6 WOX55 ) _ Name of Inspector: a'P +' ►1 E��C�o am a DEP ap roved system inspector pursuant to Sec:ian 15.3�0 of Title 3 Q10 C1+tR 15_0001 Company Name:A-M I.rTt� __0g Y�'/'r+M we p A^ Mailing Address: 0 2E 4-•q Telephone Number. ? CERTIFICATION STATEMENT I cer;if\ that I have pe'sonally mspe=ed the sewage d:sposa; $,.•stem a: this address and char the inforn-anon reported be oM is true. accurate and comole:e as e'the time of inspe=•a-. The inspect:e•t v.as pe�ormed base' cn my training and experience in the prayer lu.^.Gic� and rnaintenarice of on•s-te sew•aee drsposa: systerns. The cvj-term _ Passes _ Ca-icit.o^ai:% Passe! 1Esc; Furthe• Evaluanar- Ev the Local Ap;rcving Authonr, la- Inspector's Signature:1 ` Date: 10114 T:ie Svs-.e^ Ins _o• sh;." submi: a cop,,- of this inspecocn reccr, to the AForcving Authenn within thrrtv (30i days of completing this inspecticn. It the sv!tem is a share= stern o• ha: a des,g•i flees of 10.000 grc or g-eater, the tnspec or and the syste r owner sha!1 subs it the report tc the aperopnate re_,cnal oi:,ce of the Department of Envirenmenta' Fretec or.. The erig:na! should tx sent to the s�ster,i owner and copes to the buyer, ii applicable. and the ap=roving authority INSPECTION SUMMARY: . . Check A, B, C, or D Al SYSTEM PASSES: have not found any information which indicates that the system violates an} of the failure criteria as defines` in 310 CMR 13.3Q3. Any failure criteria not evaluated are indicate—_ below. . COMMENT5: t • ._ ..."rasa - . . . . .. .. ..--. _. B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, up{ completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N. or NDi. 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 Certifiate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; ` the septic tank, whether or not metal, is cracked• structurally unsound, shows substantial infiltration or eAltration, or tar. failure is imminent. The System will pass inspection if the existing septic tank is replaced with a conforming septic r-nk r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORPA PART A _ CERTIFICATION (ccntinuedl Property - - Owner: _ Date of Inspection: _ el SYSTEM CONDITIONALLY PA55E5 tcontrnj�:' oxis di broken or obstfucied Sewage backup or breakout or high static water level obse m The e distribution ass inspection if(with approval of the pnpe:si or due to a broken, sealed or uneven distribution b - Board of Health).. Describe observations: _ - -- •--' brokers'pipets) are ieptaced .. ..,... ._ .. obstruction is removed distribution box is levelled or replaced in re than four times a year due to tnsoectnon if tw•ith approval of theroken or obstructed pipefsl.:The system will pass The system required pumping mo Board of Health): broken prpe:si are replaced . ._...._. _. . . .. ; obstruction is iemoved C) FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HE LTH:_ Conditions exist which require iurthe•evaluation by the Board of Health in order to determine if the system.is failing to prole the public health. saieti*and the environment. . ... _ _ 1) DE-1E;LmINE5 THAT THE SYSTEM{ 15 NOT FUNCTIONING IN A MANNER SYSTEM W111 PASS UNLESS BOARD OF HE%1lTH WHICH "'ILL PROTECT THE.PUBLIC HEALTH ND SAFLiY AND THE ENVIRONMENT. _ Ce!s000l or pmti is within 50 t a surface water _ Cesspoo! or prt%-,- Is within 50 fee/�'af a bordering ve;euted wetland or a sat ttursh. 2. SY5TE.M WILL FAIL LINLE55 THE BOARD OF HEkLTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DEtER.MINES THAT THE SYSTEM 15 FUNCTIONING IN A/MAtitiER THAT PROTECTS THE PUBLIC HEALTH AND SAFe� AND HE ENVIRONMENT: _ The sys,ern has a sepii i�l: and soil absorticn systems (S.ISi Ind the SAS is within 100 feat to a surface water supply G tributan• to a surface *ate! supol). _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supnty well. well. The syste has a�ept�c tank and soil absorption system and the SAS is within 50 fee: of a priv;,e water supply The system has a�.septnc tank and soil absorption system and the 5A5 is less thin 10o fee: but 50 fee: or more from a and volatile organic compounds indicr:es, tf: private water supply well, uniess a well water analysis for coiiform bacteria the we!I is fre-from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to c less than 5 pm. Method used to determine distance (approximation not valid). 