HomeMy WebLinkAbout0030 WACHUSETT AVENUE - Health 4�; 30 Wachusett Avenue
Hyannis ,,," F, .,
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TOWN OF BARNSTABLE
LOCATION ` ® rr SEWAGE #
=.'1LLAG k*�i P Z ASSESSOR'S MAP & LOT 2
INSTALLER'S NAME&PHONE NO.ffa&Pr !/ram GO'. g0� CJ
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)
NO. OF BEDROOMS
BUILDER OR OWNER I�•
PERMIT DATE:t® Z® OMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) w' Feet
Furnished by
a
�Q
ICS,
� � � � � �� , � � Via•
No. all-1 Fee V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipplication for Oi,5pool *pstem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. W�►cH�S j Owner's Name,Address and Tel.No.
HyANN�S po2t' MAJFA N Lvv�KF
Assesso Mal�ara 1 3 b w �50 p17-2 S- 7 S q S-
Installer's Name,Address,and Tel.No. g:- Designer's Name,Address and Tel.No. I
1;�37--
Type of Building:
Dwelling No.of Bedrooms4- Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow y' q- 17 gallons per day. Calculated daily flow 1 0 gallons.
Plan Date 2y Zv o"L Number of sheets Revision Date
Title
Size of Septic Tank O GiCt/tans Type of S.A.S.
Description of Soil o �7► g tJ
Nature of Repairs or Alterations(Answer when applicable) C G M C fL tre-,�L(ma y t 47 ,
r7SIGNING ENGINEER I Oki'
I,,413TALLATIO
LCp IN
Date last inspected: J ✓nl Z a o 2,. THE SYSTEM WAS INSTAI.
Agreement: 6,(.CORDANCE TO PLAM
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 p e the system in operation until a Certifi-
cate of Compliance has been issued by this B and of Health.
Signed Date) Z
Application Approved by = Date ld
Application Disapproved for the following reasons ! 42-
Permit No. cZ00 - Date Issued 0 -'
N v� ►
o. a .�. .. Fee
THECOMMONWEALTH OF MASSACHUSETTS .7 Entered in computer: - ✓
I , i ... s .1 Yes j
PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for loioozar 6p.5 �ortgtructior� ermit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( `) ❑Complete System ❑Individual Components
Location Address or Lot No. Y Owner's Name,Address and Tel.No.
3a"W 1 JEAN ,i11TKE
Assessors pf az� I t,�l N �)s f 1�a 2 rb` �: t S t7 +'+
:G S. . 2s Lj S
Installer's Name,Address,and Tel.No. S'G F� L� `� Designer's Name,Addre"ss and Tel.No. +
.�1,36U
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft E Garbage Grinder( )
Other Type of Building No.of Persons Showers(.. ) Cafeteria(' )
I. Other Fixtures f'
Design Flow 'k q gallons per day. Calculated daily flow t o o gallons.
Plan Date Z JIILy Z v nZ Number of sheets /! Revision Date
r Title ,
Size of Septic Tank U D ��� Type /of S.A.S.
Description of Soil
i ))
Nature of Repairs or Alterations(Answer when applicable)
- s i
';. Date last inspected: J t /N ?_ -0 U Z__
Agreement:
' The undersigned agrees toensure 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 p -e the system in operation until a Certifi-
cat' of Compliance has been issuedi*by this Board of Health.
Signed r1N Date i 4_
Application Approved by ti J q. Date/d -/6-u
Application;Disapproved for the following reasons ..1! / -> >meter ma ,Sty
Permit No. Date Issued_ 10N 0
\4
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(/ )Upgraded
Abandoned( )by 7? CC-a2 C-v �.
at 30 Wcr&se# A9 has been constructed in ccordance
w th.the provisions itle 5 and the for Disposal System Construction Permit No. job-t/ / dated G �� �71�oo
Installer ( J Eh--e" Designer
The issuance of s rrru shall not be construed as a guarantee that the syste a u ti � g ed. sR
Date Inspector
- p _
No. a0d ` 1 ---- -- Ins !� �T' v`� / �i�l 0! Fee4ts,
6 THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
Miopooai *p$tem Con!5truction Permit
Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( )
System located at -)C,
and as described in the above Application for Disposal System Construction'Termit. The applicant recognizes 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 p /'t.
