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HomeMy WebLinkAbout0576 MARINER CIRCLE - Health 16 Mariner Circle? 024-099 Cotuit I Lot 80 A/ SME:A No. 153L UPC 10330 HASTINGS,BAN y�z �o- I I 1. N �z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner . Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important: fillingng out A. General Information out forms on the computer, N`\ �'jH OF rgss,''�i use only the tab 1. Inspector •9�,''�. key to move your cursor-do not JA M ES James D.Sears •,m use the return Name of Inspector - -i- key. ;*: :co Z CapewideEnterprises,LLC :*Sr 1�--V Company Name %%,ter c� N�O` 153Commercial St. °'' 'iNi Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-22-13 nspector's 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. t5ins•3113 Tide 5 Form:SubsuAaoe Sewage Disposal System•Page I of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page, cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y, N, ND)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 exflltration 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. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3h3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts vim Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name require for Cotuit MA 02635 8-22-13 required for every page. cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well•. Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 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 El ® Liquid depth in compW is less than 6"below invert or available volume is less than%day flow t5ins•3113 Title 5 Official Nspection Form.Subsurface Sewage Disposal system•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown State Zip Code Date of Inspedion B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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 101000 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 regional office of the Department. t5ins•3/13 Title 5 official trispection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owners Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurtac a Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is Cotuit MA 02635 8-22-13 required for every - page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal.tank D.Box and pit. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2011-38,000Gals 2012-40,000Gal's Detail Sump pump? Yes No Last date of occupancy: Present Date 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: t5irts-3113 Title 5 official Iropeotion Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J�. 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: 11-14-11 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 ❑ Privy ❑ Shared system (yes or no)(f yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3M3 'Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `t 576 Mariner Cir. Property Address Lois Skinner Owner owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 1980 Permit #80-539/New D Box 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"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.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: "181, 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: 1000 Gal. Precast Sludge depth: 1" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official a nsp ection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1,t 81, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level w/out let tee. Tank at 18"below grade w/both cover's at 5". No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: rest 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 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: P Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is new. D Box 16"x16"-2', Below grade w/cover at 4", one line out. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments(note condition of pump 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: t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: El overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is one 1000 Gal.Precast Pit. Pit at 26"below grade w/cover at 5". 6"water in pit w/stain line at 18". No sign of over loading or solid carry over. 