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0069 WINDSHORE DRIVE - Health
69 Windshore Drive- Hyannis P A = 271 142 r s t 0 i j d ° 4 1 1 I I i i i TOWN OF BARNSTABLE LOCATION ,SEWAGE# VILLAGE 1MAa-)No1 S - ASSESSOR'S MAP&PARCEL,) INSTALLER'S NAME&PHONE NO. R ,l ,C, , f (L kx a_ M4. 63 SEPTIC TANK CAPACITY k'k—10 1000 GA-L 6CA LEACHING FACILITY:(type)�2)'�500 by L. C-ftg%kb r>(size) '13 X as1 NO.OF BEDROOMS OWNER JE'&5G '1AluLos PERMIT DATE: 0 a OG COMPLIANCE DATE: h h Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 0%. " I e(su' Sb'��� Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within + 300 feet of leaching facility) �7 '�j/ l n• Feet FURNISHED BY Cyr. �. 1!�keen �! _ � - r _ W � d"+ _ � � � � � r � � � � i � � � � �' � _ � � � w g, 2) w � � C�3 o �' o. tn! � �. � Ili No. T orb Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zlppf tatiou for Bisposaf *pstrm Construrtiou Vermit Application for.a Permit to Construct( ) Rep Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. b q 1j9 a S tst VA-Ic Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J'7 I y Installer's Name,Address,and Tel.No. I V $ok 7a(e 'j Designer .k's Name,Address,and Tel.No. d63 ,4.4 Z . Swe 1 4— bld A 1i"IC S' �/svrw� /�► f�arrsao. �' © GD Type of Building: Dwelling No.of Bedrooms t Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildingrf nj" r+ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _&6 gpd Design flow provided ��. p° gpd Plan Date (3 I 1 j q Number of sheets Revision Date Title Size of Septic Tank �sJ"(4 ILWO Type of S.A.S. o. © SGO ����rrr Diyrlt Description of Soil Sir SPc Yl r,4,'v�. Nature of Repairs or Alterations(Answer when applicable) C S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date � Application Approved by Date cow T Application Disapproved by Date for the following reasons Permit No. OL 0 c7 Date Issued O I' V T r 9 —O 5 No. � Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repaik ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components V l ti S' uC 9' ,p,�=�n Owner's Name,Address,and Tel.No.Location Address or Lot No.6 q ; Assessor's K14p/Parcel J*7 1 !f Installer's Name,Address,and Tel.No. 110 duX 7d 6 Designer's Name,Address,and Tel.No. a63 S�Jork4 RVA Y. 9'elo"r, i 6-74,G) s l,� S• `/ �► n� Sv«}sir- f.,,,,�v,�, .�bS•6,ti&, a 2010 Type of Building: i Dwelling No.of Bedrooms i to Lot Size si sq.ft. Garbage Grinder( ) Other Type of Building rjc• in No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S3 B gpd Design flow provided �5 �p gpd Plan Date I Number of sheets Revision Date Title l Size of Septic Tank 'Si �UG Type of S.A.S. Description of Soil SPA 1s� 3�> �'• � G� t4+ 4, t Nature of Repairs or Alterations(Answer when applicable) rX r �l o _ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 01 140(� Application Approved by Date L� q Application Disapproved by Date for the following reasons Permit No. /�� C� S Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CEpRTIFY,that the On-site Sewage Disposal system Constructed( ) e ire ,_ ) Upgraded( ) Abandoned( )by r,'if u, L 4,,j C 2 A- Ix & at LJ,0 J SIB 6/_C 171 I-VO #)I1AAA,-5 has been constructed in accordance � J with the provisions of Title 5 and the for Disposal System Construction Permit No.,-- -CS 3 dated Installer Designer #bedrooms T 1� /t n Approved design flow ( gpd The issuance of this permits ll not be construed as a guarantee that the syste will c;o s de gned. Date �7 Qf Inspector No. ,�� Fee C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ' Disposal 6pstem Construction J)Prmit Permission is hereby granted to Construct( ) R pai ( ) Upgrade( ) Abandon( ) System located at G/ Lj, J E6Oil e rye 9-1//j gi r7 1 5 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must 'e corAgleted within three years of the date of this permit Date lU l Approved by \v a 1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director MASS. Public Health Division 6 ►��� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8 2-46 - Fax: 508-790-6304 Date: 20�9 Sewage Permit# )off q-a S3 Assessor's Maprnarcel 7 2- Installer& Desitiner•Certification Form Designer: ��.Jtrarf3•�t �!�/�✓�t1�/tr Installer: L*.4d Co,4c5*11v Yb-') Address: �62 Avk 71; Address: Po 13v-k 7-?6 rq ��,�.�.s, �l� oZG64 f a u4h Yvillo-ty 1414 ol?"Y On Qa 0 7 do (-"57&' 1y�was issued a permit to install a tel qq septic system at (installer) p y t/ yt'�/oal �'I- / Y�"'"'�f based on a design drawn by # +"�'/^f • (address) �c✓os�l3a"C ��u� i-✓� dated ��✓. 