l /
Date: fU l6/0.2 Approved by � I
f
11/17/05 THU 13:04 FAX 5084324385 Robert B. Our Co. C�002
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
RAWWAI
"'a' Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:. 508-862-4W Fax: 508-790-5304
Installer&Designer Certification Form
Bate: i 1-i 7-06 Sewage Permit# O Z-`6'12 Assessor's Map\Parcel _
XDesignlelr: Lc it d e Installer: f.0 bQX.T E, ouP_Co
Address. 3—? M G1.1 Vl �_ —��` Address; Y.D,73o),, 1S3q
HIV • �a-� vy!f/h� m�-D7.i�� 1 �t�i c,G� °�S ,
On 1o6cw T 1. t?y g C.m. was issued a permit to install a
(date) (installer)
septic system at a.W4 6v,<y ++.Aye based on a design drawn by
(address)
�.. / dated _
(designer
I certify that the septic system referenced above Was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank,
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral-relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations- Plan revision or
certified as-built by designer to follow.
(Instler's Signature) of
Na.3920.1
a
_(D igrier's Signature) (Affix Designer's Step Here)
PLEASE RETURN TO BARNSTABLF PUBLIC I(EA.Lnt DIVISION. CERTIF'IC_ATE OF
COMPLIANU W LL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CAAD ARE
RECFJ..yE',)BY THE B KNSTABLE PUBT,TC RTAITH DMSION, TRANK YOU.
?: l;eo iil']cnli .'C)c.tii.!nar(.:CiUfl�-%Iioil Fom,
„W, Town of Barnstable
Department of Regulatory Services
' Public Health Division Date 7 1.2-.i
�,►sa.
/a—
"6 9.► 200 Main Street,Hyannis MA 02601
Date Scheduled U' Time 11 Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: Witnessed By: D��'( S ✓170✓1
......... ................. ......... ..., ,..
LL p rd
E%ice ilf.j�lp34'eE 5U d � WPM
t
w II�� �ilY tN�;:r�4 il:f�ELN�LMJ 5,.:s;l �d�yirv�. J: ,
k _{{ hi Y M c �t ....,.,...x,.r
Location Address Owner's Name
3� wu���se��' ,�
�
Address
ddress 1
Assessor's Map/Parcel: , C/ 7/ O 2 Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
Land Use Tees ►G Slopes(%)_�_ Surface Stones
Distances from: Open Water Body ft Possible Wet Area. ft Drinking Water Well
Drainage Way ft Property Line ✓ ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
RECEIVED
y� �U DEC - 6 2002
TOWN Or isARNSTABLE
HEALTH DEPT.
...........................
L P�CW s -P
Parent material(geologic) `'� 5� Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: lbV Weeping from Pit Face ��
Estimated Seasonal High Groundwater ,
r•:p_. ;r:...-:. —..-,pq:-.::v�,F....:. :,.,v..... „py:-•.. v;r,++.: a 2� _ T*.x_•ur
.- �ir I� ..i �, {��y
Method
6- r,.I011R,
at.,. 9{
Method Used r
Depth Observe mg in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level—
. ,q ro '� ?` yi'"va,• a r fUP
FA t °u�h x' � p
YF`l4 'k•:r ,? ii. i .�' Q i .. ,11:�'. s a':t 14.r `,uYr.uS, T'�idd' .,...�4t �.ra R� i lk i 5 •d s i":� Xs ��>?',t ik• ryas. c:,_ I r !�..a. ,6 u��o. «t'' {• r �'
r ,:.A'::'i strW:,, ax ;d.,, f}sa' ]; 'u�, �i.a''
Observation
Hole# Time at 9”
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6)
�/) / t
End Pre-soak r` OM'N/ (o
Rate Min./Inch -t-
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N).
Original: Public Health Division Observation Hole Data To Be Completed on Back ---
Q:HEALTH/WP/PERCFORM
g� I 1 S� §II.ry.}Y@FS..,.4 Ity d P ...V �' ti _h�:' pl� 'fi „�J..'•,
,, y f rhy f+ -i��wn da,T 1 t r � � 4 L�!( r 'S L.n✓ k 5na� � B! ss } JsJ7' Sm rk a�1!!i �,+ '�i:
Yfy
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders:
Consistency,%Gravel
L L L
• � I l �d Ii
`• '� � �1. G
.., ^-sr MIN
i 1 Y!.0
}(��y{',J\^ � fs �� i '1!J I�E.�!a.J•!! !1!I 4i I
F.!A'S y!jLh {•V ,Y� 1 >w T
Ik:li..f r,,.,:X}Ad to Ixt. L .,,f,s...CH!'fi' .,w,.:+:lll:u,b,.:..,_...ufi_--,;.,...y!v,!.::
Depth from Soi!Horizon Soil Texture 'Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders.