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 t5ins•W 3 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Pommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 576 Mariner Cir. Property Address Lois Skinner Owner owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityfrown State Zip Code Date of Inspedion D. System Information (cunt.) 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 REAR 33 ' ° e R4 = i ❑ 03 t5ins•3113 TiNe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °f 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is Cotuit MA 02635 8-22-13 required for every i page. City crown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N Estimated depth to igh ground water: 12'+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: 11-5-79 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: You must describe how you established the high ground water elevation: T.H.on design plan 11-5-79 no G.W. at 12'+. Bottom of pit at 9'. Bottom of pit at 3'+above T.H. depth. Before filing this inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Tide 5 Official Irupection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ye 576 Mariner Cir. Property Address Lois Skinner Owner Owner's Name information is required for every Cotuit MA 02635 8-22-13 page. Cityrrown 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 c System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tsins-3113 rile 5 official Inspection Form:Subsurface Sewage Disposal system-Page 17 of 17 No.Vv Fee d d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.5A. &4A&0J6V_% Ott V_C.L�C_ Owner's Name,Address,and Tel.No. GtOTVcT L015 Sr_[ic oep,� Assessor'sMap/Parcel oa M MW L GtP_C,( C— CZ UL'� Installer's Name,Address,and Tel.No. 5462-471—SS11 Designer's Name,Address,and Tel.No. CAjP5_ce.,,tC)G —CJTCW: 4jSjn L( .- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) R Q?L4Ck-_- D-60K A r- D C•l'95 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Sign Date Application Approved by Date Lo Application Disapproved by Date for the following reasons Permit Wag "3 Date Issued 1 w}� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for-his o ' al 6pstem ConotrUttlon:Permit s E a. Application for a Permit to Construct( ) Repair.(X Upgrade( ) Abandon( ') ❑Complete System ❑.Individual Components Location Address or Lot No.57G M APj&Ajgft Ll QeLC Owner's Name,Address,and Tel.No. # uoTVI-r Lots SwCtav�v�Q, Assessor's Map/Parcel ` Q'a4 Q 57 M*t?_l WtM_ G.I.E.CA-45 Installer's Name,Address,and Tel.No.` SQ�s"4 71- rs s-i j Designer's Name,Address,and Tel.No. � CA��w��E CI�TdQ,P2cS� «� Type of Building: Dwelling- 1o.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ` Size of Septic Tank Type of S.A.S. Description of Soil g 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 Certificate of Compliance has been issued by this Board of Healt . Sign Date a—aO 13 Application Approved by Date Application Disapproved by Date for the following reasons t Permit No. 3 Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Xl Upgraded( ) Abandoned( )by��,CAPoij t)l✓ E TJ� <I S&_7; at )7 G �� l �P. a QGC.� CUTy i has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No 3 901F dated 1 ( J 3 Installer CAkCw1Q i9 Designer "/ #bedrooms Approved design-flgw j �`1? , gpd The issuance of this permit shal no e co 'tr&ed as a guarantee that the system wild cfiio, as d/designed.✓ 1/ � p 0 Date Inspector f /I /t! 1 :a / 3 p �v t/ / V V 1.11 No. C�4� b Fee / a C) THE COMMONWEALTH OF MASSACHUSETTS -. PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(AY Upgrade( ) Abandon( ) System located at 57(,2 N0' k NeW_ C L _C i_6 60Z'y IT and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction u t be co pleted within three years of the date of this permit. Date .