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Home My WebLink About0035 OCEAN AVENUE - Health EA CEAN AVENUE,HYANNIS ~• r TOWN OF BARNSTABLE Bpi IN E TO w OFFICE OF HA"STM i BOARD OF HEALTH NABS. 039. \0m 367 MAIN STREET c MAY k HYANNIS, MASS.02601 May 28, 1998 Michael L. Borselli Holmes &McGrath, Inc. 200 Main Street Falmouth, MA 02540 RE: 35 Ocean Avenue, Hyannisport Dear Mr. Borselli: You are granted permission on behalf of your client John Donahoe, to finish the basement and to install an ejector pump at 35 Ocean Avenue, Hyannisport. This permission is granted with the following conditions: (1) Only one additional bedroom may be constructed. No more than five (5) bedrooms are authorized in the entire dwelling. Dens, study rooms, finished attics, sleeping lofts and similar rooms are considered bedrooms according to the Massachusetts Department of Environmental Protection. (2) You must obtain the approval of the Town of Barnstable Plumbing Inspector, prior to the installation of a sewage ejector pump. (3) The sewage ejector pump shall be"hard-wired" into the permanent electrical system of the dwelling. This permission is granted because the existing septic system recently "passed" an inspection and is capable of handling the wastewater discharge flow of a five bedroom dwelling. Also, the basement sewage ejector pump will meet all of the criteria contained in the State Environmental Code, Title V(Section 15.229). borselli f II No variances from any of the State or Local Health regulations are required or needed for this proposal to remodel the basement at 35 Ocean Avenue, Hyannisport. Sincerely yours, usan G. Rask, R.S. Chairperson Board of Health i Town of Barnstable SGR/bcs l r 1 I I i I borselli r `F ram` t d DATE Sir 9�- r s, E Town of Bar��sti�hj ., Rgt . 8 ►^� , _:f Board of Hea 2z ., = atn yatvtt�s.:'MA�02 VSH i a ^7 1 ; li is F ,I wd. Atilce: 308-790-6265 :+ 'Suss G.Ruk,RS. FAX: 508-790.6304 t� p•K• "Ph A-Murphy,C�p VARIANCE REQUEST FORM s� LOCATION Property Address: 35 Ocean Avenue Assessor's Map and Parcel Number: 287-122-00-2 _ Size of Lot: 19. 800± square feet_ Wetlands Within 300 Ft. Yes Subdivision Name: N/A No X Business Name: APPLICANT CONTACT PERSON Name: John F. Donahoe Name: Michael J. Borselli Address: 48 Ash Street Weston, MA Address:Holmes and McGrath. Inc. 781-899-1229 200 Main St, Falmouth MA 02540 Phone: Phone: 5 0 8-5 4 8-3 5 6 4 FAX: 781-899-0289 FAX: 508-548-9672 R (List Rpg.} REASON FOR VARIANCE(May attach if more spaoe needed) It (to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) .Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no tee rot sresuard modinestion renewsis,g,eaae trap rarienes reteseels(same ow rileuee only),etneide dining variance remwels(same owner/leuee onlyl,end rsriances to repair Riled sewW dlspwal asters(only if rre eapwion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan a.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ holmes and mcgrath, ins civil engineers and land surveyors 200 main street, room 201 falmouth, ma. 02540 (508) 548-3564 e 1 (800) 874-7373 FAX (508) 548-9672 Are r i i 20. 1998 Mr. Ed Barry Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 Dear Mr. Barrv: RE #35 Ocean Avenue, Hyannisport Our Job Number 98149 ------------------------------------ Please find enclosed a DEP Subsurface Sewage Disposal System Inspection Report . On April 13, we inspected the existing septic system at this property and determined that the system passed the standards for existing septic systems. The existing septic system consists of a 1500 gallon septic tank, distribution box and two 6' dia. , x 6' deep leaching pits. The actual amount of stone ar®und each pit is unknown. The original design required 2 ' of stone around each pit. This was the minimum amount of stone allowed at the time of installation. At the time of inspection, both pits were dry, they had not been pumped. The distribution box and septic tang were in good condition. The test hole results that you were so kind to provide to me, indicate the soils to be medium to coarse sand having a percolation rate less than 2 minutes per inch. Mr. Donahoe, the current owner of the property, .wishes to renovate the house by converting the basement level into one additional bedroom, computer media room, family room, bathroom and storage. The existing basement is currently used for storage. The Donahoe family uses the house primarily in the summer months. During this period, their extended family visit. The current number of bedrooms is not sufficient for this summer use. The additional bedrooms would provide the badly needed extra bedroom space. The current Title 5 code allows only 2 feet of sidewall area to be used on any new soil absorption system (SAS) . The existing leaching pits utilize 6 feet of sidewall . This was allowed under the previous version of -Title 5. The existing septic system was designed for a capacity of 1, 099 gallons M Mr. Ed Barry -2- April 20, 1998 per day, or the equivalent of close to 10 bedrooms in accordance with the 1978 code. Under the new code, the system has a capacity of 471 gallons per day or just over four bedrooms . Although the existing SAS does not meet the current capacity requirements, there is, in our opinion, sufficient capacity for one additional bedroom within the system under the 1978 code. Strict compliance with the new Title 5 code would require significant disturbance to the existing landscaping, as well as additional cost. For this reason, we request permission to renovate the existing basement, adding two additional bedrooms to the existing house. The addition of the bathroom in the basement requires an ejector pump. Section 15. 