2Z, / (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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if required) was inspected and the soils were found satisfactory. TERENCE Su; (Installer' ature " HAYES .vt-nRti1�1 (Designer's igna e) (Affix Designer's"�S�amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc SWEETSER ENGINEERING 203 SETUCKET ROAD-P.O.BOX 713—SOUTH DENNIS—MASSACHUSETTS 02660 TEL(508)385-6900 EMAIL sweetserengia?aol.com FAX(508)385,6991 LAND SURVEYING—ENGINEERING—TITLE 5 SEPTIC SYSTEMS SEPTIC DESIGN PROPOSAL PAGE 2 PROPERTY INFORMATION AND FLOOR PLAN SKETCH ' Please fill out this form,including the floor plan sketch,and return to us with the signed proposal and retainer. This information is necessary to properly prepare your Septic System Design. If you are planning an addition,we require a set of plans including a foundation plan Total#of Rooms Al Year Round Home AJ 0 Seasonal Home N 0 Owner Occupied ?f Rental 3 #Bedrooms Family Room/Den (S Living Room \1/S Dining Room #Bathrooms YES Washer/Dryer /y_Dishwasher t_Garbage Disposal /°e) Gas Service PS Town Water �( In-ground Electric Wires* /y 0 In-Ground-Oil Tank* A10 In-ground Sprinkler* �In-ground Gas Pipes* P'lleease note on sketch where located. Sweetser Engineering assumes no responsibility if in-ground components are damaged during Soil Testings,Inspections, Locations of and/or Installation of New Septic System. Cellar: Full Partial(Crawl) Slab Wells: Main Use Irrigation Only (please provide location of all wells) PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs, trees,patios,electric lines,tanks;etc. C�i1ST•N 6 .I'"rfCH �laiu4 h; PAD f �� — zI v1du 6 �cv%t yBG� �...,. � I c ' �QooK r R.ov►u �J� V! 1 �4 (0 Y� G S4tee4 Town of Barnstable P# /J� Department of Inspectional Services r Public Health Division Date ialA ,yd 200 Main Street,Hyannis MA 02601 - Office'.508-862A664 F r= bate Scheduled rJp Time Fee Pd. 0 Q0 M, Soil Suitability Assessment fo wage Disposal u \_ Performed By: Witnessed By: _..._-._. _.............:...... �..� - LOCATION&GENERAL INFORMATION " Location Address Owner's Name 1!r;;rXd- �foJ®f�D Rz.J lt-(1Cfisht✓/f Address � GtJ 3•tJ 67f'4 s���2 ��� Assessor Map/P 1: Engineer's Name r � 4—''0 Engineer's Email: NEW CONSTRUCTION REPAIR f/ Telephone k Land,Use AX—(s Slopes(%) Surface Stones Distances Rom: Open Water Body N ft Possible Wet Area Al ft Drinking Water Well ^/ft ' Drainage,Way R Property Line ft Other ft Y4; I SKETCH:(street name,dimensions of lot,exact locations of est holes dt perc tcs%locatewetlands in proximity to holes) Parent material(geo►ogic¢t� Depth to Bedrock Depth to Groundwater.Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater Z6 DETERMINATION FOR SE ONAL HIGH WATER TABLE . Method Used: Depth Observed standing in obs.hole: in Depth to soil monies: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R Index Well 8 ReadingDate: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole d Time at 9" Depth of Pere 7 Time at 6" _ Stan Pre-soak Time® . Time(9"-6") End Pre-soak Rate Mir/Inch Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\Application FonnAPERCFORM 2018.doc DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulder. 1,0 y4! y I 2 •syr DEEP OBSERVATION HOLE LOG Hole* 2— Depth from Soil Horizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Mursell) Mottling (Structu e,Stones,Boulder. Consistena-° Gravel) 64 z_6y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Molding (Structure,Stones,Boulder. Co sistcncy%Craven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munselp Mottling (SMwIme,Stones,Boulders. omLnencv%Gravell Flood Insurance Rate Man: / Above 500 year flood boundary No_/ Yes _✓ Within 500 year boundary No t/ Yes_ Within 100 year flood boundary No ✓ Yes Moth of Naturally OccurrinePervious Material Naturally OccurrinePervious 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 occurri gb pervious material? . Certification I certify that on f (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection an at the above analysis performed by me consistent with the required training, expertise and ex en cn d/in 310 MR 7. / Sign7icationFomuAPERCFORM20l8.doc, r^�' Q: Hazardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists —Working Phone Number ur—Actual Amounts -( ie. gas being used to fuel machines,thinner to Jclean brushes all count as hazardous materials) Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it- note that it was given a Attach the Business Certificate with your sign off and comments *'The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FL, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. _. M '0 R DATE: Fill in please: K i m � e APPLICANT'S YOUR NAE/S:G G N u b N A5 c:� mer)r o BUSINESS YOUR HOME ADDRESS: cl uW rr>�v�crr D+� I-Al a n r1 5 n/`� c)26 p 4 k; L5og )8 I S 2a► TELEPHONE # Home Telephone Number NAMBOF CORPORATION 'NAME OF NEW:BUSINESS OF BUSINESS IS:THIS A HOME OCCUPATIONSL NO ADDRESS OF:BUSINESS 6.`'1, �.I � Sh0 �'D✓� a MAP/PARCEL.NUMBER �—=;(Assessing) J When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits.and licenses required to legally operate your business in this town. 1. BUILDING CO5al S ION R'S OF This individ a inf6r ed any er r qu' a ents that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION aut rize i * - RULES AND REGULATIONS. FAILURE TO AjCOMMENT . 