� Appro ed by_. ' I -�' Town of Barnstable Health Inspector oFt ram, Office Hoias P` c Regulatory Services 8:30—9:30 Thomas F.Geller,Director 1:00—100 • saaivsrnsM • 9� �A,� Public Health Division Thomas McKean,Director C P.V 200 Main Street,Hyannis,MA 02601 on Office: 508462-4644 Fax: 508-796-6304 AMNESTY PROGRAM APPLICANT-SEPTIC QUESTIONNAIRE 1. General Information: Size-of Property: Address: J //V /' Map DA Parcel: 9 Naive: Phone 5,3 2a. How many bedrooms exist,at your properly now? 2b. Are you planning.to add any bedrooms? A® If es how man ? Y y 2c. How many bedrooms total are proposed at this property(including the amnesty unit)A.S 2d. Please.include a copy of the floor plans for the entire property-showing the existing rooms in the.home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ONO w - line dS �s f { 'cgs © _ tpli�es4aaibron 4. Location of dwelling is INSIDE. or OUTSIDE a Zone of Contribution to public supply wells? we 5.. Is the dwelling connected to an ONSME WELL or to =4LICWA 6. Is a disposal works construction permit on file? YES or NO 6a. If yes;how many bedrooms were approved according to this permit? Bedrooms. 1 7. Were any building permits obtained for construction of additional bedrooms? YES or NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOR OFFICE USE ONLY r -�The Public Health Division has no objection to bedrooms at this property. Special Conditions: L�^^� -�o -(w� ro •s Signed: A 9 Date: / O;/health/wpfiles/amnestyapp Town of Barnstable Inspector ector P oeVEt Office Hours o Regulatory Services 8:30—9:30 Thomas F.Geiler,Director l:oo-2:00 • sanxsrnsi.E, MAM Public Health Division AlEG MA't s Thomas McKean,Director, 200 Main Street,Hyannis,MA 02601 . Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size-of Property: Q�7 Address: IIV / Map Qd3 _Parcel Name: 6/f. U //{�N Phone #: ZU- 53 2a. How many bedrooms exist,at your property now? 2b. Are you planning to add any bedrooms? Ali If es how many? y � • 2c. How many bedrooms total are proposed at this property (including the amnesty unit)?�S 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO n �Sf tlie�dwellmg��syconnected to pubiic�sewer,skip,queshons#�4 throughs#9;below�z�¢ ,a > 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? we . 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works.construction permit on file? YES gor Z0 6a. If yes,how many bedrooms were approved according to this permit? �Zedroams. -C N CIO 7. Were any building permits obtained for construction of additional bedrooms? cn YES ®or IVO c� 8.1 Is there an engineered septic system plan on file at the Health Division? YES or N co 9: Has the septic.system been inspected by a DEP certified inspector within the last two years? YES fr PO -------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: O;Aealth/wpf:les/amnestyapp ,� !�W\1 } �\\l � � S V f� v • (( �r. ``\^\�\ �� � � -� �� I � ��_ o � � � � �. . . . . � . . � �. 1 . - 4 :�f� r , �� �� � �� '� � � � 4 �� � r � � _ . _ � �; . r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P #- �� Parcel Permit A-L Map � •; �..:.. Date Issued Health Division i Conservation Division Tax Collector 142 Aell Treasurer Planning Dept. EX►STING.SEpTIC Checked in By ITED TO SYSTEIN Date Definitive Plan Approved by Planning Board F SEDROO Approved By Q MS Historic-OKH Preservation/Hyannis- Project Street Address if --L Village 0 cf:[�= Owner i S �f r'1� E'l-� Address Telephone �t Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 9 DD w District r Flood Plain Groundwater Overlay � 7 � Zoning i Construction Type Lot Size r ''� Grandfathered: ❑Yes X No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes '�.No On Old King's Highway: ❑Yes �(,No Basement Type:, 1 Full O Crawl ❑Walkout ❑Other _ - J4 r Basement Finished Area(sq.ft.) s`. Basement Unfinished Area(sq.ft) Number of Baths: Full: existing p2- new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: )<Gas. ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 4No Fireplaces: Existing New Existing wood/coal stove: ❑Yes KNo Detached garage:O existing O new size Pool:❑existing ❑new size Barn:O existing O new size Attached garage:existing ❑new size Shed:)(existing O new size Other: Zoning Board of Appeals Authorization Z/Appeal# e Recorded Commercial ❑Yes EX If yes,site plan review.