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HomeMy WebLinkAbout0020 ASH CIRCLE - Health Ir720 Ash Circle cotuit __ y 1 1 � t i Commonwealth of Massachusetts ASSESSORS MAP N0: 04D _ ... Title PARCEL NO: ��� 5Official Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: Y only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 tens» Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority July 28 2009 ('I;nsDtoes Signature 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. ****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. 09-136 Smith.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Di sal ystem•Page 1 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 July 28, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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: Tank is not in need of pumping at this time;leaching system has no standing water. 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 09-136 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. 09-136 Smilh.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 July 28, 2009 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. L09-13WSmith.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 L09-136Smith.doe-08106regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. CitylTown State Zip Code Date of Inspection C. Checklist 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? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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(5)] 09-136 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09-136 Smith.doc-08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped 6/15/09 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool t ❑ 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: Leaching system installed 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-736 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No .------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: Oil Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 09-136 Smith.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 Jul 28, 2009 required for Y every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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 has liquid only, no solids due to recent pumping. Tees are intact and clear and liquid level was found at bottom of outlet invert. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 09-136 Smith.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 Jul 28, 2009 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑' No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil— 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.): No solids or high stains present. Liquid level at bottom of outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-136 Smilh.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 Jul 28 2009 required for Y every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 6 Infiltrators. ❑ 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.): Interior of infiltrators were video inspected, observed no standing water and clean stone in bottom of SAS. 09.136 Smith.doc•08/06 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ 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.): 09-136 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is required for Cotuit MA 02635 July 28, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ _ ♦ \ \ \ \ \ \ \ ♦ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ♦ \ 1 \ \ \ \ 37 43 40 47 I '•� Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 20 Ash Circle Property Address Elaine Smith Owner Owner's Name information is Cotuit MA 02635 July 28, 2009 required for State Zip Code Date of Inspection every page. City/town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 20+ Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: USGS topo map:end town GIS. You must describe how you established the high groundwater elevation: Town groundwater contour map shows water below el. 35 ant topo map shows property above el. 50. 09-136 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE v LOCATION , SEWAGE## VILLAGE ASSESSOR'S MAP ��&PARCEL 1N9 tR�S NAME&PHONE NO.' r�Q SEPTIC TANK CAPACITY ®®O LEACHING FACILITY:(ty (size) NO.OF BEDROOMS OWNER N1 j kN-) PERMIT DATE: 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 f ity) Feet FURNISHED BY lLf yf J fLf�-J�fM1JM1,f1J1fyr4f'f'r 4f�f yf.1/�f yf�J1f1J�f1fyf 11�f,f,f M1f 1J 4l�f hf 1/1f v14i�f yl�r yf yf4 . 4 t t 4 4 4 4 \ 4.4 \ \ 4 \ \ \ 1 t 4 \ \ 4 4 1 \ \ 4 \ \ 4 t 4 \ \ '•: 4 4�,\�,\ r f r r ! r f r F r f r r s i !•� f F f i ! r r f r J J r ! r f r ! J f f r.r 4 \ t \ t 4 4 \ \ \ \ t 4 4 t k 4 1 \ 4 4 4 \ \ t \ \ \ 1 1 1 4 4 \ \ t \ \ 4 \ 4 4 \ \ 4 \ \ \ \ 1 \ 4 4 4 \ 1 1 \ \ 1 \ 1 \ \ \ 1 \ \ k \ \ \ \ \ 4 \ \ \ \ 1 \ \.