HomeMy WebLinkAbout0065 MASHPEE ROAD - Health -( 65 MASHPEE RD.', COTUIT
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No. 0.5q Fe :p/oa e�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitation for loisposar 6;pstem Construction Permit
Application for a Permit to Construct( ) Repair(6 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (,5 S KPOE i2.D `G Or-a'r Owner's Name,Address,and Tel.No.
RAVLOA44 K(ICGi K
Assessor's Map/Parcel 3 S• d rg-
Installer's Name,Address,and Tel.140. '$0S'477-'9& j Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size on-00 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 3 55 a a-- gpd
Plan Date `1'x^ OLD[ Number of sheets Revision Date
Title jo'5 bW-4<4,+W6 s T>_7 ,�,-y�
Size of Septic Tank t 004c> & 4 L- Type of S.A.S. 20 /4��- 3�hie— 1R1001 P=Q_S -_
Description of Soil 3a6- &Eh
Nature of Repairs or Alterations(Answer when applicable) °V t4`S774,156- 11000 �
�_Jea) 13OX—o�40 AP9.
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 lace the system in operation until a Certificate of
p P Y P
Compliance has been issued by this Board of Health.Si ed Date 3 -11-d-NI.
Application Approved by Fi�� Date /Z >_0 f Z.
Application Disapproved y Date
for the following reasons
Permit No.�� 1 L — y Date Issued `Z.
/ya GJ
No. 2,C)(Z— O5 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
21pphtation for 30isposaY *�y, pstrm Construction Permit
L «._p i..,
Az
Application for a Permit to Construct( ) Repair(R Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (A� &dK tVtX Q® <toru t r Owner's Name,Address,and Tel.No.
PA141910W a IM 16(.4 K
Assessor's Map/Parcel D
Installer's Name,Address,and TeL 146. y'p6-+i j7-'3jSTi Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size aCX? sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided gpd
Plan Date Number of sheets�� Revision Date
Title�� yM,�Q�#4P�� At7 dO—(-tj t-r"
Size of Septic Tank I Type of S.A.S. ;j< C, 3(,,fhd. Q,/n/)/ <61E�
Description of Soil S95C Q4-" ?r1 t I
law
Nature of Repairs or Alterations(Answer when applicable) S77&A5r t0Q0 624-1f7C.�l -M
1 Fa._)!D -.n,nu --!! , 4)0 co 36 rk. 14- nn I�u.�09" t,[1 HELD irto-L
ate 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 t i he system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date o Z
Application Disapproved Date
for the following reasons
Permit No. 70 ( Z — O j g Date Issued .3!JZ -7-0
z. --------------------------------------------------------------------- ---- ------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of itCompliante
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A Upgraded( )
Abandoned( )by -- C 06 a ID 9 0)12XAd11rPJ
at �V ��J"Z" l has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.Z—z75H dated �)b!70l Z I;
Installer /� Designer .�°°C (�.,J(;fE)cC
#bedrooms Approved design flow ��� gpd
The issuance of this permit shall .t be c7strued as a guarantee that the system will ction d ed.
Date Inspector.
I
---------------------------------------------------------------------------------------------------------------------------------------
U
No. O ( 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 4
Misposal 6pstrm Construction 3pPrinit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
` System located at (p 5 044EWc�
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
i
Date 3//;! 7 Approved by j
J
Town of Barnstable
RegulatoryScrvices
Thomas F. Geiler,Director
PA
MAM Public .Health Division
MAC.
i 039. Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 3-1y-12 Sewage Permit#20�a -ns`� Assessor's Map/Parcel 7 36
Installer &Designer Certification Form
Designer: S G En,�tnee.cincy , Toc. Installer: C Vewc& E�Fec�ct'ses
Address: 26.54 Crow\aerry i4gnwoy Address: IS 3 cc),ih�rh-c-4c,"OL Sf
Ea'-1 uJ4(6lawi, 11A 02539 MP's�n�, -c -/Kqq 6Z�1o�j
6o6-273-03 77 L I
On 'I�.- 20►�- �ew.At UwTr=r A til-e) Lk was issued a.permit to install a
(date) (installer)
septic system at 5 H a sk Q e Roae) based on a design drawn by
(address)
C Enginzzc(215 , -roC_ dated Horan t 2, 20 t 2
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced,above was installed with major changes (i.e.
greater than 10' lateral relocation of the'SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) ected and the soils
were found satisfactory.
