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0131 IRVING AVENUE - Health
131 Irving Avenue, Hyannis A=287 - 066 (j k ec. No. Fee UG r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes YICat101Y�� for Mtsposar *pstertt Construction permit Application for a Permit to Construct( ) Repair(s) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. i 3l 2 A1;na,3r /lve Owner's Name,Address,and Tel.No. ��Yann�g Paa<C� t8o Pvoz.Tu Assessor's Map/Parcel 2 8 7 !0 4, Installer's Name,Address,and Tel.No. Oi tv-g2li<S Designer's Name,Address,and Tel.No. --S L !-0- 763 Z$sy Crnnb`r r7. Y1Z yo2$ f�c�7Z��tl a ivy 5 og— Z 73 — �37 wa�d.a.►. n�Fl Type of Building: Dwelling No.of Bedrooms Lot Size 1,4:7(-9 ± sq.ft. Garbage Grinder( ) Other Type of Building Si•�,1•c��[y t►.;�`, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Wo O gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank l S�00 5,wL Type of S.A.S. (S � t�'2 a ba CVy,.L , ( _�. Description of Soil � a �1 3 `t�EJ g p T Nature of Repairs or Alterations(Answer when applicable) (�A t 7� Date last inspected: loos- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date Application Disapproved by Date for the following reasons, Permit No. O(J ' Date Issued / —.w—dg �f+''''3c^..:...,.,..-,... .., �.,�-r.a•._,•�... �.-..... .+m '_--t •--,... .,. ..-...�_ ..-�-_.. ..... ,• ti-q,-.. l' - -. � .. -. - No. .. , g *x., Fee UU ° A, yY THE COMMONWEALTH OF°MA SACHUSETTS Entered;ncomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS w lication�� for Mi posaY 6pst4ionstruction ertrtit Application for a Permit to Construct( ) Repair(9C) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 131 �,� ave Owner's Name,Address,and Tel.No. tA'I44,1 (YtA Assessor's Map/Parcel Z 8 7 (o(6 ..,_0 a Installer's Name,Address,and Tel.No. G� .� ;,� E�I e� ,>sS Designer's Name Address,and Tel.No. o. 3a� z651.1c.�n��fanrcte d1 27 77 Type of Building: Dwelling No.of Bedrooms Lot Size _13,7(-9 sq.ft. Garbage Grinder( ) Other• Type of Building 1., No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) (o(a O gpd Design flow provided �o 3 , S gpd Plan Date 1 t-1 S- 2 O o8 Number of sheets / Revision Date Title 131 Size of Septic Tank 1500 5 L4 L Type of S.A.S. ( 5 1a-2 o SuJ CAL C. C. Descri tion of Soil 3 p' �vo n`v� G 9Q' Nature of Repairs or Alterations(Answer when applicable) L.c . 'c� Date last inspected: I00S Agreement: r The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in' accordance with the provisions of Title 5 of the,Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign d Date / ) - Z.o-LO A- •Application Approved by (t f , ylk7) Date Application Disapproved by Date for the following reasons Permit No. cil) Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( )r; Repaired Upgraded , ^ Abandoned( )by ( A Q e..� c s.•,L'l�ti lO.f,j t� C.C .C ✓ r) �°' 3.f ".• at l l! i ,nG A Lot is` Q.aT has been constructed in accordance, with the provisions of Title 5 and the for Disposal System Construction Permit No. "2Doj It Y dated J ` /J Installer f✓ +;`y�S (_L.C, Designer 5 • C . C� ,Hsu,; l G #bedrooms Approved design flow � ,1� gpd The issuance of this U it shall not/be'co strued as a guarantee that the system `ivv lie nction as designed. � tt� c� � {� Date ! /�/�/ Ins ector �� ,�t _ •� _____.__... __,._.___. _.________ No. Fee /OCR THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction 3permit Permission is hereby granted to Construct( ) Repair X) Upgrade( ) Abandon( ) System located at t :(I U i ti and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit: Date I i'_1 o�/Uk Approved by Town of Barns table oa t�+e P# gyp'' Department of Regulatory Services Public Health Division Date 0 MAn 1 �e� 200 ain Street,Hyannis MA 02601 K, Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage) M��Disposal �, Performed By: HIC�nael Qtellle i EMT. G5 E Witnessed Bys�1/V!V/l� za �1...(l!�0) LOCATION& GENERAL INFORMATION _ Location Address 131 'r(Zv;n C� 'A IJ O Owner's Name (A�✓► > I��J z Address . Tcu(nt Aue / f 131 5 ,l�yon�ndsevrl;,rIA Assessor's Map/Parcel: 2$71 0 6 b �O I Engineer's Name 6"ft,,' NEW CONSTRUCTION REPAIR Telephone# Land Use �4 Ie, F�nni(y rCS r1((ec( Slopes(4'0) l-2 Surface Stones '- Distances from: Open Water Body ft Possible Wet Area >/d G ft Drinking Water Well NlR ft Drainage Way Property Line > 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) s� mod. PIS, Parent material(geologic) atkWlb�) Depth to Bedrock >15 2'1,05 S v Depth to Groundwater. Standing Water in Hole: 7 1§Z Weeping from Pit Face >1 sZ w 6.9 S Estimated Seasonal High Groundwater 7 1 Z �,S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 9-r-E 0PUi;1a(un Depth Observed standing in obs.hole: >(-5 2- in. Depth to soil mottles: >/ in. Depth to weeping from side of obs.hole: 15 Z in, Groundwater Adjustment ft. Index Well# _ Reading Date: Index Well level Adi,factor� Adj.Groundwater Level, PERCOLATION TEST bete a-IY48 T11e�LH Observation Hole# Time at 4" T Depth of Perc 10-/06 TIme at 6" ^ Start Pre-soak Time®. JD Z SI fl n — Time(9"-6") End Pre-soak l 0 3y Rh Rate Min flnch '� Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.)in, (USDA) (Mansell) Mottling (Structure,Stones,Boulders. o istency.%Gravel) a^Zo zo-2-8 5 LS to hr s/d La-?0 G-2 S<Il Loaoi 2.5`f y/y _ qo-t,Z C_3 ►-IS 2.5Y -7/y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. " —Consistency,% ravel r ll 20-2-8 1 rs�� — z8-�� c-1 nS 5 1"/e — yb-90 C-Z oam 2.5YV 9o-tsZ G-3 MS 2.5 — DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency. o Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones',Boulders. Consi en t Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes . Within 500 year boundary No Yes Within 100 year flood boundary No✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on X)-'2-7 q (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise a experience described in 310 CMR 15.017. Signature a�� Date Q:1SEVnOPERCFORM.DOC I a 1 c - TOW>`;® BARNS TABLE LOCATION 131 1 � . SEWAGE# di VII:LAGE .