\•k - O t t \ \ \ \ \ t 4 \ \ \ \ \ 4 \ 4 4 \ \ 4 k 4 4 4 t \ \ 4 4 \ \ 4 4 \ 4 \ \ \ \ 4 \ 4 \ 4 4 37 43 40 47 o q®--�� No. �Uy_a b S X 1' ` ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfppriration for �igpogal *pztem Corr.5truction Permit Application for a Permit to Construct( )Repair/Upgrade( )Abandon( ) D Complete System 0 Individual Components Location Address or Lot No. ZO Owner's Name,Addre s and Tel.No.' QS /✓ti � Assessor's Map/Parcel Installer's Nj�`'e,Address,and Tel.No. Designer's Name,Address and Tel.No. j �/ -7 7/ �� l Type of Building: Dwelling No.of Bedrooms Lot Size $eD sq.ft. Garbage Grinder(/60 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 4/YZ2 gallons. Plan Date Number of sheets / Revision Date Title S 4 d Size of Septic Tank Type of S. .S. 4 Description of Soil /10 .Ky Zie ;t Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issued by 's o ealth. Signed Date /v✓� Application Approved by s. Date 2 Application Disapproved for the following reasons Permit No. ta 0 0 Date Issued 2 u E7� Fee�= J` THE COMMONWEALTH OF MASSACHUSETTS' / Entered in computer: t Yes PUBLIC HEALTH DIVISION -^TOWN OF BARNSTABLES MASSACHUSETTS ZtppYicatton for Migponf *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(✓ )Upgrade( )Abandon( ) O Complete System, L individual Components Location Address or Lot No. Owner's Name,Addre s and Tel.No. Assessor's Map/Parcel /© '� .-° ,v Installer's N e,Address,and Tel.Not. Designer's Name,Address and Tel.No. f or�a �o " Ga'e57-, 7 7/ Type of Building: ,�ln Dwelling No.of Bedrooms Lot Size 2,f lgvv sq.ft. Garbage Grinder(� R Other Type of Building B PNCP No.of Person— Showers( ) Cafeteria( ) Other Fixtures ` a Design Flow gallons per day. Calcullated daily flow -1/YZ2 gallons. Plan Date -7!2 /9 3 Number of sheets Revision Date Title 2` o 1 -at r7D. s�'// S Size of Septic Tank /DDD11 0-5;" /S1`� Type of S.A.S. /35` Description of Soil 1 1 i Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issued A's,,,OAealth. ,— � Signed Date Application Approved by Nv S. Date ? o Application Disapproved for the following reasons Permit No. 2 U 03- Date Issued 2 u -------------------------- ------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,.MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( P Upgraded( ) Abandoned( )by O 1/0 /r �G�f/5 at Z a �S �' rG CD 7e1,1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,)V a3'9s,Y dated 2 S Installer Designer The issuance of this p rmit shall not be construed as a guarantee that the syste / i tic as �-�ned. Date Z�2r7 3 Inspector 76m; = ys� -------------------------- No.�3— -Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS &5po5a1 *pgtem Congtruction Permit Permission is hereby granted to Construct( Repair(✓ Upgrade( )Abandon( ) System located at 7!5�1 An! ie CGS/> i / and as described in the above Application for Disposal System Construction Permit. 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 t ' permit. Date:_ �. 0 Approved by 6 J TOWN OF BARNSTABLE LOCATION ',* SEWAGE #,a23 -dt'g VILLAGE C-/k/ ASSESSOR'S MAP & LOT Oqb' INSTALLER'S NAME&PHONE NO. k�o%fr 4�IJ4w SEPTIC TANK CAPACITY ✓A6w t � LEACHING FACILITY: (type) ,�Cr� � (size) /® /.�� 2� I NO.OF BEDROOMS BUILDER��O��WNE3�2 PERMTTDATE: ��;'G;3 COMPLIANCE DATE: , `2�I 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) Feet Furnished by Shay f I + � � I i FORM 11 - SOIL EVALUATOR FORN Page 1 of No.: Date: 1/16/03 COMMONWEALTH OF MASSACHUSETTS Barnstable Massachusetts Performed By: Carmen E. Shay Date: 1/16/03 Witnessed By: Waiver Location Address or#20 Ash Circle Owners Name: Mr. Normbert Wood Cotuit, MA Address and #20 Ash Circle,Cotuit, MA Lot# (Map—40,Parcel 79) Telephone Number: 508-428-1324 New Construction : X Repair OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes F Within 500 Year Flood Boundary: No a Yes ❑ . Within 100 Year Flood Boundary: No a Yes 71 Wetland Area: None National Wetland Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal X❑ Below Normal ❑ Other References Reviewed: USGS Topographic Map DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #20 Ash Circle, Cotuit, MA On -Site Review Deep Hole Number: #1 Date: 1/16/03 Time: 10:00 AM Weather: Sunny, Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body NIA feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel). Boulders, Consistency, % Gravel 0" - 8" As Loamy 10 YR 3/2 None <5% Gravel, Friable Sand Friable 8" - 36" Bw Loamy 10 Y/R None <5% Gravel, Friable Sand 5/6 Friable 36" - 168" C' Medium 2.5 Y 7/4 None Medium Sand, 10% Sand gravel, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Estimated Seasonal High Water Table 168" Assumed - No groundwater Observed DEP APPROVED FORM 12/7/95 ' FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #20 Ash Circle, Cotuit, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: N/A inches ❑ Depth weeping from side of Observation Hole: 168 inches (assumed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level N/A DEPTH OF NATURALLY OCCURING 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: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators 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: FORM 12 - PERCOLATION TEST Location Address or Lot No.: #20 Ash Circle COMMONWEALTH OF MASSACHUSETTS Cotuit , Massachusetts Percolation Test Date: 1/16/03 Time: 10:30 AM Observation Hole #: #1 Depth of Perc 36" — 54 Start Pre-soak 10:28 AM