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HomeMy WebLinkAbout0565 SAMPSONS MILL ROAD - Health �6� sc mpsonsz ill Ro Cotuh A = 039 087 li; Page: CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 2/13/2006 Report Prepared For: Order No.: G0634495 William deJong 565 Sampson Mill Road Cotait, MA 02635 Laboratory ID#: 0634495-01 Description: Unflushed Water-Drinking Water Sample#: 34495-01 Sampling Location 565 Sampsons Mill Rd.Cotuit,MA Collected: 2/7/2006 Collected by: W.dJ. Unflushed Received: 2/7/2006 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: Metals Copper 6.5 mg/L 0.10 1.3 SM 311113 2/8/2006 Based on the results of the parameters tested,the water is suitable for drinking,but may present aesthetic problems(taste, odor,staining)due to Copper. r.a , < V7 G!1 UZ M RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 Page. 2 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 2/13/2006 Report Prepared For: Order No.: G0634495 William deJong 565 Sampson Mill Road Cotuit, MA 02635 Laboratory ID#: 0634495-02 Description: Water-Drinking Water Sample#: 34495-02 Sampling Location 565 Sampsons Mill Rd.Cotuit,MA Collected: 2/7/2006 Collected by: W.dJ. Flushed Received: 2/7/2006 4 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.87 mg/L 0.10 10 EPA 300.0 2/7/2006 LAB: Metals Copper 0.34 mg/L 0.10 1.3 SM 3111B 2/8/2006 Iron BRL mg/L 0.10 0.3 SM 3111B 2/8/2006 Sodium 14 mg/L 1.0 20 SM 311113 2/8/2006 LAB: Microbiology Total Coliform Absent P/A 0 0 309 2/7/2006 LAB: Physical Chemistry Conductance 120 umohs/cm 2.0 EPA 120.1 2/7/2006 pg 6.2 pH-units 0 EPA 150.1 2/7/2006 Water sample meets the recommended limits for drinking water of all the above tested parameters. 1 � Approved By: ( hector) i RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION cA 7,G r�, V01 QASEWAGE # JR-3(®S A. VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. r SEPTIC TANK CAPACITY Q� race LEACHING FACILITY:(type) ''� (size) `©®' C) NO. OF BEDROOMS P� RIYATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: -DATE COMPLIANCE ISSUED: Z VARIANCE GRANTED: Yes No /�_`�/� O � ' I \ r �rW` \�� • � �.�ut. �, ` •� ` ��J7� �� IJ No.. �_ FEB.....`........................ '. THE COMMONWEALTH OF'MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for llhipaaal Warkp Toustrurtuan ramit Applicationjih gvud de for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: 4. 0.. ...x . �. ............ �� - ........................................................ Location-Address -- or Lot No. og._ ............................................Address W Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms___._ ,._ .__..Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building ............................ No. of persons............................ Showers - ► Cafeteria a' Othe ur d • ---------------------------•--••••---•-•------•-•-------------------..... 01 W Design Flow................XV�R ......................... per person per day. Total daily flow__-_....._ gallons. WSeptic Tank—Liquid capacity............gallons Length____-__-__-__. Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................... ••---•--•-----•......-•••-•---...._.. Date........................................ 4 Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water.....______-___--..____- 9 --••---•---•-•-...--••••-•••----••..........•••••-----------•-•--•-•...................•-._...-•-•--....--•--...................----------..............-•--- 0 Description of Soil...............................................................................----------------------•------------------............................................. W c.� •------•----------------------------------------------------------------------------------------------•----------------------------------------------------------•-------------------------------------- ----------------------------------------------------------------------------W V Nature of Repairs or Alterations—Answer when applicable............................................................................................... .... ••-•---•-----••••------•••---•---------------'----•---••...-----••-----•--•._......--•---••---••-------•--•-•----••-----•••••............-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued by the b and of health. Signed . .. .. ....... Nam:------ t 7 Application Approved By .....--.. .. . .®..... - J® ) Application Disapproved for the following rear ---------------------------------- -----------..............-- -............................................. ............................................q .- -------------- ----------- ------------------------------------ --- --- ------- -- ------------- Permit No. J .. Issued ........... - NO.. 1{ / FEs.....1 i...... O ...