CJOHN L
HURCHILL a
(Ins ler's Sign We)) JR.IVI a
n 4190
esigner s Signature Affix De gn Here)
P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY BHETARNSTABLE PUBLIC HEALTH DIVISION
THANK YOU.
gAofiice for ms\dosignercmification fontt.doc
CO.MMO "TALTH OF MASSACHL;SETTS fl
EXECL TWE OFFICE OF ENVIRONMENTALAF .A-JP
= E DEPARTMENT OF ENVIRONMENTAL,PROTECno
1 ONE '"'INTER STREE—, BOSTON 11LA 021Ot (6171 29A555 w Vro
p®V 999 ''I Y Cow
, ERN Secre•ar
04
ARGEO PALL CELLUCCI D. STP.'_'?is
Governor ommissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART'A
CERTIFICATION
Property Address: 65 Mash-pee Rd.. ," Cotuit . Name of owner Laura 'Opie
Address of Owner: 51 Mashpee Rd.. , C otuit
Date of Inspection:// 076_Q 7
Name of Inspector:(Please Print)Wm. E . Robinson Sr
I am a DEP approved systerr2 inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
nr CopanyName: Wm. E . Robinson eptic Service
Marling Address: PO BOX 0 9. Centerville _
MA
Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate,,
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system: i
I/ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails QQ
Inspector's Signature: 1 , Date: ",g
The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30)days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and co ies sent to the buyer, if applicable, and the approving authority.NOTES AND COMMENTS
revised 9/2/98 Page Iof11
i. -� :rledo�Recy•c1rdPane,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued) r
"rop"Address: 65 Ma*shpee Rd.. , Cotuit
,)"In": Laura Opie
Date of Inspection:PKb �l —a10
INSPECTION SUMMARY: Check 19, C, or D:
A.
SY PASSES:
1/ Irhave not found an information which indite 'any
y indicates that a y of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate es, no, or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined', explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached)indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
r: CERTIFICATION (continued)
Prop"Address: 65 Mashpee Rd.. , Cotuit
Owner: Laura Opie
Date of Inspection:
C. FURTHER EVALUATION IS REOUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if.the system is failing to protect the '
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CIIIIR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH W1LL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
_ Cesspool orprivy is within 50 feet of a bordering vegetated wetland or a salt marshy ;
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS)and the,SAS is within 100 feet of a surface water supply or
tributary to a-surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
_ The system has aseptic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
Well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
-than 5 ppm. Method used to determine distance (approximation not valid).
1• OTHER . .,
revises 9/2/.98 ,
Page 3 of 17'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 65 Mashpee Rd.. , Cotuit
Owner: Laura Opie
Date of Inspection:
D. S STEM FAILS:
You mu t indicate either `'Yes" or "No" to each of the following:
have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct,the failure.
Yes N
Backup of sewage into facility-or system component due to an overloaded or-clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE S STEM FAILS:
You must indi ate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
T e system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
alth and safety and the environment because one or more of the following conditions exist:
Yes o
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)
The ow r or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office o the Department for further information.
revised 9/2/98 Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,
9 — PART B
CHECKLIST
,Property Address:, 65 Mai ,bee Rd.. , Cotuit
Y t
Owner: Laura Ope
Date of Inspection: 0_
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:` Y
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
_ As built plans have been obtained and examined. Note if they are not available with N;A.
The facility or dwelling was inspected for signs of sewage back-up.`
The system does not receive non-sanitary or industrial waste flow. '
The site was inspected for,signs of breakout.
1C _.
All system components,;excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior.of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ Existing information:For example, Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
11.5.302(3)(b)]
-The facility owner(and occupants,if differeru from owner) were provided with information on the proper maintenanc."f
SubSurface Disposal Systems.
ti
revised 9j2/58 Page 5ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 65 Mashpee Rd.. , Cotuit
Owner: Laura Opir t , t`
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow:3 G O g.p.d./bedroom.