2. BOARD OF HEALTH This individual has een i e gfhe permit requirements that pertain to this type of business. MUST�:OMPLY WITH ALL I" ��V I iriMRDOUS MATERIALS REGULAT!O^'q Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has b��n�informed-of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: K' V T Date:6 /i(� / ��//OWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: �� ��i'y,�,/,a �� TOTAL AMOUNT: TELEPHONE NUMBER: 71-12 CONTACT PERSON: EMERGENCY CONTA6PTELEPHONE NUMBER: ®g d' 5 y:2 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum. Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) �./ Some-lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) k- �aulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers; deglossers hydrochloric acid,-other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids 1 (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS plicant's Signature Staff's Initials COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEiPAKTMENT OF ENVIRONMENTAL PROTECTION a d ti i e�M vev % �' TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A ESI�IE SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR PART A JUN 2 7 2002 CERTIFICATION TOWN QF BARNsTABLE HEALTH DEPT. Property Address: 69 WINDSHORE DR HYANNIS, MA 02601 a Owner's Name: KATHLEEN KARLSEN Owner's Address: 11 COLDHILL DR GRANBY MA 01033 Date of Inspection: 6/10/02 Name of Inspector: (please print) ,JOHN GRACI Company Name: SEPTIC INSPECTIONS I �r`�, Mailing Address: 1�,rh P.O.''B0X�2119 TEATICKET,MA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 Titleyy 5(310 CMR 15.000). The system: �t X Passes Conditionally''P sses _ Needs Furthe Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: G/10/02 The system inspector shall submi a copy this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this'inspec ion. 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 SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND'PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFT. ****This report only deseribes,con.ditions at the time of inspection and under the conditions of use at that time.This inspection does not address howith�e system,will perform in the future under the same or different conditions of use. Ti11.,-G In<. . rpii'n 1'nrrn //�S�1(l 11(1�5�•--i P.' � Page 2 of 1 1 OFFICIAL INSPECTION YORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 WINDSHORE bR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN f `+ Date of Inspection: 6/10/02 Inspection Summary: Check A,B,C,D or_E/ALWAYS complete all of Section D A. System Passes: v X 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: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. + B. System Conditionally Passes:, _ One or more system components as#scr.ibed 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. 1 4 n/a 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. .t ND explain: n/a n/a 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: n/a .;,s•;, n/a The system required pumping mo' a than Ttimes a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Flealth): _broke n,pipe(s)are replaced _obstrdUioii is removed ND explain: n/a ,. Page 3 of I 1 OFFICIAL INSPECTION.FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 69 WINDSHORE,DR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 C. Further Evaluation is RequiredCby the,Board of Health: _ Conditions exist which require fu"Aer,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 CM 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 1_.11 supply or tributary to a su�rEface 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 tanOn_d SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to'dete'rmine distance n/a **This system passes if the wellVater analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates tAt 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: n/a tj r. Page 4 of I I t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 69 WINDSHORE DR HYANNIS,MA 02601 Owner: KATHLEEN KARE EN,;;, Date of Inspection: 6/10/02 ` 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 fa'cility'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 ''/z 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 NO PUMPING INFORMATION. 