�... t t, �uz ` .F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f , 1 TOWN OF BARNSTABLE D +� I Appiiration for Dispomi. nrkp Tontitrnrtion 11ami# Application is hereby -a de for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ..... ..S:J... ........lt/ l.� !..................................................... r/... Owner Address .._..A o,,,,. ..�._.... —........ti........._y......... ............ ............................................ -... --------------------------------------- Installer Address Type of Building Size Lot..............................Sq. feet �..� Dwelling—No. of Bedrooms._'________________•.--_--__Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers #— Cafeteria 04 yP g P ( ) ( ) Otherxtures ••-••••••---'----'--•--•---'-••-•--••-•---••----•------'•--••-----••••-••---•-......-••-••......•--•----•- t ............................ Design Flow........ _ n.................gallons per person per day. Total daily flow__ ----------.gallons. W g P P P y y -- -- -• ....r WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diamete�l---- ....• Depth................ x Disposal Trench—No. .................... Width.................... Total Length................... fotal lea ii.g area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet................:./Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results . Performed by.......................................................................... Date........................................ a 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0-4 �`` Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground water........................ O Description of Soil............................................................................................. �_.. A� y' -------------------•-------------••--------__-•------------- WU 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ncee has been issued by the board of health. Signed aNA..� j -.Lt-, ......... . ------. ---------, - �'------------------os------ 4 1' ' Application Approved B .... ...... ...�./��i�� / /r//?Z.�/ PP PP y ..._ ./. �. .. . ... = � 'E_._ ------------- ----- r e>�re� Application Disapproved for the following rearo�f ................... ------------------------------------------------------------------------------------------------- r . , .,.y..A--...................................................................-------- ---- --------- Pertnit h1o. ../... .(/"-.....t) .'.1... Issued //� 4 ..-,f-. -e....-./f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cex#ifirate of C ontyliance THdS IS 0 ERTIFY, Thabthe Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..--------.! 1 ..1...�`�� .� h ------. .0... . ---------------------- VInsraller has been installed In accordance with the provisions of TITLE 5�-of Theme State E,Ivironmental Code as described in the application for Disposal Works Construction Permit No. .-.-- _/� ' S�....:)...-. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF' CTORY. DATE lv ---------- Inspector .................. .. THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH TOWN OF BARNSTABLE f(�D f No.-•;�;; .... FEE...:.................... Bispsal lVorks Tnn#rudion ramit Permission i hereby granted �����_I...!-�..----•--•--------------•-----------•-----•---............---.........-•--- to Construct oVepair (� ) an Individual Sewage Disposal System l at No....... ... -/-��// r7C1411� �I ���.. � � . 1 .... r ...a.,.,,.......o..t-._._.__..._._....I...—___._//_....--_--.--.......++_^.�./..''_ -------------------------- "eel as shown on the application) for Disposal Works Construction -ermit No.,f__!///_...._�e�.(_((_- Dated.. ?..__....... 0� :.- DATE...............v i /�/--•'-•-_---•-•----•---...-•---•---•---• Board of'Health`' FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS L Fee— BOARD OF HEALTH TOWN OF BARNSTABLE r' Zppritation-*rVell Con5tructionpermft /30 Application is hereby made for a permit to Construct ( `�, Alter ( ), or Repair ( )an individual Well at: Location — Add _ Assessors Ma and Parcel P �y // p 1�� — — — --- ner — — ow a �.i _ —N — _ Owner � Address fl e`� o/; � v< ------------------- 3�__ �� Pb./ �� �� " ,", ---- —--------- ------------------------------------------------------- Installer — Driller Address b D 6 y� Type of Building Dwelling--�o`ss e------ ------------ Other - Type of Building------------------------------- No. of Persons-------------------------- - - T e of Well Capacity ------------------------- Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificat of Compliance has been issued by the Board of Health. Signed— ------- ---—--- --____—_ =,—' - /?