End Pre-soak 10:38 AM Time at 12" Would Not Hold 24 Gallon Presoak Time at 9 Time at 6" Time (9-6") Rate Min./inch < 2MPI * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Site Passed X Site Failed DEP APPROVED FORM 12/7/95 Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N v[ snstot (NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. _ PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me ile;eC 1� 3C�'"O� concerning the property located at Q6 1=. ( o-n�tTJAh meets all of the Icilo,"Ing �:r;teria: • This failed system is connected to a residential dwelling only. There are no .ornrn-trziLil or business uses associated with the dwelling. • T1.e soil is class:f:ed as CLASS l and the percolation rate is less than or equal to -rtnutes per :rich. The applicant may use historical data to conclude this fact or may :onduct ore!trri;•,ar, tests at the site without a health agent present. • There :s no increl;e to flow and/or change in use proposed • There are no vanances requested or needed, • The bottom )f the proposed leaching facility will not be located less than Fourteen 1 f-et aoove the m3(Imum adjusted groundwater table elevation. (Adjust the ;mun(!.va:er table using the Fnmptor method when applicable) Please complete the following: �. fnp •�f Grounc? Surface Elevation (using GIS information) _.—LQ—Z t w' F!cvv.or, Jn _ ad;ustmen( for nigh G.W. 1A,;. -... - .._.L_- 1 ,.)TT=F RENCF BETWEEN Lind B S'Go rED j DATE: 1- 1(4•�03 NOTICE 3asec jcc!n t,r�z above irformation, a reoair permit wil! be issued for 'bedroorns ads: i anal bedrooms are authorized in the future without engineered :opt,. system plans. -- — . �ctun:r,:Oci puccamp Permit Number: Date: Completed by: HIGH GROUND-WATER.LEVEL COMPUTATION Site Location:�f7 � �eLL . tom Lot No. Owner: ��r� C� �.�'�a Address: �+ Contractor: Address:— 3c,y fad . 2. daS3� Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. Date { O mo h/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: S OAppropriate index well.................................................... © Water-level range zone..................................................... C STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 5�� water level for index well........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A1,current depth to water level for index well (STEP 3). and water-level zone (STEP 28) determine water-level adjustment .................... « '....................................................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water •� levelat site(STEP 1) ............................................................................................................. 1, Cape Cod Commission: USGS Well Data- December 2002 Page 1 of 2 United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible.thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. For further information, please contact Hydrologist Gabrielle_Belft at the Commission offices (508-362- 3828). December 2002 t SC;S Site Departure from Vuntl�er* Location Well No. Water Record Record Average** (links to L SGS Level* High* Low* Monthly Overall national water-le\ LI database) Barnstable 230 =24 F20.5 26.6 -0.7 -1.2 41.3956070164�O1. Barnstable 24W 26.9 20.5 28.6 -1.8 -2.4 4141.4_70165001_ Brewster BMW 21 13.2*** 6.9 13.6 -2.6 -3.0 414518070020301 Chatham CGW138 24.7 20.9 26.6 -0.3 -0.8 41410 70011101 Mashpee MIW 29 8.2 5.6 10.0 03' LL3 �4135250702919 44 Sandwich 2D2 L 45.9 -0.1 -0.3 414418070?41.601 SL=Wellneet dich 2I53 54.2 45.8 55.1 -3.6 -4.0 4.1.4.1.24070265901 13.0 0.20.2 4?0206070045901 W 7W 11.7 7.3 12.8 -0.7 -1.3 41.5'53069585401 htip:i/�vww.capecodcommission.org/wells.htm 1/13/2003 TOWN OF BARNSTABLE LOCATION SEWAGE #,Z003 -a 'r VILLAGE � i� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 7-IL ,In, �� (size) NO. OF BEDROOMS BUILDER O OWNE -1 PERMTTDATE: COMPLIANCE DATE: 1 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) Feet Furnished by Shay ��o f �r�i�' .� 4� t��:�„ T..r/rein/ �o�f _L OJC A T ION SEWAGE PERMIT NO. VILLAGE M s oqo INSTALLER'S NAME & ADDRESS VA B GUILDER OR OWNER W118£R7 WOOD Y OA T E PERMIT ISSY E D O DATE COMPLIANCE ISSUED- k1fI r i r W�M • " �Q 30 �i }¢ouie. Lod" .57-REE 7 LOCA 'N �S� �i�eL� Lot f/ Avis 40- �g _ NO. 'VILLA E Cotuit Mass . _ DATE APPLICANT_ /, !' �D�sr,PrJc>�o.v FEE ('ADDRESS Great Pond Road S . Yarmouth TELEPHONE NO. 398=8510 -(Non—refundable) 'ENGINEER Norman' Grossman TELEPHONE NO. :1... '19 8 2 DATE SCHEDULED September /� r (Applicant' s signature) . . . . oa . o .-000. o . . .: . . . 000 . o .y. . . . . . . o . . . . o . . . . . . . . . . SOIL LOG SUB-DIVISION NAME ` Pine View Villiage DATE TIME EXPANSION "AREA:- YES &,,e NO _ �(/. �A ram► /Y ENGINEER_ TOWNWATER X PRIVATE WELL �p� �� _ BOARD OF HEALTH -- : �fe�f���' =�T/4, EXCAVATOR SKETCH: (Street name etc. ,dimensions of lt, exact location of test holes and , percolation tests, locate wetlands in proximity to test -holes) k, NOTES: a co s PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: l k - 1 _ - •_ _, 2 { 2 Gj J 'i � 3 3 4 'a� 4 - - 5 gyp 5 6 6 - •7 7 9 9 10 10 11 11 12 i��� . 