Consistency,%Gravel
.,.,:,:::... .y.;a,.., t,:a:r:a? i::•i�r_!:!a!::!f!fh'"�s!a!,:-!!:,;!!alcz='.'!P:fl'!':xiP.
'� OR:
.!., trli i r�` x u k•ur.: !1 plhJr:L h� {.
!-jig!r+k"! }�jt f _ M - a u ! t
k ! f 4 'I rlt�' " x! Y,, i1{ ,�' 4'!!!Ui
' 04,
.LK�s ,,.. ..,,.:.d
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders.
Consistency,%Gravel
.auii, :z.F a :1 �i.,.
y,.q:.....:,.y;..! ! Lr.} 1 i ,yy�t.,,,, i 11in�
P!! ��!! ^'i:4! i lq {1p 'h .. x¢..,i t
Fes+' w w P- 5�)!k u '4
��r1.g��Yy.%�:irI.x500 11-a i�.:lw.�;'„Tk."'bN:N , .. vi4>"e!`: S i.,,.�5kv 100 Ax+W uzffi' .._,.C«.1-», ,5!Ph:..r-'. ,.,
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders.
Consistency,%Gravel
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 (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 and experience described in 310 CMR 15.017.
Signature Date
Q:HEAZ,TH/WP/PERCFORM
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:30 Wachusett Ave.,H annis ort
Owner:Jean Ludtke
Date of Inspection:05/15/02
SITE EXAM
Slope Level lot
Surface water None observed
Check cellar Dry
Shallow wells None observed
Estimated depth to ground water_13.87 feet from bottom of SAS
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
X Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
X_Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
According to maps on file at Barnstable BOH site elevation is approx 28'A.S.L.
Bottom of SAS is approx.20'A.S.L.
Per Water table map on file Barnstable BOH groundwater in June 1998 was at 2.5'A.S.L.
Adjustment for June 1998= 1.8'
20—(2.5+ 1.8)= 13.87+
t.
No.. .../-...!9 F4.... ..........
THE COMMONWEALTH OF MASSACHU'_-�ETT
BOARD OF HEALTH
,R. Town Barnstable
.............0 F.........................................................................................
Appliration for UhipmFal Works Toutitrnr#iun rnmit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
.O.WauchusettF..Ay. gXlue,..Iiya,mi�pi?zt.,--.MA----026.4.7.-- ---•---------------•---------•----••------••-•-•--...............-•
Location-Address or Lot No.
James Ludtke. -... 3.4..�da Qk�>> e t _.A.y�7z11�.,.. �xtna. �2axt,..] ..02647
Owner Address
A & ....Ces...p Service, .128.B shogs__Te � }--1iXi xlr�7. - MAP,.---.Q2 Q-t---
Installer z Address
d Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms.............................._ .....Ex Expansion Attic�-+ g— p ( ) Garbage Grinder ( )
`4 Other—T e of Building No. of persons..2....................... Showers — Cafeteria
Other fixtures ---••-------------------------------------------------------------
---•---------
-----------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__---____.__--_- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ),
Percolation Test Results Performed by.......................................................................... Date........................................
4
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_---_-___-_-__--___--.
p14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Al ----------------------------------------•----..............................................................................................................
O Description of Soil..................;3.aX ------------------------•-•------.......-------••--------------
W
UNature of Repairs or Alterations—Answer when applicable__ixls_ta.11ati on_.sQ£__,a....1,DQ0_.gall.on..ZePtir_._tank,
distribution-box.and--a.-1.,000_.ga�J.9x�,.. oxl�_..}�a<CI�ed__�ach--g7.t---4.QY�x11sit-)--•---------------------------------
Agreement: STIPULATION: Crawl space, under the addition.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in aficordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further a er not to pl the system in
operation until a Certificate of Compliance h -' uued by the
Signe ............... ......-- ----••-• ---12/1.7A&..._....
Date
Application Approved B - - --- -----------------------• -•----------121' 7 .--------
PP PP y---------------------
Date
Application Disapproved for the following reasons:.........................................................................................................