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. X Any portion of a cesspool or-privy is within a Zone I of a public well. X 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 eoliform 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 s ;., less than 5 ppm, prpaov.ided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.', (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 e necessary to correct the failure., =LLF 5,Vi1 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"on.'no"to each of the following: (The following criteria apply to large'systems in addition to the criteria above) yes no f X the system is within 400 feet of a surface drinking water supply i•yS. v _ X the system is within 266 feet ofa tributary to a surface drinking water supply X 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 laig"'S,",tuti lia fade�l The owner or operator of any large system considered signifir..;tnt t.tr�at under Section E or failed under S,.ection D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. i � 'A.11 d Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE iSEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 69 WINDSHORE DR HYANNIS,MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information'rs provided by the owner,occupant,or Board of Health X 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 Have large volumes 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 they were not available note as N/A) X _ Was the facility or dwelling'in�pected 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. Fo 'ezainple,a'plan at the Board of Health. X _ Determined in the fiel''d` by of the''failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302,(3)(b)] 4. y�r P; i Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 69 WINDSHORE DR HYANNIS,MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3' : ,Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: n/a Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(y--s or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd#j&4a- , 3e2DO Sump pump(yes or no): NO Last date of occupancy: 8/31/01 0� �� ��� COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): niagpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the'title 5 system(yes or no): NO Water meter readings, if available:'.n/a. Last date of occupancy/use: n/a OTHER(describe): n/a { F GENERAL INFORMATION Pumping Records Source of information: NO PUMPING INFORMATION Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons, ,P'ow•was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach p_.evious 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): n/a Approximate age of all components,date'installed(if known)and source of information: 1974 BY OWNER , ' Were sewage odors detected when arriving•at the site(yes or no): NO r M Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WINDSHORE DR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage, etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age�coi firmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7 .•W',4' 10"" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" Distance from top of scum to top of outlez tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND i.ND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY`TWO,YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_mega_fiberglass_polyethylene_other(expLin): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a l f i 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WINDSHORE DR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN ' Date of Inspection: 6/10/02 ` TIGHT or HOLDING TANK,.;(tank must he pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in workingorder(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LL"+VEL WITH BOTTOM OF PIPE 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.): , D-BOX IS STRUCTURALLY SOUN:,D. I PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or'no) !NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a . j . J 5 R I •Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WINDSHORE DR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,sign"`of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.PIT WAS EMPTY AT TIME OF INSPECTION.STAIN LINES INDICATE PIT HAS NEVER BEEN MORE THAN HALF FULL. BOTTOM IS.AT 8'. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) ' Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil;signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WINDSHORE,DR HYANNIS,MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 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. e . o � p � � AA Aryi 3° rk -%V �c sy t in r Page 11 of I I OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WINDSHORE DR HYANNIS, MA 02601 Owner: KATHLEEN KARLSEN Date of Inspection: 6/10/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water'12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local 6e cavators,iinst"alters-(attach documentation) NO Accessed USGS database-,e'Kplain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. 1 c t r i i f .t 4 , _ ! = COIN -W ALTH OF MASSACHliSETTS 3 = EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS DEPARTMENT OF ENVIRONMENTAL P QTECTIOI�T.r �" e � . e, S ONE WINTER STREET. BOSTON Kk 02105 l61" \92.5500 � CID � � a TRUDY CORE l € 1p t9 ��O Secretan ARGEO PAUL CELLUCCI y'ot 1 kwDAVID B. STRUHS Governor �,9 Commissioner n 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP.CTIION FO 't'sr � PART A CERTIFICATION m`U Property Address:�0�1 W►4a,0IC-.