�Ha44 if Tv r r' ASSESSOR'S MAP&PARCEL AF 7 INSTALLERS NAME&PHONE NO. �� efi,,d� V L SEPTIC TANK CAPACITY / UU i f i o P��s�,c LEACHING FACILITY:(type)�� s-y 0 L C (t -Z 0' (size) 13 Y S-U NO.OF BEDROOMS �O x OWNER fi7al F-re t /a f�S PERMIT DATE: I t "1,c7 s Zo d COMPLIANCE DATE: l,a-0 5-2.e+s Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ev6 l Z 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 �.ZZI Nb w °s' v Q _Gc0 Tows o B LOCATION AHNSTABLE $ � t✓ri VILLAGE SEWAGE# LpLp=�S ASSESSOR'S INSTALLERS NAME a PHONE NO. M PARCEL AP& c Pub SEPTIC TANK CAPACITY 5'Z e-1 0 ? _ II LEACHING FACILITY. ' (type)�S Lc (t ZU I NO.OF BEDROOMS (� (size) j 3 Y S'U OWNER /9�76L//� / Grp t Ta r PERMIT DATE: + 1 COMPLIANCE DATE: 1 Separation Distance Between the: '2_6-4 Maximum Adjusted Groundwater Table to the Bottom of Private Water Supply Well and Leaching Facility Leaching Facility �y` � on site or within 200 feet of leaching facility(If any wells exist Z Feet Edge of Wetland and Leaching Facility within 300 feet of leaching facility) (If any wetlands exist Feet FURNISHED By Feet C ( A l S2,u i AZ 4y u VZ 30..� 53 �7 C3 3 c(o a9•� D S 3.7 D(0 33:o s a � 1 3 DEC 708-2008 1 0 :01 A'M JCE1�G NEE Ri:IN G! I 58 273 6367 J P. 0 j r I s li s li0 n of .sarfistamejU&Iator i i� s I � SirVicles ht�rnsts +. C��fler, l) rrector I ` 11A�N B[E Y'['A � i � i1 � 41 a' .� Tu lie Health Division I 'h 'R3a$ MCKe on,!Di recto>I '! 200 Main Street,Hyannis,jMA.02601 0lt,,:s. 508-862-4644 l I Fix. 506-71)0-63(: 1 �I 6 bt let Desizatr Cer cat "arm . I I Iastull Ir: . Address: Addresi: a Loot j ,.�_C... "Z — C c( n, `��„",�' '' was t rued a permit tci in tall'a j (C ate) i I (in$t ller) `_` _ �.. ! stem at __ J _ based on a des ' sept c system design dram b -(address)dated -- (designrj --- �__ T certify that th6 si ptrc ' 'ste' I, ' it y 1 Y r?1 rcterenaed about, was installed s��bstant'ally ac.cordin g :o j the design, vvhi.ch may include)miizbr approved changt;fi such`as lattral�r;lc cati+�n of the distribution.box and/or,epticitan ! j I certify that the septic �systexn ef r '.rented aboveiw Cis installed with rrialynr{rhiuiges (i.e.: j greater than 1l) latezal �elacaiti6n of the;SAS or ahy!vertical� relocation of army c:ornponent I Of the septi system) bud in a card�ance with State Local Regulatigns.f l)l4n revision �r certified as.-built by designer to;follOw. s' — ! I JOHN l.chuqcm, (�aist er s Signat a aet 1 ! ! 41607 + j 1• esigner's S!igniture f ; ' (t 1fI Designer' Starn Here) f'LI?ASE RETIJ TO�B 'I IC' HEA T j FI ' , r 3 t i Of, C. IANCE T' E,1ISS 1 ;. •i i � � ' � i i j j }ra��hhlSci ieJl7esigner Certification Fum, i 9AVE HYAW-4ttp Fog - I ' ' A f � DRESSING I ROOM .... i I i I ; MASTER am ROOM a=.. W Demo T-lilr ur�us o OD o MASTER BATH BATH WA W,5 w -- LAUNDRY EXISTING LAUNDRY KITCHEN KITCHEN XISTINCx FLOOR PLAN PROPOSED 1=LOOR PLAN SCALE 1/8" _ 1'-O" SCALE 1/8" V-O" commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Govemor Trudy Coxe Secrelery,EOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A M>.p 297 {�,�,,,��c.. G(p CERTIFICATION Property Address: 1 ] liz-V t NA Cx. /%.V �YA►J I�.Xtc>?0eT Address of Owner: Date of Inspection: b c.T 0, 19 9 S (If different) Name of Inspector: G—me- Suk-uV0.r.a Company Name, Address and Telephone Number: S U l_L 1 V &t 1=w16 G GILD►.. 4 CERTIFICATION STATEMENT ,a rtc�� I certify that I have personally inspected the sewage disposal system at this address and thatenfor�mvt�or,�reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my trdrtffigyanffd�ex��rlerice the proper function and. maintenance of on-site sewage disposal systems. The system: SULL1VAU NO.29733 4 V Passes C+IVI _ Conditionally Passes 1.00 Needs Further Evaluation By the Local Approving Authorityr .� cyw O Inspector's Signature: Date: � D(_-r )9� �99� 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] SYSTEM PASSES: �C 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. M CONDITIONALLY PASSES: One or more syste vents need to be replaced or repaired. The system, upon com t e replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Descri o ation in all instances. If"not determined explain why not) _ The septic tank is metal, , structurally unsound, shows su infiltration or exfiltration, or tank failure is imminent. ;;ern will pass inspection if the existing septic tank is replac conforming septic tank as ved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02108 a FAX(617)SW1049 a Telephone(617)292-SSW ID Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A A CERTIFICATION (continued) Property Address: 13 �t(0 '"`� ���` 1 S'POe 1 Owner: ItbFs Eae C u 2 a:-( Date of Inspection: C)CGT B YSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken o obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with proval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The s em required pumping more than four times a year due to broken or obstructed p' (s). The system will pass inspectio if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRE BY THE BOARD OF HEALTH: Conditions exist which require further valuation by the Board of Health in o er to determine if the system is failing to protect the public health, safety and the environmen t) SYSTEM WILL PASS UNLESS BOARD OF H TH DETERMINES TH THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH ND SAFETY AND HE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surfa water _ Cesspool or privy is within 50 feet of a border v etated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOA MANNEROF ETHTH PROTE PUBLIC THE PUBLIC HEALTH AND SAFETY AND HWATER SUPPLIER, IF APPROPRIATE) EEERMINES THAT THE SYSTEM IS FUNCTIONING I ENVIRONMENT! _ t he system has a Septic tanK and soil sorp'iun system ai !S 'itizi llf! l�u f8c� iG a SU faCE water SUpN , Gf o , surface water supply. _ The system has a septic tank and oil absorption system and is with a Zone I of a public water supply well. _ The system has a septic tank a soil absorption system and is within feet of a private water supply well. _ The system has a septic tank nd soil absorption system and is less than 0 feet but 50 feet or more from a private water Cates l is c compounds supply well, unless f well ater at facility ysis for and the coliform bacteria and presenc of ammonia nitrogen aani nitrate nitrogen di equalttotor�less tlhan 5 free from pollution fro Ppm• D] SYSTEM FAILS: I have determined th the system violates one or more of the following failure criteria as defined in 10 CMR 15.303. The basis for this determinati is identified below. The Board of Health should be contacted to determine wha will be necessary to correct the failure. Ba up of sewage into facility or system component due to an overloaded or clogged SAS or cess _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or c ed SAS or cesspool. 