12 f 13 D 13 - 14 _ 14 _ 15 1S - 16 16 - SUITABLE FOR SUB-SURFACE SEWAGE . LEACHING FIELD LEACHING PITS LEACHING TRENCHES - - � -` UNSUITABLE FOR SUBSURFACE SEWAGE. REASONS: ` NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E AND RETURNED TO BOARD OF HEALTH COPY. RETAINED BY APPLICANT _ _ 4050 iA & '7 NJ�n.......... Fm3 .... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ........OF............... .V>, . ............................ Aplifiration for Disposal Works notrurtion Frrutit Application is hereby made for a Permit to Construct or kepair an Individual Sewage Disposal System at: .................................................... ...................................... i�o�n-Ad ess..,,.... ..................... Lot N C — " — 11 .......... .... ..................... ......................................6,U. ........................................... 0- - .1 dress ..................................a",g::a ........... .......................................... ................................................... Installer Address Type of wilding Size Lot..2Y1.zA7._ ..Sq. feet Dwelling—No. of Bedrooms................. .....Expansion tt Garbage Grinder�*/4) ..........*.... persons......-jA0 ..i.c•.. P4 Other—Type of Building ....ZVVY......... No. of p Showers Cafeteria P4Other fixtures ... ......:.........................................................................I.................................................... Design Flow.........S.-.r ............ gallons per person per,,day. Total daily flow-------------?2.d..................gallon�_W r 1:4 Septic Tank—Liquid capacity.,;W?j'gallons Length._ZZ........ Width.....6....... Diameter________________ Depth.....4........ Disposal Trench—No. Width____________________ Total Length.___..___._...._._.. Total leaching area_.__4..sq. ft. Seepage Pit No_____________ _�e iameter.................... Depth below inlet__.___.............. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by-._._.. .......... Date_____________ ........ Test Pit No. 1..G�.minutes per inch Depth of test Pit......1,42... Depth to ground water________________________ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit_.__._._..______.__. Depth to ground water............*"*-------- P4 ........... ------ ............................... ..................................................................I......... 0 ....... . .... . ... .... - ------- -------------- ----------- ....... Description of Soil............0____/_1 ................................ ------------------------------ ----------------- ....................................................................................................................................................................................................... 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 TI ITA!Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..__...joe!!� JaA4_ &,/P........... ..... .......... ...................... ..... ....... Date Application Approved By______________ ....................j........ .......I?..... ... u....... Date Application Disapproved for the following reasons:............................................................................................................... ---------------------------------------------------------------------------------------------------------------------------------------7*...*---------------------------------------------- ------- Date PermitNo....................................................... Issued........................................................ Date ------------------------- ------------------ No......................... Fxs....... THE COMMONWEALTH OF MASSACHUSETTS t O BOARD OF HEALTH ......7. a N..-- ....OF.............../ ....................................... Appliration for Biipo#41 No Tonitrnrtion prrafit Application is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual Sewage Disposal System at: t' ` .......�'�•.:,:l ✓......RUC .� ...l.�f . .................................... Location Ad . e ................. r I of N ..... n Ow er Address WW1 % ! -// -•-•-------•-----•-------------•------•-•-.. .......-----------------._._._....... .� ...---........._.._....._..._...-----------..... s Installer Address, d Type of Building Size Lot.... feet Dwelling—No. of Bedrooms__1 ________________________Expansion Attic ( 1�i'(� Garbage Grinder,(z/)) pa,, Other—Type of Building No. of persons........6............... Showers Cafeteria ( ) P4 Other fixtures ....1'M _ W Design Flow..........K�.........................gallons per person per,day. Total daily flow............ ..................gallon4, WSeptic Tank—Liquid capacity._ern%gallons Length__ _._..____ Width......6�_... . Diameter________________ Depth..... x Disposal Trench—No._ !!}- ____:Width.................... Total Length.................... Total leaching area...vQ:�'�__Lsq. ft. Seepage Pit No______________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (lr Dosing tank ( ) / ~' Percolation Test Results Performed by._______---ee.2r:" �'.. -f -p:�-�_____________ Date__..________.