Number of bedrooms(design): Number of bedrooms(actual):
Total DESIGN flow 34 a
Number of current residents: i4
Garbage grinder(yes or no): % o
Laundry(separate system) (yes or no):,bO; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no):-A-10 1999 53, 000 gal.
Water meter readings, if available (last two year's usage (gpd):
Sump Pump(yes or no):" 1998 76, 000 gal.
Last date of occupancy:
CO 5 ERCIAL/INDUSTRIAL:
Type f establishment:
Design flow: apd ( Based on 15.203)
Basis o design flow
Grease rap present: )yes or no)_
Industri I Waste Holding Tank present: (yes or no)_
Non-so itary waste discharged to the Title 5 system: (yes or no)_
Water eter readings, if available:
Last d to of occupancy:
O R: (Describe)
Last ate of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and so rce of information:
� ,cV
System pum ed as part of inspection: (yes or no) 40
If yes, volume pumped: gallons
Reason for pumping:
TYPE ID SYSTEM
Septic tank!distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records;if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known) and source of information: /S%9-0 vts 3
Sewage odors detected when arriving at the site: (yes or no) O
revised Page 6ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'ropertyAddress: 65 Mashpee Rd.. Cotuit , P
owner: Laura, Op-le
Date of Inspection:
BOIL G SEWER: . .
(Locate n.site plan).
Depth b low grade:
Materia of construction:_cast iron 40 PVC other(explain)
Distan a from private water supply well or suction line
Diam er
Comm nts: (condition of joints, venting, evidence of leakage,-etc.)
M t
SEPTIC TANK:_
(locate on site plan)-''
Depth below grade: 1
Material of construction: ✓.concrete Y metal_Fiberglass Polyethylene_other(explain)
If tank is metal,list age Is.age confirmed by Certificate of Compliance (Yes/No)
Sludge depth:_ 7—c. •+'
Distance from top of sludge to bottom of outlet tee or bafflers
Scum thickness: 3-
Distance from top of scum to top of outlet tee or baffle: +
Distance from bottom of scum to bottom of outlet tee or baffler/0*
How dimensions were determined: 6 ip't, roc. )�
'omments:
(recommendation for pumping, condition'of inlet and outlet tees or baffles, epth off liquid level in relation to outlet invert, structural integrity,
evidence of le kage, etc.) '16-6`0 G'.CiI Td�.I� !�d r77�4 An- 4e/0
GR SE TRAP:
(locat on site plan)
Depth elow grade:_
Materia of construction: concrete metal Fiberglass Polyethylene other(explain)
Dimens ons:
Scum t ickness: +
Distan a from top of scum to top of outlet tee or baffle:
Dista a from bottom of scum to bottom of outlet tee or baffle:
Date f Mast pumping:
C ments:
(rec rnendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evid nce of leakage, etc.)
revised 9/2/98 Page 7of11 ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Arop"Address:O Mash ee Rd.. Cotuit ,
5 p r ,
DWner: Laura Opie
Date of Inspection:��aoaa�
'nG TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(Iota on site plan)
Depth elow grade:_
Materi of construction:--concrete_metal_Fiberglass_Polyethylene_otherlexplain)
Dimen ions:
Capac ty: gallons `
Desi flow: gallons/day
Alar present
AI m level: Alarm in working order: Yes_ No_
D e of previous pumping:
Co ments:
(co dition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution i equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
r
ze
PUM CHAMBER:_
(locat on site plan)
Pump in working order: (Yes or No)
Alar in working order(Yes or No)
Com ents:
Inot condition of pump chamber, condition of pumps and appurtenances, etc.)
reviser 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(contims6d)
'rop"Address: 65 Mashpee Rd.. , Cotuit
Owner: Laura Opie
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods{
If not located, explain: +
Type: J
leaching pits; number:!
leaching chambers, number._
leaching galleries, number:_
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Altemative system:
Name of-Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level o ponding, daJtip soil, conditionyf vegetation, etc.)'
a f ?o—is d c AC7 //'� t-GI 5 7— ,;� 4. 1�
C'E
- POOLS:
(Iota on site plan)
Numb and configuration. '
Depth- op of liquid to inlet invert:
Depth f solids layer.
