HomeMy WebLinkAbout0064 WASHINGTON AVENUE - Health 64 WASHINGTON AVE, HYANNIS
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TOWN OF BARNSTABLE
LOCATION
VILLAGE �/ /��,VZ` ASSESSOR'S MAP & LOT Y
INSTALLER'S NAME & PHONE NO. A & B CANM 775-6264
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) Z,0� (size)
NO. OF BEDROOMS_,-? PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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.. BORTOLOTTI CONSTRUCTION, INC.
765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 A
508-771-9399 508428-8926 FAX: 508428-9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
i
Property Address:
Date of Inspection: V laspector's Name:
O%nees Name and Address-
A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal sjr5tems. The System:
�/ Passes
Conditionally Passes
Needs Further Ev o y Local Aproving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(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.
INSPECTIONS 1MMARY�
A)SYS944 PASSES:
1// I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR J 5.303. 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 comple-
tion of the replacement or repair, passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If
"not determined",explain why not.
The`septic tank is metal,cracked, structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup 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):
i t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
w. `. PART A
l CERTIFICATION (continued)
' ► '��' Broken pipe(s)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 pipes)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 HEALTIU (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM,IS FUNCTION-
ING IN A`MANNER.THAT PROTECT THE PUBLIC HEALTWAND SAFETY AND THE
ENVIRONMENT: t . _ . .....
The system has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with 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
_ the 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 system violates one or more of the following failure criteria as defined
in 310 CMR 15.303, The basis for this determination is identified below. The Board of Health
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the surface of the ground or.surface waters due to an
overloaded or clogged SAS or cesspool.
Static liquid level.in.the distribution box,above outlet invert due to an,ov6rloaded or clog-
1,; ,ged SAS or cesspool ti, 5 s Y
"s4 ;,Liquid depth in-cesspool is less.than G"below invert or available volume is less than 1/2
day flow.
Required pumping more.than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
-
i
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM +`
PART A
CERTIFICATION (continucd)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation:
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well. _
Any portion of a cesspool or privy is within 50 Feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 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
_,:.- -..co nditions exist . ,
t .- Thesystemyis withtn_400 Feet:6f a surface drinkuig water supply
The system is within 200YFeet of a tributary'to a`surface drinking watei supply
The,system,i ,located in a nitrogen-sensitive area Interim Wellhead Protection Area
(IWPA)or a mapped Zone 11 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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if a following have been done:
Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for atleast 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.
V As-built plans have been obtained and examined. Note if they are not available with N/A.
=The facility or dwelling was inspected for signs of sewage back-up.
I'he system does not receive non-sanitary or industrial waste flow. .
le site was inspected for signs of breakout
_ All system components,=exchidi'ng'the Soil Absorption System,have been located on site.
�1'he septic tank manholes were uncovered,opened,'and`the-interior of the septic tank was in-
"' ed of 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 hasbeen determined based on
existing information or approximated by noii-intrusive methods.
t
-3-
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
The facility owner and occupants,if different from owner were provided with information on
a o e
tY P
the proper maintenance of Subsurface Disposal System
:-SUBSURFACE SEWAGE DISPOSAL.SYSTEM-INSPECTION FORM
PART C
SYSTEM INFORMATION
/ FLOW CONDITIONS
RESMYNTIALe
Design Flow: lions Number of Bedrooms: Number of Current Residents:
Garbage Grinder: Laundry Connected To System: Seasonal Use: /JD
Water Meter Readings,if v ilable:
Last Date-of Occupancy:
Type of Establishment: 1
Design Flow; l;alIons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENE A INFORMTION
PUMPING RECORDS and source of information: 2 / r
System Pumped as part of inspection:_ If yes,volume pumped: V olons
Reason for pumping:
TYP"F SYSTEM:
_k/00'� Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach"previous inspection records, if any)
_......_ Other(explain): _ _ . ..
APPROXEKATEAREofallcomponents'd e installed(if known)and_source of.information: 5':
Sew a odors detected when arriving at the site: 426
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK: ll� �
Depth below grade: Material of Construction: concrete metal FRP Other
(explain)
Dimisions:JO,6 X 6 'X Sludge Depth: '/ Scum Thickness:
Distance from top of sludge to bottom of outlet tee o.r b.11Tle: 3 7'� t_
Distance from bottom of scum_to bottom,of outlet tee or baffle: •�l/trdw
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation to outlet invert,structural inte 'ty,evidence of le age,etc.)
