Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0809 MAIN STREET (COTUIT) - Health (2)
{ r ' 809 Main Street � i. Cotuit A= 035 -067 ,}}}:� �yi I �. F • �r'��� � I� li 1' �, 3 `�` T �; �. . —o �� �� a ; � _ Town of Barnstable . P _ �5 7 3P _ d,via t Department of Regulatory Services iA i Public Health Division Date 7 • � 0 200 Main Street,Hyannis MA 02601 ^ prEll MKl� .. l � Date Scheduled D / • Tf ne // Fee Pd._ Pd Sort Suitability Assessment for S ge Disposal �a Performed By: <f--o �i�/LmF Witnessed By. LOC TIO555��N�7����QQQ-GENERAL INFORMAT�9,11 Location Address ���(�/---� Owner's Name //�91t 04 4 40eAddress � fib/ Assessor's Map/Parcel: ` Engineer's Name NEW CONSTRUCPIO REPAIR Telephone# Lund Use LJ�. l Slopes(96) y _ Surface Stones I� Distances from: Open Water Body ft Possible Wet-Area 46—ft Drinking Water Well / Dralhage Way ft Property Line D ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pera tests,locate wetlands-In proximity to holes) st Parent material(geologic) Z �'�VII�V�L/�V S4n/� Depth to Bedrock Depth to Groundwater. Standing Water in Holc: N�� Weeping from Pit Face Estimated Seasonal High Groundwater 7 Z DETERMINATION FOR SEASONAMIEGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to sell mottlayl Depth to we Ing from side of obs.hole: In, Oroundwater Adjmtment �✓ i Index Well-Z:2tading Data:---;;;,,�lndex Well level_�_�_/ Adj,-thetor---,._--Adj.C)roundwater.Loval I PERCOLATION TEST Data T 1 n10 Observation Hole# r Time at 4" l� •_ /7 . Depth of Pero Time at 6" N Start Pre-soak Time @ ll 7 /D _ Time(911•611) End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Sita Failed: Additional Testing Needed(YIN) Original: Public Health Division Observv6on Hole Dkta To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conselrvation Division at least one(i) week prior to beginning. Q:ISEPTICxPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole#_�_X �I,Z Depth from Soil Horizon Soil Texture Shcl Color Sol]. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. o tsIstency.%'aravel) Ap'Al �lr7C 7, DEEP OPSERVATION HOLE LOG Hole# Z E Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsisteLicy. / D /D YX 31 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, I • I ' DEEP OBSERVATION HOLE LOG Hole# Depth from, Soil Horizon Soil Texture Soil Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. a Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within I-DO year flood boundary No.,,_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious in itorial exist in all areas observed thrpughout the area proposed for the soil absorption system? � d If not,what is the depth of naturally occurring per material? Certification that on �� S (date I have passed the soil evaluator examination approved by the I certify ) P fy Department of Environmental Protection and that the above analysis was performed by ma consistent with . the required traigIM c ertise nd pe ' scribed in 10 CMR 15.017. Signature Date Qc1SEP1rICWERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Forme Subsurface Sewage Msposal System Form-Not for Vdurdary Assessmerfi E ..y Or ner Ow ner'a Hama iNorn�ion to =" re*dredforovary �Tt� 1 T— POW Csylrown 210 axle Dnte-d hspecuord Inspection results must be submitted on this form.inspection fortes may not be adored In any way. Please see completeness cheddlst at the end of the form. f a"' A. General information use only the tab 1. Inspector tee►b move your cursor-do not 37� Pet'—K7 A4 tomorn m the n Name of tapector C A,S ��rvJ�Y ant Company Add'ess Ctty/Town Stabs Zip Code Tebphone Pbnter LEW"timber B. Certification 1 ON*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 papector pursuant to Seddon IL340 of Title 8(310 CUR I&000� The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority . id-eZ -/S- hap Mr's 30wha - Oise The system Inspector shall submit a copy of this inspection report to the Approving Authority (Board d Health or DEP)van 30 days of campletdng tNs inspection. If the system is a shared system or has a design low of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional ofke of the DEP. The original should be sent to the system Omer and copies sent to the buyer, if applicaft and the approving authority. '",*This report only describes conditions at the time of Inspection and under the condddons of use at that time. This dnspecdon does not address how the system will perform in the fixture under the same or difftrant conditions of use. l9A•yt3 V TIMO W hrpcftForm&*mien Onspotiposr syMM.pap I ort7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Roperty Address Owner inforr tion is Cw ner s Narrte m required for every G�'TU,1 —I— page. Gty/Tow n State Zip Code Liate of inspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: Jul 1 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: 4 /6`!� (e_0rv-c-d GITI ( S- �-� .J �✓ Ng B) m conditionally Passes: ❑ One or ore system components as described in the"Conditional Pass"section need to be replaced o epaired. The system, upon completion of the replacement or repair, as approved by the Board of th, will pass. Check the box for`fires , " o"or"not determined"(Y, N, ND) fur the following statements. If"not determined,*please explain. The septic tank is metal and over ' ears old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltratio r exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structu IXsound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years o s available. ❑ Y l] N ❑ ND(Explain below): t5ms•Y13 Title50f8dal lropecymFam subairface sevageofsposw system.Page 20f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 1 rr/&t2rn -E2 Cw ner ow ner's Name information is required for every �---�i v L T_ A page O Z 3 s p _ CdyrTown �" State Zip Code We of Inspection B. Certification (cost.) A�1,0,,, ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) stem Conditionally Passes(cont.): ❑ Obsery ' n of sewag e backup or break out or high static water level in the distribution box due to broken bstnicted pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspectio if(with approval of Board of Health): ❑ broken pipe(s re replaced 11 Y ❑ N ❑ ND(Explain below): ❑ obstruction is remov ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled o placed ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to bro or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND( lain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain low): 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 th stem is failing to protect public health, safety or the environment. 1. System wll nless Board of Health determines In accordance with 310 CMR M303(1)(b)that the.sy of functioning in a mannerwhich 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 wetla�®rsalt 18ne•3113 TIV95 Offidal trepecfion Form subsurface Semage Disposal S)Stem•Page 3of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name infomatan is required for every G�TU l i �( A- O page. CitylTown State Zip Code Date of hspection B. Certification (coat.) �I AJA 2. System will fall unless the Board of Health (and Public Water Supplier, if any) de Ines that the system Is functioning In a manner that protects the public health, safety d environment: ❑ The syst 1 has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a sue water supply or tributary to a surface water supply. ❑ The system has a tic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic nk and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank an S and the SAS is less than 100 feet but 50 feet or more from a private water supply we Method used to determine distance: **This system passes if the well water analysis, perfo at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of am nia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria ar riggered. 