229 (pumping to septic tanks) , allows pumping to septic tanks, when approved by the local approving authority, if certain requirements are met. The volume of effluent pumped must be less than 250 of the total, the discharge rate must be less than 60 gallons per minute for a non-grinder pump, and the minimum septic tank size is 1, 500 gallons . These conditions will be met. The existing septic tank size is 1, 500 gallons . One bedroom, 200 of the total daily flow will be pumped. In summary, we request permission to modify the existing basement into living space including one bedroom. We also request permission to install an ejector pump for the effluent generated from this additional bedroom. Please review the enclosed report, and consider our request. We intend to follow-up this request with a telephone call later this week. If you have any questions, please call or write. Sincerely, HOLMES AND McGRATH, N . L t Mic ael B se li, P.E. Vice Presiden mj b Enclosure: cc: Jack Donahoe t 1• .4,,_i-�,-,�,-'`-.,.-,.-*-,il It-,*�,�',l".-.�z!.-;,:-1.��.",--.�Ir I,,J.i)"�."-, ! i .,,..,Ij1�"1_.',"'�1,-,....i`1.f.i.i,..�,..,:,-".i-.,...,�.,:1--,'"-,,.!:..._�I!..I.-,..--w,,l...-:,. "'�1*..:,,1.�,.�..,�-..,'..�..-:,,-'.�,I-,-.m��, -,.-�'-. 1. -,.,..,�.-. ,, ,.. I o < '� • C? sr 'P� s .� :,' SOIL T PIS` DATA. ' �I��4t.-1"�i��-�-�gl-i-,-...",�--� s } ', , o'Aes /Mj �! I,..ri1.,Ij,`,.,4Ii I,-I'-.,-,.�,,,.:.;I,-,,i"'l!%.I"!:r,I i 1,,,-,,,�,Ij�..�.1,.t.J 11.�.��i,. '.,i,'.-.1-,.�l:'I..�,��,�w:-;--�,-1.,�V�1��.',,,,,I.-."V,;,".-�,,-,.-;-t..!-,�-'PF.�.;i-'..-..,,i',�.I:.-,i.--`7,,I�.,.�:,'��i�-� 9 r , 7 , i � �.'. J :ri ►r ' �VYOCAVD r i''I. •. VA tr:�s ,' r ,:@r�u"Dw, 4 1. a s't h y 1�•'y, �' �S,y ti..;, a c' °- [ - •. l ' n , ^' ' r Sr $i K°7 A �y'; F� sr".[+ �a ,' r s^I ;.� j., . s 2 r.,. ry, ,\ , 1 Pt. sd t r i .; {, �3R�� EL �,�=4 GRD. EL 1�.._ dod ,EL x"' D. EL, ` ,,:� GW: EL CW.`EL. w """ , t3W r,EL � :t . 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R'.'1' ' ` :lr �yF 't ._, 1 . i .q ( r I \ S u � _yam N �„ r S t l -t x r r 1. ` - ..a i. 1 ✓"" a fii, i A ,� rr {.-t t y0 } q ; - ` t 1 ,l t ,, •t,• ) X i46 '�• a .�,�1 3j t '��i� J� •1 t �7 7.�'�'' �*Y {, -M 1 �J ;, Id t { / -r,, I- I- y a v t r;Y�}+ +'i-i i r ' NT' °'� ,f1M 1 i T' r s fir .+ #," %., JST 1yk ` 4 y7 {-il} tb, + .-11IK^, 'iS ! s` Ac r,K l;.at ,' 4] «' P _ '.i I .[, f P4, -V•t .a 'ht t �:; t "f} N 1 la 'L] +. i .,R r ,t V' J ; I. Y `I 4, t f f "[ 1., , Y DESIGN FLOW: BEDROOMS AT 1..iO G P.B./D o G.P.D. r The 9$GGrou' F. REQUIRED SEPTIC :TANK: 440 x «a — +I!a�C3/C GAL. A. SEPTIC TANK PROVIDED: / :GAL. mu SIZE OF LEACHING; FACILITY A y' DESIGN PERC. RATE: - MINJMdCH i�61.Maiq Street 1 Route'6A �' a " � ' 88'm5tab16 Village MA' 02 68 0 J T �- 617 3�� 6133 SIZE OF LEACHING ACV Y`PROVIDED . IP'ROJEC'fi - 1 S. V1fAG C�1 'CA 5►D�wAt�s I'I8 S,F X .2,5 w 44� yrP.13 '' D0° TOM : '71 SA x ►;o u. 14 d YST "toTAL LS7 S/F, 514 5,1= Nt 1 ' f n� �;'F✓ pt�h'< s ' LOCUS PLAN: il'Rt 'ti r - pRfPA'RE6%FoAc • � .. � 1`V i � i l,: as .4 "�, i c t + �" 1 y bATE >_ 1 1 94b ` AV at. a 4 ° , •' a r COMP/DE51GN ' f a: CHECK,- A, DRAWN. iN13 s r • 'r!`� 35 N. FIE -.r ,4F .t1• h � .... rlk �; t ILE N0. .Dw� .No. .r. :4. TN OF BARNSTABLE LOCATION /Ive SEWAGE VILLAGE ASSESSOR'S MAP & LOT —INSTALLER'S NAME & PHONE NO. ,�ah�> %��/�d ��y) `%6F M/5 �6SEPTIC TANK CAPACITY -LEACHING FACILITY:(type) aZ i�, fs w y J(size) 10140 Q�,NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER OBUILDER OR OWNER le-i' DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 119 i , t COMMONWEALTH OF MASSACHUSETTS Uof EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION' ONE WINTER STREET, BOSTON. MA 02108 617-292-5500 WILLIAM F.WELD TRUDY COX Governor Sccrcm ARGEO PAUL CELLUCCI DAVID B.STRUM? Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissions PART A CERTIFICATION Property Address: 35 Ocean Avenue Address of Owner. Date of Inspection: April 13 1998 (If different) Name of Inspector: Micheal A. Borselli am a DEP aPeroved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 1S.000) Company Name: Holmes and McGrath, - Inc. Mailing Address: 200 Main StreetRoom-MI Telephone Number:Falmouth, MA 02540 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation the Local Approving Authority _ Fails ,v Inspector's Signature: Date: April 17, 1998 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 16,000 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: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303_ Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank 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 04/25/97) page 1 of 10 DEP on the World Wide Web: httpJ/www.magnet.state.ma.usrdeo i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued). Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the-. Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. MPthm tocPA to.+�te.�.;in` � �W.^.w 1.:�'.j.SvXiiTaii0 iiut valiup: 3) OTHER (ravisad 04/25/97) page 2 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 DJ SYSTEM FAILS: You must indicate eiv,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 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A, Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. NJA 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. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply - the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or 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: 3 5 Q c san Avenueh Owner: Jack ona oe Date of Inspection: April 13., 1998 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. _ P S X _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: x _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X _ Existing information. Ex. Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 1 10 ¢.p.dJbedroom for S.A.5. Number of bedrooms: 4 Number of current residents: 2 Garbage grinder (yes or no): no Laundry connected to system (yes or no):_yX g Seasonal use (yes or no): Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):no Last date of occupancy: COMMERCIAIJINDUSTRIAL: Type of establishment: Design flow: pilons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)e S If yes, volume pumped: + lions Reason for pumping: gene ralmaintenance TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system c 1 oo d7Ti^6�c •.c$.ip ! - 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: 10 years ± Sewage odors detected when arriving at the site: (yes or no) no (rovisod 04/25/97) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued)' Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: —cast iron _40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:X (locate on site plan) Depth below grade: 12" ± Material of construction: X concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 1500 gallon Sludge depth:__= Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Observation 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.) * SeT)tic tank was numptarLpriox to inspection. 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 04/25/97) page 6 of 10 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: ' (condition of inlet tee, condition of alarm and float switches, etc.) . DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: 0" Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) good working order. PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) I (reviead 04/25/97) Page 7 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 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.) Z-b cliameter xdeep 7eaching pits . Both pits were dry. CESSPOOLS: _ Ilocate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: indication of groundwater: inflow (cesspool must be pumped as part of inspection) -omments: note condition of sod, signs of hydraulic failure, ievei of ponding, condition of vegetation, etc.) 'RIVY•_ locate on site plan) materials of construction: Dimensions: ')epth of solids: _omments: note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 04/23/97) page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) 7� 2 / 33� 9 4AV46C 18' fi HovsC (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Date of Inspection: April 13, 1998 Depth to Groundwater520 Feet Please indicate all the methods used to determine High Groundwater Elevation: x Obtained from Design Plans on record . Observation of Site (Abutting property, observation hole, basement sump etc.) x Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data ,4 .: 'Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Review of design plans. (revised 04/25/97) Page 10 of 10 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ? ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 WILLIAM F.WELD � `k � 'DY COaE p .Governor EC6VEQ Secretan ARGEO PAUL CELLUCCI °''( APR- 2 3 19 9 FA`�' Br STRtTRI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F f' ommissione PART A TOWN OLTHOFPTA9LE CERTIFICATION f�1 Property Address: 35 Ocean Avenue Address of Owner: Date of Inspection: A r i 1 13 1998 (If different) Name of Inspector: Micheal A. Borselli I am a DEP approved system inspector pursuant to Section 1S.340 of Title 5 (310 CMR 1S.000) Company Name: Holmes and McGrath,• Inc. Mailing Address: 200 Main Street Room Telephone Number:Falmouth, MA 02540 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation the Local Approving Authority _ Fails Inspector's Signature: Date: April 17, 1998 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.,The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303- Any failure criteria not evaivaied are indicated below. COMMENTS: 61 SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank 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 04/25/97) page 1 of 10 DEP on the World Wide Web: http:/hvww.magnet.state.ma.us/dep aA. printam nn Racveled Panes i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: Ap r i 1 13, 19 9 8 BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the.. Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cj 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 PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 p m. Mpthnd 11CM.� p (app:oxtniaiiv8-1 iwt Yaiid). 3) OTHER (revised 04/25/97) page 2 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 D] SYSTEM FAILS: You must 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 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. 2L Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply - the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or 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: 35 pc an Avenue Owner: Jack �5onahoe Date of Inspection: April 13., 1998 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. X _ As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste Flow. X _ The site was inspected for signs of breakout. X _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: x _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X _ Existing information. Ex. Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, . 19 9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: 10 R.p.d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 2 Garbage grinder (yes or no): no Laundry connected to system (yes or no):_ye S Seasonal use (yes or no):_ Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):no Last date of occupancy: 1 n 19 8 COMMERCIAUI N DUSTRIAL: Type of establishment: Design flow: Rallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_Ye S If yes, volume pumped: 900± allons Reason for pumping: gen ral maintenance TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 10 years ± Sewage odors detected when arriving at the site: (yes or no) no (r.v d 04/25/97) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: X (locate on site plan) Depth below grade: 12" ± Material of construction: X concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 1500 gallon Sludge depth:_.. Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Observation 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.) * Septic tank was =limped prior to inspection. GREASE TRAP: (locate on site plan) Depth beiow 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.) i (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: 0" Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) good working order. PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revisad 04/23/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 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:x 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.) lame er xdeep ieaching pits Both pits weredrv. CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, ievei of ponding, condition of vegetation, etc.) PRIVY._ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/45/99) Page a of 10 ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Jack Donahoe Date of Inspection: April 13, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 7� 2 / 33` H Ous (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Ocean Avenue Owner: Date of Inspection: Ap r i 1 13,. 19 9 8 Depth to Groundwater>2 0 Feet Please indicate all the methods used to determine High Groundwater Elevation: x Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) x 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) Review of design plans. (revised 04/25/97) page 10 of 10 v q . L1,lei) Commonwealth of Massachusetts p J N 2 Executive Office of Environmental Affairs %V '996 Department of Environmental Protection IT William F.Weld Governor Trudy Coxe Secretary•EOEA ' David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:36 OC¢,t!%�n Ave. "*Vi)Qot+, Address of Owner: Date of Inspection: 4-46-Wo (If different)' Name of Inspector: W'WkAAX 1ZtWv3a1 5IL- Company Name, Address and_Teleohone_Number: 506-1-1.5 1�� William Robinson Jr- ig � ,gg��}}.,,� 41 Captain Ellis Lane CERTIFICAT�AT�M NJ Hyannis,MA 02601 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: —/Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature:W;&Z1V4_ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, orb: A] S7Im PASSES: 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. 