(��/� _//.... Test Pit No. -.minutes per inch Depth of Test Pit._.___/ _....... Depth to ground water........................ GL, Test Pit No. 2...............-minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 D Description of Soil ! 11..................................... ------------------------------- - -•-•-•----._._._........................................................... rfA a1 e P `—............ --------•--•..._..fr�� �..� -------- j V ...................•-------••-•--••------r - ....••� -------+-' �+�'�--••�fi...�G!1-_-- �r!.l� r lA.f�e-{'__.._..:....-- - WCI x .............. ..•-------------•----------------•-------------------•••-•------------••---•-••-•••---•-•----••-•--=----•--....------•--•-•--•--•••--.==•------------------•----••-•---•--------•--•- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the {board of health. Signed.......��-r-='./X= !�s._4-h _--,�- 4? C /f 3 y-•/--1 ... C. Date Application Approved BY .__..-.�"r -------- ------•-----._..1..._.._. --------roc Application Disapproved for the following reasons:.............................................................. ............................... e ...................................... --•-•-•--•-•----------.._..-----••-•--------....-----•----._....----------•-----••-•------...___.__._--•-...-•--•----•--------•-•..-----•--•----•--------•-•----- Date PermitNo......................................................... IssuecL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .........OF............:0............................................................. -�t.�,l.�,-'�(' (Irrtif iratr of Tomptiatta THIS IS TO CERTIFY, hat the Individual Sewage Disposal System constructed ) or Repaired ( ) i _.;. ................................................. _._.._...----•---•---------•-•-----._._.._._..--•-•-•---•---....._... -- �_--___ ..•.by----------- Installer � ................... -- ------------------------•-••-• -- 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 Perm'_, 54 _________________________ dated--------- ,. ._ .*?.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR NEE THAT THE SYSTEM WIL -FU CTION SATISFACTORY. - C, DATE........ �',. _ -?�.±_..... Inspector.................................................................................... THE COMMONWEALTH,OF MASSACHUSETTS -- j BOARD OF HEALTH ,�-�� tar No...... �' FEE_110................. �i��'ro � �r�� C�� �#rnrtion rrnttt Permission iVI-0-erlRepair, by granted ----{ •----•----•..........::........•----•--••-•-•---------•-----••----------•----.._....--•-•-•-•-----............_ to Construct ( ( ) an Individual Sewage Disposal System at No........k-----•. In i.J�_-,b0�/ ►= �..............rf! r l'-t'-------=---•------------ rrtJ / t?is,.. •• . Street as shown on the ap licatio for Disposal Works Construction Permit No..................... Dated.......................................... ------------------- --- '.�o ----------- .......................................-----•••--•-•-----•-•••--•---- Board of Health DATE--.��__v- ..-••--------•----•- FORM 1255 A. M. SULKIN, INC., BOSTON i.•. ;. 1 f _ + P\,tN OF P�HILI o WE � DuE.R > /ONLE� (C)0 tuIDTt} , 4: a-D/10�lo k, (gx,� LE,4«/A/6 8ASiA1 w irrf 7 sTo,U£ burs�bE • MIj vA r fir , T�PV bA f bu PAN 0 n 4q ti icy t 1H OF MSS jo ee Mv 28874 CC- LE ND r s`. EXISTING SPOT EvaTION Q CERTIFIED PLOT PLAN EXISTING CONTOU FINISHED SPOT EL NATION } ' FINISHED CONTOUR 0 ----- 'J•-OT 6 6'LAU �3K 2�� P� )5 � IN APPROVED BOARD OF HEALTH t r r DATE AGENT SCALEl I "—.zi DATE, 9� )3/�3 LOREDGE ENGINEERING CQ_N� C;LI6T;j SiDt t CERTIFY THAT THE PROPOSED EGISTERE REGISTEREQ ;`r: J09 N0. 4 gb BUILDING SHOWN ON THIS PLAN CIVIL LAND DR,BY� � CONFORMS TO THE ZONING -.LAWS ENOIN ER OF.�ARNSTA9 E , ASS. .. . 712 MAIN STREET - CH, 9Ys N YA N N I S, _ YO MA S 5,.. " SHEET.1 OR'� D.ATE R 8. LAND SURVER /V0 /F E/TiYER THESEo7-/C TAN. OR . 20 FT.. M//K 'EACN/NG �/T AitE MORE TH,q.y I2"BELOrt/ /O I•T. M/N- �,RAOE� 4 24�0/AM ETER CONCRETE . COt�E.P —. SNALL BE BROUGHT TO G/gADE. �.-+N EXTRA CO/VGq!'TE '�'PYG' P/pr h+EAVY CAST IRON CO{iER Sh�ALL !jE USED C,� coymcs yo PAM"0107 /F/N 2:;PRI vk WA Y � ,,r,A,, CONCRETE A G .�oE Co ✓ER CLEAN .SA/YD y— BA Ck F-/L L 2 LAYER/B GAL 0� IRON P/PE . L 4i► M/)V.Jp/TC/d D/ST. � • • • ► • • • • > 6' WA SM 0E FO 57 %'palm I SEPTIC TANK ' . • r . . . • • , . . BDX o • r $ • . • • • � .�� • 314 • • •. DEP7J+/ • • • • . WASNEO STONE i s. � • • • s • • • r • P�v PREC,45T SEEPAGE . INYGRT wAZVAT/ON-S �yI.SX,/,S. y7� �tP� ♦ �. • • • • • • • • • •. o R17 OR EQL//V. .. .• , . 7gSx /d•-:=!_` GFrD/AM. EL = 91,5 /NYERT AT 4ffl//LD/N6 FT Sycl G Pb` — INLET .SiEPTAC TANK 9 8.3 FT.::. . - � FT. oiA/►s. TA8uL.4 ow.) O�lTLET SEPTIC 7A 9 • I FT !INLET D/STR/6!/T/ON BOX q� q FT_ GROuNO ATE/e' TADL E SECT/ON OF S7' B /ON BQX O(lTLETD R �/7" .SEWAGE . 01SAOSAZ SM.�T.EM IM4ET_LLsACN/IVG. PIT �'► FT. - TABULATlO/V LEACHIM40 A/T s CAL& : /s _ /=O� D4MENS/ON. A DEShTV CR17'RM1A 8 .a fT- NUM4ER OF®EDROOMS SOIL. LOG G/HENS/ON C L—FT. K r G,4RaAGE 0/SPOS1tL UNIT SO/L TEST TOTAL A-3-f ►ATED FLOry 33 o GAL.AoAY SOIL TEST A/ SOIL 71FST,02 NUMBER? QF ZrACRIM4 P/73 ELEK 99•o + �`-ELEJ! DATE OF SOIL TEST y /k3 - SIDE L.G'ACH/IVG PER PIT 1 -5.SY; i'T. RESU47'5 IV/TNESSED dY J� J'2 a64 sv FT Qp �o-�,r Ld � 9oTrOML.E,�ICN/NG pER P/TZS PERCOLAT/O!v AA7E,0/ 'S' Z hf/N�/iNCN TOTAL LEACH//VG AREA -26 7 SO iT... T�sa i I �XCOLA r/ON RATE/k M/N.