3) _ OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DJ SYSTEM FAILS: You must indicate either -Yes` or -No' as to each of the following- I have determined that the system violates one or more of the following failure criteria as d fined in 310 CMR 13.303. The oasis for this determination is identified below. The Board of Health should be contacted to d ermine what will be necessary to correci the failure. Yes No Backup of sewage into facility or system component due to an overload or clogged SAS or cesspool. Discharge or pondtng of effluent to the surface of the ground or surfa•e waters due to an overloaded or clogged SA5 or cesspool. S;a:ic !iaujd level in the distr,b.,tion bo> above outlet invert due o an overloaded or clogged 5q5 or cesspoo!., Liauid depth in cesspool is less than 6" below invert or avail ble volume is less than 1/2 day floe. Reauired pumping more than 4 times in the last year NO/due to clogged or obstruc;ea pipes . — — Numoer o'times pumped _. Anv portion o`the Sod Adsorption Svsterr•, cesspool r prw)• is below the high groundwate• eieyauon An. par-.:on of a cesspool or privy is within 100 • t of a surface water supply or tributar to a surface water supple Ant portion of a cesspoo' or pn.)• is w rthir a one I of a public well. An. pc^lo- o`a cesspool or prra• �s %,,thi 50 feet of a private water supply well Am por,.or. o a cesspool or pri.� is les than 100 feet but greater than 50 lee: from a private water supply well. with no accep;able water qualm analysis. li th well has been analyzed to be acceptable. aaach copy of well water analysis for coliiorm bacteria volatile organic co pounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each f the following. The folio..;r.g criteria app;% to :arge sys ms rn addition to the criteria above: The system ser-es a facilit\ with a dfsign flow of 10,000 gpd or greater (Large System; and the s.•stem is a significant threat to public hea!th and safety and the en rronment because one or more of the following conditions exist. Yes No the system is withrn�400 feet of a surface drinking water supply the system is wit in 200 feet of a tributary to a surface drinking water supply the system is I sated in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water ; pply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program . .. -requirements-0f-314.CNiR-3 0 ands n0__ Please consult the local regional office of the Department for-furihec-information ----------- - i' i (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO-N- FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: 101 16, C\ Check if the following have been done: You must indicate either "Yes" or 'No" as to each of the following: Yes do Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at feast two weeks and the introduced hai into receiving ceivi g normal or flow races during that period. Large volumes as pan of this inspection. As built plans have been ootained and exarnined. Note if they are not av2ilable with WA. x The facdr-.� or dwelling ..as inspected for signs o:sewage back-up. Tne s.stem does not receive non-sanitan or industrial waste flow _ The site ..as inspected for signs of breakout. _ All s,_steT co^.rponenu. excluding the So+l Aosorpuon System, have been located on the site. r opened. and the interior of the septic tank was inspected for condition of _ The septic cant manhoie� Nere uncovered. one. — baffies or tees. materia o' construction. dimensions, deptn 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 , maintenance of The fac�lit. o•vne• ano occupants. is d nineren: from ov,neri were provided with information on the grope. Sub-Suriace Disposal Svsterr.. _ Existing information. Ea Plan at 6.0 H. De;ermined in the field !c an. of the failure criteria related to Part C is at issue, approximation of distance is unaccea:abie 113.30231tit paq• 4 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: U FLOW CONDITIONS RESIDENTIAL: Design flow: p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):j Laundry connected to system (yes or no): Seasonal use (yes or no):� Water meter readings, if a Table (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy: Co [ERCIAL/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 PUMMG RECORDS and source of inforntation: o System pumped as part of inspection: (yes or no). If yes, volume pumped: gallons Reason