)epth f scum layer. `
Dimens ons of cesspool
Materi s of construction:
Indicati n of groundwater:
inflow (cesspool must be pumped as part of inspection)
Co ents:
(no a condition of soil,-signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRI
(Iota a on site plan) _
Mat ials of construction: Dimensions:
Dep of solids.
Co ments:
(no a condition of soil, signs of,hydraulic failure, level of ponding,condition of vegetation, etc.)
�revise--4 9/2/7C Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Nop"Address:65 Mashpee Rd.. , Cotuit + •
)caner: Laura Opie
Date of Inspection://—;LO_p Ci
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
M
4 6 A-
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icorrtinued)
mpertrAddre s: 65 Mashpee Rd.. , Cotuit
owner: ,Laura Opie
Date of Inspection: g
NRCS" ;Report name '
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked, rr
Groundwater depth: Shallow. Moderate Deep
SITE EXAM Slope ,
Surface water
Check Cellar
Shallow wells,
Estimated Depth to Groundwater .!'Feet
Please indicate all the methods used to determine High Groundwater Elevation: i
Obtained from Design Plans on record
Observed Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health•.
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
s
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must*be completed) _
66
r
revised; 9/2/96 k Page iortt
L'UCATION SEWAGE PERMIT NO.
VILLAGEa ;
C'10 L 7--
I N ST A LLE/R''S NAME i ADDRESS
Y C. li "a-zz
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
F-r �
Y
r
!L\
W
TOWN OF BARNSTABLE
,LOCATION 6 5 MMAVEV2 Q SEWAGE# A Q i a- "b
\1
VILLAGE daTu►T ASSESSOR'S MAP&PARCEL MAC 7 PARS 3(p
INSTALLER'S NAME&PHONE NO.dAVEW(DE eQT1 k1,5EK LW
SEPTIC TANK CAPACITY ( O 0 0 CAL.
LEACHING FACILITY.(type) a0 13 loot C:Fu,%t39& (size)
NO.OF BEDROOMS 3
OWNER 13ARbARA %<MIECky,
PERMIT DATE: 5 ri 1 � 0-, COMPLIANCE DATE: �" -� ,0 k-.)-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY 0,AQF_ i0ti; eL)PMPe sees U_JL
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ri
GIN i w
CA C G ��S`
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V1�
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THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
........... CR' ............OF........(2�r_C---------------------------------------------
Appliration for DWposal Works Tonstrnrtiun rumit
Application is hereby made for a Permit to Construct ( ) or Repair (. ) an Individual Sewage Disposal
Sys at:
Location-Address or Lot No
. .
�. �4:..- �?�'':....._::E. s :......... C • ` -•.........................•-------...................--------•--........_....................•...
q - n Owner Address
W
a f -- - - ---- ......_..
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder (IJ6)
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ......................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity 0.6d.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No...... ........ Diameter...Z........ Depth below inlet...... ......... Total leaching area..' ®_.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by._..rll/ +N.,� _E_..__. C......... '�..................... Date.._ ,�:1_[.1. 1...........
a
a Test Pit No. 1...4A�.....minutes per inch Depth of Test Pit:__ L:.......... Depth to ground water....�/A......__..
f? Test Pit No. 2...GL...minutes per inch Depth of Test Pit__ �.............. Depth to ground water...1Q ill......___.
R+' •---.....--•--•-•••••••••••••-•------•-•°--........-••••----•----•......................•-•-•------•-. ..........
O Description of Soil....................... Z .........Lste r.....------. _/L .... ..............................
x
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------
------------------------------------------
... ......---------
•---------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ,.I.I-E 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 b the bpard of alth.
ate
Application Approved By------. ' '---- v .......
------ --// � ----------
Date
Application Disapproved for the following reasons---------------------------------------------------------------•-------------•-------------------•---••----.---
.................................•----•---------------•----••-------•---•-----•---------••-•--.............---•-•------•-•--•-----•--------•-------•-------•----•-------••-------••••------••--•...•..---
Date
PermitNo........................................................ Issued.......................................................
Date
UV -
No.®RL .�z�-. � 9` _ FEs...3.. ..