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 I ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® F(/Q 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 tyre-3H3 rlde5of8dal ftpectlonkrm Substrfaee Seviegeoisposal Syrtem•Page 40f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address <�lA.12Vf%jEM Owner Owners Marne infornation is required for every page- Cityrrown State Zip Code Date of inspection B. Certification (corn.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ In Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 fleet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 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 wateranalysls, performed at a DEP certified laboratory, for fecal collform 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.] ❑ trti The system is a cesspool serOng a facility with a design flow of 2000gpd- F" 10,000gpd. ❑ ,� The system ftft I have determined that one or more of the above failure criteria exist as described in 310 CM 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. u/,�,E) Large Systems: To be considered a large system the system must serve a facility with a de flow of 10,000 gpd to 15,000 gpd. For large systems, 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 et of a surface drinking water supply ❑ ❑ the system is within 200 feet of a trib to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive are edm Wellhead Protection Area—WPA)or a mapped Zone If of a public waters ly well If you have answered'yes"to any question in Section E the system is considered a s 'ficant threat, or answered 'yes"in Section D above the large system has failed. The owner or operator ny large system considered a significant threat under Section E or failed under Section D shall upgrade system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5 re-X13 T1Do5Offldal ins pecdon Farm Subarface Se%ge013posal Sptem•Page 5of 17 r Commonwealth of Massachusetts u p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 0-7 A4 A, Roperty Address Ow ner Cw ner's Name information is required for every Z-OT-u l'- I cJ— ( Z— 1 ,57 page. Cdyl row n State Ip 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 I ❑ Pumping information was provided by t 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? C] Have large volumes of water been introduced to the system recently or as part of this inspection? rTrt ❑ Were as built plans of the system obtained and examined? If they were not available note as N/A) (� S t t Ir 27 t E 5L ZETC Vi fC-UVL)P O V 1 ❑ Was the facility or dwelling inspected for signs of sewage backup? / ❑ Was the site inspected for signs of break out? ❑ Were all system components i�Ls �.� heSm(Sslocated on site? ❑ t. 10 MAC,-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(arid occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the SS 9 Absorption System(S/ks) on the site has been determined based on: i—i�� +n15 PF�-T► u nJ ❑ [�1 Existing information. For example, a plan at the Board of Health. C9 ❑ 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)] D. system Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): taro•3n3 Tile S OM W bpeckn Farm Subsurface SevAge Disposal SYMm•Pape 8 017 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address . Ow na information is Owner's t�Farrmm► required for every page- City/Town State Zip Code Date of Inspection D. System Information Description: GUt_(_�G—Tc22 _ 4rj t'-_:> Ova 12�C��S Gc�f�Tl'cgL) t c j A- �rw tit-C-lJ S� ts�.f o �-�to Gv Sc F't249 M kA�%j se 1 , 4)Q zv(-1;- 5 �v^a'�wd er Number of current residents: 1 Does residence have a garbage grinder? . ❑ Yes Q No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? ❑ Yes 91 No 41A Seasonal use? ❑ Yes ®, No Water meter readings, if available(last 2 years usage(gpd)): Detail: 17.5 p� Sump pump? ❑ Yes I$ No Last date of occupancy: GUI-4 Date Commercial/industrial Flow Conditions: Type of Es ent: Design flow(based on 3 R 15.203): Gallons per daY(9pd) Basis of design flow(seats/persons/sq. . 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: tSn$ 3M3 T16950f f W kuPeOm Form%beuface Semegeoiepoed System-Page 70f 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g5ao� e �- Roperty Address ON ner Ow ner's Name inforrrtatlon is required e edforevery !Town �-rU t-r— _ 42 5- State Zip Code Date of lnspeation D. System Information (coat.) N 1a Las cupancy/use: Date Other(describe below): General Informatlon Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, wiume pumped: N/s6 gallons How was quantity pumped determined? WA, Reason for pumping:' �a L�ssa�y '6{t'i>Zt Cs) ZLErMvJ Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow,cesspool�.5) ❑ 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)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight'tank. Attach a copy of the DEP approval. Other(describe): tyro•Y13 Titles WWI kspeclao Form Subaeace SOY"90iapoed SWIBM•Pape 13017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �l39 K/t,c�t �f Property Address �,�2�►.J 1=� Ow ner Owner's Name information is required for every � ! O S Cily/Town � page. State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: t z8 (9-7 �0LzO.1fsI?- `tL, 3,SCE?e) {* 4 Were sewage odors detected when arriving at the site? ❑ Yes W No Building Sewer(locate on site plan): Depth below grade:, ( c ��0 ¢�if 5_4-*B) 2 feet Material of construction: cast iron ❑ 40 PVC ❑ other(explain): Distance from ri vate water su �' ^J '� s ry P ppfy well or suction line: - feet 4-w p N tot G tt B dam.-I Ao t:> Comments (on condition of joints, venting, evi ce of leakage, etc.): Se tl\c Tank(locate on site plan): Depth low grade: feet Material of c struction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) --------------------------- If tank is metal, list age: . years Is age confirmed by a Certificate of Compliance?(attach a copy rtificate) ❑ Yes ❑ No Dimensions: Sludge depth: tine-3f13 Title50rcidhupeotlm Form SLbsWaoeSevMeoispo"SyMm• 09of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9F5o —2 Ilt/L Property Address Owner Information is Ow ner s Name requ ked for every tU�� ,v`4 Oz _'9- page. 5W/Town —\ 1 S State Zip Code Dated Inspection D. System Information (coat.) n!/A-Septic Tank(cont.) Distanc m top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scu to top of outlet tee or baffle Distance from bottom of scum t ttom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inle d outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, eadence of le e, etc.): A)IA Grease Trap(locate on site plan): Depth beta grade: feet Material of constructi ❑ 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 Mns•3M 3 711950fodel kapectlmForm SLbaufece SevM@0jW0W SyeMM-Page 10 d 17 i Commonwealth of Massachusetts Title 5 ,Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ents Property Address Owner �a2p�E infom ation is � Q"'ner's Name required for every C CCU t ��page, CitW town State Zip Code D. System Information (corn.) °�°� hspectlon Tula Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid lev related to outlet invert, evidence of leakage, etc.): MA Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Dept low grade: Material nstruction: ❑ concrete ❑ metal ❑ fiberglass ❑ Polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow. g ns per day Alarm present: ❑ Y ❑ No Alarm level: Alarm in working er. ❑ 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 t9ns•3M 3 TItle5Oftl4:7al ftPeatlmForm Subewaos SO"sDlsposm SpWm•pep*11 Of 17 Commonwealth of Massachusetts WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ►M ,,t ,J > Ropeity Address 4;-2vn1 JE7,2. Ow ner ON noes Name inforrration is required for every Gnu t r 1M 4 DZG 775 page. Cdylrow n State Zip Code Date of hspectlon D. System Information (cont.) NIII Distribution Box (if present must be opened) (locate on site plan): Depth o 'quid level above outlet invert Comments (n if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leak a into or out of box, etc.): NIA Pump Chamber(locate on site plan): Pumps in ing order. es ❑ No* Alarms in working ord ❑ Yes Comments (note condition of pu chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ns•3H3 TAe5orficlal VapeatlonForm SubWace Sewegeoisposd System•Page 12 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments RoAerty Address Ow tier hforn�is Ow net's Noma requkedfor (A page- C�ylrownstm �� ,5 D. System Infoation (coat.) z�cDde oeoa of ram , lem Type. ❑ Ong pits number. ❑ leaching chambers number ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: (overliow cesspools s co � -�uvs number: $ ❑ innovadivetaitematiw system Type/name of technology: Comments(note cod n f soil, signs hydraulic failure, level vegetation, etc.): (4v^jg ,n �n9� p soil, edition of l Lc �-Le-. �4Tr- s GRL L L Cesspools(cesspgd m�us�t (PV be 'S „f,���s"pion)(locale on site plan): Number and configuration v e cC,✓) 6 o.9'g) Depth-top of liquid to(niet invert 5t'� �yU+1 !�d-�-4-�»� ) =A eL y 6o4+ej w� Depth of solids layer -------------- Depth of scum layer Dimensions of cesspool/4/S�OEp/g�DJr.,r 7Z ¢"d,�'�'e�o.,�� 6 /0' At lo`' tocloW l4.a*1 ' Materials of construction F- F Indication of groundwater lnfiow ❑ Yes No �•ana TItla50ffla(y k3MCft Fags albadaes S*wop6DWpwd Syftrn•Pap*13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessmerds RoP"Address Owner hformitlorr is Owner's Mane required for evey C CS7TU tT De9e• Cly/Town Smte Zip Code Date of hspectbn D. System Information (cont) Type: ❑ leaching pits number: ❑ leaching chambers number ❑ leaching galleries number. C7 leaching trenches number, length: ❑ leaching fields number, dimensions: (overflow Apo co t fie`- ups rumba: 8 ❑ innovativefalternative system Type/name of technology: Comments(note coropon fsoil, signs hydraulic failute, level of vegetation, etc.): c�y'�� v ,� �n9� p sal, c�Ldition of d�I D F{-Y Dt �l L i L L Y Cesspools(case must be e5d as part o inspection)(locate on site plan): Number and configuration �pvE,QF�ow� Z 8 Depth—top of liquid t<nlet invert 9Z"4vu7 by � f 6- �Ju //071r Depth of solids layer f�, o f Depth of scum layer Dimensions of cesspool i4Ji dia 6p,' rTT - 72+/ ¢,'i�� ��� /8�m'.+A'-1# ,¢l'y Materials of construction ck Indication of groundwater infiow ❑ Sm•3H3 Yes No Tf#05Wdet kuPeclan Form&ftWam Seaepet)teposd SYMM Pep#13d 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Dlaposal System Form-Not for Voluntary Assessments Roperty Address owner infonratbn b QM noes Name required for every C lT ram• Ckyr/Town rVIA �3S 10- I Z- \S D. System information (cont ) s z�code o�or Ina , Type: ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number ❑ leaching hunches number, length ❑ leaching fields number, dimensions: Pf (overtow cesspools s co(�e�-�uYs} number. $ ❑ Innovative/alternative system Type/name of technology: COMM ents(fie n f soil, signs hydraulic failure, level Of vegetation, etc.): C�r"�g olng, p soil, "ition of C-� •d.�t, �cam, E-i-r- ass�ooLs ry Q4=T7�,.5 c 1-4 I�riID N, pQ. �y LlG4LL Cesspools(cesspoo � pjof inspection){locate on site plan): Number and configuration w ) 3 --/ 8 1/ Depth-top of liquid to(let invert 42 � l�Vawt \x,"V►l OVA CYy,7 LV Depth of solids layer b.4-Luyy Depth of scum layer Dimensions of cesspool h' 7z" �i ''o•,Q- c.r�o� ,� �.✓s� 5 vz r Materials of constriction 3 y^i c Indication of groundwater inflow ❑ Yes -No We•3M 3 Tile 5CfkW kwpwdMFarm SLbseem SB%gp oftpwd symm-Papa 13d a Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Dlspflsal system form-Not for Voluntary Assessments ��— RoperryAddress Qrner hfmrrathn is Qv nets Name required for every �ty/Town C BIZ,tT' stme 7 Zip code Date of hspecticn D. System Information (coat.) Type: ❑ ling pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: 9 <oveedow cesspw% number:' 8 ❑ i►movativedattemative system 1ypefname of technology: Comments(note connTo�n Qf soil, signs hydraulic failure, level of vegetation, gelation, etc. : C� ) nv► j ng, damp sal, cpndition of S �'J�=R v r.1 t--4 G, St 'ttS LTtYQALL`( LI�AE-L Cesspools(cesspool mus be ion)(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 a. 6D'' /��g ?2 Z 4-'i0i 4 Occ"3 `411L x 32"d a Can's Materials of construction Gv YI c (o% indication of groundwater inflow ❑ Yes �( No . �s•3M3 T11e50fkW kvpxtlanFam&+bu18oeSM96DWposd SMM'Page 13d 17 Commonwealth of Mmac husetts Title 5 official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments R'operty Address Owner D �- Wocrndbn is Owner's Nema corn.required for every C c 1�"TZ 1T Pap- vZ�3 s l 0- !� G�yFrown D. System Information t' ) z comae aa� �D ' Type: ❑ leaching pits number ❑ leaching chambers number l] leaching galleries number 11 leaching 6wiches number, length ❑ leaching fields number, dimensions: (overflow cesspools s co 1 sec.-�ovs� number $ ❑ innovative/attemative system Type/name of technology: Comments(rote corgl on f soil, signs hydraulic failure, level of vegetation,� a etc.): g � �,n���9. damp p soil, c9ridition of C( LL tG, E-F?' GE-ss�ooLs r=u&lc� ►•t!n st��-'�VQALl Y fp Cesspools cess �,�/a�"�l/Ec� s��y ( p4o1 must be pumpe�as p�Codnspection)(locate on site plan): Number and configuration CL /�c- ►� �Y° wz�e✓ Depth-top of liquid to inlet invert (0""p44 Depth of solids layer l/ Depth of scum layer Dimensions of cesspool dia 36 �/i�3� t Af3'�O�� c. �. •,��jl„h �o '�°c�r�l4 l•�f�e7 -fai CoJJ'�'7t .G Ott/eY �/Q Materials of construction age, Indication of groundwater inflow ❑ Yes �" No f9�R•3n3 - T1095OmdQ bpwoonForm 9JbOO8o*SenepeDMpmd syftm.page 13 d 17 JVLA Commonweaf h of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal S p Formystem Form-Not for Voluntary Assessmerds Ropert(Address owner 1nforrWbn is ON rnWS Pfarrla required for every c FTU lT l�A D. System Information (corn.) a fete hspe , Type: ❑ lung pits number. . ❑ teaching chambers number. ❑ leacWg galleries ' number. ❑ leaching trenches number, length ❑ leaching finds ,. number;dmensions: (overtiow cesspools co j'lec.-�u�s number 8 ❑ innovative/attemative system Type/name of technology: Comments (note cor> io itesn f soil, s 9etation, etc.): C� gic failure, ICv�Of �ng, damp soil, c ition of • C' � ,a.L t E-1- �, �t-r ass r=U fir.!p t4-V M7A-t11r lGam,LL q . Cesspools cess«'f �ss�+Ry)_ ( I must fie pun,Ped M Pert of inspection)(locate on site plan}: Number and coniguration � y y Depth—topg liquid to inlet ins, /\/ tA9VE,5z'I-IYdn� /O cle 14 cPh,TL f o?j Depth of solids layer Depth of scum layer Dimensions of cesspool o5.5,, ?die /o'' qg�„ �► • � d � JJ�«gS 4, .e✓ 22�'X Zg� try, Materials of construction �rjc Indcation of groundwater inflow tSM-3"3 - ❑ Yes No 111680MW bdPSCUnFOmt SLbWate Sevrep00b PWd Syalam.Papa 13 d 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal system Fonn-Not for Voluntary Assessments �o -5�1 K AI ►�1 Roperty Address Ofr rrer �orrnstbn is OuN rter a fine re4uisd for every C C:rT'Li tTA OZ�3S I O— I Z.