4 Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) IV' 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 Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 , e Telephone(611)292-5500 0 Printed on Recycled Paper >`•' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property Address: 35 ®CeA, Avg, 4• Owner: 7, Date of Inspection: 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 une distribution box. The system will pass inspection if(with approval.of the Board of Health): /mping ipe(s) are replaced tion is removed tion box is levelled or replaced The system require than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(withBoard of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: it further evaluation b the Board of Health in order to determine if-the system is failing to protect the Conditions exist which require y public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF EALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC LTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is with' 50 feet of a surface water Cesspool or privy is w' in 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLE THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCT NING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The sv em has a septic tank and soil absorpt{on system and is within 100 feet to a surface water supNiy or Uibutary to a surf a water supply. _ T.e 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 D] SYSTEM FAILS: I have determined that the sy tem violates one or more of the following failure criteria as defined in 310 CMR 15.303. .The basis for this determinat/isidtified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup nto facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Z (revised 8/15/95) :y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 04ogn. Aur, HYg4014 pof1,. Owner: T, Date of Inspection: D] 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 inert or available volume is less than 1/2 day flow. RequirZped more than 4 times in he last year NOT due to clogged or obstructed pipe(s). Numbeumped t _ Any poSoil Absor ion System, cesspool or privy is below the high groundwater elevation. Any possp of or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any poesspool or privy is within a Zone I of a public well. Any poesspool 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 floe' of system is 10,000 gpd greater (Large System) and the system is a significant threat to public health and safety and the environment because one or ore of the following conditions exist: the system is within 0 feet of a surface drinking water supply the system is ithin 200 feet of a tributary to a surface drinking water supply the sys m is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a publiewater 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: 367 oce-AN Ave, 14YA44,/ f04- Owner: 7", Res/� Date of Inspection: Check if the following have been done: //umping information was requested of the owner, occupant, and Board of Health. I�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. s 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. i4The system does not receive non-sanitary or industrial waste flow ►+rThe site was inspected for signs.of breakout. All system components, excluding the Soil Absorption System, have been located on the site. �0 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. it 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 o•, ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 i 0 ,t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 350CQAn Ate. ��AA;Nigo(14• Owner: Date of Inspection: R FLOW CONDITIONS RESIDENTIAL: Design flow: llokka allons Number of bed ooms:--!�J- Number of current residents: il Garbage grinder(yes or no):-.)sL Laundry connected to system (yes or no)Y11- Seasonal use (yes or no): Nr6 Water meter readings, if available: (G3v q14?50c.„� pnfa,a, g -- 7T�7�/w� AA�t, (, LL-�^ IYoL NfZIMR RPAS RAL�6 CSA�tK� S.V�PYYI Last date of occupancy: Q6 COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/d Grease trap present: (yes o no)_ Industrial Waste Holdin(ye/so present: (yes or no)_ Non-sanitary wasted charged to the Title 5 system: (yes or no)_ Water meter read' gs, if available: Last date of occupancy: , OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: e WA No ,-owier N�05e- Is of SC�cr-,PA System pumped as part of inspection: (yes or no)_YO .If yes, volume pumped. eallons Reason for pumping: TYPE O� SYSTEM _1, 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: !D Vrs, PSG-R®9 Sewage odors detected when arriving at the site: (yes or no) . (revised 8/15/95) $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 ®WM% Aire HjAnn�%POC4•• Owner: Really } Date of Inspection: 9-(0-C:b SEPTIC TANK: (locate on site plan) Depth below grader � Material of construction: �concrete _metal _FRP—other(explain) Dimensions: !Q` fu'` Sludge depth: V Distance from top o sludge to bottom of outlet tee or baffle: lee, Scum thickness: 911 _ Distance from top of scum to top of outlet tee or baffle: V Distance from bottom of scum to bottom of outlet tee or baffler 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.) /,Q111f %� in (n3Br ,y)� eoAdi Z/J aed,'cOr n• And Pa /10'�— heed 4o L� ClP�ne -94- June oF�'ncnocYtr`e�: GREASE TRAP: *we enSit-• (locate on site plan) Depth below grade: Material of construction: _concrete etal _FRP other(explain) Dimensions: ' Scum