.........---•------------------------------------•••---------....---------....---•----.......------•--.----••----•----------------------------------------•---------------------------------•--...--•---
Date
Permit No..............84.... -------••-•-•---•---•-- Issued.................... ...............
Date
Fq .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 11
�. ...................T own---.........O F.....BarZletable.........-----...---....-----.....------•..............---
Applira#iun for DiipuuFal Works Tomitrurtiun Famit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
34--WsUc43,use-tts•-A*er+ue-p--l� a is�port,-lam•----02647----------------------------------------------------------
Location-Add
Ad ress gores Lot No.
James..yudtka---•••-----•------Owner------••-•-------------•----------------- 30--�SUO- uSet-tis...AV -Addrjss4l3raMA:8po�y---FA-----•02647
aA-A_3_-C.essp.000l--Servicc�,...�r ............................. �2$ a o�xs Te Qe iiAHd x ramie. A
1 Installer res i
Type of Building i :. Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....=------_-------2_-----------------Expansion Attic (I Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons_.2.__..............__ ___ Showers ( ) — Cafeteria ( )
dOther fixtures -----•-----------------------------------•---...-------•--•--•---••------•••--....•-----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9- Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test"Results -Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(X4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
C p ------�a--`---------------------•---------•---------•-••-----------••-•-----•----- -----.-----------
--------------
•-------
•--------------------------
O Description of Soil.................. -------------------------------•-------•----•---•--------•------------------•-------------•--------------------------------------•--•--------
x
U
W
U Nature of Repairs or Alterations—Answer when applicable__ nata aA��...o --- 1�-iDOO_.ga}-l-on.-.gepti-e--t-ank,
dis tx1but1on--box--and-a•--1,000--gal l-on-,---s-t e--pao�ed--la-Gh--p.it--{-vie no*. .=
Agreement:STIPULATICNs Crawl space under the addition.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIS 5 of the State Sanitary Code.— The undersigned further ag es not to plac theCsystem in
operation until a Certificate of Compliance has- issued by the b o h
Signe - --------- ---• ----.... f.. --y •12/1./$�----------
ate
ApplicationApproved By.............<...•.... ••- - ............ . ....................... ----------
Date
Date
Application Disapproved for the following reasons:----- ......-••---•----••--------------•-•-----------•••••---••----•-•-•••---•-•-•------•----•-•-•••----....._
Date F
Permit No.....:.............. ------------------------ Issued....................12.17 _84:.--•----.._..---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF;,"HEALTH
...................T.cw.n............OF......13aM.zt4ble....................................................
_ Trrfifiratr of TioutpliFan �e r
THIS IS TO CERTIFY, That the Individual Sewage. Disposal System constructed ( ) or Repaired ( x)
A b -�'..F 33 Cess-P-...Se r c...�... Xto.�.._... � g s 4� --.T_ e.--
y ......... ar�xnis,.. g-----026-1.......................
Installer
at...
3Q_.Wauchsetts-Avenue_�.:_H3nsZ?o- , MA 92f7 ' Ja ..Luttke
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No5k:n/ .� ................. dated..---12 _1"70�4___.._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................ "" � Inspector
Il
001
THE COMMONWEALTH OF MASSACHUSETTS
" _. BOARD OF HEALTH
-
.................T.QM...............OF......---......Barris.table-_..-----------------•----.:................ +
No.---84-...... FEE..$..15..II0.---. 1
�liaru�tlrku (by"unutrnr#iun Trani
Permission is hereby granted----------A---& B•-Ge8spG41--&e-TV10ey----Ine-----------------------------•-•-----••-------..-.•--.-----•---•---
to Construct ( ) or Repair (X ) an Individual Sewage Disposal System
at No......31--Wauchusett,S••Auenus,---Hyaar;l.*por .,--MA--•-•0264-7-----da-mes-1ud-tke-----------------?---•-----...---•--.....
Street
as shown on the application for Disposal Works Construction Permit N&t ................ Dated....122/47/84-------------------
6_-•-=--------------------------------------------------------------------
Board of Health
DATE.................................................................................
FORM 1255 A. M. SULKIN, INC.. BOSTON
40
r
/ +f
C .
S P L
128 Bishops Terrace
Hyannis, MA 02601
(617) 775-6264
James Ludtke
30 Wauchusetts Avenue
Hyannisport, MA
.o
s
ti
Z
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h
0
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L
8'
O O
10
•
Proposed installation of a 1,000 gallon, pre-cast septic tank
and 1,000 gallon, pre-cast leach pit, stone packed 1 1/2' around.