— 1S page• Citylfown D. System Information (corn.) zIP code Dab of Wpec-fogy Type: ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number ❑ leaching benches . number, length: ❑ leaching fields number, dimensions: (overflow cesspoolg co�'�e�-4�vs number. $ ❑ inravativdaitematire system F Type/name of technology: Comments e xt�i�n fsoil, signsnhydraulic failure, level of vegetation, getation, ) G Cog nolng, damps oil, c�a ition of 25 A-Lc -.t=Le,— 1-IT GEC moot_ �v hnlD pQ��1 LI�LL Cesspools(ces �I must ed as part f inspection IJo•>— t�c�SS�p ,f )(locate on site plan): Number and co duration (•ova ���,,� .r�L �Ja -Q"- � o g Depth-top of liquid to inlet invert -1/Q,-L;-z y Depth of solids layer Depth of scum layer Dimensions of cesspooi,ns•sele 41 '�/ Tom" /U'd�a aj- Materials of construction �6Y, A indication of groundwater inflow, ❑ Yes X Pb ors•3N3 T'0450Hf W haDsatMFamt 6lbarfaoa qqVM*DWpMd Smtem•Pape 13of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments Property Address Owner Infometbn is Owner's tame page. for cxyRown G�CZ��-c— NtA oz�3S 10- ► z- �S D. System Information (coat.) Stdo code Wof hspectison Type ❑ leaching pits number. ❑ leaching chambers number ❑ leaching galleries number. ❑ iWhing trenches number, length: ❑ leaching Gelds number, dimensions: (overflow cesspools co('�e�-(,uvs number. g ❑ irmovative/attemative system Type/name of technology; Comments (note con f soil, signs hydraulic failure, level of vegetation, etc.): y"�� r„� , n ding, �d p soil, c9ndition of �l�S3 /S•LL.�.C!� !-FT GE'ss PaoL s C=v ti1G��,1 t�.i�, StttS�T�YQAt1.� Cesspools(cesspool must&SW part of i pection)(locate site an oT 2 PSSaY ): Number and configuration(CII )eCjC) ) (( k Depth-top of liquid to inlet invert Depth of solids layer J Depth of scum layer 2 a Dimensions of cesspool 0/,a /. '�/f��Pr•a (� 9 ya d.. Materials of construction tSM•3N3 Indication of groundwater Inflow ❑ Yes No T1"5 0ff4d kW P=#M Famt Su6aufgM Seaege 0Wp0W S)Mm•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 44 AP4/�E-P- Ow ner Ow ner's Name information is 6vnt 7— required for every A* oZG 3 S— page• City/Town State Zip Cade Date of hspection D. System Information (coat.) ,4L L (1— S, Comments (n c ndi 'on of soil, signs of hydrau'c failure, le I of pondin , c tion of vegetation C AS Fbc>ys etc.): �Y� C �?v�je� m"TJe ��v� �!o✓�z�) w/FPr on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level nding, condition of vegetation, etc.): ----------------- Ons•3h3 TitleSonldal UspecOankrm Wbsurface Sewapeoispceal S)SWM-Paps 14 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ptoperty Address Owns information is Ow Hers Nerna lug requied for every U LT pap- . CAy/Town MA 0Z,& 3 5- [ D. System information (corn.) �� zpcode Date orisp��r, Sketch Of Sewage Disposal System: PmVde a view of the sewage dis al ties at least two permanent reference landmarks or benchmarks. Locate ail wells wiithinn100 feet.Located where public water supply enters the building. Check one of the boxes below. hand-sketch in the area below O drawing attached separately S�� /e P�JV J Jam [ —o,vT�t_ TC 5 14-0' ------------- Z L i 1 � A- 15,3' 4- 77- -i` 1 " r two.3M3 nres orWd trrpeetlM Form subsWace tea•DfWO al gym.pap 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments Property Address Ouv her Cw Hers Name information is G�U X- — AAnn required for every 1_l P- 0Z-',35 I o lZ- lS page. Cty/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: hand-sketch in the area below drawing attached separately L �%t'-A Z •X ��g [- , �- S �4•S' ��— S z5' .p- � 3s.a' �-� z 2• �' } 45 t T 4 m C`n e Y' " 1 tyre-3113 Ti195Official ire pecum Fart[Su(mutace SeviegeDisposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface sewage Disposal System Form-Not for Voluntary Assessments �- PropertyAddress �aznNc� owns Owners iFw heanyvan r for every �+ITavn C—�R�t T t�4 y-z Cv State Zip Code Dabs of trspecdon D. System Information (conL) Site Exam Check Slope t o f [Z Surface water A3/P- Check cellar Shallow we"s i Estimated depth to high ground water. Z✓� � - r �`� few Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record H checked, date of design plan reviewed: Date Observgd site( utting property/obs®nration hole within 150 feet of SA ) g tw1 S� GPiP/,mil tc A 6;'A RV��� ��a�i ❑ Checked with local Board of Health-explain: ke-VO"C) PP) v£ ❑ Checked with local excavators, installers-(attach documentation) , Accessed USGS database-explain: ou must`describe ho you established the high ground water elevation: 6u T-To c-�ssPvv�s I s 3 7 mac- �-� 5 r�4 &,P'o%?CJx twi�TGcy a-5 �9 �� c 2a.Jc� 7a Se--,-Ti,:- Gruen tam e. Before fliing this inspection Report Please see Report Completeness Checklist on next page. TltloMkid trspecOmFomr Sebw ace srameoiepaso symm•page to of n Commonwealth of Massachusetts Title 5 Official Inspection Form UIV M A- I 'L I <-- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Ow ner infomation is ON naps Name required for every CoTU t'r � d 3 S l 0 _ t page- CaP sown Z— State Zip Code Date of inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed L System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file . i One•3H 3 riide5Offidd ins pecioiFcm Subsuf ace SeMegeoisposal System•Page 17 of 17 COIIN mwoom a , Title 5 Official Inspe ction Form h a-ft for Va1�ry Aswmrmftg car= rajuhd foraray `t�cS l T'" 44 A PM& Wfoan z$ of lb-21- 17 iqF wo M114 b oo C"ft , bn o o y Rdanystat It ow of! Rams ucoq • fly '' ��� �a'�-� �. �r � '�t3+V� <, [ C' .5 �c / taonpexyAM= " Cpf/Town 7f. a zs ` � 1�nber _ . . i.ioc;nse Marbar , B. man r trust I true.==ift and anei tl�st tloe camps ffi of the tune of the pecQormo�trasd on in artdpodemiInthe f `crrd op='systes • T�3�CAR lII , 7fuf - . . S�of mitt�.8�tctl+oa►i . P sea ❑ Conftons!ty PasB 0 Fps' QFu�therf'010on by tfre Loca!Ap v g As af#y. : i 10 ' .t Do ¢ . &mor d Ir and sYstevn orslt�stt,the t once `tll fi d be*' to#I arm ' s o� s:citt t of hopedwo at IAet tom.Tl s; *wa.m o hoar fo ;semis or' m""Itomt 6m tote t aadw also. •,ans - W ov r - ..fir.,.• k' , r � Commonweafth of Massachusetts Title S. Official 1 'n se c Subsurface Sewn- p �'on 0 M D[sposal System Form-Not for Voluntary Assessments Roperty A�ress�O GJ �A t,S owner4{_9 infonwition is oar's requhWforeveryMe- in State YIP Code Date of Ins tbn B. Certification (coat) Inspection Surnmary'Check A,B,C,D or.E f aftayscompiete all of Section D A) System Passes: any t have-not lbund - " _ • . indicates that c in'310 CMR 15.303 inn 310 CMR 15 304exist AIof the failure criteria described indicated below. . Y e cnterta not evaluated are Conments: �< Ct�L c Ci 4 i�Pin �� B) m Conditionally Passes: r ❑ One or �e system conponents`as described in the replaced o `tndsttonaf Pass section need to be Wired. The system,lot completion of the replacement or repair;as approri by, the Bid of , wtll Check the box br des ; o'or"notefmined" determined,'please exptai y �. N,ND}for.the foitowirtg statements. I'not The`septic tank is metal and over ears day E tnfi orthe septic tank (whether meta!ornot)is structurallection if the e�dsttrKj tank is m r ex> allon or tank failure is imminent. System will pass a'complying septic t it ank as approved by the Boani of *'A metal septic tank wiq pass irnpectrort if it is strict Con�ar ce ingi, that the " sue« not:leaking;aftif a Certiticate:of ` n9 tank rs less ttran"20 ears Y s awaitabte: ❑ Y 'D N' x❑ ND(Exptatn M•Ms TabSMcdI WIF=.,M aftNftmsg�+m- ZmH7 r Commonweafth of Massachusetts ' R Title 5 Official {Inspection � Subsurface Sews a Di ■y o rm 9 sposal.System Form-N�for Voluntary assessments VA owns AI&¢is.f E 2 F Waffrefion is ow Hers t�rie requirW for every cT_ page. Cityffowrl 4 O Z4-3 S t c- State Z' Code 6. Certification Date or inspe�tbn �I� ❑ Pcanp'ctramber Pumps/alarms riot operational.S stem will pumpslalarrris are repaired. pass with Board of Health approval if B) stem Conditionally Passes(Cont.) Q Otis n of sewage to broken backup or break out or high static water level in the distribution box due`, bstructed pipe(s) sue to a broken, settled or uneven distribution box;System vuitl <. pass inspecti ( appravat of Board of Health): Cl broken pipes re replaced 0 Y D N Cl NU(E _ xplain below). obstruction is remo ❑ Y 0 N `❑ ND (Explain below): distribution box is leveled o placed ❑ Y ❑ N 0 ND (Explain below): ` The system required pass ins Pumping more thiiii 4 times a.year due to or obstructed pipe(s}. The system will pection"if(wri a roust:O pp of the Board of Health}: broken pipes)are replaced 0 Y' D N ❑ NO( lain betoar ' ❑ obstruction is removed ) Y . N M ND(Exptai n y r,A C) Further Evaluation is Regiitced by the Boats of Fteaith -�- �--.