GREASE TRAP:
Depth Below Grade: Material of Constriction: concrete—metal—FIT Other
(explain)
--
Dimensions:� Scum I llickness: . '
Distance from,top.of scum to top of outlet tee or baffle: r
Comments: (recommendation for pumping,condition of inlet and out lees''or baffles de' 'It"" liquid
r.--level.In relation to outlet invert stmctural.integrily,evidence of.leakage...etc:)
TIGHT OR HOLDING TANK:_..A)6
Depth Below Grade: Material of Construction:—concrete metal FRP_Other(explain)
Dimensions: Capacity:_ gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee, condition of alarn and (foal switches, etc.) _
DISTRIBUTION BOX: ✓ ,
Depth of liquid level above outlet invert:
Comments: (note if level and distribut'on is_egt�al, eviden e of solids cart}-over, evidence o leakage into
or out of box,etc.)
}
a _ ......P.UMP..CHAMBER._ /_t/9/\/...
Pump is�in*oiking order° . r
Commepts;.(note condition of pump chambe , condition ofpunips•and apptirtenances,etc:)
•
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
..., PART C
SYSTEM INFORMATION(continued)
SOIL ABSORPTION SYSTEM(SAS):_
(Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determine
d to be resent explain:
P P
Type:
Leaching pits,number:_Leaching chambers, number: Leaching galleries,number:
Leaching trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool,number:
Co ts: (note condition of soil,signs of irydraulic failure leve of ponding,condition of vegetation
e
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CESSPOOLS:_ - f
Number and configuration: Depth-top of liquid to inlet invert:
Depth of solids layer: Depth of scum layer: 1f Dimensions of Cesspool:
Materials of construction:: Indication of groundwater:.
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:_ i p
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.)-
-6-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, land
marks or benchmarks.
Locate all wells within 100 Feet.
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DEPTH TO GROUNDWATER:
Depth to groundwater:_ Feet
Meth of Determination or Approximation: marl/W"� IPGm It12
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VERIFY IN FIELD - UNLESS NOTED OTHERWISE.
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oE WALLS AND ALL NEW INTERIOR WALLS TO BE
20 STUD WALLS UNLESS NOTED OTHERWISE.
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222 Third St.Suite 3212
VERIFY IN FIELD I Cambridge,MA02142
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fax:617-621-1477
www.LDa-architects.com
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WALLS AND ALL NEW INTERIOR WALLS TO BE
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tel: 617-621-1455
fax:617-621-1477
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222 Third St.Suite 3212
Cambridge,MA 02142
tel: 617-621-1455
fax:617-621-1477
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www.LDa-architects.com
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— N — FRAMNGF6A ONC — T - r. Urtw dlenmewnmmeos�ips.PmiOero@,T mtl�.+Yweibm n®mmN O
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DASHED-IN EXISTING�BEAM,VERIFY CONDITION LID BLOLKINS(Z'a L s.ND FLOOR EG UNDER Mary cmeaspaaAmuae.N emosel aemmn rm`e a°a map�"•�I.
WALL
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bme m WaaF amabp.ro��msama
EXISTING FRAMING _______
OVER LMNG ROOM MATO I� —- / vme Fambm
——— ———— 1Z — — — NEW FACE OF — aslal beommned bM1lloxipaim.N mabbmaNbntltlm Amiwn
7FIN C f I. NAaoa 6mA
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—————— —— — C EXISTING FACE OF Mmiifanmepgmm aem,aMilelm Yvuemb Tmrpf momnwaFa w
ROUGH FRAMING I 1 I I I I I I I r+ ROUGH FRAMING 2 repaammN anapailcola¢Nl pima eaA oe APA rmelpaaa'valepetlnmA