-ta). Name of Owner 0_01-a 4 A.Ick ►S Address of Owner: i09 !emu e, t_ t+►%\ 1� Date of Inspection: \�j�j ,�+ t , / 5, A4.Wrp�l�i IKA. Name of Inspector:Pll ase Tfint)/ l C h ct e I %f D EL�t U l am a DEP approved system inspector pursuant to Section 15.`340 of Title 5(310 CMR 15.0001 Company Name: �t• �i �k U�'r�r�u ..� � r^ u F Mailing Address:I_F�a &,n a J245-4 c7 Telephone Number: 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 Eval tion Ely the Local Approving Authority _ Fails Inspector's Signalb Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS revised 9/2/98 Page Iorll i� Printed on Recycled Paper 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) "roperty Address: 6ci Jwner: �1 W Date of Inspection: INSPECTION SUMMARY: Check A, B, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. 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 complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determin if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE H 3 00 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALT AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland r 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 AND SAFETY AND THE 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 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. Method used to determine distance (approximation not valid). 3) OTHER i / r revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: - D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 C 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what I be necessary to correct the failure. Yes No Backup of sewage into facility or system component du/ee erloaded or clo ed SAS or cesspool. Discharge or ponding of effluent to the surface of the grurface wate due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invo an ov rloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or vol a is less than 112 day flow. Required pumping more than 4 times in the last year NOlogged or obstructed pipe(s). Number of times pumpedAny portion of the Soil Absorption System, cesspool or elow the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I q(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: You must indicate either "Yes' or "No" to each of t/fowing: The following criteria apply to large systemition to the criteria above: The system serves a facility with a design10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment be ause one or more of the following conditions exist: Yes No the system is within 400'1ket 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) r r The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. i revised 9/2/98 Page 4ofII I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: of WI S(,tcubc Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with WA. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. 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)1 The facility owner (and occupants,if different from owner)were provided with information on the propermaintenan"-of Subsurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roperty Address: (1-1INj Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: :�30 g.p•d.lbedroom. Number of bedrooms (design): Number of bedrooms (actual): Total DESIGN flow sad Number of current residents: C.) Garbage grinder(yes or no):_ Laundry (separate system) s or(o._: If yes, separate inspection required Laundry system inspected y s r no) Seasonal use (yes or no): Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no):_L�,> Last date of occupancy:�ywT"NS COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: 2pd ( Based on 15.203) Basis of design flow -- — 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: NO Qszc.ett� System pumped as part of inspection: (yes or no) If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Yl_ 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) IIA Technology etc. Attach copy of up'io date-operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/96 11age6of It • 40 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address: �( �� �C;`r lv► Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) 1 Depth below grade:� Material of construction:_cast iron 40 PVC_other (explain) Distance from private water supply well or suction line VJ Diameter Comments: (condition of joints, venting, evidence of leakage,etc.) V SEPTIC TANK: (locate on site pl n) u Depth below grade: lL Material of construction: 1 concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: ` Distance from top of sludge to bottom of outlet tee or baffle:11 Scum thickness: a`' A. Distance from top of scum to top of outlet tee or baffle: � Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: V6NQatsM. ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, s uc ural int grity, evidence of leakage, etc.) ( l T G (N i C� 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 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ._ ( SYSTEM INFORMATION(continued) 'roperty Address:611 Owner: Date of Inspection: TIGHT OR HOLDING TANK: U%)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 present _ 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:�J 5. (locate on site plan) // Depth of liquid level above outlet invert: Comments: - note if level and distribu ion is equal; evidence of solids c yover, evidence of akage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) r 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, etca revised 9/2/98 PAgV8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C c, SYSTEM INFORMATION (continued) 4operty Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excav tion not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:4oxIio 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 damp oil, dition of ve ration,etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth 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, 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.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address: GPI WiNctsko�:�� Jwner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) `O 1 i Z Piz _ aLl; revised 9/2/98 pigv10orn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address: Owner: Date of Inspection: NRCS Report name — ------- Soil Type_ — -- Typical depth to groundwater USGS Date website visited Observation Wells checked Pa Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Nc: Surface water rv,L� Check Cellar DQ-L� Shallow wells 0J.4, Estimated Depth to Groundwater})d Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records 4Used Checked local excavators, installers USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) G. revised 9/2/98 Page 11of11 TOWN OF BARNSTABLE LOCATION (b9 t N S kq ak_X. SEWAGE # lILLAGE k-�'J Kf'w k 5, ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY of LEACHING FACILITY: (type) ?`7 (size) NOCQ!�& NO.OF BEDROOMS BUILDER OR OWNER 1� 'DATE: \S�CI COMPLIANCE DATE: Z /q Separation Distance Between the: Maximum Adjusted Groundwater Table to the y1y 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 N within 300 feet of leaching faci ' ) Feet Furnished by Q C.� ' � OS� s ' a N � i f�!'► N 1 ���� � 3 � � � � � � � � � w '�� � s • I t m �. � e LOCATION SEWA G E PERMIT NO. VI L•LAG E INSTA LLER'S NAME S ADDRESS B UILDE R OR OWNER -6e--4 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ` � . O� No....` `.........-- ..> _. .. �. F�s<( ..P.® ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..__. Aliptuution for Bisposal Workii Tonstrurtuan thrutit Application is hereby made for a Permit to Construct (/--�,-or Repair ( ) an Individual Sewage Disposal System at* == ==------------- ------------•-•---........�Y, Ar i t........------..•..........---••-------...•---- A f'l location- dress f ( i�_. /.00 Owner IF Address W Installer Address Type of Building Size Lot.... �rE_ ��- ---Sq. feet U Dwelling—No. of Bedrooms.........9..............................Expansion Attic ( ) Garbage Grinder .(W-O Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria Otherfixtures -- -' .P..�-------------------•---------.-------•---•-------------------------------------......-----------------••----...........---• W Design Flow..................,2 S. ..............gallons per person per day. Total daily flow.......... ;.' ...................gallons. WSeptic Tank Liquid capacity/Q-1C/gallons Length................ Width................ Diameter---------------- Depth....._.......... x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.1&�'-�_.. DiametgPZ&A,W;; pth below inlet.................... Total leaching area..J/#27....sq. ft. Z Other Distribution box ( ) Dosing tank ) =0,d- //-Je) " 77 Percolation Test Result Performed by._.._ > .................. ............ Date....11 m J4.::.77.............. aTest Pit No. 1._ ------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - --------------- ------.... Description of Soil------.... a 9--- .............. . --. ----------- A V --- ----------•----------------••------------•--•------•-•-----•----------•-•-••--•------•---...------.------•-•-•-----------•-.----- ---- -- - �-- W •----•-•---------------- -- ------------ :_.... ------..--...........---------------•-------------•----------••-•-•-•----•-....---••-•---- U Nature of Repairs or Alterations—Answer when'applicable.___...............:............................................................................ ---.........................................-.......................