-�-�.-�.I].�Cond+tiois exist which r - ; egisre further evatiron by the Board of Health in order'fo demiine if stem �s fairing tope uMic'health;'safety or the erivironmerrt: ti Systiem wi! 1ess.8�rd:of Health defenrrines rn accordance vWth 310 tI1R 16.30 and.. that the sy 7S ',n a Mannerwhicli will protectpublic heaffh,tyand the emrironQ Cesspool orprivfedt of a surface water Cesspool or pri yfeet of at bordering vegetated weftd or a;salt iSns-3ry3 - TsUegO/frctaFGe PectlmFam Suhwiaa;SeMe9eOisRasa1 System-Page3of17 Commonwealth of Massachusetts E Title 5 official lh action Form Subsurface Sewn go_9 Disposal System Form.-Not for Voiuntary Assessments . . RroPertli Actress _ _ owner �Arn information required forevery ONrter's page. (kytrown 3�'• (O- 21- \'7 B. Certification State Ztp Code' DeOe inspecti x eirtification (corn) on, • Nfa Z. sham wit fait unless.the Board of Health (and Public water Supplier,if any) de roes ihat the system is functloning in a ma nner that protects the public health, safety d environment: ' The syst has a septic tank and sal absoron system(SAS)'anii`the feet of a water supply or tributary to a surface water sup�y. SAS is'within SD The systerrt tras a taNc and SAS anupply. d the SAS is within a Zone #ofa public water The system has a supply Sent ' and SAS and the SAS is within 50 feet of a private water • ❑ The stem has a septic tank ; Sand the SAS is less than 100 feet but 50 feet or more from a private water supply d Method used to determine dstat>r ` •,Ttris system passes if the well water analysis, pert at a DEP wit bacteria indicates absent and file cerbfied laboratory,for fecal to or less than 5 Presence of am rua nitrogen arid nitrate it is equal PPm, provided that no other failure criteria ggered. A be attached to this'li m. copy of the analysis must 3. Other ------------ D) System Faitue+e'Criteria ApplicaW Ali `A S!►sbeins: You must indicate"Yes"for"No.m each of the foitow(n for 1 • d. 9 9.Q nspections y ,.., Q Backup of sewage'into facility or,,system.coin clogged SAS,or.cesspooi ! due to overkraded�' x.. p; Dischge or pending of efsuent to the surface of the due to an overloaded or CldWed.SAS or cesspoolground or surface waters Ste'.r p ® /A+ rgtsd levy in the distribution box awe owlet invert due ta art or ciogg�SAS or cesspool Overloaded fit}- ! esspoDl is-4quid depth tas tFt�t 6'below invert or available volume is less. tfti M3 s .' { 4 TitleSORld�InpeeSanfamt SLbsu/8oB '` - - '. Sei°e8eoi�f Stem•Rage4otfT Commonwealth of Massachusetts Title 5 Official Ins ection FrM subsurface sewage Disposal system Form .Not fiar 1/otuntao ry Assessments , r'r rtFAddress Owner ON ner's Name infornsdon is requiW for every -R1 C T U 2 �� Pam• Cigr/Town 57 - 2►. 17 C tip Code tp Date of hspecGon. R B. e�fication (cone) Yes No ❑ Required obstnx ed pumping more than 4.times in the last year NOT due to clogged ar pipe{s). Number of times pumped: 1' Any portion of the SA$, cesspool or privy Is,below high ground water elevation. , ❑ A portion of.cess pool or privy is within 100 .of a surface water supply or tributary to a siaface water supply Y Portion ofa cesspool or privy is within a Zone e 1 of a public well: ❑ Any Patios of a cesspool or privy is within 50 feet of a supply• . " . , private waters well: ❑ Any Portion of a cesspool or PnvY'rs less than 100 feet but greater thin,56 feet from a private water supply well:with no acceptable water quality analysis. (This i system passe sifthe well waterartai{ yds►performed at a DEP certified ,laboratdry,for fecal cWiGorttt bacteria Indicates abserit"and the presence of ammonia rdtrogen and nitrate nitrogen is a uai to or less than 5 tvided that no outer failure criteria are triggered A copy of the antis and chain of 'custiody must be attached to ihi fcmi.} ❑ e�j ` . The system Is a cesspool serving a facility with'a d6sign Qow of 200 d F' 10,000gpd: l The st►simem i s f have c ermined that one or more of the above failure criteria exist�described m 310;CAAR 15.303,the the system faits. the system oairter should contact it,e`Board:of Health.to determine what vi+il be necessary:to c6wect the dune u1�Q Large Systems: Ta be considered a 1ar9e system�the systiem must serve'a fact with fiovv of 10000 gpd to 15,000 gpd. :a Y a For large sys#wns„ must indce.either yes•or°rro'to each of the foNovying;►n'addition to the �estions in Section D:. Yes No the system is van of a sucuface dnriki ti ng water�PPly tlisystem w 200 feet of a to to a;surface ydnnki 'water supply El 0 the system is kxseed rna nitrogen sensitive are brim Wellhead Protec.•tior Area—IWPA)or a mapped Zone s.of a public water wen you have answered yeS'to any question in Section E the system is considered a. or answered ryes,in'Section D above the �� system cicnsidered'a sigrg6cant`thr .` system has failed:The ovmeroroperDr tor e under Section E or wed under Section D shan tpgrade system in act ,310 Ci1�215:304. The system owner should contact the mortal d1ce of the Department Lora•3/13' . i ' T Tf1e50f CWa spwftnFomr5L4wrfaoa:3evregeDiaposa:SYMetn•Paje5of17 Commonwealth of Massachusetts Y Title 5 Official Inx s . ect�on p Form Subsurface Sewage Disposal System.Fonn-Not for Vduntary Assessments Roperty Address ---------------- Ow ner 4�,©�E } inforrretion is QN nees Mane page. d requiredfor every page. C /Town (T Zp Code Da*of irm C. Checklist Check if the fdlowing have been done. You must ind cafe • •yes, or no as to each of the wrx: Yes No Pumping information was provided by t owner occupant, or Board of Health Were any of the system com Y ponents pumped out in the previous two weeks? Has-the system received nomtal Ao ws in the previous.two week period? . 0 Have large vdumes of water been introduced to the system recently or as part of this, 71 Were as built plan s'�the system' aired and examined?((if they mere not available rye as fV WA) k3 tit T t E SiZETc Was the Wlity or>. dwelling inspected for signs of sewage back up? Was the site inspected tix,signs'of breakout? (] Were all system components ,tom g' located on site? Were the se pc tank mahhdes.uncovered' opened. and the.interior of the tank inspected the c ondition of the baflles or tees,' at of constnrction, dmensioris,depth of Crquid depth of sludge acid depth of sctini? - p Was'the facility owner(and occupants ' infomiabon.on the if different from owner)provided with propel:"mRjntenarice of subsurface lI sewage dispose systems? r The size and IOcat on otthe a Abso { on System(3�4S) on the site has been iktermned based on: 't�ii�pS Pe �-T►u n) Existing rntarmation for example,a plan at the Board of HealtFi �►%e 10�s '�,J �� -i o Determined in the field d k Ed s su2�eY 0 ( any of the iarture criteria related,to Part.C is at issue approximation of stance is tmacceptabte)[310 CMR 1'S':302 f5}? D. System tnfarnation do' Flow Conditions` `" rnber4vf bed rooms(designy Number of'bedroamnis(actin 7 �SIGN,ibw•based".on 310 CMR 15'2a3(ibr scalrtple:1'1Q gpd x#of bedioarms): lv l9is�3H3 - ` 7beS�ofylasp�Fartc Su4v+feoe-SewgeDtspoa�S�sBam-:Paga8of.17 Commonwealth of Massachusetts T'ite 5 Official Lnscion ? - Subsurface Sewage � � - �®� s °� System Fom- ot:11or Voluntary Assessmerrts Property Address ONner Qvra's r4 me inforrrojon is reWked for every tare• Fn K a IiD Code Ddte of tispection IC D. System Information . Description: AA t,l'. 