for pumping: FSan1 Septic tic t 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 ctc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04125197) Page 5 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM BVSPE CTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: I Date of Inspection: Lp 1Ll�l� BUILDING SEWER: V (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:* (locate on site plan) t) Depth below grade: (2 Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal. list are _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: k o 1 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:�l Scum thickness: I L Distance from top of scum to top of outlet tee or baffle: I t� Distance from bottom of scum to bottom of outlet�ee or baffle: ' How dimensions were determined: AWA.3,A Comments: (recommendation for pumping. condition(in�and outlet to or baffles. depth of liquid level in relation to outlet inverk structural inte rity. ev' ence of leakage. etc.) t IN x GREASE TRAP (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 04125197) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORm PART C SYSTEM INFORMATION (continued) Propert% Address: iS1 OH ner: Date of Inspection: TIGHT OR HOLDING TANK: "-rank must be pumped prior to, or at time, of inspec Toni (locate on site plan, Depth below grade. Material of construction _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm gallons Deslg" flog galtons"da. Alarm level Ala•'m in %corking orde• _ Yes. _ No Date of previous pumping Comments (condition of role! tee. condition o' a!alrn and float s),%-itches. etc.) DISTRIBUTION BOX:4S tioua a on site p•a- Deo:�i of liculd le%e' aoo�e outle: in%e- Corn'ne'Is mote :i leve! and dis:nb::I-or, is e^ua' evic.e-ce of solos carryover, e dence of leak a (nto,or out of boy., etc.) L a��cJ PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No, Alarms in working order Oes or No" Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) SUBSURFACE 5EWAGE DISPOSAL SYSTEM INSPECTION FORM PART C c +_,,,.n�f,�, SYSTEM INFORMATION (continued) Property Addr-ss: I J1 �,-C f,l'"`�v v Owner: Date of Inspection: U SOIL ABSORPTION SYSTEM (SAS): jF 'S (locate on sue plan. ri possible: exca.a;ion not required. but map be approximated by non-intrusive methodse If not determined to be present, explain: Type: _ leaching pits. number. i,.&G leaching chambers, number:_ leaching galleries, number. leaching trenches. number,length: I\ 2sI Tw leaching fields, numbe,, ci.-tendons overflow cesspool, numbe- Alternative system name of Tecnno)oEv Comments in condition of soli. s!gr.s of hydraulic failure. leve' of and ng cond too oz veget o CE55POOLS: (locate on site play. Numbe, and coniigura:-on. Depth-top of liquid to inlet Inver. Depth of solids lave-- Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwate- inflow• (cesspool must oe pumpeC as par, of inspection:., Comments: (note condition of soil, signs of hydraulic failure, level of ponding. condition of vegetation, etc.) PRIVY: (locate on site plan) - Materials of construction: Dimensions: Depth of solids: - - Comments (nose condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): (revised 04,25/97) Page ! of 10 SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued). Property Address: S`l �� ►7.ct� Owner: Date of Inspection: `C , 1 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) i`4 151 LA S I 2 ly �4t1 (revised O4125/97) Page 9 of 10 SUBSURFACE SEWAGE DIS SAL SYSTEM INSPECTION FORM RT C �-7 SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater 1 Feet Please indicate all the methods used to determine High Groundwater Elevation: Design Obtained from Plans on record xObservation of Site (Abutting property, observation hole, basement sump etc.) �C 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) Cp (revised 04125/97) Page 10 or 10 7 LOCATION SEWAGE PERM NO. V I L LAG E - �09--��/G IN-STA LLER'S NAME & ADDRESS B U IlL D E R OR OWNER 44 Q 4 444 1--) 1Aq f)air DATE PERMIT ISSUED DAT E COMPLIANCE - ISSUED '�1 Imo_ i � \�o i � ® ,, (ice �� . �_. C � L'o �� c�� -� . ---_ �--�; � �� . No.. �f .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT ......--- ..OF...... . .. .:: _ Appliration -for Bhipoiitt1 Works Tomitrurtion Vanift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -L� -1] - -- -------•----- P-= ation-Addre - or Lot No. � �_:. .:. :.. .r_.._ . ----- Owner Address a �_ ._..