�INCH R s er AREA SQ. FT.. E ERtiE LEA CN.W 1-o 7 �� �� o yy P �ZN Of�y �P ZN OF Ar \ � V�le� .StF►Jb U oMv pz O `' "`,RLWE G l;�F� GQ2./,c V e ' � L DREDGE ENG/NEERINCr CO /NC. Il10.Z987i ,off pF 66 7/ "Ally ST 2 . fi�Y.4tlN/S, MASS. , ! �HOSS'TLq F, <i,_ ONALE [9/ NOGROVIVO vv,4TER ENCOUNTFREo CL/EN.T:.Oi9 S/L1� DATE i='/�i 4- M GROUNO LvATER AT EL Et! _ P06 'vo. �3D4 Z�. SHEET OF No._& 75b C/ — O q9 w �— FEll..., ..�...". ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH (X�' Town Barnstable ............................................. ................................_......_........------..............._.................... Appliration for Dispnua1 Works Tonstrurtiun Vauti# Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Lot 11 Ash Circle Cotuit, Ma ................__...._........................................................................ ......--------------.....................----------.........._..•--------..._......--•---.....--•- Location-Address 24 Great Pond Der b.e-Yanncuth, Ma. -------Dance -• s-Z ,Qo;s .o�taon-Co-------------------.---..- Owner Address 1.4 W � Installer Address 21,800 VType of Building ize Lot............................Sq. feet Dwelling—No. of Bedrooms......3...................................Expansion Attic ( ) Garbage Grinder ( ) � Other—Type of Building -------------- No. of persons............................ S owers ( ) — Cafeteria ( ) Otherfixtures ------------------------•------•---•------------•-----....-----------------•-•----------------.--•-•-•---------------•-•....--•---•-•--.............. W Design Flow...............55........................gallons per person per day. Total daily flow.........33Q............................gallons. WSeptic Tank—Liquid capacity...100Lgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... TotaHeaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by..Norman..Grassmaa.P_.E.......................... Date..SQ9.ir.,.16�_-1982 --. a� Test Pit No. 1...... ........minutes per inch Depth of Test Pit._12............. Depth to ground water.......none....... fr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •-••...-•--•-•------•--•--•-••---------•---•--•---•-•--••---••-•-...-•••----------•-----------------•.... ...................................... 0 Description of Soil....Q" 18."_%wady--- lsx�m,_._1$':.= c21].�... F"-60."._�ravell•_60"-144" sand 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 TIT�.;,.. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d by the oar of health. Sign .. -----------: .................... ............... te Application Approved By............................... ... .y y � " Date Application Disapproved for the f ollo in aso :.............................................................................................................. ........................•-••--------------•-••---•••--•--------.......... -------••--....•-----•-----._.....•---•-•-----••------------••--•.......................-----------..__ ............-- Date PermitNo......................................................... Issued_....................................................... Date No ..... FE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .-.own...........OF....Barnstable App iration for Disposal Works Tonstrur#ion truth Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Prot 11 Ash Circle Cotait, Ma ................__.............................................................................. ---••----•--...--•••••••--........._.......----------..............•---•--.........._.....-•••--•- Location-Address r Lot ----•24 Great Pond D�'., S4.0' Yarmouth, Ma. ------------------------ ----------.......-------•--------•--___---------•----•-••-- ................ Owner Address W ' Installer Address 21 800 UType of Building Size Lot............................S feet Dwelling—No. of Bedrooms-------3......____________________________Expansion Attic ( ) Garbage Grinder ( ) �`4 Other—Type T e of Building No. of ersons____________________________ Showers YP g ---------------------------- P ( ) — Cafeteria dOther fixtures ------------------------------------------............................................. ..........._................................................. W Design Flow................55i.......................gallons per person per day. Total daily flow.........330...........................gallons. WSeptic Tank—Liquid capacity.... 00Qf allons 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..2kXMW1._(;r.0S 1__F..B•_•---------------------- Test Pit No. 1......2.......minutes per inch Depth of Test Pit... 2_............ Depth to ground water.......n ...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------•-----------------•-•---•....•----------.....•---•----•---.............•-----•-----•..__.......-•-----•.._.._.__....---•--•••---_...-- 0 Description of Soil__--Q.'