4,,� s P 4tl �t �=JS GvrCt-tgiJ'CcJwG�y . Aa4 D 2e-jn,, St 9 K} a.3 SC. Number of current residents: Does residence Crave a Barba grinder? Is laundry on a separate se stem? i. ❑. Yes ,� No information in this.report.j a sy ( xlude laundry system inspection ❑ Yes If 'No: Laundry system inspected?' . . Seasonal-use? G ❑ Yes•® No /, Yes.rff No Water metier readings, if available Deta;l: (last 2-yearstriage(gpd))Zia tA s Sump pxnp� C7 Yes No, Last date of occupancy: z al/�� . gate N/A Comm erciaYindtistrial'Fiow Condlttons: Type of Es ent Design Aow(based'on 31 R Basis of design how• cars pe[ f (se persoris/sq; -. Cease tree Present? ,. ❑: Yes: ❑ Nm hn ukrral waste holding tank present? ! . Yes.❑ No.+ te'drsd�arged to nie Tide 5 system? Yes CI No Wye meter readtttgs available:' Twe3 :6pWrwFam'b dXWaw SSVA p,OWP=A syMM- Pegg 7oftT 41 Cornmonweafth of Massachuseffs .11 ' Title 5 Off al nspecti.oh ,Fob `. , n Subsurface Sev�rage Dtsposat 3ysbenr Form-N�fnrVolurrtary Assessments Ntb.�jjc - k R'ePertvAddre is . Qarrw ��.rLol cz nforrretion is Owner's Marne requiedforevery 4 -t c-r PW �ytfawn V-4__ 3 S— G� 2l-- l 7 S�6e Zip Code Date of hspection D. System information'"(cor upar cY use: ; Sher(describe below): D W General infonriatton a Pumping Records Source of infior aUon � r Was system pumped as pit of fhe inspection?` fl ,,, ❑ Yes No tf Yes, wlume pumped: How was"qu*4 rptxnp determined? molar' Reas on for pumpi ng: Type of System: "0 Septic tactic, digtribtffion bok.Sal ab.Sorption System s r Six, e cesspool' OverAAow cesspo y 0` Priyy VV . shares system(yes a. � .. no}(ifs,attach pr+ewous�p�t�on rec:oros �f anyj - Q'` �elAttnve w: r mac enance ntiract Attach a Py of the current b ecation and co (to'be obtained from system owner}'and a copy of fatesf 1fisperfian:of t1�e VA systerrr by syst�n b urxler:c�tr Q. Trot tatdc.`"Attach a cW_ofthe M-P aWoVWL o V964cbe� pOc�fiFam[Subaut8oi3sr�e�WR�Sy�ent•p8o(17 4 f Con monweidth Of 1�9assachusetts' . Title 5 Official'. Ins ectiort - Subsurtace Sewage O n� 9 Disposal System Form-Not for Voluntary Assessments RopertVAddre;s Owner � r> _ nformation is Ow ner's Name feQukW for every Me- /Town O 3 S 1 t>—Z l- 1 7 Zip Code 4, D. System Wbrmatiot, co owe Approximate age of all componefrts, date insfalled(f known)and source of inrmation: t LS t�•zo 60r;J,uIX_ fL` Wen=sewage odors detected when arriving at the site? Q Yes No Building Sewer pocate on site plan): Depth below graders feet Material,of construction: cast iron ❑ 40 PVC ❑ darer(exphn): Distance from private water supply well orsuctlon fine: "ta``�^( `J> L S tL. 's fs� feet It B a p Comments(on condition of joints'venting, evf age. etc.):alc , • ,. Se" Tank(tocate on site plan}:, A Depth ow grade: Y • few J . Material:of tcuctionc COe 0 metal ❑ fiberglass- ' E7 Polyhyrene Q-------------- (explain) If tank is metal, list age .• , yam. 10 b age coffiimed<try:a<Certificate of Compliance?(attach-a c�pY Rate) Q Yes E.1 Pb Dimensions: . Sludge depth Ift-7.13 nnesa lb"P- tFwm S Sewe9e0ftpoaalS*Mm• g0Sot97 Commonwealth of Massachusetts " Title 5. Official ins ection Foy Snbsn dace Sewage Disposal System Form_Not tor Voluntary Assessments RopertyAddr � i rJ �- r ON rter ow mars(Y•arra �forrrebon is • _ required for every TL)t C— - 2t Pam• /Town Zv Go—de Date of hspecUm D. System Information (cont) WA-SepticTank(cont.) • ,'� Distanc top of sludge to bottom Of outlet tee or baffle i ScUrri thickness Distance from top of scu to top of outlet tee or baffle Distance from bottom of scum t om of outlet tee or baffle ^' . How were dmensionse'nnined?Comments " (on FurriPing recormrnendatioms, d outlet tee or baffle condition, structu`al integiity, iiclsd levels as related to outlet invest,eNderice of le e, etc.): AJ/!fr Grease Trap(locate on site plan). IDWh grade: Material of construch ❑ concrete ❑ metal , 01 fiberglass ❑ Pgty +tene, C7 other(explain). Dimensions: ^ y ' Distance front top of scorn top of outlet tee, ee or baffle. Distance from bottom of scum to:bottom of outfet tee or tiafAe, Date of last;pumpingDaft ` tsn..ohs, " Ti11�50tlfusi hepadSmFarta Subxrraee Sawp�Dispoe�t SyeO�m•Pap,1od.:17 Commonwealth o€Massachusetts ' . Tate �` � - 5 off't c t Inspection .Foam Subsurface Sewage Disposal SYstem,Form-Not for Voluntary Assess'rrerds w a �oRer iyAddreas Owner Q W__8 lVne A.¢p7,4 e= t required for every tt— VtA ' K Pam• oCtyrrowrt - !J z G3 S Zip Cie Dabs w mPecWn D. System tnfol•mation (pbr .) u Comm eats - , �Q liquid. (on pimping recommerxlations, inlet and outlet.tee bafffe condition, structural'Integ , 4 Wasted#o outer intaert, evidence of leakage, etc.): "t -------------- - y ; N/q Tight or Holding Tank(tank must be,pumped at tie of inspection)(locate on site plan): . owt Y grade: , Material trtictian ❑ concrete ❑ metal p ass ❑ PY� f?Y lerte Q other(explain)'. Dimensions: ------------ Capacity: _ . Design Flow Per day Alarm present: K `Alarm level` Alarm in worl6n9 era Yes p ` !late of last pw►rping: Commas{condition of alarrir and boat switches tea r etc.}, , .fir .._ .. - :.-: .• ._... -. - *Aftactizopy of current pum (per+gyp (� .. .o ph 'correct{req�red). 13 • •O f. •*. , Cl`.Yes' am-M3 . y [ T(9a50tRa0 hrtse6an Fom�51+ aw:Sewapi.Di spWM-Page It d 17 µ Commonwealth of MassacHusetts 4 Title 5 Official 'Inspection Form . , subsurface Sewage 9 Disposal Systiem form-Not fbr Voluntary As aocenyAdd►ess owner Ow Wonraton is required for every t tJ c-c— G S f Page. State Zip Code Owe of mspecUort II .System Ink'mation..(co.nQ N/,q Distributlon Iox (f present must be'opened)(locate on site plan): Depth quid level above outlet invert Comments( if box is level and distribution.to outlets equal, any evidence of solids canyover,any evidence of le zl a irrto or out of box, etc.): WA Pump chamber(1owe on site plan): Pumps in ing order es Arms in work ing`ord ` C7 Yes Canments (rrote:cortdrtion of` chamber, condition. _• pumps and appurtenances, etc.y M •if purnps or alarms are not in vmrking,order, system is a coridrtr ortal:pass. SoilAbsorption§yseem ($ASj(lo on srt cavafion not re . .qui red). If SAS.not located;explain: ►Y= s LoG, Tt t7 , � ��A60 am l ►.r tSris•3H3 R { F TiMSalieA isOxiOnFumt 5 Sim•Pape Y2 d 17 tl'mo fltYl/@afth Of onswimsetts. ifs 5 ji T anspecfo rrtace s®t m ftni- t vauhw jy, khhnftn a gem a fwmR fequwforevey G �tA VMS- �Qown �IZ3 iT p2,� �'Z(- I rT y - Z�►Gbde - {�ls cf hsPecltan D. System Inf+ rraa {cow.} R • ypec 9 dumbeis r des mnbw,_ten gh g fields . runbear,d Mwwjom: ' ,. 7r°� � �o�rar oesspods ,r� co t•��-�,r�irs� �� .. g - Commwb We conAbn ve!gllgftn,ft4 "(44) 89 U(.*Onf hY&a&fahm, rgal of t=v►kc c>�1 t�.i� SCRe3c �y7A11�( } compl 018 i #le/tTE c��� ��p )ilol:a8 Orf sit@ =bw amid 9u l �: -tP kqud tot ttVert Depth of stwrtit*or ef Ic of. /Uvt✓DED/�E�'".L/r4 TZ" 4`�a/.�' �� `� ul -� ee ' `A Of CMgnftmc. 'H „►( 4^ out:[a i t+2r�vY :9►,3, t." 13 Yes Common reaUh of usefts' T t1e 5 at Ins, . Fob surface Sj► am Form-Fft forybium y waffmftis awe r�art,e torevery . � Gcs���r- • : . . - PM& c rlToarn (T2,2;35 .10- 2 i- 17. - ZO Code Ottba d D. System In=VINlion (cod) Typec i g pfts tusmtier. El rriber a ,abwtaes R , s fields dm mxnber +ea Tie of technology: Commers(not Win,etc.ksn +c blurs, Of of p�r�a�ng, cunF �on of QOL,S r t 1-44n ` C—t' St�t1Q-�4LL w y ftpecion) 8 on a te.OWY , : .hluriber aid configunn T 60 AA)Dqgh t :. (3f to -----�- sods jjyw D�tR at Scun 1w1w ± .T ;of cesspool��s�u�c�• � „ l / A� �W`lii(/it9rYdr in of gronr er11111,11M -i .rgf3 IIes _l�'" TfttS�itltl h WC tF.. ft" .SMM-P=*13 d 47. Conunonwealth of uses Title 5 ia1 Ins s 16ce sew f . ctio 1 FOB Not ftfm for Vdu ftfy Asse$emmfts parry p it torevey pop- �brblown35 (©- 21- 17 lls U. S In . fi {corgi.) q.