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.B 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. r Sig t! = ./r - ..../. . �, . `/ Date Application Approved By........ r - 7.7._.. Date Application Disapproved for the following reasons:................................................................................................................ -•-------------------•---------------•----------------------...--•-----------.._.._..------•---...........-----•---------•-•-----•-••----•--••----••------------•-•----•----••-------••--•-••----.._..... Date PermitNo......................................................... Issued•--- .7 '_.................. Date No...................... _ ; Fxm'. .................. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :, Appliration for Disposal Works Tontratrtion lermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System . i ............................................ ocation-Address - __•- ................................... ...._.. .......-•••--••• Owner Address ..__ ................ i ... . ...._... ..._..... i Installer Address �} Type of.�Buil'ding� Size Lot___12:e?q..._Sq. feet aDwelling.-No Z of Bedrooms __ _______________________________Expansion Attic (, .). Garbage Grinder a '•`Other—Type of°Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) j' Other fixtures ..;*0 -e............................................................................... W Design Flow______________17,r. ..........gallons per person per day. Total daily flow..____._ gallons. WSeptic Tan —Liquid capaclty/ _gallons Length................ Width................ Diameter..._............. Depth.....__ ______. x Disposal Trench No ____________________ i dth � Total Length_.______._._____.___ Total leaching area .._99_��__._.______...q. ft. 77 Seepage Pit No:/>_ .... DiametX _ 'Gepth below inlet____________________ Total leaching areal , __....sq. ft. Other Distribution box ( ) Dosing tanA )"f�` �" d `� - ------•--•------ Date---��----`s...9� z Percolation Test Resu s Performed by. ________ _ ___________..__ aTest Pit NO. 1__ `_.........minutesper inch Depth of Test Pit____________________ Depth to ground water-----------------______. Gz, Test Pit No. 2___...........__minutes per inch.,. Depth of Test Pit.................... Depth p to ground water........................ R+ ••• // t X. O Description of Soil........ fL.'.--..... W =- ...----•- UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITlS— 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 '} Date - v � � '�7APPlication Approved BY -- - ---•• ---�- -------- -----•--------------------- -----1.---`- � - - ----- Date Application Disapproved for the following reasons---------------------•-•---------------------------------------------------------•----------.._..•--•••••-•=••--- .. .....................•----._.........--------•--....----•--•••-...--•_-••-` •••- ---•....... ee t k•"5", Date Permit No.......................... ----=-••--••••------- Issued...... .............. Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......./ 'f lb A.............:OF... .. 1.....!..: ..........._..._............-...._............-. (Srr#gf iratr of ToutpliFanrle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) bY---------- In gall �� at, ' �`/ � . -.._-•--i ` ---------------------•------------------------------------ has been installed in accordance with the provisions of ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ________ � ----------------- dated /'7,-'_t-----f_....77................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILD. FUNCTION SATISFACTORY. DATE. ..'a�..._....? ..�.. Inspector...... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 14— 7� ; , OF... !.~......................................} : ��C •r'l► No......... .... FEE.__....--• ........... ............ Cnoarttt#ion rnti Permission is hereby granted............................................................-.......................................................................... .__. to NCoAnsItrOP or ep >r ( ) n Individual ewa e Disposal System , f 1' Street as shown on,the application for Disposal Works Construction PVMit Dated_.�X_�'7_�'�� = •--•--•---•-----•-•------ .N Board of H DATE.-=�-------------••-•----•••----••--•---••-•--•--•••..__.._-----•--•••---..._... FORM 125�5 HOBBS & WARREN. INC., PUBLISHERS uo GAtza�� Gtzl Qt> -- :" t>-&I L.4 1~LOV./ _ 110 x 3 t 33d G.pTa R fo _ t-1c -r' Ic = 33o,j ISo % • 4-i5 6 P. t v 1•Z Use- 100o GAL. �15Po5,�L _PIT uSE. loco GAL,. t � • � AV-eA.SUEWALL = l50 S F. prr lcw SF )4 2.S • S 7S G-P.D. , I BO -ro�t/� ,ye a= sr=. ? I N N TOTAL -t�ESIGIJ = Q P.D. , r 't t 1.9 r' 'rO T'o L. "r->A►1-:4 l='LOW = 30 l?L� � 2�3t' 1t � •PEQGOl.QT10I.1 0ATE : C 11.1 SM I tJ 01t L>�S, � 3 ;, • tt 5�. . i.. :. Of cis RI HARD G� / o� ALA: r A. W i� t v BAXTER W J dZS 9No.2'1D480 .c �UIUU by �a18TEp� / TE�/ SUS" y U,YAL f• f'yyp�74 if Tor FNi1 IQO.O p- :. LO Ar� Iw- 'A DIST iw G,aL. qa� t -$ox 90 d Se nc f 10 TAWK INV. f 1000 45.4 mv. I►W , PIT I i SAPJDy wlr�t • t' _ , WA5WRD r c ' Pgzor--1 L-Ea I' + LoCATIOW A 4W 15 12 &5S No ScA.