.'" $"--• y--�4 1.._ $.".- ... sO ll---360—�®"--gravelr- 60"-1a4" sand x 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 T'L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed....................•--•---...-------....-------...._...---.....•••--------........... ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:......................................................_........................................................ _ --•...............................•--•--.......-•------------...........-------------•-----•-----...._._..-._...__._.._....------•----------------------------------------•--------------•-----•••------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOM Barnstable ..........................................OF.......... .......................................................................... 01rrtifiratr of (�out�rltttnr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by----------------- -- -• •--------- ------ Installer at--- ----------- •---- has been installed in accordance with the provisions of TIE 5 of The State Sanitary Cod s scribed in the application for Disposal Works Construction Permit _______________ dated . .... � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GU A ANTEE THAT THE SYSTEM WILI/FU TION SATISFACTORY. DATE......C�....._ :,�................................................... Inspector.... .--•-- •- •-•--------•--•----....._._...._..•-•-----•----------......_...__. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Torn Barnstable ..........................................OF..................................................................................... c` No......................... FEE.....I&............ Disposal Works %'-pllnotr ion rrntit Permission is hereby granted_.._ .Star COnstr=tioli 00• ----•---------•--.-------•-------------------------••--------------------•---•-----......................._...._. to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at No...IAt__ll-Ash_Circle,. Cotuit{-Ma..-----•---- --------___ --------- sr t as shown on the application for Disposal Works Construction Per • No. ___...�'�.,Dated_�� __-:/.._........ ............................ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - --- - ------- - - --------------.SECTION A -A __----- --- 1' = 2000' �/- 10' min from .NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P,V.C. ALL MTIOUTUET PIPES FROM THE Existing Foundation house to septic tank PROFILE VIEW OF ADDITION TO LEACHINC SYSTEM pfSTfT6UT1ON Box SHALL eE 12• CONCRETE COVER $eptc tank covert must De 3" of 1/8" - 1/2' Washed SET LEVEL FOR AT LEAST 2 FT within 6 in of linished grade he St on v'H'?•, Cxode o.e. ^ bw - 'Jr!:S 3/4" t0 1 1/2 Washed Crushed Stone r.. 3 - 5- OUTLET \ /l- -,rode over SAS -10025 xNOC1KOUTS ,RG��S� 0— p �vsA,.s. - ` -tS S• OUTLET 12• INLET S 0.02 3 HOLE H-I O �m ' s• r 10' EXIST s-o 01 0. Greater Of 190X y" " "e' —Top of SAS - Eie- _97 25 - 2- p` I T E b N EXIST. PIPE h O 1.000 GAL. S- 0.01' Per fool - - ~15_S• 4- - SCH. 40 T v 1 75• O 'IJ¢ �E Za FROM EXIST. FCIl1NDATIDI yXj SEPTIC TANK n 'S —2 Eflect:ve Depfr �f ROV �, O h +I PLAN SECTION CROSS—SECTION °�el�S N rn H-10 r a CONCRETE FULL FOUNDAT V N �I 1 1 ar N Z o o rn II o S 3 6 Units E 6' 36' PLMD SYSTEM PROFILE 6 not 3/4-' '/r v 11 v �. r sT[x4E u+ R CHAMBERS 3' F 3 HOLE H-10 DISTRIBUTION BOX LOCUS MAP compiled flan! I C y �' �I 2' LOCUS 1 'A P NOT TO SCALE Not to Scale - > v 4' 4' > _ Effective Length 25 SOIL ABSORPTION SYSTEM (SAS) 6 in of 3/4--1 1/2" > compacted stone -` Effective Width �o CULTEC MODEL .25 (H-10 LOADING)/ SHOREY PRECASTE --- GENERAL NOTES 2-18- EXAM ACCESS MANHOLES 9- 4� PERCOLATION TEST P g Desi r1 CaICUIOti n 1 Contractor is responsible for Di safe notification e Number of Bedrooms: 4 Equivalent to 440 Gal /Day (440 Gat./Doy Min. per Title V) and protection of oil underground utilities and pipes. _ Garbage Grinder: No 21 The septic„tonk onj distribution box shall be set Leaching Capacity Proposed dW Gol./Doy Minimum (Min. Per Title V) Date of Percolation Test JANUARY 16, 2002 level on 6 of 3/4 -1 1/2" stone. Test Performed By: CARMEN E SHAY, R.S., C S E. 3 Bockfill should be clean sond or grovel with no Septic Tank - 2 x 440 Gal /Doy = 880 USE 1,500 GAL Septic Tank Results Witnessed By WAIVER ( per Barnstable B.O.H ) stones over 3" in size. \ 1 + THE ACCESS COVERS FOR THE SEPTIC TANK, SOIL ABSORPTION AREA: Using percolation rote of <2 min./inch '/ Excavator: Shay Environmental Services, Inc. 4 This system is subject to Inspection during installation INLET / 1 -- / DISTRIBUTION Box AND LEACHING COMPONENT Bottom Area: 0.74 got/sq. ft. x 420 sq. ft. - 311 gallons Percolation Rate Less Than 2 MPI by Carmen E. Shay - Environmental Services, Inc. Our ET SET DEEPER THAN 6 INCHES B 5 BELOW FINISHED Sidewoll Area: 0.74 gol./sq ft. x 208 sq. ft. = 154 gallons . The contractor shall install this system in accordance GRADE SHALL BE RAISED To WITHIN 6" of Providing. = 465 gallons with Title V of the Massachusetts state code, the approved plan FINISHED GRADE g' g I and LOCOI Regulations. INSTALL TUF-TITS GAS BAFFLES