2 (revise 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13` EV--`41 w L(� A� - to% YA e...l aA 15 V O 2 1 Owner: 12-0G C—!L Date of Inspection: Q LT ►91 l99 5 D YSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or ces ol. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow _ R uired pumping more than 4 times in the last year NOT due to clogged or obstructed pi (s). Num r of times pumped Any portio of the Soil Absorption System„cesspool or privy is below the high gro dwater elevation. Any portion of a sspool or privy is within 100 feet of a surface water sup p or tributary to a surface water supply. Any portion of a cessp I or privy is within a Zone I of a public well. Any portion of a cesspool or ivy is within 50 feet of a private ater supply well. _ Any portion of a cesspool or privy less than 100 feet b greater than 50 feet from a private water supply well with no acceptable water quality analysis. If t well has bee nalyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compo ds, am nia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems ' addition to the crit 'a above: The design flow of system is 10,000 g or greater (Large System) and t system is a significant threat to public health and safety and the environment because one more of the following conditions exist: the system is within 00 feet of a surface drinking water supply the system is ithin 200 feet of a tributary to a surface drinking water supply the sys is located in a nitrogen sensitive area (Interim Wellhead Protection Area PA) or a mapped Zone II of a pub water supply well) The owner or o ator of any such system shall bring the system and facility into full compliance with the groun ater treatment program requirements 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further info tion. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: t 3 l S�� t tiD C� Ave 1-tyl�r.l►.�t S 1�0�-� Owner: 0.dGEe' GUQ 2 Date of Inspection: aC.T k9 l 19 s Check if the following have been done: v Pumping 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- u g 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. 6-1 The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All 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. ` The facility ov (and occupanrs, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. 4 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C '1 SYSTEM INFORMATION Property Address: 1'6 12�/ 1 kic-t �` (E � YA[a&Xts FOP— Owner: (20.'eQ Date of Inspection: OL? t 9 t l9 9 5— FLOW CONDITIONS RESIDENTIAL: Design flow: t5gallons Number of bedrooms:_ 2 l�5� S���Q-S Number of current residents: Garbage grinder (yes or no):=CS Laundry connected to system (yes or no): `E 5 Seasonal use (yes or no): I ILS Water meter readings, if available: Ne�iC AYAt 1.Ai3LC� 11 V 1 ire Last date of occupancy: ''Z P cY� MERCIAUINDUSTRIAL: Type o shment: Design flow: ons/day Grease trap present: (yes or Industrial Waste Holding Tank presen . s or no)_ Non-sanitary waste discharged to the Title 5 s es or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe Last dat ccupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 8 Z7 Toy-en-) ©F �,z,9s�cRr �uatQ�rt76 ��ccaL�C �7 System pumped as part of inspection: (yes or no) ES If yes, volume pumped. %SDO allons 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: ��T X K CA- L Sewage odors detected when arriving at the site: (yes or no) D (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 13 1 TC-./t Kj Gc Air C t't`>!sk►.�Ulis�O Q:T Owner: (Zo&ee. cye-2�-( Date of Inspection: Dc-F- SE C TANK:_ (locate n site plan) Depth belo rade: Material of cons ction: _concrete _metal _FRP_other(explain) Dimensions: Sludge depth: Distance from top of sludge bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top outlet tee or baffle: Distance from bottom of scum to bott of outlet tee or baffle: Comments: dition of in and outlet tees or baffles, depth of li id level in relation to outlet invert, structural (recommendation for pumping, con integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP ther(explain) Dimensions: Scurn thickness: Distance from top of scum to top of outlet t or baffle: Distance from bottom ot scum r- nottom i outiet tee or bariie Comment; (recommendation for pumping, ondition of inlet and outlet tees or baffles, depth of liquid level in rela n to outlet invert, structural integrity, evidence of leakag , etc.) 6 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM l PART C SYSTEM INFORMATION (continued) 3 Property Address: V ��J t k-lEx Av E AAA —►KA IS eOt-"T Owner: ozc'ep— Date of Inspection: TI T OR HOLDING TANK:_ (locat on site plan) Depth belo grade: Material of co truction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallo Design flow: gallon y Alarm level: Comments: (condition of inlet tee, condition of alarm.a float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distributiur, i�eyuui, evidence of solids c over, evidence of leak a into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or Comments: (note condition of pump amber, condition of pumps and appurtenances, etc.) 7 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION (continued) Property Address: Owner: � Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_, leaching galleries, number: leaching trenches, number,length: leaching fields, number, dim nsions: overflow cesspool, number: C'6"Cce '$L-0CX- ailure, level of ponding, condition Comments: mote condition of soil, signs of hydraulic failure, of vegetation,etc.) SIC�t-lS �F 4l1's�[�All L1C FAILI1P ► YSC yt� LbO1GS ��n(Zf"1 Pc P2[�X Qd 8F_L1 011� l� 1 CESSPOOLS: ✓ T v)G'R(9 W kYQ 6 Acs 16 EPTtC, Ti�N V—' (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 groundwa!e, �D G Zo0�DVJ'&,-T � 1 t1 L'CK� inflow (cesspool must be pumped as part of inspection) Comments:"(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (locate on site p an Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, Si au is failure, level of ponding, condition o etc.) 8 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C q SYSTE1M' INFORMATION (continued) Property Address: 13( T_�V I i.t a / �4 C- Owner: ecc s qe Lc,22� Date of Inspection: OCT �7 1995 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I�l p \l C L-c S w L T}4 L 1�p VJ ET Loa,Kk,0S V,a, Lit to kO r rDEPTH TO GROUNDWATER 1(nI feet t _ th to groundwater. TEST (o-T e)9 -Dk hod of determination or approximation: _ r, ` ` �e� Old S MATE P1 A L M i-7vised 8/15/95) 9 1 P 1 � � 1 i 'PaTIU O � i 8 c gs4 1�1 6 \a �= 1 L6�� C-,>S ITt-,I 1 OO� T 1�10 E LL.S -�--Z-S c WA,-k"nZ, APPLICATION FOR PERCOLATION TEST AND Ub6E1'(VA'1lUiv Y11'J NO. U 1 ATION DATE //-15'-97 :LLAGE -PLICANT FEE )DRESS ' TELEPHONE NO. (Non-refundable GINEER TELEPHONE NO. TE SCHEDULED /?