- --- -- --- . ------------- --•---. ------_------•---� = f Installer Address / Q Type of Building. Size Lot-../�,1-15_ -__Sq. feet U Dwelling—No. of Bedrooms.---------- -Expansion Attic ( ) Garbage Grinder ( ) aH _ __..._.___. // Other—Type of Building / ' No. of persons-.._......�5/__________. Showers ( ) — Cafeteria ( ) Q' Other firtures��'-------------------------- -- // 1,�y W Design Flow................. ----------------gallons per person p - c�y. Total daily flow........... - S�-.............gallons. WSeptic Tank—Liquid capacity/lgallons Length... Width Width.__ Diameter................ Depth._..___._._..-.. x Disposal Trench—No.--__--_-•-____...._. Width �____________ Total Length-------------j./`total leaching area.__._. sq. ft. Seepage Pit No._.._.._./._______ Diameter........ Depth below inlet_._._...... Total leaching area,,f �_sq. ft. Z Other Distribution box ( ITosing t ( ) '-' Percolation Test Results Performed b +t7..L ✓I_ _ .......................... Date----la Test Pit No. 1----------------minutes per inch Depth of "Pest Pit..------------------ Depth to ground water-------.- --- ---- -... (z., Test Pit No. 2----------------minutes per inch Depth of Test Pit.------------------ Depth to ground water c � �.- G xDescription of Soil------------0. --�---'�----f---.-�--- ->/"-'.------------------------------------------�------------------------------------------------------- W ----------------------------------------------------------- -------- B A�r ��y•� -------1 :./r.------. ------------------------........------•---------------- ------------------------------•------ ----------------------------------- -------- ---------------------------------------------------------------•••......•-•••-------•--- ------------------------- 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 Article XI of the State Sanitary Code—The undersigned furth r agrees not to place the system in operation until a Certificate of Compliance has been issued by the b 5-he a Signed.. .. . ._ - Date Application Approved By..... 1 C� --------•---.�.L.- -`------�- Date Application Disapproved for the f ollo""Zing reasons:. .............................................................. n Date Permit No......... -- ----------------•-------.•...... Issued..�� .. �d-- ' •--...--•---•-----�- 1-- .... z Date No.. Fas.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDPF HBALTRo ............. ° ApV irtttiuu "fur Bhipo l Works Tonfitrurtion Vrrmit P pplrtion is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal E t: System at = ::....: ...... ...---------- - ... 1 = :. _ cation-Ad r s -- r of. o. C1 / � =.. . ! —L 4�f --------------•-------- ...... W Owne(r"�� Address ti Installer Address U Type of Building Size Lot...IVV2.......Sq. feet Dwelling—No. of Bedrooms. ._...--._�_-�-- ----------------------.Expansion tic ( ) Garbage Grinder ( ) aOther Other—Type of Building _ No. of persons..-_-__ _ Showers — Cafeteria fi_ e W Design Flow.................. .......... allons per person per Y! Total Bail ow__.__. Z ......_....._.._gallons. WSeptic Tank.-Liquid capacity-/......... tllons Length........j..... Width... .. . Diameter............. Depth................ Disposal Trench—No -------------------- Width. ... "Total leaching area---.-------_._.-----s . ft. x p �'_.___..... Total Length_._..__.I ,,P,! g q Seepage Pit No...... ............ Diameter------- ------ Depth below inlet__ ........ Total leaching area -�`c '...sq. ft. Z Other Distribution box ( Dosing tank ( ) ~" Percolation Test Results Performed by-------- _- -447-------------------- Date---. .. .._.. X�7 Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water_..._-�-------.-.--- f� Test.Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water�_Q O - -- --------------------------------•--•-----......................................................... Description of Soil---------- ------------------------------------------------------------------------------------------------ U ;C ijsj� /gK ? t ------�`-�---"--------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 Article XI of the State Sanitary Code—The.undersigned,,further agrees not to place the system in operation until a Certificate of Compliance•has been, db the b�arel ooh h 'ca ;r.v 0 =' Signed.... - ! // Dafe Application Approved BY------ "!