OR EQUALS Test Hole +�^ — .T=- r:.r �; - -t�• Use (6) CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, i NO. 1 6. If, during installation the contractor encounters any • -• ' ' � '• � soil conditions or site conditions that are different TO BE USED WITH 4.0. OF WASHED STONE ON THE SIDES, AND 3' OF WASHED STONE DEPTH SOILS ELEV. from those shown on the soil to at a our design STEEL REINFORCED PRECAST CONCRETE _ 9 9 PLAN VIEW ON THE ENDS AND 1 FOOT OF STONE UNDER ENTIRE INFILTRATOR AND SAS. 0 1002 installation must halt & immediate notification be Loamy mode to Carmen E. Shay - Environmental Services, Inc. 3-24' REMOVABLE CODERS Sand 7. No vehicle or heavy machinery shall drive over the io YIR 3/2 septic system unless noted as H-20 septic components. •. :_. _ 4. 0 -8' A, 99501 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 3" min clearance 13' INU7 • EXISTING LEACH PIT TO BE PUMPED & REMOVED TO FACILITATE NEW SAS INSTALLATION Loomy 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. INLET 8_mm_--- min Went level ouelst 6-,,,r, OUTLET end 1.( j^Su�j 10. All solid piping, tees & fittings shall be 4" diameter 10' min 1 LI°"d le el „`. NOTE. ANY STRIPPED OUT SOIL CONTAINING LEACHATE _ Ia B.YR 5/e 97 251 v7�j'a"^ u Schedule 40 NSF PVC pipes with water tight joints. ' ----� + FROM THE EXISTING LEACH PIT TO BE DISPOSED 8" 36" s -7 £ S -2 Medium 11. Municipal Water is Connected to The Residence and Abutting OF AS PER BOARD OF HEALTH SPECIFICATIONS. Sond 'oE a•.do Y Lqu c deptn 2 s r , Properties Within 150 Feet. '4 C / 625 + - J _ j I THE PROPERTY LINES ARE APPROXIMATE AND 8'-0'• - 4' -Io' COMPILED FROM THE SURVEY PLAN GENERATED BY CROSS SECTION END—SECTION LRote= NORMAN GROSSMAN, RLS OF HYANNIS. MA 6" to 54" ENTITLED " PLAN OF LAND OF LOT #1 1 IN COTUIT, MA" Tho 2 MPI DATED APRIL, 1983, USE EXISTING 1000 GALLON H- 10 SEPTIC TAN k bserve AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN N >DC IT SHOULD BE USED FOR NO PURPOSE OTHER THAN O ADJUSTED H2O Elev. = None THE SEPTIC SYSTEM INSTALLATION. NOT TO SCALE r I S 34c1 45' 32" E 150.00 Qr 3 ' �— PROJECT BENCH MARK LEGEND S6+ TOP OF SUN ROOM FLOOR SLAB \ t 12' TEST HOLE #1 \ ELEV.= 100.25 ELEV. = 100.00 (Assumed) DENOTES PROPOSED \ \ 104X1 \ ' SPOT GRADE • r't:.�.. DENOTES EXISTING 46 j LOT # 1 1 ` , ;.•�.,t ,;:: ,, SPOT GRADE \ \ fib 6 `•J•''Y. p'• \ EXIST 1000 go[ t, • .? 21,800 Square Feet + ` e �- p PL PROPERTY LINE 1� \Sc tK Tank � -.:•1' �,y. � i \ he PROPOSED CONTOUR Failed D-B DECK \` ox Leach Pit �t i — — — _ -97 EXISTING CONTOUR DEEP TEST HOLE & 108' v '� it ��� �i PERCOLATION TEST LOCATION �r V EXISTING 4 BEDROOM i `� lipp ---+ 6 FOOT STOCKADE FENCE 10z_ \\ \ / HOUSE LOT #10 - 20 ,6 1 / PLOT PLAN /\a - , OF PROPOSED SEPTIC SYSTEM 'UPGRADE Q a �_ / �o / I PREPARED FOR MR . NORMBERT WOOD AT >o2 #20 ASH CIRCLE Edge of -�--- 6-pOp, �► LOT # 12 COTUIT MA <A .S'H CIJ�� I,�l �/ 5 a�a� ssq PREPARED BY: ,} V / (40 FOOT RIGHT OF WAY) yG�;' CAR-YEA" I .. kS H�1 1 0 �H 1 r ENVIRONMENTAL SERVICES, INC. 0 ( 4n 50 o F �� P.O. BOX 627 o GfST11 EAST FALMOUTH, MA 02536 SgNl7AR�P� TELJFAX 508-548-0796 SCALE 1 "=20' SCALE: 1 "=20' DRAWN BY: CES DATE: JAN. 30, 2003 PROJECT#SD386 FILENAME: SD386PP.DWG SHEET 1 OF 1 -AL L EL E-�G. S�1- W tiJ A1Z r< ce" c', C .. -! ... LJ�ATU►.a� P'LJ�w2vE. P11--W ALL LJ NES A m 1&1 jm vr� of U" / AL-- P',PE S T t s- c3 A,,1P JTI.1(T- i kr5i i �I ® � �-.;-- AFL '5EPT#L YA►3Ks Dr`T"f�IF5JT1��1 t�sC A► L) • �� I - � - •�— - �.._ _ ` � ` E.E�•CH,.JC-I Pt•T�, SHALL 8E DES1G..1EU Fc�� 30 ��:/ �` �J 1� - v..1�•tEE1✓ I�AG,�1C'lS „L - _..i` . �'--_-- -.-•� `� ��-- szEMo✓E Au_ ��,.1St��rA3�.E MAT�,"Z1Al- BE,JE..,>T�i le I C) O/ OF L.EACI-41.161 Pits f�'oc on C) O (�� �) r+F�L-Tl-1 "UST 1 11 �,E NCSTIF,E� WHE-kJ T►�c ��i�TEM 1S NEAP f d O �% �; CC�r.It�ETI[��.J 11. 10 Peto� T(oC► FiLtilu6� IC,— lJl.11._.c 5 OT'A��o- .I�,E PSoT�U, ALL. `a`/STEN� (j� �\ f r) h'S �E 1,.-,51 Lr_. 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Cow. is 4aoo PS.T Tp-,T J 1 C `� 1S.E F1vILT LIP TO 1?�hiCl4�'L . �.�..` Y f_: 7/.'.:2• -. _ ."\'rR7..� PLC �E lGviJ F�r.l 1}�J G u"A '��R TOT`' FouKPATtO..� �- �, J F1hI15i4 UCAOC F INISrI 64r Lm: F I►.11-54 DE. cvix-. 1/ FINISH C-X^M . ` UJEIL I-Aj-(K ",-7 LEAcWIl7C- n � ✓ _ _ 3" PEr�-To.JC�. .�G/ � � 1 `�;uV�64xe' JV (s0 1 j 0-0 es n►� ` Q ® .O • • ¢ttLylE D �yTo+.lL } �n.A � / '• L'e,AJFoeceT� caJc• ptST `�K m 0 0 0 O - r3e T IroM Prr I 10 SE¢fIC TAtirG O 0� CD /� TyP i CA L 5 L trAGE 5; s'1 P'rO F I L IE f b t r4oT Te 11 LIP IJ /. L`'g'YS�spr OES/GN ce/7Eel,4 ) 15r (? C7cAe �9 PROPO5ED I)VELL I KG, LOCATION e ca CFMg5 PROPOSE!] SEWAIGE DISPOSAL 5Y--5TE.M fj ? ROBERT -� PECSa/✓5 PerQEo�'0oM i'RpP. .�djEL-E(/ Gv/LL ot/S Are iC 1'.v✓ oE?O4 Yam_ PE�P1�lATlavx r KAYMOiJD �EAG�/NG APEA �'EGlurCE! _ � !'� ryWl oes�,c c��rl�. Pr. rie r, �a /�p�iJS�/9 x MA - .1n L�.ICNiVG Ae,-e4 /'Vov�Dr� v ND 1J/�.J� . •�1 '� j �`• "� /S•PPL.1c.e.tii'T' : Ewt6i/.lt�.2: PROPOSED L-A�HiNv piT f, ` IUo EAPAKI510N * H ROBERT ' i� Q L f 7� M�a RAYMOND f No.1987 iq SCALE DATE SHEET STEP/0c44 X 3 f r' F S/ONAI E��°\ ' ' \, DRAWN By CHKD BY APPD BY PLAN NO. �� 405