-�— date Application Approved By date Application Disapproved for the following reasons:------------------________________________-------_______________�_______ date Permit No.--- — —` - -------- - Issued------- --- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (Compliance THIS IS TT CERTIFY, Tha thed ividual Well Constructed ( ), Altered ( ), or Repaired ( ) JCU►�rr J-�,-t - —/ C — — ---------------------- Installer — — --- —— r at =_— �_—------- --- —— —_— — --- --- —_ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit Nopjj_-Z_4�_' n ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE— __--- --------------- --- Inspector _—_— * .. � '" " ,fi .•••••••�'.+ .r _fir. .r e.. �.. • �. •1 ryj1 ll7 777 / a. f - Fee--,- `'f Y BOARD OF HEALTH i TOWN ' OF BARNSTABLE applitation-ftMell Con5tructionpermit /C Application is hereby made for a permit to Construct ( ' , Alter ( ), or Repair ( )an individual Well at: 'T �- ------------- ------ l � �vTu� Location 1-Address Assessors Map and Parcel jo lJ ��. Box �i e ',,,, /_ ek . ------------- --------- n Owner; 1 Address vie j/ oir t�V 31• &%,A,,•, IP • PbAox 96e .1 cam. Nc, Installei'c—"Driller, Address Type of Building Dwelling Other - Type of Building---------------------------- No. of Persons-------------------------------------------- !/#' Typeof Well--------------------------—----------------------------------- Capacity------------------- - ----- ------------------------ Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance-with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not.to ,place the well in operation until a CertificateAof Compliance has been issued by the Board of Health. � � 7/F Signed-- -----------------__-_------------- ----�---------- �r /oe—rlgoloj Application Approved By-_�_ % - �-4''__ - --- --- -- ---- - -- - date Application Disapproved for the following reasons:--------____:________________________________-_—__-__-_—____________________ ------------------------ ---- ---------- ------- ---------- -------------- / - —date Perrnit No. > / --- Issued------ -- date .... � �' fir( µ k � � "r• ,r � t BOAR;D.00 HEALTH f -4 Z'? TOWN OF `BARN-STABLE !r� ertifirate Of Com Ytance THIS IS T, CERTIFY,,That the,I•dividual 4�11 Constructed ( . ), Altered ( ), 'or Re alsed (lCr/rLt t A/ `/I 6, /- - r f P by- '�- —--� - /( f f-- ,-- ` - ------------------------------------=------------------------------------------------------- - --------------------- • J/ � Installer at_i�2---�G��5�w P -/t-c c- `r --/1-�------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit Nok1"�1;71 Dated- '07`-'-l4.,` C 2 a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i r "" DATE------------------------------------- - - Inspector-- - -�-- --------_ -- -- 1 BOARD OF HEALTH TOWN OF BARNSTABLE V ell Construct ion j3efmit 'I No. ----------- ---- --- / / Fee--------- �l� S�h�wt_��c,��l�4irl�J----��� - Permission is hereby granted-r-_---=--- -------------------f ----------------------------------------------------- to Construct ( •), Alter ( ), or, Repair ( ) an Individual Well at: Street as shown on the a plication for a Well Construction PermitNo.- - = ---' r �''�-----"--- / -- - - - Dated - - -------------------------------------------- DATE /� -------,9 r _ :� - Board of Health ---!— - --`- - ----- ENVIROTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Bruce Kelly LOCATION: Sampsons Mill Rd ADDRESS: 32 Third Ave Cotuit,MA Osterville,MA 02655 COLLECTED BY: D. Scannell SAMPLE DATE: 7/10/92 TIME: 4:15 PM DATE RECEIVED: SAMPLE ID: JOB #: New Well WELL DEPTH: 49 f t RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 PH pH units 6.0-8.5 5.05 Conductance umhos/cm 500 147 Sodium mg/L 20.0 21 .1 Nitrate-N mg/L 10.0 1.30 Iron mg/L 0.3 0.15 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria COMMENT: Low pH indicates high corrosive characteristics. Volatile organic compounds UG/L (see attached report) 3.0 UG/L Chloroform s (EPA 601/602) }(ajC WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARA ETERS TESTED. DATE 4Z' ' i � t 3 GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: M-76 Lab ID: 3437-01 Project: Kelly Batch ID: VHA-1026-W Client: Envirotech Laboratories Sampled: 07-10-92 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 07-13-92 Matrix: Aqueous Analyzed: 07-21-92 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL I Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL I 1, 1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 f Chloroform 3 1 1, 1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+P-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethene BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 . 