- Types tellies Q . 9 des nmbw,fen , " n�iwt+ terra ie sys TYP*Imnre e oftocivig(gf► n. tc.e a f_ taure, wai of pon�ng, • n��b k �J fin¢.) • �,n�r,� n of y �-1 aT{casaE'°� f }(bcade Qnr sft , l Of W*ftr�jjjft� 'I lonsicm, ; nth of sCcari(ayes � • of _e �i d a .,H ?z" 8'%m•.v- c.l ,y, ' ,�r„T of it ft' v 4 No WW-W13 a v T SpSrty�sP�efonFbr� � Ste.fte13CU7 COM=fP&O r of Title � �� y of - 5 0 S ectt ice see�g;, ,, n Form RaFe�hAfOquhdddreas tar every WTown D. System In _ or , («ont) Type > g number%aft l s ►ber - gaff r number, 9 tomes tkanber, t 01 oVergo�r - dm�enslorffi. " pools cod Ie�-4,�,rs number ' •0 imae�emahve . TYFe of techioo� con Vegetation,Cmnwft ek j r. mire, of wn t3 �LL.��4••�T GESS��soL.s .f�U t9x XtQmv-AA,u die( o v -& sAt9 )(dare wale p;tink Number and Cond 91twon Depth top Of kod t6 E evert % r of ode d%a: 2¢gibl4 OWNCcshG�lt�✓ ��-ij c j•it . hffcaft of 13M•W13 n Yes r 7ft5 taPM;*MFaia 13d:Tr Commorwealh ofnw8adiusetts. „ Title 5 I . 10toection Fbfvn for Vdumfy, Ckim Wameft ecw kerns warn see U2�3S (O— Z1..,C,7 U. UYSI il'1 inforilatj r _ 11 corgi.�� � iia ocae , D�a at�Di � } _ 'ryPe: kmwmg Pft n�xr,ber , 0 --- 9&Onbers rxanb� d `Q saner number ❑ wwtng#reriches ► tber,iengtb; ❑ g Idds -t d comermions . munber. 8 0 � emative i . TyPeFname ofitechn 41*r , . Gcmmeft(note n ;• , ' - v89 on,etc. C-�Y f �Ietiei of}xmdn /�t-L tla t-tT GE' SS�?oota5 t�U v+�I t Gi STt;'tsL 1 U Y LtGa`LL . Y Co=paqfi s{ass r W be {tocate on s • . . <<�����s• ,;� ate�� . . . umber Ltd con; 9' w2�e✓ tOP of kud to mart (1 Z -Up44 @ 6 t •. AV, t�tn a�sa�ds --•- . ofsdidz 444 t3�1 t$'"D„g c, i .,r. y ` �► of nd�ter�mtbyv R '� ❑ flit , MW— nsNo 1VU50MMh4XCftFana' Sin•pme act 17 ConlMonvoillaftof gets { Title al :ins .� peotico o 8"=T& e UMP MPOW g"Wm ftm-!ft forYdtMFy.4sae Qv mom �►/,roYtrn '� c7ZtP'aS [o- Zl- l'7 D. S ztp cocas owe at haaecctlan y8�@m � RNTIN } (coni) Type: 0 o Pft 0 kwtmg dambers ; 0 91�e +mintier, mm.bw,,hmgft MEOW.cigmen": nLnnber s. Q emshe Wsi TYPeftne of tello�r e C f 1 hY� c fare,level of " �, v soil, ron.o! 'e jDLIG�LL t;+ Y $(CeS$p0pl m( �LFSS/4/Q yy))� %ER ofi ir�pan){ e on site Plan): Number a w:conj gulsom ° ' ��- ► ,b t two j d►� �bot � ` 6 F, nth Of scum.layer. .oftpOl�s,a( gyp' a•_ ' `. da ,., t���r/�«ass s� zz`x���• Of r o puny of i �sns Q Yam' . Mo Tf�50t�d 4sspefw►Faas afta{aeas-o Sybm,pjl 13 of rn, Conatfom�ea { USORB Title 5 - n� e � »ft* Foy FvM,-fft IwVd ,► WMMSDn breq* MA �.35 - aforevey rr 10�ly6tOwe. �rz� ZA- l 7 D. System In fi {corgi) I . - &RMa , Types d + ❑ 9Pits ❑ feacting s number ❑ 9 Wedes number Dnumbw w ' Wgft • g fteids rwrn�r dm�sions: . 's) number nano afi„a Ty0ow_nrs of tedind r v Commwft(note conAjon qf sat ,. hen,etc. (-Lv W -nhY fi ae: ei cf Acn�9,damp sal coo pf • $t Aor [�t � mud t�&mber and co ('ov, 4t �� �Ja -ems g it Kok• ►Scwi k' d`t0 k t 1 C5 (}wol !!T -go Of ca3sspoot«tee a�ra � y 3•f" /fj''d+aC'„ZiS,Ri,7 re? of grc LmdwoaW D Yes hQp* ,. � T rSOlitttl'�spp Faaz g 3SPbm•PassV-dI7' 6 Coninwriwat Rh of $fturface so=W Chi gl► m Some-Mat for Vduftry Assam calm °"►Mft W 4Y/fown C�iZs iT A c7Z 3S (O— -Z(— lUa 7 U' U"It n In (corgi.) w a"ft TYPpV. i+ •. yr Q number 0lewtfnil Viers number - Q 9 number . $des Mrdw- length. Q 9 Qds ' _ � �no�t'rvati+rs$cistern . TYPOku.n.e ofUdhn 3toW. CbM w Sts on, e c Q �, .k C'� J n fare. �ei of po�cng, riP sal, n of Yf` )[PoWe an! n 8ft'l� umber'and Co igur 6e1 ile'to h—,gip mid to kft mve E 0001�0 sods - ofCesspool, h?si tie off•' . h , Mawtift fCOM o CommonweaMi of Wimchusetts Title 5 cal I`ns ection* i`orm Subsurface Se r Sewage Disposal stem_Form._Not fdot . �r Voluntary Assessments �� � ,� gyp-.- • � • RW—"Address ON ner ow fser's Name �for"now is T required for every wi- 006 3 f !U =21 t 7 �• G1j/lfOW n �t .aiatC ZQ COd@ t Qa<e Of hspecbon D. System Information(conQ ALL 8) - Comments( •on of soil, s" of dr c failure to eta of pannq, cctiort of etation s PAS ) Ge '' r� rz j A111-PrZiVq,(t on site plan): , Materials of constrixxiori: Dimensions De th'of solids Comments(note condition of soil,"`signs of hydraulic failure, l etc.): evel ding, condition of vegetation, a .=-..wr.-.e...-.+a..f 'fin•--.e..r..—an... ...+mr-....n-...r.. . .' _ i '. -' 4 GM-3M3' rct5ofxW6,spW§MFam&ftdawSjVMVUi ow;4�0m,•Pape7401I COmmonw 4 ,} eat of ,sachusetfis Title 5 jciel Ins scti subsurface Sewage r Qn QrM, System form Prot trVdutary Asaessmoft ' L totj' .. • ��� Q211 QvfW 1Rt feqL*W - t"ev" L-C Mrs oz� D. System inTor" -a (nor .) sma� , zQ Doeof Sketch Of Sewage Dispo�Sy, at two. stem: Provide a view of the Wheie p saner nd4erice ka dmaiks or berx na lcs Lssca#, a 1 system 0 teA. Eo�e P eaters the build n9 Check cne of the boxes b�cror ' af>artd�tetdt in the area bdow - - t 9 d sep$rat y V*,i 5 S , z.. 1t. 5 t - zZZ .a ` A - 3 31, �' t 3. ip•Z' Z= .�7 t �.0''6 _�> 21.5' ,,r B- t7. S 8s.� - t5 3- ¢- y Pk' 7U!'S }� imFC[nt Spa.POP iS d IT i r 3 Commonwealth of Massachusetts' Title 5 Official inspection Form subsurface Sewage Disposal stem Form Plot SY for Vol untary As .sessm � eats RAW Property Address Owner Wonra4on's Owner's Name ) reWkWforevery page. Lay!Ipwn 1 • She 'Zip ode t7ate of hspection - - D. System information (cor .j'` Sketch Of Sew r r. age Disposal System Provide a view of the sewage disposal system; including tiesito ax least two p�rnaner>t reference landmarks benchmarks. Locate all wells within 1U0 feet. Locate where public wader supply enters the bulkfi n9-:Check one of the bones belowr hand-sketch In the area below � 'drawin rat - SZ, B. INA i .uN e i tvf�IEEE `T' T4e50rfiueF68peermnFamc a~—Sep%epis OW 8pem•Pegs 15ar17 " 4_ Common tt�t vg@ttg ' E Id `� e e 10 AA, _ ce, t m Form- br vagary Assess, PMPortyAddrce h >�c � awi�ers t t-c--. lit - D. SYst N #aet caode Date ar te�mceon . tom.) . sfb exams Check�e [ Surface w . calk c `-�Y Shallow w Estimated .. ; depth to high gmund Tv feetL ' P used to the t�Sid rimer ede�icm Q Obtained fan system deli plans on record ' . I checloK date of de�' re ieaned } I spa s�{�� � li f�ly MA k•�i lobservatioi�We'within 15D feet"of } Checked with�! d of P� ; Fitt-e�k t a� tcccrZsd.13 ,v£ Checked why . ems (eft dwmerdWT) Accessed uSGs $-_. 4¢,Aviss, -�.- P � ' �u M uu mu �ixibety wed , ft high ground Wojer elev�on Pvois' 1S 1aip- { k ` TfNStffidQ iaQeeEo22 nFarA[ : 20 _ Commonwealth of Nlassachtiset#s Title 5 officlrM al ins` ection Subsurface Se wag sposat System Form Not for Voluntary Assessm is Property Address � MA t Owner :rnfomifion is avners Ptarre . requh4forevery C-oZ c3 iT page- Cdy/Town State . '7 �.- Zip Code ,'. , Data of hspectiart E: Report Co ffq). teness Checklist P Inspection Summary:A, B, C, D,.or E checked Inspection Summary D(System t=allure C►iteria A ppticabte to Alf Systems)completed E System y lnlbffnation=Estim�erl depth to Ngti grouiidwater Sketch of Sewage Disposal System either drawn on Page 15 or attached in separate fife s OM—M3 tft.5 DWP-i.iFamt&,ba ffaw Sqj%& lspmal Syssem •Page 17 of,TT 0.1 t, Citizen Request Management Request ID: 21891 Created: 06/11/2008 15:14:46 Status: Assigned To Staff Assigned To: Stanton, David Health Office NAAnonymous: Yes Category: Article X - Food : Illegal Operations E.C. Date: 07/01/2008 Created By: Stanton, David Citations: Health Office Time Worked: 4.00 Response Time: 2.00 Request Location: Cotuit Jellies and Jam 809 MAIN STREET(COTUIT) Cotuit, Ma 02635 k. Parcel Number: Map: 035 Block: 067 Lot: 000 Request: Sign says it sells Jams and Jellies, no food permit Request Work History: Entered on 06/11/2008 15:30:47 DS went to said location on several occasions to confirm if the sign matched the business. One day a man answered door and confirmed it, said his mom makes the jam. DS explained it would need a food permit and DS would mail info. On 6/11/08 DS mailed info about getting a permit. Entered on 06/30/2008 15:30:04 Jayne of 19 Ocean View Ave in Cotuit called and left message that she is upset with Health Depts decision and that she has been buying jams from them for 35 years now. Entered on 06/30/2008 15:31:36 DS went back to said location on 6/30/08 to see why they had not registered yet. The gentleman stated they were discontinuing the jam production and sales as it is not worth it with all the regulations. No further action required. i PROJECI Ail r CCT 15 2018 F-v,031:40 CENTRAL CAPE CONSTRUCTION COMPANY, INC. 820 MAIN STREET COTUIT, MA 02635 All , W cam... a _ l ...s c,�.::.,. �G�,f�'tai.