-- �' 7 �� (Applicant's signature) ...... SOR'SbiAP�LOT NO: ••••• •••SOIL•LOG•••••••••••••••••••••••••••••••••• • B-DIVISION NAME DATE _ -P� TIME O j1CL PANSION AREA: YES O M1f.NN)f�►MMfI) EER :? BOARD OF HEALTH WN WATER PRIVATE *ELL A 11% EXCAVATOR ETCH: (Street name,etc.,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) N 'TES: 'L (� go,s9 I.34 V-p_ o� N )'14k cy . �tiy- g RCOLATION RATE: ST.HuLE YO: EL ATZON:)S.6 TEST HOLE NO: ELEVATION: - 1 S U�Po 1 1 1 2 -SO�'SoI� z 3 - �0X.,to S 3 tr qL-_. L w�7�''1 ��; 5 G ' 6 - -- 8. GL�q�.s M—9 G 9 10 !S b 672fl vetio 11 12 12 13 d3 E 5.6 lq ,• 15 WfPj_fV L 15 16 16 CTABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS_ LEACHING TRENCHES__ SUITABLE FOR SUB-SURFACE SEWAGE. REASONS: CE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION CGINAL: COMPLETED IN ENTIRFTY BY P E AND RETURNED TO BOARD OF HEALTH ly: RETAINED BY APPLICANT HOMEOWNER RECORDS SepticA Reference-Guide • - • Septic systems are individual wastewater treatment systems that use the soil to treat small waste- water flows,usually from individual homes. They are typically used in rural or large lot settings where YOUR centralized wastewater treatment is impractical. There are many types of septic systems in use today. While all septic systems are individually designed for each site,most septic systems are based on the same principles. SEPTIC A Conventional SYSTEM Septic System Homeownersfor Mcesch?souse, wpdc tank. kachiag UcMty and --------- /�, show d'istaates icon septic tan:ooaC to nnsest house comem TANK SERVICE RECORD Daft coNvanw s..ia PWOOMd 0 0 kt II r ' A septic system consists of a septic After the partially treated ted wastewater tank.a distribution box and a drainfield.all leaves the tank. it!lows into a distribution connected by pipes.called conveyance lines. box. which separates this flow evenly into a ''.,r network of drainfield trenches. Drainage Your septic system treats your household holes at the bottom of each line allow the was- wastewaterby temporarily holding it in the septic tewater to drain into gravel trenches for tempo- tank where heavy solids and lighter scum are rary storage. This effluent then slowly seeps allowed to separate from the wastewater. This into the subsurface soil where it is further separation process is known as primary treat- treated and purified(secondary treatment). If you have problems,ccataet yaw local bond of mew. Tne solids stored in the tank are decom- A properly functioning septic system does not health or health agent posed oy bacteria andlater removed.along with pollute the groundwater. - the lighre-scum.by a professional septic tank "'4 pumper. Nit Caring for Your Septic System Tips tokyoid-Trouble The accumulated solids in the bottom of be very expensive to re • DO have your tank pumped out and pair, DON'T allow anyone to drive or park the septic tank should be pumped out every and,put thousands of water,supply users system inspected every 3 to 5 years by over any part of the system. The area three to five years to prolong the life of your at risk if you live in a public water supply a licensed septic contractor(listed in the over the drainfield should be left undis- system. Septic systems must be main- watershed and fail to maintain your sys- yellow pages). turbed with only a mowed grass cover. tained regularly to stay working. tem. Roots from nearby trees or shrubs may clog and damage your drain lines. Neglect or abuse of your septic system Be alert to these warning signs of a failing . DO keep a record of pumping,inspec- can cause it to fail. Failing septic,,systems system: tions,and other maintenance. Use the can sewage surfacing over the drainfield back page of this brochure to record DONUT make or allow repairs to your maintenance dates septic system without obtaining the re- cause a serious health threat to your (especially after storms), . quired health department permit. Use family and neighbors, sewage back-ups in the house, professional licensed septic contractors • degrade the environment, especially lush,green growth over the drainfield, 'DO practice water conservation. Re- when needed. lakes,streams and groundwater, pair dripping faucets and leaking toilets, • slow draining toilets or drains, run washing machines and dishwashers • reduce the value of your property, sewage odors. only when full,avoid long showers,and DON'T use commercial septic tank not use water-saving features in faucets, additives.Theseprohurtyursystually min shower heads and toilets. help and some may ixmrl your system in the long run. • DO learn the location of your septic system and drainfield. Keep a sketch of DON'T use your ragatcdet as a trash can it handy for service visits. If your system by dumping nondeg toilet or drains. Also,.d don't down your :... has a flow diversion valve,loam its loca t poison your tan, and turn it once a year. Flow septic system and the groundwater by diverters can add many years to the life pouring harmful chemicals down the r« of your system. drain.They can kill the beneficial barxe- .M* ria follhat owing treat you wa am ler. Keep your septic nn:n.Mw i - oU w.wwr.r v ' ' �•� Box DO divert root drains and surface water system: FkW from driveways and hillsides away from the septic system. Keep sump pumps and house footing drains away from the septic system as well. SP : c. DO take leftover hazardous household chemicals to your approved hazardous waste collection center for disposal.Use bleach,disinfectants,and drain and toi- let bowl cleaners sparingly and in accor- dance with product labels. 1 ��� z�`l Qr�21✓�� �� i � 1d COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 9� DEPARTMENT OF ENVIRONMENTAL PROT iCTION G ONE HINTER STREET, BOSTON, MA 02108 617-2921550 0 P� 9 .. W Governor F.WELD A � t t 1 T.Rl1DY COS Govemor SecreL*\ ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 3` r_V I N 6t. Av A.M LX%S?CwS Address of Owner: ZN OFrd Date of Inspection: t% /97 (If different) pEITR� Name of Inspector: VEML S ULL, ?..F', SULLIVAN 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) ✓ SU SUNO.LIVAN Company Name: $urrt..lVAr.1 �►.s CIVIL9733 to Mailing Address: 3q ew GtZ 'Da C_Qiq-Me_VtL.t.t2 MA eeco s z '$. 