# Current Use SSC��'� A0&--rfV—/t-04osed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTIONPEBRIS RESULTING'F7 HIS PROJECT WILL BETAKEN TO DATE ;SIGNATURE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: R0 K_ a x A S,/S Tx—tM_C BUSINESS LOCATION: S,76 M o-e_,Alt—e C i P2GIL MAILING ADDRESS: MAi-I NE—r_ c r r2[LC- Mail To: TELEPHONE NUMBER: -09- 771-- 06g Board of Health6 Town of Barnstable CONTACTPERSON: )'�I 1C NY'fCZ �- p�'T12�151 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: S_6T_ 06 9 Hyannis, MA 02601 TYPEOFBUSINESS: Co M Pc1xl-� C 0 rJ501.T) N Gr Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO _— This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid)T =- Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers - WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS The applicants J recorded in the B At the hearing on July 27, 2005 the Hearing Officer made the following findings of fact: Lois Skinner resi 1. The applicants are Lois A. Skinner and Dawn E. Correia. Lois A. Skinner has a life estate on the Lois A. Skinner li property, and resides at 576 Mariner Circle, Cotuit MA. She is requesting a Comprehensive Permit to I convert an existing one-bedroom apartment in the lower level of the principle residence into an fpermit. As the tru affordable rental unit. The conversion of the unit to an accessory affordable unit within a single-family A. Skinner to app owner-occupied residential dwelling qualifies for the"Accessory Affordable Housing Program." i Relief Requested - i 2. Lois A. Skinner and Dawn E. Correia were granted title to the property by deed recorded in the The applicants hai Barnstable Registry of Deeds on May 17,2002 as recorded in Book 15168,Page 105. Commonwealth o town of Barnstab 3. A site approval letter was issued for the property on July 1, 2005 by Elizabeth Dillen of the Office i of Community&Economic Development, in accordance with MGL Chapter 40B and 760 CMR. The zoning relief i Notice of the site approval letter was sent to the Department of Housing and Community 14 of the Code—J Development, in accordance with the requirements of CMR 760, and no issues were communicated occupied residenti from the Department on this particular application. affordable apartml 4. The proposed accessory affordable unit is approximately 525 square feet, and is located in the lower Locus and Backg level of the principle dwelling. The property at is 1981 with a single 5. The applicant is aware that the unit must meet all applicable building codes to be occupied and that residence. The sql squauare feet. The the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. The lot is served b 6. The house is served by public water and private on-site septic and is in an identified Wellhead District. On July 1E Protection Overlay District. The proposal has been reviewed by Thomas McKean,Health Director, approved the propi and he has approved the use of the existing on-site septic system for a total number of two 2 PP g P Y ( ) Procedural Sumn bedrooms. A site approval let? 7. On May 19, 2005 the applicant signed an Accessory Affordable Housing Program Agreement Economic Develol: Affidavit that commits,upon the receipt of a Comprehensive Permit, to the recording of a Regulatory the site approval le Agreement and Declaration of Restrictive Covenants at the Barnstable Registry of Deeds. That accordance with th document will restrict the unit in perpetuity as an affordable rental unit and requires that the dwelling filed at the Town C be owner-occupied as her year-round residence. 8. The applicant understands that the affordable unit will be rented to a person or family whose income -� -- ' is 80% or less of the Area Median Income(AMI)of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and further agrees that rent(including utilities) shall not exceed 30%of the monthly household income of a household earning 80%of the median income, adjusted by household size. In 2 Maximum Wastewater Discharge Allowed Based Upon Lot Size *if one parcel is within multiple zones, use the more strict limitation for parcel (bolded below) State 1+1/3 1+2/3 Defined True Acres Acres 2 Acres Acre Acre 10,000 13,333 20,000 30,000 =33,334 =40,000 =43,560 50,000 58,080 60,000 =72,599 80,000 87,120 S.F. S.F. S.F. S.F. S.F. S.F. S.F S.F. S.F. S.F. S.F. S.F. S.F. STATE Red Title V: 310 Diag. CMR 15.214 110 110 220 330 330 ( 440� 440 550 550 660 770 880 880 Lines *applicant can ! apply for a -...... variance. STATE Red With.UA Diag. Lines Technology 110 220 330. 440 550 660 660 770 880 990 1100 1320 1430 [I/A with 660/acre Credit] (+not in town ordinance) TOWN ORDINANCE Green Regulation of 330 330 330 330 330 330 330. 