thickness: Distance from top of scum top of outlet tee or baffle: Distance from bottom <<um t� hgttom of outlet tee or baffle Comments: (recommend_' n 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 8/15/95) 6 n r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 0C@ArA 11ve, f'�Am&n pa*�. Owner: 7o R�i11y Date of Inspection: TIGHT OR HOLDING TANK:_figm eng& (locate on site plan) Depth below grade: Material of construction: _concre _metal _FRP—other(explain) Dimensions: Capacity: eallons Design flow: allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: V (locate on site plan) Depth of liquid level above outlet invert:--E�-�Al Comments: (note if level and distributic7� equa!, e\idence of solids car ,vnver, evidence of leakage into or out of box, etc.) Signs op tArry toe' 'legel- r 62 ae W n 0041i 4;m PUMP CHAMBER: IVU*- oq rAea (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump amber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 S 0 cem Mie, 141MA6 PO Owner: T 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: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) �1 n AA- r c r I' 'I�w, CESSPOOLS: MrV- ens;; , (locate on site plan) Number and configuration: Depth-top of liquid to inlet inve . Depth of solids layer. Depth of scum layer: Dimensions of cessp Materials of cons coon: Indication of oundwater. inflow (cesspool must be pumped as part of inspection) a Comments: (note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ /ion: (locate on site plan) Materials of constr Dimensions: Depth of solids• Comments: ote condition of soil, signs of hydraulic failure, level of pond ing, condition of vegetation, etc.) B (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: OCearl Aug, V�tgyy s Owner: T. Rei i1•t . Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' a q p�. CaC-Pft , l� e kc 'fan k D�Box DEPTH TO GROUNDWATER Depth to groundwater: ie feet method of determination or approximation: (revised 8/15/95) 9 �WN OF BARNSTABLE -E, LOCATION five .SEWAGE # ' � VILLAGE S`1 v1 E ,` S O 0 C't ASSESSOR'S MAP & LOT 00;z —INSTALLER'S NAME & PHONE NO. V,�—V515 ;;�SEPTIC TANK CAPACITY w 1 ,LEACHING FACILITY:(type) oZ � Ali f3 � (size) Qr,NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER 'v/,/,"C BUILDER OR OWNER I�/Cr o � DATE PERMIT ISSUED: "f-4 DATE .COLiPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,— .�K.- `^_a J � � `� [ �� to n �� i ��f � ..:� ,> ,. --' ��: � _o� 1 �C� t No.... .... -- .. F�$............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Ot�➢.O�?..................o ................................. Appliration for D-Wpusal Works Tows rurtwit thrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ••-•--------.LQ'_..... ...O r dl1�... V.. ------ --•-•-....-•----------------------•----.....------•---.....---.....----------------....----------- Location-Add ss r Lot No. -t��.i��.VC?J ---------='.'......-- Z_�Y�....... `-- .................•------ --------.---------- ,�,�11 Ow C Address ---------------- ---------------------....-----... Installer Address �. U Type of Building A Size LOt.Z O.1 Z3 Sq. feet Dwelling—No. of Bedrooms......`................................Expansion Attic ( ) Garbage Grinder (�Jd) Other—T e of Building No. of persons............................ Showers a YP g.---......................... P ( ) — Cafeteria ( ) I dOther fixtures ---------------------------------•------------------------------------------------------.. ---------- -------•-- W Design Flow.......5..S.........................gallons per person ej day. Total dail flow..... .4b..........._..........�._ lons. WSeptic Tank—Liquid capacity1_ �gallons Length_ - Wldth _ �. Diameter________________ Depthi�._-�_S� � x Disposal Trench—No..................... Width.................... Total Length....................,Total leaching area____-___---_ ----sq. ft. Seepage Pit No------- „--------- Diameter.....uQ_.__..... Depth below inlet.-_.t-G-7... Total leaching area.10QB...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed Date_..-!YA.a/8.6........... Test Pit No. 1__.. .......minutes per inch Depth of Test Pit-14.4........ Depth to ground water-._------Q. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..l k.._....... Depth to round water__1aJ. H-OFp' p� Description of ------C .".1 ----1.0'30.7L `� ._...OGER x -------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- --- - -.=VIA �O 45 U Nature of Repairs or Alterations—Answer when applicable.___________________________________________________________________ P -•--------------------------•---•-----•---------------•-•--...---•--------......-----.......-------•-------•------•--------------•----------------------------.........-- . -- ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in cordance wi the provisions of iIHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system n operation until a Certificate of Compliance has b issued by he board of health. Signed------. - -------...................................................