`,
THE COMMONWEALTH OF MASSACHUSETTS,
BOARD OF HEALTH
G.. ... OF...... J.Gr•�+ :
ApplirFa#ion for Bispoii al Works Tonotrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst= at:
ffit
0
- - ---._...---
ation Address or Lot No.
s y. . ........:..: . s ?�--•••• -!�...c -e. -----....----------.._.....------------...-- - ........._.....------
} ww Owner Address
"Install,i';;;, Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..........._1............................Expansion Attic ( ) Garbage Grinder (MCj)
`4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
dOther fixtures •---------------••-----•----•--•-------•--•.... ----•-•----•-•-=---•---••-••--•----------•---------.....-•--•-.........--------_.....---._.._..
w Design Flow.............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.1.0.09.gallons Length................ Width................. Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length........ ___._... Total leaching area....................sq. ft.
Seepage Pit No......I............. Diameter.:.:.• -------- Depth below inlet....... .._. Total leaching area..4� .....sq. ft.
Z Other Distribution box ( ) Dosing ank )
~' Percolation Test Results Performed by.__-�3.-� ,4�.�..._.. ... /. -..................... D a t e...sl f d I...........
Test Pit No. 1... _z ...._minutes per inch Depth of Test Pit....,,?'_......... Depth to ground water....tiA..........
fZq Test Pit No. 2---5%_ ....minutes per inch Depth of Test Pit.................... Depth to ground water...A?JA..........
ar --...-••----••-•-•••••-••-------------------•-•---------••••---•--•-•--.._........._•---•--.._.._•----
D Description of Soil....................... - L 0---...L 9/S Z_..........................1 . /L *' - �- �T
IRwf-�.ctin..-•=--d.......4.----------•--••-••---•-••----•
x
w
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
.............---------------------------------------------------........................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLi:, 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 b the and of alth, J `�-'G�.
ed - •- --------------------------------
Application Approved By........
= �. .. ..:t ........ �'
......_..---•--
Date
Application Disapproved for the following reasons----------------------•-------------•-----------------••-----------------------•--------------------•••-_•_..._
---------------------------------------------------------•---------------•---•--------......:-------...--•---------------------------•----••-••-•••---------•-----------------•---•---••---•------------
Date
PermitNo.......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/'
...... ..............OF....... ( i
(T ntif iratr of fTrontph anrr
THIS IS TO CERTIFY,..Jbat the-,Individual Sewage Disposal System constructed ( or Repaired ( )
by................ ---- ------------------•••----- --•-------------...-----_.....---___......•••••-••-•---.._..•----•_........---•-•......----•----
_ Install
has been installed in accordance with the provisions of TI" 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 6 _�_ '`��_._....... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
-.SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................� 3V� -------••-- Inspector.........) =`-k�•-......------------....._....-•-------------•-•.._:.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,✓ �.y�yvtr OF.....: ........ ...... :.....................................
p '`
N •• -!.. �?..FEE. 0.............
Disposal Works Tonotrudion Vamit
Permission is hereby granted.........
' + = --- _________________
to Construct r Repair ( ) an Individual Sewage Dis System
--- �
Street
as shown on the application for Disposal Works Construction No.............
_._�.... D'' t d_.______..._____._.._.____...._.__.___....
~ _...��.... -------•------------------------•--•-
Boar eal
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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T.O.F. EL.= 36.8'± FINISH GRADE OVER D-BOX= 33.0'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 31 .81 33.31 GENERAL NOTES
PROVIDE EXTENSION RISER SLOPE @ 2% MIN.
WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE " F.G. (ONE PER OUTER ROW)
@ FND. EL.= 34.5± F.G. OVER TANK EL. = 34.$ - 5 DIA. OUTLETS)
CODE AND ANY APPLICABLE LOCAL RULES.