R
FAILED INSPECTION
TITLE 5
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP
Property Address:30 Wachusett Avenue PARCEL '
Hyannisport, MA 02647
Owner's Name: Mrs.Jean Ludtke ►-OJT
Owner's Address: Same 4-
Date of Inspection: 05/15/02
Name of Inspector: (please print)Janet E.DuPont '? CE ED
Company Name:wind River Environmental
Mailing Address: 120 Great Western Road MAY 2 8 2002
South Dennis,MA 02660
Telephone Number: 508-760-4827 TOWN OF BARNSTABLE
—--ALTH DEPT.
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 the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5
(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
X Fails
Inspector's Signature: alzL�s afiw Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of
Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a
design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the
appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to
the buyer,if applicable,and the approving authority.
Notes and Comments Upon arriving at property,noticed boggy ground near leach pit. We opened the
tank and found it full over the lines. When the leach pit was excavated,sewage rose up through the hole
over the top of the pit, It should be noted that while the house is presently listed with the town as having
3 bedrooms,and last septic plan is for 2 bedrooms,inspection confirms that there are 4 rooms with
closets,doors,and windows that should be considered bedrooms.
****This report only describes conditions at the time of inspection and under the conditions of use at
that time.This inspection does not address how the system will perform in the future under the same
or different conditions of use.
i
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection: 05/15/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310
CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced
or repaired. The system,upon completion of the replacement or repair,as approved by the Board of
Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"
please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is
structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board
of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to
broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass
inspection if(with approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection: 05/15/02
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines
that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet
of a surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply
well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more
from a private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for
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,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.
3. Other:
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection: 05/15/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or`no"to each of the following for all inspections:
Yes No
_X_ _ Backup of sewage into facility or system component due to 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
_X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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 SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
water supply well with no acceptable water quality analysis. [This system passes if the well
water analysis,performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered.A copy of the analysis
must be attached to this form.]
_Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria
exist as described in 310 CMR 15.303,therefore the system fails.The system owner should
contact the Board of Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or
a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or
answered"yes"in Section D above the large system has failed.The owner or operator of any large system
considered a significant threat under Section E or failed under Section D shall upgrade the system in
accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the
Department.
f
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection:05/15/02
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
Pumping information was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Has large volume of water been introduced to the system recently or as part of this inspection?
_X _ Were as built plans of the system obtained and examined?(If not available note as NIA)
X — Was the facility or dwelling inspected for signs of sewage back up?
_X_ — Was the site inspected for signs of break out?
X_ _ Were all system components,excluding the SAS,located on site?
_X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge
and depth of scum?
_X _ Was the facility owner(and occupants if different from owner)provided with information on
` the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined
based on:
Yes No
X _ Existing information.For example,a plan at the Board of Health.
_X_ ____ Determined in the field(if any of the failure criteria related to Part C is at issue approximation
of distance is unacceptable)[310 CMR 15.302(3)(b))
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection:05/15/02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_2_ Number of bedrooms(actual):_4_Plan on file Barnstable BOH_
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_220`
Number of current residents:
Does residence have a garbage grinder(yes or no):No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)):2001 =4300 cu ft=32,164 gal
Sump pump(yes or no):No_ 2002 to last reading=2600 cu ft.
Last date of occupancy:Current
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:4/18/1995 4/14/1998 per Barnstable Treatment Plant
Was system pumped as part of the inspection(yes or no):Yes
If yes,volume pumped:2500 gallons--How was quantity pumped determined?Dump station record,tank
and pit
Reason for pumping:Tank and Leach pit full over all lines, boggy ground over pit
TYPE OF SYSTEM
_X Septic tank,distribution box,soil absorption system No DB
Single cesspool
_Overflow cesspool
_Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract
(to be obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:_15+years
Barnstable BOH
Were sewage odors detected when arriving at the site(yes or no):No
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection:05/15/02
BUILDING SEWER(locate on site plan)
Depth below grade:_12"
Materials of construction:_cast iron _X_40 PVC other(explain):
Distance from private water supply well or suction line:_20+ft.