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 28 93 x 83 - 117 % Fluorobenzene 30 30 100 % 87 - 113 % 8RL ■ Below Reporting Limit. Non-target canpound. "?race" indicates probable Jresence below listed Reporting Limit. Method References: Method 601 - Furgeable italocerbans and ►*t:xd 602 - Purgeable Aromatics, 40 C.F.R. 136, Appe-sdix A ( 986). � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP _ a S PARCEL rJ a LOT TITLE 5 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECE��' °"'' CERTIFICATION i Property Address: 565 Sampson Mill Road MAR 0 3 Z664 i Cotuit Owner's Name: Lisa Mycock TOWN OF :IiS i ABLE Owner's Address: --� ji Date of Inspection: 2/25/2004 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: . (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes j Needs Further Evaluation by the Local Authority Fails i Inspector's Signature: Date: -Z) Q 6 r7! 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. Notes and Comments i ****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. f Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 565 Sampsons Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 ` Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D j a C. System Passes: j/ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. i Comments: { I i B. System Conditionally Passes: j One or more system components as described in the"Conditional Pass" section eed to be replaced or j repaired. The system,upon completion of the replacement or repair,as approved by a Board of Health,will pass. i Answer yes,no or not determined (Y,N,ND)in the for the followings ements. If"not determined'please explain. i The septic tank is metal and over 20 years old*or the septic whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failEnthe ' imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved Board of Health. *A metal septic tank will pass inspection if it is structurally sount leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or h static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or unev n distribution box. System will pass inspection if(with approval of Board of Health): broke pipe(s)are replaced obst action is removed distribution box is leveled or replaced ND explain: i The system required pumping/morean 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): i broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Bo 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 determin in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which wil rotect public health,safety and the environment: _Cesspool or privy is within 50 feet of a s ce water _Cesspool or privy is within 50 feet of a rdering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)det ines that the system is functioning in a manner that protects the public health,safety and environm t: _The system has a septic tank and soil absorption system(SAS)and the SAS is 'thin 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 o a public water supply. _The system has a septic tank and SAS and the SAS is within 50 fee of a private water supply well. The system has a septic tank and SAS and the SAS is less than 0 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 EP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is ee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be a ched to this form. 3. Other: I. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 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 and overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _,/-Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is 50 feet of a private water supply well. _„zAny 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] r c�(Yes/No)The system fails. I have determined that one or more of the above 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. F E. Large Systems: To be considered a large system the system must serve a facility wit design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the teria above) yes no _the system is within 400 feet of a surface dri '' g water supply the system is within 200 feet of a tributary ,6 a surface drinking water supply the system is located in a nitrogen sen 'five area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply wel If you have answered"yes"to any questi in Section E the system is considered a significant threat,or answered "yes"in Section D above the large syst has failed. The owner or operator of any large system considered a significant threat under Section E or 'led under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should ntact the appropriate regional office of the Department. r Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: i i Yes No Pumping information was provided by the owner,occupant,or Board of Health I Were any of the system components pumped out in the