--.__ . - -- _._. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
--EXISTING 4" PROPOSED 4" 9"MIN. 9„MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
- T SCH.40 PVC 36 MAX. 36 MAX. TOP OF SAS/B.O. = 30.33
SEWER PIPE SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED.
i1� 3"DROP MAX " _ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
- 6 3 2" DROP MIN 3 9 L - 28± JOINTS (TYP.) -� ELEVATION =30.33' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
MIN.SLOPE Q 1%
�� 10" 4" PVC IN FROM r/ 1.33' j(TYP)
16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
'! �! 1 " * '+ SEPTIC TANK 4"PVC OUT TO (TYP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
4 32.1 _ 0.90 10.7
CONTRACTOR TO PROVIDE O LEACHING FACILITY + 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
SPECIFIED DROP BETWEEN
INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL i 12" 6" 29.90' 29.00' laid flat 2.875'(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 30•30 MIN. 30.13 ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) 5'MIN. 11.5' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE REQ'D
25.0' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 33.00'ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 21 .50' BIODIFFUSERS (END VIEW) ON A NAIL SET IN A 24"OAK TREE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
TO THE DESIGN ENGINEER.
*CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616 B D) BIODIFFUSERS (H-20) 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE
- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
r L/ If ;� / .� / i TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
NOTES: � it
,J N
it ,,rr� t/ PERC NO. 13564 APPROPRIATE AUTHORITY.
G + • . . •
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH y �, G kJJ d/ ) ftr' ,� == INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
SEPTIC SYSTEM COMPONENT. lid F `i I / LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
Fes' '- EVALUATOR: Michael Pimentel E.I.T. I
,� w r ~--:51 _` ( I7 THEY SHALL WITHSTAND H-20 LOADING.
'l w � / ` g/r C.S.E. APPROVAL DATE: Oct. 1999
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE 11 f.!� 1' j
i \ . ° * 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA 1 , ••. ,•. - - March 6, 2012
SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF ` • ;;;. DATE:
% '` Jr v ,.1" / • ` • ' '' TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
=
3. ELEV TOP 32.00'ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. ' I .� � �_ i /
• ,,f` i O REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
�� ,\�, Y, • ° ` • / � � ELEV WATER= <21.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
_ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
All
4rPERC RATE <2 min./inch• SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
,ii+' r f / p • Q' DEPTH OF PERC= 30"-48"
i } /�� • t• 16. PROPOSED PROJECT IS LOCATED WITHIN:
MAS �. r• f Oil, • *• - ,
EPEE cants •
TEXTURAL CLASS: 1 ASSESSORS MAP 7 PARCEL 36
(40' ROAD a ,, ' I,� - -
/ WIDE LAYOUT }e h ••• •� Q - OWNER OF RECORD: BARBARA J. KMIECIK
I ti i LOCUS '• i " ADDRESS: 65 MASHPEE ROAD
N ii • 9��
/ �� a� �i� 'r!► ' - 0 Fill 32.00' COTUIT, MA 02635
E - ' 4" 31.67'
DGE :' i f = ' r t'� " ►� Loamy Sand
OF p r. �/ -`~ t it 1 A/E
AVEM / ; • �" � °., 10Yr 3/1
EXIST. 1,000 GAL. SEPTIC TANK S7 -0o E "� �NT r' ' t`\\ 31.00
9 46
" 4., _ r`+ • I I �� I 12" FEMA FLOOD ZONE C
TO BE UTILIZED IN THIS DESIGN 141•00' Loam Sand COMMUNITY PANEL# 250001 0021 D
/ M 4 l/// , s • ; ,I�: a r \� .'11 �..... -* � J v 10Yr 5/8 17. 1 P
STONE �m • yy , t , . e i ,, DEED REFERENCE: DEED BOOK 9857, AGE 23
* 'S 4 l "
/ r . !t 1 r 30 29.50
DRIVE * �"' ;T. � t -- Perc 18. PLAN REFERENCE: P.B. 256, PG. 46
I� 41 r . 48" 28.00' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
/ . 4 0 ��'. �4yy FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
EXIST. LEACHING PIT (approximate / / 0�� �' �1► `� \ O `y C Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
U FILLED tt
MPED P
/ r *
location only)TO BE o� � � � `` r' �a °"� !> � �-"` �;�', ,�'?, 2.5Y 6/6
W/ CLEAN SAND & ABANDONED4.