-------- -- r2/—aV —4 Application Approved BY ---------••--- ----- -• . ---•-----•------------------------••----- ` Z _-t�----•--- Date Application Disapproved for the following r sons-------------•-------------------------------------------------•.......-----------------------------.....------. --------------------•-----.....--•----------•-----•------•------••-----.....---------•-------...-•------• .........=.................................................................................... Date PermitNo.......... (•-...... ------------------- Issued_....................................................... Date J. - 4 - - y THE "COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .—TOW.0.................O F.....B-FU=iQS—rA1a_LjF,..-----------..........---------- Appliration for Dispoti al Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: +q� C ` ' /� ` .............1—Q.-Y-.................Cc 1IIV — 1)L ,...... ........................................... -------------------- ..... ----------------- Location-Ad s � Lot No. Xtj ----------------------•---------........_....._.._..........----------- Owner Address a .I:t _....._..i:_ .� ............... ............... _...---- �.....-------- --------------------------------------------------- Installer Address ' Q Type of Building Size Lot_ZO 1?.�.....Sq. feet Dwelling—No. of Bedrooms._____'T...............................Expansion Attic •( . )y Garbage Grinder QJo aOther—Type of Building ____________________________ No. of persons_..._-----------------------t�`Showers ( ) — Cafeteria ( ) a -- � Other fixtures ................... -----•-----=---==�--•--------------........=----------------------------------/--�--------------•-------------••----..__.._...---- W Design Flow_________.........................gallons per person e� da . Total d�il ��w____'T _Q..._.__.__ ___._.__.___ �lonsj t W" Septic Tank—Liquid'capacity1_500gallons Length_!�"r0_ Widths"_�___ Diameter________________ Depth_ gt_- x Disposal Trench—No ____________________ Width...... Total Length_.___._____:.__._-__Total leaching Yarea....................sq. ft. Seepage Pit No-____-..--------- Diameter.....�_O_________ Depth below inlet__ _?'7._. Total leaching:Irea.LQA$_.sq. ft. Z Other Distribution box ( ) Dosing tank��y ) / a Percolation Test Results Performed by.CATI__4flb �.ORVEY-. �?�-. Date__�L_�_� .......... Test Pit No. 1_.__�_.___minutes per inch Depth of Test Pit__.4—_4_�___ Depth to ground wafer �d_ (s, Test Pit No. 2...........__._minutes per inch "De th of Test Pit 1 � ____._ Depth to round water Ji4 FFs p �,�,P ) �. �41 0 l3V �'_r s?�!°7[ _.._.5". -pO�ER O Description of Soil... s.. 144 >!+� T Z ------0" �'�------rC.p�1L -.....PAU L ela s x ! '4 BRQl }�....sA- '.f- autt -�1 4-4 h�1 ICHNIEYIICZ - fb0:3 20 .--.•.-.----•----•------••---------•--------•-•-••--•--•-•-•---•----•------•----•-••---•----------------•----•-•---------_.____....---•--._.------•-----•-•------..._----•-••-•---•-- 5Q CI Q U Nature of Repairs or Alterations—Answer when applicable............................................................... _______ _______ ------------------------------------------------•----------•-----------••--•--•---------•------.....----.._.._•-••••--•-••-•••-•-•••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i cordance w th the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..... �s -------------------------••--•------------- -----------------------••------- _ a . Application Approved BY ---.._.._ ........................................ b�r Z ate Application Disapproved for the following rdo-n"'S:----•--••-••-------•...--•------•--•---=....•................................................................. ---------------------------------------------------------------------------- ..,.....: Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......... (Errtifiratr of Tontlrlianrr THIS IS O CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by- t i'd�-�... ......_..... .......-----------------------------------------------------------------•---•-•------________--•--------------•-- Installer at �,. --� CdZ ;RUC - .. r,_wt.r1.a 'G rL 1 .................... has been installed in accordance with the provisions of TITi 5 ofThe State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated................................................ --THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector---•-- -------•-•----------__-_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c.1�... .<.�1�.1 ............OF..........�`� :.{.�!....-._1_`7 �.[ !................. V FEE........................ Disposal lVorkv Cannuitrndion rrntit Permission is hereby granted.................. ..........1,14, •C-1-0-----------------------•--•----------•--------........•--•---....._.......