9F0� PLO Telephone Number: %9-_9?A- ppgp STE 6 AL �y CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information repo e tr 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 _ Fails Inspector's Signature: Date: V Fi 14. IS)5-7 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, 8, C; or D: 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. COMMENTS: B] CONDITIONALLY PASSES: One or more system onents as described in the "Conditional Pass" section need to be repl r repaired. The system, upon completion of the replacement o as approved by the Board of Health, will p Indicate yes, no, or not determined (Y, N, or ND). Describe base t ion in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner rator has ed the system inspector with a copy of a Certificate of Compliance (attached) indicatin that a tank was installed within twe �) years prior to the date of the inspection; oc the septic tank, whet of metal, is cracked, structurally unsound, shows subs ar+' infiltration or exfiltration, or tank failure is i in t. The system will pass inspection if the existing septic tank is replaced wit orming septic tank tia0 roved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:l/www.magnet.state.ma.us/dep Z'j Printed on Recycled Paper tb'r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 l C.V I N 6 kv Gi IYAw�w►SPa�•(- Owner: Qos E2 G ZQ�( Date of Inspection: B/.Lt 1g7 44. B] 5 TEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or structed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with proval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system quired pumping more than four times a year due to broken or obstructed ipe(s). The system will pass inspection if( approval of the Board of Health): ; roken pipe(s) are replaced o ruction is removed CJ FURTHER EVALUATION IS REQUIRED BY T BOARD OF HEALTH: Conditions exist which require further evaluatio, by the Board of Healt in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH D MI THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAF AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surfa water Cesspool or privy is within 50 feet of.a bo ering vegetate wetland or a salt marsh. ' 2) SYSTEM WILL FAIL UNLESS THE BOARD OF. EALTH (AND PUBLIC TER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MA ER THAT PROTECTS.THE P IC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has.a septic t and soil absorption system (SAS) and the SAS i within 100 feet to a surface water supply or tributary to a surface w er supply. The system has'a se is tank and soil absorption system and the SAS is within a ne I of a public water supply well. The system has a ptic tank and soil absorption system and the SAS is within 50 fe of a private water supply well. The system ha a septic tank and soil absorption system and the SAS is less than 100 fe but 50 feet or more from a private watq supply well, unless a well water analysis for coliform bacteria and volatile o nic compounds indicates that the well 'S'free from pollution from that facility and the presence of ammonia nitrogen and • rate nitrogen is equal to or I,-- W5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97). Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A A CERTIFICATION (continued) "f Property Address: \3 , f-%3►ill G k%)r; AyI►.w►w►S eo Q.-T Owner: Date of Inspection: gel\ 197 D SYSTEM FAILS: You ust indicate ei;-,er "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 defined-in 3 CMR 15.303. The basis or this determination.is identified below. The Board of.Health should-be contaded.to determine-w at will be necessary to correct th failure. Yes No ackup of sewage into facility or system component due to an overloaded or clo ed SAS or cesspool. .Dis arge or-ponding of effluent:to the-surface of.the ground or surface-wate due.to.an overloaded or clogged SAS or cesspo I. Static liqui level in the distribution box above outlet invert due-to an .verloaded or-clogged SAS or cesspool. Liquid depth in esspool is less than 6" below invert or available olume is less than 1/2 day flow. Required pumping re than 4 times in the last year NOT d e to clogged or obstructed pipe(s). Number of times purr d Any portion of the Soil Abs rption System, cesspool o privy is below the high groundwater elevation. Any portion of a cesspool or pn is within 100 f et of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is ithin one I of a public well. Any portion of a cesspool or privy is wit 50 feet of a private water supply well. _ Any portion of a cesspool or privy i ess than 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. f the well ha been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, vctlattleorgan compounds;'am ogia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as o each of the following: The following criteria apply to arge systems in addition to the criteria a ove: The system serves a facili with a design flow of 10,000 gpd or greater (Lar System) and the system is a significant threat to public health and safety nd the environment because one or more of the follo ing conditions exist: Yes No the stem is within 400 feet of a surface drinking water supply e 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 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13l 1e14'1wc; /N'! �lYptNtvlS+�0e.1 Owner: Q06 fc2 C.u 22.`{ Date of Inspection: Vkt/97 Check if-the following have been done:You-must indicate either "Yes" or "No"as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or 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. 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. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of brea<out. i All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncove-ed, 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Vec—reov%00$ %fts.9a_moo N S Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 I TM\1 t a r- lab Owner: F—oGE:Q.0 witR.,f Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:tSlbx g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: 2 l-4ST 7YC-AZS Garbage grinder (yes or no):Ye 5 Laundry connected to system (yes or no):VE 5 Seasonal use (yes or no):_U—`7 Water meter readings, if available-(last two (2) year usage,(gpd):. Sump Pump (yes or no): Alb Last date of occupancy: �2ESEf kT%__y C- C RCIAUINDUSTRIAL: Type of esta ' ent: Design flow:_�a Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes Non-sanitary waste discharged to the Title stem: (ye o)_ Water meter readings, if available: Last date of occupan OTHER: scribe) L ate of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: `Frew N e C ?7Aa B . G Q�CAfLs7 8 Z7 O System pumped as part of inspection: (yes or no) 5 If yes, volume pumped:!