330 440 440 '550 550 660 +Red Wastewater Zones Discharge can not apply for variance and doesn't allow I/A. ALL BOH-Interim BlueSaltwater Estuary 330 330 330 330 330 440 440 550 550 660 770 880 880 Protection Regulation *can apply for variance, but doesn't allow I/A QAOFFICE FORMS\ChartTable ListingWWDISCHARGE MAXIMUMSIdoc McKean, Thomas From: McKean, Thomas Sent: Friday, June 10, 2005 9:52 AM To: Dillen, Elizabeth Subject: 576 Mariner Circle/ Lois Skinner The Health Division does not possess any septic system records regarding the above-referenced property. Please have the applicant submit a full septic system inspection report(16 page report) regarding the existing system. v � is M u i ztp r a 3 . x M f o� ol '�'L JK N x 3 s <4-5 ,42-� /:377 0 3 n S S 1 33Nvlld003." 31r0 03nSS1 11w113d 150 113NMo no 113alint p ell sS3voo * . t 30VN ' S.11311 1S/N41 3 9V111A N01 1 s 3. 01 ON 11M8 3d 3 9 y M 3 S . No...........d.. .1... " Fxs. ...'J... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF H ALTH ).................OF..... ....... Applilratiloan for Disposal Vorkg Tnnitru.rtiun Verutit Application is hereby made for a Permit to Construct (X or Repair (tom}, an Individual Sewage Disposal System at: �� ... --- .................... ��;U� /!/�------------------------- L--ation- dress or Lot No. ...•_._ ...... .. ....... .............. nO A� ner Address f� Installer Address Type of Building Size Lot__ ®,__ ..._Sq. feet U Dwelling—No. of Bedrooms..................... .................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No, of persons..........�............ Showers ( ) — Cafeteria ( ) dOther fixtures ----------- --------------------------------------------------•---------------------------------------------------------•-------•--......•--• W Design Flow........... ................gallons per person per day. Total daily flow...........Q_�___?..................gallons. WSeptic Tank—Liquid capacity,lO.C__gallons Length,/Q.-lp.___ Width_, -_o___ 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 nk ( / )Percolation Test Results Performed by._ KM __.� - .---'t.....S'.. ............ Date--�_•/ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_-__/�_,- ______ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water./ `._.._..._�.. O Description of Soil. - --- --------------------••------------------- - -------------- ----- -- -- -- - -- ------ -- - ---....._..._._. 3 CCU% � W •--•----••••----••------•--tea -/1�1. 1 = UNature of Repairs or Alterations—Answer when applicable,�____________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------•---------------_._...--•-•---••-----------------------------------------•------_---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL• 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 b td of h lth. / Q Signe ..._ !✓------_-•--- ---{ � Application Approved By.. j! ail --_--------------- ------- ................... 7 Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ----------------------------------------------------------------•--------•-----.._......--•-------......._ ---------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date LOCATION SEWAGE PERMIT NO. VILLAGE ro 'TC/ / r— IN/STA LiLER'S NAIVE D ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� �� I�—� — �. � � `''� � � � o I + � � � �'I �� No............J... Fick ............... THE COMMONWEALTH—OF MASSACHUSETTS BOARD OF I-i ALTH ,� .....................................,- Appliraation for DisposalVorks Tnntitrnr#inn Prrmit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: �, /�.r'iUf�G��!._ ................. ,� --------..... r..... -- , ---.-.-••-•-•-•• ---•--•-•---........_.............._--•--- T._ 7 L 'ation or Lot No.- dress__... ............................ -------------------------------------------------------------------------------------------------- Address O/dviner - -------------------------------- lInstaller Address Type of Building Size Lot..s9Q,..R 2..Sq. feet U Dwelling—No. of Bedrooms....................:..... ...............Expansion Attic ( ) Garbage Grinder ( ) aType g _ .... .. No. of persons._......_.-;�......_._... Showers ( ) — Cafeteria ( ) P4 Other—T e of Building _ a L' dOther fixtures --------------------------------------------------------------------------------•---......