�"`. �tS U�-,,..ty � �I ��� f,.•.�� I l 9.i"'• � ° sj`''. _ y�q ♦ I Fc ......._;.,.... i�� aw.•,ua e�r•+��,mfmw: � � ;iy„� I .� � 9g �'`',�i" / 3f E h x { 1... F.f , '.. .-.. .. -p ,x.S..',v :' r •. �. f : ._ .. $ i§ .,:n�-...,Y.S.._.-..,...,...."„4,'..t_ /Ir6,"4. l- (J • L r .nMN+weW w n con ftcft I � '.�.....4 ..—y,-.,,... -.. ... _ -. �+.^» a.'. _ s... . __ .�:_4 � 3.7 .r#,,,z ,a t' ma`s,.. ♦-:��r�'.,„a ':�',�.. _.t"^�...,�. .».e k 9 u C n co "n Inc* i 0 DAT QfAUitPI - � u �..?7. ..r_3 1 '�i2� t MA>�«_.- _...,..•.....,.- .»....:...1_...✓. , s'f - "�.. '.A i ry l.,At .' •: ` A� ( ..--•-.""' ...,.z.--"""'s""'.v.*�. `'"^.....-� -^• � �-;—•-- Ste, �� .:�... � �r'�"�'�� it m **-� .�._."_-•�'t i -. �,,. t ti §.G. � "'y"x'Y" ( i 7 1- __ �1.:.... j i4` �' •� 3. a S�`�..»-w_. � .d....�:.:� � � ,. �.....,.h-..+,,....�£..................:......�_..i.:....��4.�,y�'p ii y } i q• qFe; -.....�.r_._ } ;_i S Iii!•--q-- ]•• { S i ��-�-{-_ a Y S '�,A}},�. �y J' - A k "1 � ' f�l �i � f t F S --a.� t�.n;. �! j _.`.� :.•.�..� ! t Je E ;�.��"�V�• T,a.��Sf� ;A y t.t.t� � � e• � 7 f 3 _. } 1 FY_..,:. .' i ••. r -°" tzE�'$.Si�� Fi Sty #'. SFCQ 14 COY -. t CA. Otv}� t` w i. ------Central Constrwflon Company, I y820 MAIP StrOat a Catult.MA $08,420-1,340 t?bt0o; F. CHECK A'- DRAWN -M _y. g , 4 _p 1 pp ,� 9 Y 3 ..........it t e • t# x t } i 1 i j T x � ii4 it r = # Ci VAa 31 t 4 $fir � r �wsss gE p' Oil .: 4 Lit WNW 9 Qa _ PROJECT T'ITLE r •.. ., j 5 C Ngtwtrt (` r ,}f RAP Svax.r �W t c c tw.._� _ toe tm � p i mVr .......,.�.._..__. LET t Is , v f — 1. .a«+wrt.,+w_n.e...e«.,www_«+.41ur �.ri�+iVtv,..nvuw�n:�.4.,✓+ "�-���� _ �° . ( t'FFIARED _ �i Vitt •^yy = f/ }.AI i; y ...._ _ y. Y tral Construdion Company, Inc. Cep 820 Main street.a C,,Dtudt;MA- 8-420.1340 . .:-mow..+...e•,w'" }� .»o....,:m .. - SCALE � n r ff t- o w� ,. DRAWNDESIGN CHEC .. ., .. ._ ,. ._ _._...�._ A i s { i f � Y r' 1 a j}...�.s..�,•,. y�`�Off`. 71"j y e { 'ITT ;J y I ' f kit 117L TE k 1 f y1yy y � y�t tv !( fd[t � I y r Al Lis irk cS C7 i� 1 ? r „ I` Oil, a .� T ij .115 F 5� 4 . � � �r'.?:... _ ��r+�• ' tea s. k �_ }�� . f a sx N t z � A k r i I a n ' i #� i P ]4 CR $. 3 r�7 t t t r3ia�#i e �. � ,•'a '� �� �� �� i ����Cf l3 r �1 S i i k.. t 4 x p{ k ! a F K10JECT TITLE .e-t�s '-...._ _.. Wc K� _ - ............................ u, �A ........... I - '. - --- f � 3 w .:..:. � ,cad .M'F- ex�f` ["4:' N K i.F• xs ' '+.^,.•- sum .. tt m _ S ^• V. Ale 55 9 Cff FFF9F[ t i L , §S�+ f: trfJa(� t' s !1 0 } ,I Rio �I � € EP „ F�— �,��� �',� �:; �$ ; ' > ,m � . k {ig i - I f r} �(# r}&$r�•y { j - 1F. F .. . ; fill l l ( - 4p u' " ;t FI: ,s� to t [i; [ a:% r e en 1 1 , ., �,Lit"' t s :`` is jj fr..,.,.,®.V C ���G.. j Hill '�.' ittF4s f �k t ,p p 4 3> ` ill I 4 fed ii$ N v�' '€1!3 � a� , JsAmVdhsgAl 820 main.'st et.C Jtuit,iA•S06 420-i UID SGALE DATE DWG NO, DESIGN e JOB NO. � I SHFX " OF 1 {' t t E 3' r I { ._x 3 -x ' e PROJECT TITLE r . - { i ...^..,., ........ 1( _ ... � .. ...r_ ...I. _x3^.��.cs�.ti—r..,:,o��.r ..-sx-,..rK..,«.,-....,.•a--.•-..._...�..�.,...,.«.�, .. .... ..._ .. .. � �.. �_F ..,w:..:.........�+-.:..xro-+w,..^«.......«,_...........w...,._ 3 1 I f+� T T'F tr��'i��ryry j�@@��• y+f��y 5?'S\ I tf t i IY is tom, r co- Central company, Inca Sieve DO-Win President c 1 ` f h �I t � ° �_.._ ,..: Sy ".,. , : >.. 4..,:.•._ ?: .,. 'A ? ,., _ �#3 M41" tMet°Cofult, 40 � �..rr��li:ua���wt���rasci#�sn�r��g��tt,ca�r•� • -Website: SCALE e TE DEStGN T PROJECT TITLE ` IT i Steve Devlin-F°.reead / i2.�i_,..�_,..,._�,..,..._�._.....r......._....._....�m..._._...w.......,_._:j C°��fi��1�P,.� 3'&$��#`4$#.�8►1.lat6itl f C IP SCAU y` }$ -....�..... ,_.._-_..,.-..._-.-.. .._.._:_ ....,,.,.,,,....,.p,,, .-.r.....��s.� .«� ""'y'�' .....«.,.... . VK, L�.A p W� �`-S•......�'�`..:�.......�......�.......�._..... .ae.....,._..�..- �.. .F w. :.�....�.�.«.�....,......".a.'.9 l DWG NO, 'DESIGN" a 11 ... '• F7R, `. FIn t s � �... _.... ...- _ ...._.. ... '1.�-t$¢ 'P'>'t€ -a -`63�' a Centmi _ S l s ' Inc® Sleve De gg ....,._.....a.,.,,.. ,..,.,:.w......-.>,..,.,Tr ....�._.: ti......4 ............ ...K.. "- a 49 C 9 (�iU 811, Grattan.MA» 8-420.1340. Wobcits,w . ratralcapec ,ostrajrtion.tom SCA,Lkl w DESK CHECK t 4 1 F � ( 3 1 27 vi L PA RED a P 4' ti lw.:„..,�,...��16._�-�,d�..;w�°� �'����- ���? �� �� � _ .� a-rnaDt;ceaitraacevnettuCkdo nco(mDimall,C Om websitG;r +;v. sgr Dc a �a�trta�t#on:c� m > LE CA DATE TT( JOWG No, DESIGN DRAWN I R C I Y t h T PROJECT TITLE Ile It PFPAf?E' Pon Central Con*uction Company, Inc* COtUit,MA.•608-420-1340 SCALE DATE DwG NO, DEStGN ECK DRAWN • itV��.�st�3'v� sytr ..0 j Z� 9 won - lu w�OipJ -.• da anr�sl6 V• ,. _.. att�u FF 1 ` 04+ 'l t^t0flS ,_t2, ,L. q'- f�A..�1 .�... . µ ,Gtt <" .-�5.2'k! {'Lap14 .. ..:_ ..,. mab PREPA RED FOR z p 1 -. .� �^ :1;. ----�-- —!-•=' �!_...-.a-_.1 �t` _ `'t� ,t�,b�..,�i.;,.,.L�i�.h-Q_of!vi).1�1'�� Centra ! Inc, cantmicuistnictlanouearnso.earn TE �- IDWG NO, �.. . DMON DRAWN PROJECT TITLE �� �6� r ,��►err_ � �;�.�.. ss { rL LA .... _. 22, "'- • � � 1�°1.�rx a �" i i t s;sa #�AfW FI FOR i+ y °=r �2 G � S a✓ a 7- � .i��. COW con*ucrl on cmpany 7 - n , Inc. ,' —___ R, h 0 r• �1 vita�al�ea a 00guit;MA+ 8-420-1 d0 o"M.aall; taflr�ls aro�3raac;3 aa�y �N. website: .c rat ael a� sa i�a�u 8c�?a, ra it —_L-�,�. SCALE ,.�- .— . DATE �, L` ._. ..1 e.. DWG NO,�a�. . Wf44 Wf jig 3 bf � • o1s m� _.r r ',ZL Sp t e a � i i O r 7 1 `k- y 0 �{ Li t s { s f r !� � + _r �Y_„_,._.,,,_.►-----"""' � \ ;. .....�.., =tee..-__.._.����.: �. ¢..5.,..-.,�;�,` t'�;. } PROJECT TITLE Con*udon Comp" 'I Inca All 820 Main Stf&W b Gatuit,MA s 8420-1 (.) �t jarl9:���rsi9c�11strrac8lasegsr►iall. ry . `` �'��SA�i3�1;�,►.�v.az�arttPxadc�l��C,d�r`}�#f���ti�rr.�.�easa SCALD �� # _Pr�` .. .._ r ow PREPARED -FOR 1 i t it ! I A , e � F � ..,:. 7 : a - Inc. Sieve Deviin-Pre lident - v 820 Main &qoi.Sabtult, »4a0.,1343 IL I, ,-i SCALE _a C-1 of i IV4G"_�'Cad- 4F_0_U1 A 94. 4 14 =° A V . DATE 9 JDWG NO. DESMN DRAWN L ip ti w I-) S L a s.uc cyl, FT i z �I� LW F F4. F•, F'ti �I f i6 i � 7 �� i LJ- f 1.. - ,x�ud - 3 c �1•cr ",:.�1,-' tit � :. !. —_F-�:�_ _ ,. k � � �� (i- .�m.w.�r.=++��wea�ew•.--^. 11 ` M , � c . e _ I { j q % e � 4 # 1� � - € ti ( ,i I a � ��• ...�4T1 _ _.R.CJ�ft�'_ - f � � i, a _ � � i � •, �' �I �{x � 3 � � tf � ��_� � t ��.�.�. ii � t. I � ait ' Z y �e�7f[�.i;.�x � } , n. �,,,'. ���. � �g f✓ �. f. �'s 4 �6 I; ��$ ...,..x F £ '. 6 E- EEE flll_ FFF r Y i F »„.....-,. _ :� fy , =f r __."'---•^�".,':'..�:..,,���.._,..� I � � � _+ 37 a 1� _ e3 1 � �. �i I i 411I a I � + ' � � '- j��' it _ -• ��}. �1� _{_ � - �, � (., _,NG4v..It�v-,�'gt.(`,!�:_..��v.�:.:dJ'�:.R-,� 7,ex _.-.-- --.•3�___�. i! F��;9� '1 �!_ .�< <1 Ott — � � iI 8! � t`� �i� t _ - .._,...r,.�—.�I .v���.._:....:.,.._„ „ ,».._�. r-�-r� ,....., -� `3 ,a, e�_ it n# t # � _ - _-,:.,.•�-h..-...... ,- � ....._,...uy-.. i 9 _ emu L k M H