�� gallons Reason for pumping: 615 U-( TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool X _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: LX Sewage odors detected when arriving at the site: (yes or no)—90 (revised 04/25/97) .Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �31 S�2V I N 6 �E u�Pates Nt S�O r2.1'° Owner: Qo6 t2 Gv QR.�( Date of Inspection: B DING SEWER: (Coca on site plan) Depth be w grade: Material o onstruction: _cast iron _40 PVC_ot-)er (explain) Distance from ivate water supply well or suction line Diameter Comments: (conditi n of joints, venting, evidence of leakage, etc:) SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _concret metal _Fiberglass P lyethylene —other(explain) - If tank is metal, list age _ Is age co 'rmed by Certificate Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet ee or ffle: Scum thickness: Distance from top of scum to top of outlet tee or le: Distance from bottom of scum to bottom of outlet ee r baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of nlet and outlet t s or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: oncrete _metal _Fiberglass _Polyeth\� er(explain) Dimensions: Scum thickness:' Distance from top of um to top of outlet tee-or baffie: Distance from botto of scum to bottom of outlet tee or baffle: Date of last pump',_g: Comments: (recommend on for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, ev' ence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C II(ISYSTEM-INFORMATION (continued) Property Address: 13 j IQ.V tro 6 )kh 6 t1dAN1WIS+P02.) Owner: V- C uzey Date of Inspection: 6AL/9-7 . TI T OR HOLDING TANK: (Tank must be pumped prior to; or at time, of insp ion) (looat \onsite plan) Depthrade: Materistruction: _concrete _metal _Fiberglass _Polyethylene o er(explain) Dimensions: .Capacity: gallons Design flow: gallons/day Alarm level: arm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condarm and float.switches, c.)itio of al DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert- - Comments: (note if level and distribution is an al, evidence of solids c ryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in workin order: (Yes or No) Alarms in wor ' g order(Yes or No) Comments: (note cond' on of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEINA.GE DISPOSAL SYSTEM INSPECTION FORM PART C a t' SYSTEM INFORMATION (continued) Property Address: 13 I e.V 10 6 ko G k-/&Aa#j ISM Q„T Owner: Z. Guee-y Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length; leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure; level of ponding, condition of vegetation, etc.) �o SlG 11S O R (�,�/DfZA t9 LAC FAt t+ U 2� SYSt'ac rvt L6(9�L5 Gzc©� CESSPOOLS: (locate on site plan) Number and configuration: T'i+Uc.R6"LVC. A.S S E PTIC. -Any Y——%AA (OCC&.4,(rh o Ili S Depth-top of liquid to inlet invert: 4ti45 TUC. "T" Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: (�tzAcataU�Arl'8e. t(..FL.CAA.I inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level cf ponding, condition of vegetation, etc.) (locate on site p a Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic fail ve of ponding, condition of vegetation, etc.) (revised 04/25/97) Page .8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C }} 111SYSTEM INFORMATION (continued) Property Address: t31NbA�W Alt 5 �fb Q.'S' Owner: Date of Inspection: SKETCH OFSEWAGE 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) o W El.L.S W ITbtfN 1060 r K1 o W E►LA."PS r (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property,Address: ZM t A1 to �V c w"s Qo_¢-Z Owner: �•G ufl Qom( Date of Inspection: Depth to Groundwater 16 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Ra a(. I rmS i ATC-ti� Observation of Site (Abutting property, observation hole,basement sump,etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established t-)e High Groundwater Elevation. (Must be completed) v LP-Po tQA*. 2 EYt t.,j o r 1-tA E N TTv%'-L+1' �- TrrST ?- (-7 89 fla 1Z• 3 8"7 Ar Sti F200.l o0e. 5YsTsfI k 71-T is oPt(v to vv T-pvPc—\ —,4+:2G lS A - l..lr=:AS; a r �� A2`� MhVeQ-a A,C_ $��oW b�2 SEPTLC.S�Ib�U.�. (rovined 04/25/97) YAgo 10 of 10 1 � F 1 m � 33 Z ST�( ^F'eAM c 1, l�,ci y�LLt�•.�C� � ; y \ cr V-1, L i LO,i (�->S O \LA vTtom—i2.S —R ffD APPLICATION FOR PERCOLATiUN Thb-1• Ji L) yt»crcve+llviv riio mm ( TION /. NO. CA :LLAGE DATE PLICANT S ��., ,•.�_Q-, FEE (Non-refundable )DRESS 0 ' .TELEPHONE NO. GINEER TELEPHONE NO. TE SCHEDULED -"93BSSOR'Sb[AyS y LOT NO: (applicant's signature) .................................... ..................... . , SOIL LOG B-DIVISION NAME DATE J!j , 3 TIME 10 Y1n PANSION AREA: YES \NO Fgf�`�f��=M1fN�/JF11MZI� EER WN WATER PRIVATE WELL rq 1P 4, BOARD OF HEALTH EXCAVATOR ETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: 2 6 90,519 . I.34_+-�-p _ ►3GD6 I°'—� ON N . �Ny- RCOLATION RATE: P-oT- I A ST.HuLE FO: ELENATIONOS.Go TEST HOLE NO: ELEVATION: 1 TOT'Son, s SUJgfo JZ 3 6 GL. 1 Z J 6 - . .--- 80�jLDQs�i.i1,3�7 --- 8., 9 GL GT�.s Nl- G 9 10 SA ►j b s 6 2 A vEL10 11 11 12 12 13 d3 E 5.6 14 .. 