� t f` `�` -.---�----•-y--•••.................................................•••. Date Application Disapproved for the following reasons-------------•-.---.--------------------.---.---.-------.---:-.--.-..-.----------- .............................. -------------------•--------------------------------.---.•----•-------------------------------------•----•----•--•-•-------------------------------------------•----------_------------••-------- ...... Date PermitNo.------- ................................... Issued...................... ................................. Date r;THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?: ..7........OF...... .. .+ :. . ' w.............. Trrtifirate of Tumpiiaurr THIS IS TO GERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 1 by............................. -------- ......... ----------------------- ----------------------------------------- Installer � f at..........r, �_�!",r, ' . --- ,j,r .. I ir_/, IiJ r has been installed in accordance with the provisions of Article, XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.---. .................................. dated_--- /-�__ �ir�_. J'�............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------- ............................................. inspector............................................._...................................... THE COMMONWEALTHrOF MASSACHUSETTS *� BOARD OF HEALTH �� f' FEE........................ Bi poiial 'ufrksi 01un�st rur.t`i'o n :j:Ja`4m.fiit Permissionis hereby granted__ 1-1 . . 9' ; to Construct (;"") or Repair ( ) an Individual Sewage Disposal System at No..... f_. '� /: ifs 1 r'/ -z,. ` .�` - r- R ----- -----------------------------•-•-------•-••--- 7 _..Y_* - -'-$--;;'---,:. -•----------- -- - Street as shown on the application for Disposal Works Const uctioi�Permit No---Zi_ ------- Dated--.-. ........ t. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ram--• TOWN OF BARNSTABLE i:CsCA NTl T � SEWAGE # VILLAGE_Llk4)eoW t�:)1 ASSESSOR'S MAP & LOT `1 c2 (g INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY VCDC7n 5 vor LEACHING FACILITY: (type) (size) C NO.OF BEDROOMS BUILDER OR OWNER I 'DATE: `A\ko\ cl CA COMPLIANCE DATE: ` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility l01 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ey Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N Feet Furnished by Ilk I _ cN 1 n �FLL!//e _ F/NISN �✓P/1DEe� F71tvtSN GIPA - — - l O✓eR Ti4 N K 13XD ovEa PlT Top c F f✓o.�H v. I �rl _, - T-- - - --__�„�G CA-iCFfLG ` 3'=osASro ^6 D W G��.L Iv 0- (�` ly CEUA ft F7-,L, r,: - +� + ' �4� to l/L - � I IPEi n.•oi'CEID Co/✓G D 1ST 6 o x SEPTI c TAN K — A r (3,6 srA8EE4 A + ° ° o c _y � _ 10 o c o J �j ✓� �oTf?�// o/r 1iT dY4 /VOT TO SG AGE4w �— LEr9CN/NG J'oiT DES 6w CAP/ r" erRIA } i 2- GAL• 1� GA.E'�3AGE GR/NI7E�E' " NcvV"r , or O � To rA� b.4iL y - oa✓- za a _ v L EAG.V�/✓G �9,P6A P,PG r/aED: � y,� 4q" 1 �' 7�ccwa•[1 .Q.�E�9= i s 3�x 2$= yo7 � { J � '1� SO NG Ta r44, yS7644L. Qr+ SQ`�' ' Ir. Z5 a SAND • J P/PDf'QS,'-;:D-�E 1419GE T�/SPOSAC rsr�ivl i,vsP�c rE17 gy : PAc.L �c.,p,�.oy �iPOf a.SG�D Ip`l/EL L/NG D 4 sE :a r_ 4�/4'n t� °�✓ as N�c rev A,e/V�746LE Y4,0 S FEEC• RATE: L 2/YiN�j^! S'C ALE' _ oThD DA_r� !._iC--/•'S_7�- — _ i ti •�Y NOMOAH / svcwwr< /VO�f'MAN GRaSSMAN R E <• E`��v,` �aG«t�V` GEi1/7'•ER V/[LE MASS' #, s r s r "'c- e .fie :b� ._ ,.; •; -. _ f � /C/'C�#'W( Fi•�!=.Ir N G�.+D�•-Lad ri N t m arAipE -- - / D✓G/C Tip NK = t3xo O+�E1t /�� s 12U, Top of F.Pa4mv. u7X��w/,i✓�w, __ _ C WOL 4 f N O' -r-- — - -- !`- g G_�1 �----_ "'lF'`� �•,�+sxl .«a/fnr , Q�nC�cft[L 3:Pf A S re.r 6 o fL�✓ • ' 1 /O OD 64t- I , L o o o �/ ��q� ti IYz.� APB,�,�1lCEa CoAV } : D I S T. lox I o o , • I -.� c¢��,yEa sre.vE . -- ----- -- —J X ♦ 1 .SEPT'I G .+r a srwBtE \\ I o 0 0 0 l f G o c o SYS rFM PROF'L E }c --- ivcT � LEs9GH/NG PiT DES G/1/ C el TER/A i 2- GAG- GA.QL�.4Gf GR'/ND�aQ ' ivavf � ,LOT �2 .�G�►'- ,� LEACNiNG Aeew REq 'D. . S L EAcm tw/G �+ �` ` �M'O 44" 1lie K L-~ ' GRAYEL- Qs�o %0 ' ass l Gr SG,}LL�; /i 30or qb ro B� aAI� CGuQSE 9X .SAND �'1017 LYAGE �J/SPoSAL /.✓SPEc TED Lay : P,Qc.L �v�t�.vy f'�'D�-05,e 7 I>�1/EL L/NG D,a rF :a r 4` r-� .mow' as .yam r v /9`z,,v3,7,- 14-N!v/S� PE,ec• P.4 rE: 2 H,.,Vl --T- - — sc got 6-� . _��`'d__�nA re cl , ANa DRIM,�Gacssy i✓o,PMAN GRoARE- it