•-••••••-•-••••--•----.....•-•••---•---------._....--------- _...gallons per person per day. Total daily flow.._......_. �0................... lons. W Design Flow..._.._...._��________.__ g P P P Y• Y ��-- '� WSeptic Tank—Liquid capacity/.gallons Length./ "`/',.'.. Width_ 5_.-.2... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------ Diameter.......Z......... Depth below inlet... 7.'_3...... Total leaching area..................sq. ft. Z Other Distribution box ( /) Dosing ank ( / ) Percolation Test Results Performed by__% �! ._......_�!` y'�U!:�............. Date----�..,1-�.......�..�.____. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.___. .`_ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...!�G.� __ P4 ---......... ....-•........................................................................•--•---------------•------.......................---- _ D Description of Soil �....�� 2�.�2 c_LGI?(... --•----------------------------------•- cxj ........-•-•---- G--.3 .._.-1! �C e i% ......... - - - -.._._.. - 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 I T TLE 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: Application Approved By....... { `l: au ------------------------- 'Date Application Disapproved for the following reasons----------------•--------------•------------------------•------------------------------}--.------------------•- ...................................•-••---•---••--•-----------••---.........-••--•----._.......••-•••-------------------------------------------------•--------•----................................... Date PermitNo......................................................... Issued-.. .................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........cKt-)AJ...............OF.......: Q'?� .}� ................ .................... :................. r Tnrtifiratr of Tout rliFanrr THIS IS TO RTIFY, That t1�e Individual Sewage Disposal System constructed (A or Repaired ( ) has been installed in accordance with the provisions of T �`f The State Sanitary Code as descri ed in the application for Disposal Works Construction Permit No ..................3 `?r " , , --------•---. dated----------^..__•�..---�!---"--•----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISF CTORY. f DATE ���Tg�-------- Inspector....... r... ���/ C/Y------------------------------•-•--- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �✓ �.G .� }. ............OF........./_�..� ?.IPAJ ................................... N ........�J`�... 1`.... FEE.. .......... Disposal Works T'n str iatt unit Permission is hereby granted..... .._ C�__C..--«C`__.___.._.. i.......���.._ .____.. ............. to Construct ( or Repair ) an IndividuC Sew ge Dispo"- AZ em- at No.... 1 t-i.' U?!L /� Stfeet as shown on the application for Disposal Works Construction Pe No.- _ _______ ___ Dated....... ................................. RR Y '"Lt --------------------------- - "7' Ar" Board of Health< DATE........... ..-----•------ -•----•- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t CAA.,. ,r Vk.k Q. f 0 0 CC - I 1 � 2 `� I � � �.,�.+a��.yi► ,...ter �'"*'� �,3�,...� � �,,..��:1D �C. OFrn { { lJ U Vi ID 90 wl� 10 i p J 'v V ti.! �1-� �✓ #r s �"+■y5 11�34T�©; L.1_ �y''�r Ty P I C A L D sTle.k r-m>kiT"I o d.s U — Tr C�RTc. 5T Surf a+� grJ►c. r4�.1 I C-�A1_ A Q'E� OQL�� `jtEPr i G f�.111 Pam`! 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Svsmm r vrzon Lv�3, c� UEQ SC�►,13 f- 8E r>T��C��'✓1 .3 G'�_o P SPO r I.E`�-1 • t�EfZ c.c��i ►o� (-�A L_l...Q►�J 5 � r�-.S-�►J CIF-_ D�1'Y � ( � ("1�,..C � �'-r-� /- �--1' ,A Q } �"'T'.,Li C2. . MASS. �, I..EACF-4��IGt P;6c�v�E'�u J •_��; C��,1,. dfl nBSEtZ_�/�+,"(--to..s 7�5�"" `..... _ SC A,LE A5 ►JC1rEO 0Al—mc I DE WALL AR EA.' ,,' c�� � - ►SO ,70 x 2 .5 = 37C. G-PI7 7-NI=t. ouS`1 �UC�T tc�t•t : �: ►., r GlggS�c ��� OF M,qs� f i k' E_ '. r 1-%s'� i-D 'r i�L A�t`1 SQ x ,O - SO G PL) NORMAA F� ? NORMAM _ — - P L O o C M N a �N�c t r,i�E r lofz MAnS G-- q-C)<,5WAu3 G. To-TA L 4 2 G C� P D o'R0` GRcsS7N/5 Pam. U ' 12715 Q SCA L.E � " � �„J � � c� ��Ff �`� �r�cc�-r��� 22� L{0�1.,._� �t►,J'T� (�� t-- L n'r S t-t C rc!!<.� �F'L A ttt `?- IJ d 6 7 SHd!5 '�. SSICHAI E�G\r �ND SUR4, �� �f