--•-•--- to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo.......................... `—---------�3�.1:�`��---------- •1------- ...... Street f as shown on the application for Disposal Works Construction Permit Ao_____________________ Dated.......... � - tIP DATE................................................................................ rd of ealth FORM 1255 HOBBS & WARREN. INC., PUBLISHERS SOIL TEST PIT DATA: INDICATES INDICATES SEPTIC TANK DETAIL: 1500 6,4L , DISTRIBUTION BOX DETAIL: "D B _ 5 LEACHING PIT DETAIL: REVISIONS: PERC. - OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE NO DATE +• � � TEST GROUNDWATER LOAM 9 SEED NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON OR � � � NO. OF OUTLETS: MANHOLE COVER OR PAVEMENT TP # REINFORCED CONCRETE. �.. r BROUGHT TO FINISH GRADEFTP Z TP TP SCHEQ 40 PVC, TEES TO BE CENTERED UNDER 7- GRD. EL. GRD. EL. GRD. EL. GRD. EL. 2 SEPTIC TANK TO WITHSTAND H-10 LOADING MANHOLE COVER. -1- NOTES- / UNLESS UNDER PAVEMENT, DRIVES OR --� 1. DIST. BOX TO WITHSTAND H-10 LOADING 2"MIN.OF I/8" ' GW. EL. GW. EL. """" GW. EL. GW. EL. TRAVELED WAYS,WHEREIN H-20 LOADING j i UNLESS UNDER PAVEMENT, DRIVES OR TO I/2" - 12"MIN. FILL �/ I TRAVELED WAYS WHEREIN H-20 LOADING 7.6 4 `i6a� WASHED SHALL APPLY. TC�F.S(JIL, 9 •� Tar o11r � ! I PRECAST I SHALL APPLY. STONE -� = ��j, 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER / ( DIST t / Fq ry�l.f s� � CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF - i ❑ a = = o 0 o n ❑ � u t,� PVC INLET PIPE 51�lti17j=`+f' Sa�� l I I INLET PIPE EXCEEDS 0.08 FT./FT. OR IN (('')�.� , � S ' 7lRR�JS�C I I PUMPED SYSTEM. °°O9Po°�°O P vJ J° L__ J _ o o = _ = = o a NOTE � 12" MIti -r-1--- %' 9•{ SUP5 ! f)GiI „ ' COVER _ 3. FIRST TWO FEET OF PIPE OUT OF DIST = / o ❑ �Oo� LEACHING PIT TO GENERAL NOTES: BOX TO BE LAID LEVEL. ~ o u WITHSTAND H-10 LOADING E o_ ° ❑ a = r� d = a o ❑ I. THIS PLAN IS FOR DESIGN AND • » PLAN VIEW w o ?� UNLESS UNDER I o PRECAST o` o • PAVEMENT DRIVE OR CONSTRUCTION OF THE SEWAGE ONOItrAL WATEN LEVEL l� CEOVEREABLEI w - 3/4' TO 1-1/2" Q � � ^- Q Q o G ❑ TRAVELED WAY" WHEREIN DISPOSAL FACILITY ONLY. r - - - - - - - - - - - - - - - - - - -- i t2 �} D(UBLE LEACHING P! °o H-20 LOADING SHALL ,� ,, *rt /� WASHED Uj ❑ R �, = o o o ❑ 0'� °' APPLY. 2 ALL CONSTRUCTION METHODS AND t,! • INLET TEE PROVIDE WATERTIGHT U_ (no finest ° MATERIALS SHALL CONFORM TO MASS. I "4. PRCIVIDE ,i. •' � •� ...,; - .. .,.:...•.: w STONE B� D.E.Q.E. TITLE 5 AND LOCAL BOARD - t ' _ w ❑ o = d = o = o ❑ D.E.O.E. OF HEALTH REGULATIONS. — PRECAST — t,_ JOINTS(tYR) I ( I 1..: 30- � .I SEPTIC �, 4'.O" r/N. OUTLET 5 �j 'l 9EE I`- t p • h ►•1 i. 0 3. ALL PIPES LOCATED UNDER PAVEMENT .I TANK _ ` 5�� LIOUID DEPTH TEE 4" INLET I NOTE 2 i i �_ .� I� 1 O o p p o C� O C7 R BAN t =kii ;_I 4"OUTLET I _ 0 o OR TRAVELED WAY SHALL BE SCHEDULE 40 OR EQUAL. 1: ! t ,• ••. •I � DIA 6��MIN. t- - - - - - - - - - _� L------�� L----------�_ - �- --- °. ON , BOTTOM ON LEVEL STABLE SASE• ='o . a o� LEVELO TABI� -- �� CROSS-SECTION " a %✓�i - BASE J L(a srri�/rL .nsrrr�.v PLAN VIEW CROSS-SECTION VIEW I�4- NQ ft►'T�, �� p !WSJ{ ��, CROSS-SECTION \ { CONSTRUCTION NOTES: DATE: DATE: DATE: DATE: INVERT ELEVATIONS. � E iTEST BY: TEST BY: TEST BY: TEST BY: Z O N �F- J4 1 l.y, 1, INVERT AT BUILDING40 A 4 > S, N � WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: SEY`E�14Gk5 : TOP C&/T){ INVERT AT SEPTIC TANK0n) ` 7- 50 FRONT - �,C7 ~� '.'�. E"�• � ✓0 4,GUI �4 Sstri.�EQ� ` -- tJo _ INVERT AT SEPTIC TANK(out) J • 5- PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: ' �� r - MIN./INCH MIN./INCH MIN./INCH MIN./INCH SII>�, I $ INVERT AT DIST. BOX0n) 4 7,10 INVERT AT DIST. BOX(out) q 7. l9 3� �S INVERT AT LEACHING PITS c:4 DATUM. ° 4 " BOTTOM OF LEACHING PIT 9 • y 49IT�ST` r°w,4 U.S.G.S. MAXIMUM GROUND VERTICAL DATUM: A 5tm E) oN WATER ELEVATION BENCH MARK USED: 5EE PLA1 OBSERVED GROUNDWATER PkDPt��cp 'o ELEVATION - o r.. l DESIGN CRITERIA: NA i L T !n� SASE ALL UJt/, (/l 7'A 8 L t MATS R„/A1 L of E"tc. _ 4Z �•. � '� DESIGN FLOW: �� >✓�N 98 j 1 /r� .5v+l�►5',m.) -�`v E 67 Rzt mo viz b �t > �:� i r• r BEDROOMS AT tic' G.P.B./D °�O G.P.D. �o /i -D1 STAA1-4F 0,P i s 4COun4 Z BARN -.r 0 f e ISO G�f1 G� P!r AND ,�,6,,�[,ACED I �z GC3 N�K C k D 4 `` �" i� �,.�... TF, '�fi ri IO I Th :,L gA►N COA.Q Sdi sAAJD. NO 6LA k"&Aa (T)C jA/iDE�, `K ' � The BSC Group A e ExIST. E'FA s � '( t \ _._ REQUIRED SEPTIC TANK: Ivy RF 440 K /�fi, _ 4a GAL. SEPTIC TANK PROVIDED: _ 1500 GAL. Cod Survey Consultants f '�r SIZE OF LEACHING FACILITY REQUIRED: Cape y ro / MMI DESIGN PERC. RATE: ----_-_-� ----_-_ MINJN�ICH / r° \ '"+► �rI► f — ------ - --- ----__ 3261 Main Street Route 6 t,6 �"9R D ---- Barnstable Village MA 02630 y / ` ` ,� , / 617 362 8133 �>, 1 SIZE OF LEACHING FACLITY PROVIDED: PROJECT TITLE: s w k' Srnl• 1 / � � ` � '► � �.- � SEWAGE DISPOSAL 1 , SIU&wA�4s : 178 5,� x Z , 5 44� CTP',� r� AI<9A• Zd,�113 S. b0T-TOE : IJ E x 1' U = 79 �rPb SYSTEM DESIGN �oNcl I , r 5- ►4 5,F 104-5 c,�P� \ q3 5 / r c OYCOZ N, LOCUS PLAN: ROGER PAliL a S Z / 6g PREPARED FOR: �, 4 1 ti tAG 14 DATE: SUL`Y 15 , 086 .l-•.�. .. �•_ ;� c. �N COMP/DESIGN. S.A.'P. FRANK A i WHITING r ��ss� � CHECK: T Pti7 f P L N VIEW No. 29t3$9 g�' �,f — �, '` � DRAWN: TA,P s�, T11 ! L C� , FIELD: e� /, 7,v 6 . �. D, 2 N tu�,ltu FILE NO. FEET` Rn DWG. 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