4 I I 1 I I \ I I I I P10N am m R sm mem l rneocmm q Rw urn y�YesA
1 I I 1 I I 1 � �� 1 1 1 I 1 � SpmAamtRatrn areuvp.
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1 I I I 1 I I I I 1 I 1 1 I I H y5 tr� m.e,mp eayaewm.P�wn.p�op.ws�pawn�lwgma��
I 1 1 I. I I 1 I I I I I I 1 I amm�aoeary namp,.lm momiA nayovsmammA.trarcq mMroaA Pmrb,mnimq
1 AC \J - O ESING FACE
ROUGH FRAING —- _ _ _ _ _ OF
ROUGH FRAMING
1GTnoon 1STROOR
DASHED INSTRUCTURE
emmasmmdo��mry am trlml'e"e^mA�onmmalaay.TM
a xmammmntlA amoarosbW�m wannraMmmaua eNaam,remmn asvRsaMAFrvaarAe'm mamtrroNAe
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SOLID BLOCKING UNDER I BEGIN Mmrvmra<.mpAml.apw.
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anae mms+ary P�mm pammnaa�aremrm.mmm�annmaveeriegiadm
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I- I VERIFY IN FIELD - I ammtlmmauction.OsaeparmaMwnM�mem6wbpeatleMtemuelbaiga L,
bwbpt mYmmm rma0amum maMNpntl
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222 Third SL Suite 3212
Cambridge,MA 02142
tel: 617-621-1455
j a6-tt j fax 617-621-1477
VERIFI'IN asuw¢
www.LDa-architects.com
PERMIT
yT�aadti`,Yt.$F. ,�7�
T? SARKIS L' 9
2EROUNIAN .P
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`'' No.29713
d .h L�h 4,f Ab a`re 18 JANUARYW
a '(SfG r.� 4 pA.wam
LB,EKG
area�e 00
SECOND FLOOR
STRUCTURAL
PLAN
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- STRUCTURAL NOTES—EXISTING CONDITIONS
I
- I. vwaybma Memmemsmrp maammeam dvdwd eappon area.Pm.madaa�wF � " m,
vevegamvgal Me+mdmrawdoa ummm a¢ImM1mdN syamnbarrdwea.i+n �F2
6s»�ren Mwa.,m a wm w n.dudad re mdmd.d eaa am De uw�W m ue
adadxmnmmawww wemm,Pm.iRtltM�swyrvewdiAaav9nlimry -„��,.�'
- masmnmagmeanme mrn aaamM�rosram sane -.,._a 1
% - � r mvmrdmdmabnnmamaam.Antlbmeb mmedaromm " 3i� .' � a
STRUCTURAL NOTES—GENERAL NOTES " �
1. are.mumaAentNl Da nA/mrylbrq.imtl mulore adi Oeid9maes
fmmOeM1n w1x
- - 1. SwmOfmMp Fgagela¢weam�eaaenmrvnpeBAnA DmaaiaedJbl.Nmdvge ,-/
NtlE°(�wMmulitisbrpep^gnmi.mabiimrOlNbtev�elBMagnwe0hl N
An B 7l-0' C D w�Pdevadepnw RwE ewaPMn.m amwraPab �,
24'.11' B-0' pamrendmmigs. O
VERIFY W FIELD
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Ya51II <$ memwu�m AASHrOmaarrotlmem awnarmbrwendbumm a.DP aaeedNepdtl N
bvtleOwrwdewBMitl rm lmidnpe amdea. �
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mnw�tlm m AMe.
a. RwbereWomlopmbipa.Aw.ered'ewtl ewvina Bs�"Cmdwm.Urm Mmea. w,
W
s. NPmmtlebmWsonwtla bd'ogs.mm emn,bmrse dawam.ererw m�npiwed. ux
Fantlasonrtle walroapetlmlra�emn'eman e'daaw9 mNw dtl Ee Pmmama epdw
6 EMT NO FACE OF _ _ _ _ _ _ _ E%ISTINGFACEOf /��\� he tlAmmmre aWnpm odw � /���
ROUGH FRAMING FRAME OVER EXISTING ROUGH FRAMING
ISTFLOOR \II I I I/ ROOF STRUCTURE I I ( I 1ST FLOOR �/ U)
r_ CONNECTNEWRIDGE r_ eramma t
t. �awm mwrpndama,ApA PdM78mr.amewem.mwamu..emwawmd
TO EXISTING METAL
STRAP
M < p°Porcoeae.r�,e,aropamawmrvm.+simd _
z. tmoama maoele dm e.asea aw mtl oe ,Fr1
Btl6y S
X EISRNG FACE OF \ I I I I I I ePOmeaamnemtmOiN mOPrmpy A\
5 ROUGH FRAMING _ �L u�L _ I _ _ _ RIOUGH FRPA/G 5 S Nmvemwd mlm gry.PNab atl mam mm mee Om°nCI CaOa W/F� U)
-��\ vl\ /I` . o.onaC rw:�.re. Q� +�+W N
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(21 w10 NC.