�.� r GcAL — dv f I -1, VJ peop GGtz-t•tF-.{ T14A-r T14a V&vW-UQ(. -SIAOW l ptAl.l REFER 1a PL VS W ITIA TOG: •$IDt�..l.t►-t6 Auo 5CTC3AGK VG4Ul6ZEAA&wTS OP TNT. 'tow►.l• cF 13A2QkTA8 & . SAXTMR, RCGIS't"c-_RED 1.AWa SUrZv�YoeS� TI-4I15 a l_AW I< ` W OT �',Ale,Et7 V4.1 A,aJ osTEIZv►L.L.G-. o MASS, APPL.Ie.A-" 'Iti.>r C',U'4 Pa Lk It"a BM CIDURK SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE DATE OF SOIL TEST JANUARY 22 2019 - ___ 10 FT. MINIMUM FROM SLAB 1-'-"" c� CQ ELEV. = 1�•� 10 �T. MINIMUM SOIL TEST DONE BY SWEETSER ENGINEERING P ul5884 (ASSUMED) CONCRETE CLEAN SANSPECTION PORT ND WITNESSED BY COVERS ` LOAM AND SEED �r �t *ry 4" SCHEDULE PITCH E1/8" PER F 40 PVC I . 2" LAYER OF OBSERVATION ION HOLE 1 ELEV. 1/8" TO 1/2" PERCOLATION RATE < MiIN./INCH AT __47_-_ INCHES WASHED STONE OR FILTER FABRIC T DEPTH H4RIZ TEXTURE !COLOR MO7T. OTHER 3.00 4" CAST IRON PIPE �'25 .0 MIN. N MAX O REQUIRED IO 15 !Ap LOAMY SAND !10YR4/i NG ROOTS (OR EQUAL MINIMUM PITCH 1/4" PER FT. FLOW Z 05-30" IB LOAMY SAND �10YR6/4 ROOTS I 1 LEV LERS TEE , ! I I i + L30-,, 20" IC MEDIUM SAND 12.5Y7/4 FLOW LINE I ---�-- ELEV. _ _9_7_•0_0 10" I rn NO WATER ENCOUNTERED AT 120" ELEV. _ _ 87.5__ 2 ,. ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ s 7 j �7 MIN. + l` ELEV. _98.53 6" SUMP L LEVEL a ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o °I 1JG7RV�1TILJ111 rG ELEV.=__97.8_ ° ° { I ELEV. _Q�,_9- ADD GAS ° ELEV. _ __84_�_ ELEV. _S4.8CS `Y o DEPTH HORIZ�TEXTURE COLOR MOTT. OTHER BAFFLE o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ '° 2' ° DISTRIBUTION ELEV. � ° ° of ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° of �0-15" Ap !LOAMY SAND 10YR4/1 NO ROOTS LIQUID OUTLET ��/1 � _ o °° o ° o o ELEV. _ _92_5_ 15-30" B {LOAMY SAND 10YR6/4 ROOTS DEPTH TEE 4 FEET 14 INCHES (EXISTING) TO BE WATER TESTED 2 500 GALLON GALLEYS WITH 30-120" C MEDIUM SAND 2.5Y7/4 5 FEET 19 INCHES IF MORE THAN ONE OUTLET STONE IN AN I 6 FEET 24 INCHES 1000 GALLON N O WATER ENCOUNTERED AT ___120__ ELEV. _ _ 87_8 _ 7 FEET 29 INCHES �+c y (TO BE PLACED ON FIRM BASE) t3' X 25' X 2' TRENCH FORMATION z WELL�A DESIGN x p L8 FEET 34 iNCHES SEP 11� T� I'� J' ZONE -- 4/� �'1L .« 4T�V DOUBLE E 1 1/2" CLEAN OIL ABSt�RPTlt N INDEX N NUMBER OF BEDROOMS 3 DOUBLE WASHED STONE ADJUST GARBAGE DISPOSAL UNIT _ - FREE OF FINES & SIFT SYSTEM (SAS) _ f - TOTAL A� ESTIMATED FLOW USGS PROBABLE WATER TABLE ELEV. = ------ ( 110 GAL./81R./DAY X j_ BR.) _ 4_ GAL./DAY SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = ------ REQUIRED SEPTIC TANK CAPACITY __��Q_ GAL. NOT TO SCALE BOTTOM OF TEST HOLE ELE'�. _ _ .a�_ ACTUAL SIZE OF SEPTIC TANK (EXISTING) 1000 GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE <-.5___ MIN./IN. E' '_i_,ENT LOADIN4 RATE Q.7-4- GAL./DAY/S.F. LEA.CH,NG AREA 477.00 SO. FT. (13X25)+(38X2X2) LEACHING CAPACITY (AREA X RATE) 30Z.-9$ GAL./DAY I 477,00 X 0.74 RESERVE LEACHING CAPACITY N_QN-E- GAL./DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITAR)' SYSTEM SHALL BE CAPABLE OF �-- WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. c" �� 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 97.3�` .. lad ��� BE MORTARED IN PLACE. 97.6 97.6 ! i/'� 5. NO DETERMINATION HAS BEEN MADE' AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO I 9 �` OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 97, 'a-, 9 F U'"LITIES SHOW' ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR ,;, ¢ 15 TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS I 98.5 PRIOR TO COMMENCING WORK ON SITE. 9.1 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS { / SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER O IMMEDIATELY. - CR j 8. PARCEL IS IN FLOOD ZONE _ X gY� 0 �, 9. LOT IS SHOWN ON ASSESSORS MAP! _Z71 _ AS PARCEL _ _ D. `� 9.2 10. EXISTING PIT IS TO BE PUMPED AND BACKFILLED. SOIL - "' OX ` 99.3 _ f�°� 7 ,��(aIC 11. THE INSTALLER IS TO GIVE THE ENGINEER A MINIMUM OF 48 HOURS % TEST 1 �`` p ; � .' ('� � I�fi` \. (2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW). i 98.2 'WOO GALLON 7 - ,�`SEPTIC TANK a� R 99.3E SOIL ?p �' TEST 2 ``` / � � 96.5 98.3a� APr` � :. . BOARD AR F HEALTH LOT 77 '� 1 11,572.5 f c F f j ff i 4" Tz$„ MA W PRV PO E � . TUS I k 98.5 97.9 T' ,t I •�:', ARROSO 97.6 I 97 ' � A. N- DEP I.� 1 ' z � ;, _DLEN LOc. _ _-_ SWlF" 203 SETUCKE" ROB GE ND: 385°6900 LE SOUTH DENNIS, �nAss. h6o J EXISTING SPOT ELEVATION 00.0 SCALE* / --µ i �' } I EXISTING CONTOUR ----00---- - FINAL SPOT ELEVATION t N g � ' I � " � Lv ! 4 Z_ � FINAL CONTOUR SOIL TEST LOCATION OS UTILITY POLE j 0� P NO TOWN WATER ....W w�. CATCH BASIN giw. �.,<..� .. GAS LINE CLEAN OUT C. _�.----"`. - �.��,:�tjO� MAPREV. �'�-,ir.� ! c t I CESSPOOL C.P. ( I 02019 SVdE.E_SFNC,,�"FERING! q d e.