Comments(on condition of joints,venting,evidence of leakage,etc.):Piping seemed to be sound with no
signs of leaking
SEPTIC TANK:_(locate on site plan)
Depth below grade:_8"—
Material of construction:X_concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a
copy of certificate)
Dimensions: 1000 gallons_
Sludge depth_
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: Tank full over all lines,
Distance from top of scum to top of outlet tee or baffle: pumped after inspection
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
Tank appeared to be sound with no signs of leaking,baffles in place,due to failed system pumped after
inspection to allow continued use by owner until replacement
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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection:05/15/02
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: NA (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any
evidence of leakage into or out of box,etc.):
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.):
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection: 05/15/02
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_X_leaching pits,number:_!,6X6_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.):_Found spongy soil,when digging was begun sewage rose into hole above
cover
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:30 Wachusett Ave.,Hyannisport
Owner:Jean Ludtke
Date of Inspection:05/15/02
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference
landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the
building.
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128 BISHOPS TERRACE, HYANNIS, MA 02601
BUILDER OR OWNER
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CANER TO BE WI THIN 1 I
TOF 31.9' " MK •COVER . ,6 OF DIED GRADE M
F.G. 30.r+/- COINER TO BE WrIMN
• MIN El EV 30.25' 6' OF FINISHED GRADE WATER TESTED FOR LEVEL 6 0�� o
• 2' LEVEL Fq JO
3' MAX. COVER MAX 30M
4 SCH MIN 2SAW
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LESS r LEVEL o 0 0 C3 0 C3 " AVE
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as sw" T-1 - 27.90
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PLACE SEPTIC TANK AND 2LW _ 24-W
DIST. BOX ON r-OF STONE '� • r
EXISTING ---OR KANICALLY COMPACTED 1 I � 3/4" TO 1 1/2" LOCUS MAP
BUILDING DISTRIBUTION 4 FLOWDIFFUSORS H-20 NOT TO SCALE
P BOX 11 'X 37' s 'MIN
PROPOSED 1500 GALLON ABLE WASHED STONE
SEPTIC TANK H-10
H-10
BOTTOM OF TEST HOLE 0
SEPTIC SYSTEM o PROFILE t9.oa'
LAUNDRY
NOT TO SCALE
BAT} KIT1p.IEN�NI4 BATM NOTES;
1. SEPTIC SYSTEM SHALL BE INSTALLED ACCORDING TO
BEp 310 CMR 15.00 (TITLE 5)AND THE TOWN OF HYANNISPORT DESIGN CALCULATIONS:
BED BED BOARD OF HEALTH REGULATIONS. cj^s�
uHNG 2. ALL PIPES SHALL BE 4" SCHEDULE 40 PVC NUMBER OF BEDROOMS: _ 4
3. THE DISTRIBUTION BOX SHALL BE WATER TESTED TO GARBAGE DISPOSAL UNIT: NONE
BED INSURE LEVELNESS AND EQUAL FLOW. TOTAL ESTIMATED FLOW:
* 4. THE INSTALLER IS TO VERIFY THE LOCATION OF UTILITIES ( 110 GAL./BEDROOM/DAY X 4 BEDROOMS = 440 GPD )
FIRST FLOOR PLAN SECOND FLOOR PLAN AND SEWER LINE ELEVATIONS PRIOR TO INSTALLATION.
5. EXCAVATION FOR AREA WHERE FILL IS REQUIRED SHALL REQUIRED SEPTIC TANK CAPACITY- (20OX) 880 GAL.
EXTEND 5' LATERALLY BEYOND S.A.S. ACTUAL TANK SIZE: 1500 GAL.
6. VERTICAL DATUM - T.O.F. = 31.9
7. SYSTEM IS NOT DESIGNED FOR GARBAGE GRINDER. -
8. ALL PRE CAST UNITS ARE TO BE PLACED ON 6" MIN. LEACHING AREA REQUIRED:
CRUSHED STONE, MECHANICALLY COMPACTED. SOIL CLASS
9. MIN_ PIPE SLOPE 1/8 IN/FT. 1/4 IN/FT PREFERRED. PERC RATE - S.E_ MIN/IN.
- 10l AL?_` COS<STRJCT10N DETAILS ARE TO CONFORM TO LTAR - 0.24- GPD/FT
STATE'OF .MASS. ENVIRONMENTAL CODE (TITLE 5) AND 440- / -0= GP6/S.F. = 594.59 SF USE 595 SF
;D LOCAL REGULATIONS.