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T 100 LVL IDGE I I m d u mAsnau�z r/s.sws dm gw mawmmas asps. xY _
to OASHED4N EXISTING �T I 1 I I I _ ER — m e
FRAMING 70 REMAIN (21 L10 /I �� DN 1/4' ENT TE I I — z Iam.F4atiwr.mdEmdm ditlmamnbW6mm maawa sp®smmad0e
EA ='
(CONDITION AND OREMAIEXACT % I I I FRO R W/17G RU i Am.mammasma[wsnvmwL
/2 p. R'vatl smdrmNwbmddrim immbq pmanNrmryfbimMae Sbd SOuan �.
b rn d ft"C°wdlseeaxatan ae�adetlwmbrtlemtlaMdaPOeraimL
1 LOCATION UNKNOWN) o BOl SIDE
� A. smdsm Marep.ebaawNgreOerg101iPeea.a.ddaA dmAmlmamreagmprm I/ex
MaweenainNmnpbiawNEebV5AW5.Slwmma.Coveame9ol peb¢lyma W
ameMsrdMwaavc Rasarsama.
NEW EYEBROW—� I"V2111Q_— I I I 1
DORMER FRAMINGn I I I — (21 0
JLL
U ___\ I I _ � _ _ NEW FACE OF Z W°°a Frmrog
` IIurn _ _ _ FWUIWGBfANC\\ \ I _IvIvIROUGH FARMINGROUGHFRAMING M�mr�.Mrma na.eam.ereso.�amuTA,,-,-1e10e Ta
AllPIAA -tymfiuma apAw°aaW hAAA to JOweEI METALSTRAP smdaam�.Faeradmm. 5mrmdlraea enamaf'nA:R°d 6sreaA�YN+a
Y� I" REINFORCE EXISTING swarel,Rama alreamnp.
%� I I I I I I — ROOF AS REQUIRED PER MSTC 40
�\ �I �� CODE COMRIANCE p. RmaelrAry page wd,�weaemudm,mwaysi,ImrmvsroewePpamersw
EX1S71NGFACE OF _ _ 1 �J_ �� ��—� — — — — — — — — deFOmamwbm macmvn PmAebmnm Orr Mragw9e Si�eeml mean
EXISTING FACE OF /��\\ a00wwn1•dae m.sma0mn Rwiae p°pma®mddpMwtl wk+lwgm.tltl
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ROUGH FRAMING
ROUGH FRAMING mom Aom awm mreraem tl marbOeephmmredwn.armmlmreamre acerb Mbr
1 ST BOOR
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LL 8. Pviae mN,SJf'tlxk eiruwmaeP OrabAam Mmsw40oaes.NmmwO^Irin Owrds
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'�� r. amumvd.°aa w+smamM Ae pbdeamMmenmAmvMem.ws merwse rom
24.1 1' 27-0' g-0'
Mnem dSwNuml Drenxn
VERIFY IN FIELD I ,. ,ne amadme mudveldednpammawtlm nimn ehudud leaovgara etucmrelamipn
- ama Rana Mnameda�a�:earm.dmaeeam�rpmrnerr,mn mvmadawwroaneo L Da
plmmvd mWWba Dmerm�sOebeen eeuenl dermmmd mtlaedvaamw,Ae •LLP w
aerromwyamammwomameaatmdemawmmbwswraavlMamr. ••�ne..� mwwmnw:,
222 Third St.Suite 3212
Cambridge,MA 02142
VERIFY IN FIELD - 1
lel: 617-621-1455
- - fax:617-621-1477
vwvw.L Da-a rchatehitects.com
A B C D �°� � PERMIT
RKIS
q� ZEROUNIAN
No.29713 IWa�
,1 ,.P•R 18 JANUARY7DO7
LB.EKG
_ urerun DO
mF ROOF
STRUCTURAL
PLAN
S3