15 {LSO t�P112_ -: 15 16 16 [TABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS_ LEACHING TRENCHES SUITABLE FOR SUB-SURFACE SEWAGE. REASONS: CE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION [GINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH )Y: RETAINED BY APPLICANT The accumulated solids in the bottom of be very expensive to repair, • DO have your tank pumped out and • DONUT allow anyone to drive or park the septic tank should be pumped out every and,put thousands of water supply users system inspected every 3 to 5 years by over any part of the system. The area three to five years to prolong the life of your at risk if you live in a public water supply a licensed septic contractor(listed in the over the-drainfield,should be left undis- system. Septic systems must be main- watershed and fail to maintain your sys- yellow pages). turbed with only a mowed grass cover. tained regularly to stay working. tem. Roots from nearby trees or shrubs may Neglect or abuse of your septic system Be alert to these warning signs of a failing clog and damage your drain lines. • DO keep a record of pumping,inspec- ` can cause it to fail. Failing septic systems system: tions,and other maintenance. Use the can sewage surfacing over the drainfield back page of this brochure to record DON'T make or allow repairs to your • cause a serious health threat to your (especially after storms), maintenance dates. septic system without obtaining the re- quiredfamil and neighbors, health department permit. Use Y 9 sewage back-ups in the house, rofessional licensed septic contractors P.. • degrade the environment, especially lush,green growth over the drainfield, DO practice water conservation. Re- when needed lakes,streams and groundwater, pair dripping faucets and leaking toilets, f • slow draining toilets or drains, :run washing machines and dishwashers • reduce the value of your property, sewage odors. only when full,avoid long showers and DON use comrneraal septic tank `use water-saving features in faucets additives.-These productsusuallydonot shower heads and toilets. help and some may.hurt your system in the long run. .. • DO-learn-the location of your septic system and drainfield: Keep a sketch of DON'T.-,use your Deal as a trash can �` �y,y, ►��utr ►_.._� ._►fr► -= i,,.. it handy for service visits. If your system by dumping nondegradables down your has a flow diversion valve,learn its loca- . toilet or drains.:,Also,don't poison your tP!!, .a"1:''�+!a septic s stem and the groundwater by .:.-...._,•.•:•.:.:.�•.. �•�• •�:.••• • � � 'tion,'and tum,it once.a year. -,Flow .-� P Y diverters can add many years to.the life, pouring,harmful_chemicals-down,the T« _ of your system.. drain.They can'kill thebenefidal_bacte- that �.► n«..a w..�...., divert fo low ngematena sat your of you a sept c Drain Dieft,, B°_ •' DO ' ert roof drains and surface water system: from driveways and hillsides away from the septic system. Keep sump pumps 00 w•a...w and house footing drains away from the septic system as well. se,'disposab ,... • di lastfcs,etc. • DO take leftover hazardous household chemicals to your approved hazardous P waste collection center for disposal.Use gasoline,oi, bleach,disinfectants,and drain and toi- thinner,PeS let bowl cleaners sparingly and in accor- dance with product labels. L s HOMEOWNER RECORDS Septic • - • jA ReferenceGuide Septic systems are individual wastewater treatment systems that use the soil to treat small waste- water flows,usually from individual homes. They are typically used in rural or large lot settings where YOUR centralized wastewater treatment is impractical. There are many types of septic systems in use today. While all septic systems are individually designed for each site,most septic systems are based on the same principles. SEPTIC A Conventional SYSTEM Septic System _ - - - for Homeowners Sketch house septic tank. leading fatty and sbow distances h=sep&tank corer t4 nearest house earners. TAn SERVICE RECORD 0 o Ds cow"WW sa.b►�Aawnd ! A septic system consists of a septic Alter the partially treated wastewater tank.a distribution box and a drainfield.all leaves the tank, if flows into a distribution ° connected by pipes,:called conveyance lines. box.which separates this flow evenly into a network of drainfield trenches. Drainage Your septic system treats your household holes at the bottom of each line allow the was- wastewaterby temporarily holding it in the septic tank where heavy solids and lighter scum are tewatertodrainintograveltrenchesfortempo- rary storage. This effluent then slowly seeps allowed to separate from the wastewater. This into the subsurface soil where it is further separatior process is known as primary treat- treated and purified(secondary treatment). menf. Thr solids stored in the lank are decom- 1f you have problems,contact your focal board of A properly functioning septic system does not health or health a8�- . posedoy'bacteriaandlaterremoved.alongwith pollute the groundwater. the lighie,scum,by a professional septic tank ;r4 pumper. l OWN OF BARNSTABLE fi t LOCATION 3 �� �` ' SEWAGE# VILLAGE ASSESSOR'S MAP&LOT IE�7 (( INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACELrrY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -4 o tiff E&-AiZ. f t �- _ Gam. r ------------- ------ TOF=21 .1'+- PROVIDE PRECAST CONCRETE FINISH GRADE OVER D-Box= 20.9'+- PROPOSED VENT WITH CHARCOAL EXTENSION RISER WITH CONCRETE FINISH GRADE OVER CHAMBERS= 20.7' - 21.1' FILTER TO ABOVE GRADE GENERAL NOTE S COVER TO WITHIN 6"OF F.G. OVER REMOVABLE COVER TO SLOPE @ 2% MIN. OVER SYSTEM I. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION INLET AND OUTLET COVERS. WITHIN 6"OF GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISHED GRADE 5" DIA. OUTLET(S) ACCESS BOX WITH COVER TO GRADE STONE TO CROWN OF PIPE FINISH GRADE OVER TANK EL.= 20.0'+ (SEE NOTE#22) ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. @ FOUNDATION = VARIES 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE :7\ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 20" MIN.ACCESS COVER PLACE RISERS ON ALL OF HEALTH AND THE DESIGN ENGINEER. (3 TYPICAL) 12"MIN. 60"MAX. I I Lj 36"MAX. See Note 23 TOP OF SAS 16.10' CHAMBERS WITH 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 60"MAX. INLET PIPES TO 6"OF BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 15.10' See Note 23 BREAKOUT EL 15.60' FINISHED GRADE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 2" DROP MIN. F PROVIDE WATERTIGHT ELEVATION = 15.60' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. 6" 3" 1 10% MIN, 3" 9" 1 JOINTS (TYP.) - 3'DROP MAX. 1 IN. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. 4"PVC IN FROM AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 10" SEPTIC TANK 4" PVC OUT TO 14" 0 > 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 6.50' LEACHING FACILITY 0 0:> 96 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 00 FINISHED 'I FROM TANK T Pi� 12" ta r = = = - 6(::, 00- 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO OUTLET TEE 15.52 15.35' 2- 00 BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR 16.75' 4- DC D INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING 6"CRUSHED STONE 00 00 CD APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER.-22"ZABEL FILTER OVER MECHANICALLY C�l 1 CX:> CDC> -14.8'TO FND.