Crn� �QC A Al, ' AALJ11
o ... '-LEACHING C.APACir`1:, .,
a FINISHIeD GRADE.
12. SE?TIC TANK TEES SHALL CONFORM TO MASS & LOCAL 4 FLOW DIFFUSERS WITH 3.5� OF STONE ON SIDES
E REGULATIONS. 2.5 STONE ON ENDS AND 1 STONE UNDER
g SIDES= [M-' x 2 _'] - 192 SF
13. ALL STONE IS TO BE DOUBLE WASHED ACCORDING TO
MASS. & LOCAL REGULATIONS. BOTTOM= [ 11 ' x 37'] _ _407 SF
W O � 14. GROUND COVER OVER SYSTEM COMPONENTS SHALL NOT
TOTAL AREA = _�;39� SF
ACRES EXCEED. 3'. TOTAL CAPACITY = 599 SF * .74 GPD/SF 443 GPD
15. EXISTING LEACHING PIT, SHALL BE REMOVED ACCORDING
Z CB/DH FM S 831D5'00. E TO LOCAL REGULATIONS
50.00 16. LOCAL UPGRADE VARIANCES REQUESTED ACCORDING TO
> 15.405 (1)(a) REDUCTION OF S.A.S FROM EAST PROPERTY E�. , •• � •-asp
Q LINE FROM 10' TO 3.5'; FROM SOUTH PROPERTY LINE FROM
GAS GAIE p . y e:,� . ,�,,,
0D 10 TO 4.6 ; FROM WEST PROPERTY LINE FROM 10 TO 9 . Tom. M
BASBIENT DEOC REDUCTION OF SEPTIC TANK SETBACK FROM WEST
PROPERTY LINE FROM 10' TO 3'• FROM SOUTH PROPERTY
LINE FROM 10' TO 7'. ACCORDING TO 15.405(1)(b)
~ EMSTING FOUNDATION WALL NEEDS REDUC'11 ON OF S.A.S FROM PROPOSED CELLAR WALL FROM
W fui.BASEIIENT o TO BE REPLACED VATH REINFORCED 20' TO 5'. REDUCTION OF SEPTIC TANK SETBACK FROM APPROVAL ENGI
} wA7M FWD TCONCRETE W�ROO WATERPROOFED VA H PROPOSED C�� CELLAF' WALL'FROM 10' TO 5'. -11
Q Q�31.g• 701 MEMBRANE.
U. PROPOSED BAsEIIENr
Q M TOF n/f DIONISI Date DESCRIPTION lDrawniChecked
3.0 P017q 1 = 31.9
T to co DB =9 Pg 233 R E V I S 1 0 N S
GML GATT HOLE I 02 �EV��: o� STANTONE SEPTIC SYSTEM UPGRADE DESIGN
PROPOSED TANK C � y TEST HOLE 1 GSE- 30.D6
CO/SEAL AID 195.95- n 1 11' x 37' �+ FROM SOIL HORIZON SaI.TExruRE SOIL COLOR Sat. IaoTTUNG BETTY LUDTKE
I 50.o c 3.5'LEACHING u�HEES) (�) (MUNSELL) (WETS. ETC) AT
a 7W N 8s'oW AREA
28 w 3".18' TD 10014' 0-1.2 FILL 30 WACH U SETT AVE
"M LAMER GALE DOSTING
oc ""` 1.2-2.0 A LOAMY 1 OYR 4/3 - I N
D F SAND HYANNISPORT
WACHUSETT AVENUE 2.0-31 B LADY IOYR5/8 -
ELEv. =�.06•-- 3.o-t t.o c. � toYR s/8 -
SCALE: 1"
= 20 DATE: JULY 23, 2002
PLAN REFERENCE: EXISTING STRUCTURE LOCATION IN HYANNISPORT, MA
PREPARED FOR JEAN S. LUDTKE BY BAXTER, NYE & HOLMGREN INC. 6ZQ342 LA BARGE
ENffiM 1G h CONTRACT K INC.
CI1dIND 1f10E�t Nor t91000111EIlED PERC AT 4.7
Bun JN OF TEST ME AT 1 1.0' ELEv. 19.06, ��, t 0 K LG MOSS HU RD.
SITE PLAN- 0 7:00 MIN MIMMANS
1 " = 20' (S08)432-6360
DRAWN BY: SEM 0238
CHECKED BY.' TAL SHEET 1 OF 1
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