..t. o r; b �, 111 / . (loose)
/ TREE (TYP)((TYP) #65 / LOCUS PLAN
EXISTING
000 3-BEDROOM o� SCALE: 1"= 1000' 126 21.50
DWELLING
TOF = 36.8'± No Mottling' Weeping or Standing Observed
w( X
Q J � _ DESIGN DATA _ - TEST PIT DATA Q ( / / L x PERC NO. 13564 LEGEND
G
W SHED DECK �`� INSPECTOR: Donald Desmarais, R.S. 50x0 EXISTING SPOT GRADE
EVALUATOR: Michael Pimentel, E.I.T.
�' PROP. H-20 -34- o - 50 - - EXISTING CONTOUR
m m 1 � � NUMBER OF BEDROOMS (DESIGN) 3
24.9� 118, D-BOX < / C.S.E. APPROVAL DATE: Oct. 1999 -
DESIGN FLOW 110 GAUDAY/BEDROOM
�---- r March 6, 2012
-32 WALL �' DATE:
TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED SPOT GRADE
j �� / / PROPOSED TOTAL 20 ARC 36HC TEST PIT#: 2
/ (#361613D) BIODIFFUSERS (H-20) IN DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP = 32.00' 50 PROPOSED CONTOUR
AFIELD CONFIGURATION W USE EXISTING 1,000 GALLON SEPTIC TANK _ ❑/H/W - EXISTING OVERHEAD UTILITIES
z I o o ELEV WATER- <21.50
/ w PERC RATE = W W-- EXISTING WATER LINE
W 0 � :
^ o
w �"z TP 2 N MAP 7
Q / ' �324' Z DEPTH OF PERC=
a PROPOSED INSPECTION PORT PARCEL 37 TEST PIT LOCATION
o ( WITH ACCESS BOX TYP OF 2) SWING-TIES SCALE: 1"=20' INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20)
( TEXTURAL CLASS: 1
T2x0, DESCRIPTION HC-1 HC-2 O EXISTING 1,000 GALLON SEPTIC TANK
o 3 SYSTEM CAPACITY
w - I ( BIODIFFUSER CORNER(1) 28.4' 71.6' (TOTAL L.F. OF BIO'S)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD p~ 32.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY " Fill
1 TREELINE / \ BIODIFFUSER CORNER(2) 22.0 60.2 ( 4 Loamy Sand 31.67'
0 PROPOSED DISTRIBUTION BOX
o wo BIODIFFUSER CORNER(3) 46.1' 68.8' A/E" 10Yr 3/1 31.00'
o N I LANE I \ TOTALS: 12 Q PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20)
EE BIODIFFUSER CORNER(4) 49.5' 78.9'
\TR TOTAL NUMBER OF BIODIFFUSERS: 20 B Loamy Sand
co f TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/8
/ MAP 7 TOTAL LEACHING AREA: 480.0 30~ ,29.50 REV. DATE BY APP'D. DESCRIPTION
TOTAL LEACHING CAPACITY: 355.2
� Benchmark PARCEL 36 ' PROPOSED SEPTIC SYSTEM UPGRADE
( 3� Nail in 12"Oak 28,200 S.F.± #65
Elev. = 33.00' EXISTING NOTE: PREPARED FOR:
Approx. M.S.L. 3-BEDROOM EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C Medium Sand CAPEWIDE ENTERPRISES
DWELLING DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 2.5Y 6/6
TOF = 36.8'± "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED (loose)
S790 I HC-1 DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED LOCATED AT
46pp~E JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052.
141.00. v
65 MASHPEE ROAD
FE111.8,
DECK HC-2COTUIT, MA 02635
SCALE: 1 INCH = 20 FT. DATE MARCH 12, 2012
MAP 72 126 21.50 0 10 20 40 80 FEET
1 No Mottling, Weeping or Standing Observed
PARCEL 30 ( - _ -- - - �_ ok!Ma- r - _
Iv PREPARED RESERVED FOR BOARD OF HEALTH USE N` �� N
o v�`J JC ENGINEERING, INC.
�"`' �� 2854 CRANBERRY HIGHWAY
EAST WAREHAM, MA 02538
SITE PLAN (4 11.5' 3) 3
SCALE: 1"=20' ? /Z/1 2 Drawn By. MCP Designed By:MCP ( Checked By:JLC � JOB No.2165