- MODEL#A1801-4x22 COMPACTED BASE ---- 8. ELEVATIONS BASED ON APPROXIMATEL M.S.L. DATUM OF 22.00' 5 OUTLET DISTRIBUTION BOX .75' 8.5'(TYP) 4.09 4.9' 4.01 ESTABLISHED ON A NAIL SET IN FENCE POST AS SHOWN ON PLAN. 6"CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE 50.0' A (TYP.) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET < 8.03' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE COMPACTED BASE (3M M M M, GROUND WATER ELEV.= AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY PROPOSED 1500 GALLON H-20JCONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 13.10' 12.9' DISCREPANCIES TO THE DESIGN ENGINEER. LENGTH 10' 8' WIDTH§�410' DEPTH 6' 2 it (DIMENSIONS PER CROSS SECTION VIEW 5 - 500 GALLON H-20 CHAMBERS 5'MIN. CHAMBER END VIEW 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE WIGGIN PRECAST / H-20 DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE STRUCTURES SHALL BE MADE WATERTIGHT. 'Contractor to notify engineer if differer H-20 SEPTIC TANK PROFILE CORP., POCASETT, MA) NOT TO SCALE H-20 CHAMBER DETAILS 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR NOT TO SCALE NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. TEST PIT DATA i 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS Well LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE PERC NO. 12415 THEY SHALL WITHSTAND H-20 LOADING. Ca^ h INSPECTOR: Donna Z. Miorandi, R.S. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. EVALUATOR: Michael Pimentel, E.I.T. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND DATE: November 14, 2008 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN TEST PIT#: 1 COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN IRVING 4VENUE ELEV TOP 20.70' ACCORDANCE WITH 310 CMR 15.255(3). 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN • 140'WID ELEV WATER <8.03' E-PUBLIC) SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. GE------ EDGE 13/WW 0 PERC RATE <2 minF PAVEMENT ./inch 16. PROPOSED PROJECT IS LOCATED WITHIN: 6"'w DEPTH OF PERC 90"- 108" ASSESSORS MAP 287 PARCEL 66 D/H/V /W Mark E. Freitas 17. OWNER OF RECORD: '75.00, U/H/W TEXTURAL CLASS: 1 PROPOSED PVC VENT PIPE SHRUB - `,,,� C/o Marcus&Berk Norwood Lo 180 North LaSalle Street 179, �, SHP7 ADDRESS: PROPOSED 5- 500 GALLON --ii5775 H-20 LEACHING CHAMBERS 0" 20.70' Chicago, IL 60601 Fill FEMA FLOOD ZONE C co PROPOSED INSPECTION PORT 21 20" 19.03' B Loamy Sand AS SHOWN ON COMMUNITY PANEL# 250001 0008 D 0 CL Benchmark TP 2- 1 OYr 5/6 ,--r- 0 28" 18.37' d 20x9 lu 18. PLAN REFERENCE: PLAN BOOK 509, PAGE 39 0 Nail Set in Fence Post z - P L0 0 C-1 Medium Sand Elev. =22.00' 0 I\; - CPO co 2.5Y 6/6 ca Approx. MSL 46" 16.87' 19. DEED REFERENCE: BOOK 10920, PG.92 z d- 6 20. ALL DISTURBED ARFAS SHALL BE RESTORED TO ORIGINAL CONDITION. PROPOSED H-20 D-BOX Silt Loam 0 > EXISTING C-2 2.5Y 4/4 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY _3 �:- . 5 1 REMOVE ALL UNSUITABLE -TPI STRUCTURE FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY MATERIAL DOWN TO C-3 SOIL 20x7 3 90" 13.20' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. AND REPLACE WITH CLEAN Perc 22. A 4"PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A COARSE SAND 108" 11.70' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A (4) (5) LU C-io i REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. Medium Sand CY) C-3 2.5Y 7/4 0 V- 23. IN ACCORDANCE WITH 310 CMR 15.401-15.405, THE FOLLOWING LOCAL UPGRADE 0 70 LOCUS PLAN APPROVALS ARE REQUESTED FROM 310 CMR 15.212(7): 1.) A 2.0 #131 -(5.0--3.0')WAIVER FROM MAXIMUM COVER OVER THE PROPOSED DISTRUBUTION BOX. EXISTING SCALE: 1"= 1000' 1152" 8.03' 2.) A 2.0 MAP 287 (5.0'-3.0')WAIVER FROM MAXIMUM COVER OVER THE PROPOSED LEACHING FACILITY. 1 1 6-BEDROOM PARCEL67 0 No Mottling, Standing or Weeping Observed MAP 287 DWELLING PARCEL TOF 21.1'+ 0 DESIGN DATA TEST PIT DATA 0 MAP 287 Cf) PERC NO. 12415 PARCEL66 j INSPECTOR: T Donna Z. Miorandi, R.S. (3) (6) 13,769 S.F.± EVALUATOR: Michael Pimentel, E.I.T. DATE: November 14, 2008 LEGEND 3 PROPOSED 1,500 GALLON SEPTIC 0) HC- TANK (EITHER PLASTIC OR .8' yn NUMBER OF BEDROOMS 6 TEST PIT#: 2 4 HC-4 CONCRETE TANK ACCEPTABLE) DESIGN FLOW 110 GAUDAY/BEDROOM ELEV TOP- 20.90' x 50.0 EXISTING SPOT GRADE C/o TOTAL DESIGN FLOW 660 -GAUDAY ELEV WATER= <8.23' 50 EXISTING CONTOUR #131 EXISTING CESSPOOL (approx. DESIGN FLOW X 200 % = 1320 GAIJDAY PROPOSED CONTOUR PERC RATE = EXISTING location)TO BE PUMPED AND EXISTING GAS EXISTING GASLINE FILLED WITH CLEAN SA', - P I USE PROPOSED 1500 GALLON SEPTIC TANK 6-BEDROOM j 0) STRUCTURE DEPTH OF PERC O/H/W EXISTING OVERHEAD WIRE DWELLING 19,W N830401 0i TEXTURAL CLASS: 1 TOF 21.1'± o W EXISTING WATERLINE 82-67. -2 N83040119 TEST PIT LOCATION -W z INSTALL FIVE (5) 500 GALLON H-20 CHAMBERS MAP 286 EXISTING CESSPOOL TO 24.58, 20.90 0. PROPOSED 1500 GALLON SEPTIC TANK BE PUMPED AND FILLED ' PARCEL22 WITH CLEAN SAND SIDEWALL CAPACITY Fill PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE MAP 286 (LENGTH +WIDTH)(2 SIDES)(EFF. HEIGHT)(0.74.GPD/SQ.FT.)=GPD B 20" Loamy Sand 19.23' 13 PROPOSED H-20 DISTRIBUTION BOX PARCEL 23 (50.0'+ 12.9')(2)(2')(0.74 GAUSQ.FT.)= 186.2 GAL. LEACHING/DAY 28" 1 OYr 5/6 18.57' PROPOSED 500 GALLON H-20 LEACHING CHAMBER 1 BOTTOM CAPACITY C-1 Medium Sand [12) 2.5Y 6/6 (LENGTH)(WIDTH)(0.74 GPD/SQ.FT.)= GPD 46" 17.07' (50.0')(12.9')(0.74GAL/SQ.FT.)= 477.3 GAL. LEACHING/DAY REV. [ DATE_ BY AF DESCRIPTION Silt Loam PROPOSED SEPTIC SYSTEM UPGRADE TOTALS: C-2 2,5Y 4/4 PREPARED FOR: C-1 TOTAL LEACHING AREA 896.6 SQ.FT. 90" 13.40' CAPEWIDE ENTERPRISES TOTAL LEACHING CAPACITY 663.5 GPD LOCATED AT Medium Sand 131 IRVING AVENUE SWING TIES C-3 2.5Y 7/4 HYANNISPORT, MA DESCRIPTION HCA HC2 HC-3 HC-4 ----------------- SEPTIC COVER IN (1) 31.0' 282 --- ---- 152" 8.23' SCALE: I INCH 20 FT. DATE: NOVEMBER 18, 2008 0 10 20 40 80 FEET SEPTIC COVER OUT(2) 24.8' 35.4' --- No Mottling, Standing or Weeping Observed N L PREPARED BY: LEACHING CORNER(3) --- 18.3' 43.9' C CH CHILL R. JC ENGINEERING, INC. VI LEACHING CORNER(4) I 67.0' 75.6' 2854 CRANBERRY HIGHWAY NOTE: 41L LEACHING CORNER(5) --- --- 69.7' 69.3' SITE PLAN- 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG EAST WAREHAM, MA 02538 LEACHING CORNER(6) --- 26.5' 31.8' SCALE: 1"=20' THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. 508.273.0377 Drawn By: MCP I Designed By:MCP Checked By:JLC JOB No.1528 ----------- -------- ------------------- --------- ------