previous two weeks? i 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? i 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 than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? I' The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No 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(3)(b)] f i Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 565 Sampsons Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: a/ j Does residence have a garbage grinder(yes or no):f? Is laundry on a separate sewage system(yes or no): yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage Sump Pump(yes or no):,�c Last date of occupancy:Ce,.x-jg;; Z iI i COMMERCIALANDUSTRIAL Type of establishment: _ Design flow(based on 310 CMR 15.203): d { Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes r no):_ Non-sanitary waste discharged to the Ti 5 system(yes or no): Water meter readings,if available: j Last date of occupancy/use: OTHER(describe): :71 GENERAL INFORMATION Pumping Records Source of information:'� r,,-,;aL,� ,�.� Was system pumped as part of the inspection(yes =S If yes,volume pumped: lSQg�gallons--How was quantity pumped determined? S%Tt Reason for pumping: TYPE OF SYSTEM eptic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval i G _Other(describe): Approximate age of all components,date installed(if known)and source of information: l Were sewage odors detected when arriving at the site(yes or no): L Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 BUILDING SEWER(locate on site plan) Depth below grade: J �� Materials of construction:_cast iron_40 PVC_other(explain): Distance from private water supply well or suction line: 13® ' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:�ocate on site plan) Depth below grade: �2 " Material of construction::L/concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top of sludge to bottom of outlet tee or baffle: "-)'c( — Scum thickness: 3" 'dre Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: A_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition, s ctural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): JD® ns 8 GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal—fiber ss_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or affle: Distance from bottom of scum to bottom of o et tee or baffle: Date of last pumping: Comments(on pumping recommendatio ,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of 1 ge,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 TIGHT or HOLDING TANK: (tank must be pumped at time o npection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal fibergla _polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working der(yes or no): Date of last pumping: Comments(condition of alarm and at switches;etc.): DISTRIBUTION BOX: if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): �`•��.� � �dC'�^� ra c.�a.r�r�,ro u6,�-- or ln`.` cum.,— ;v,.`�, PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,conditi of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 SOIL ABSORPTION SYSTEM(SAS):�ocate on site plan,excavation not required) If SAS not located explain why: Type eaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): O L. � `�s r.Q_ �'G J C. \ of' S " �A'Ci lox.., ♦�:�C.,r�. �1 ^�`:w.� e7-� CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on s' 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 or no): Comments(note condition of soil, signs of hydraulic failure, evel 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 hydrau/ailure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. I « Q. 1 A L3 �3q/ 3` ` `i 1` 0 .1 br o - L/ „ S3 • Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 565 Sampson Mill Road Cotuit Owner: Lisa Mycock Date of Inspection: 2/25/2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�Q feet Please indicate(check)all methods used to determine the high ground water elevation: __,., �btained from system design plans on record—If checked,date of design plan reviewed: gla Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: y-,.Q, You must describe how you established the high ground water elevation: !V� �.roc ti.c^� • >� r 6.�c�1ti�c',�✓� 1—�Z'O G 1:n - °� a` Page: CERTIFICATE OF ANALYSIS O M Barnstable County Health Laboratory Report .Prepared For: Report Dated:.4/20/2004 Order Number: G0424671 Bruce Kelly P.O. Box 218 Cotuit, MA 02635 Laboratory ID#: 0424671-01 Description: Water-Drinking Water Sample#: 24671 Sampling Location 565 Sampsons Mill Rd Cotuit MA Collected 4/6/2004 Collected by: B Kelly 39/087 Received 4/6/2004 Routine ITEM RESULT UNITS M MCL Method# Tested LAB: IC Lab Nitrates 1.4 mg/L 0.1 10 EPA 300.0 4/6/2004 LAB:Metals Copper 0.2 mg/L 0.1 1.3 SM 311113 4/7/2004 Iron <0.1 mg/L 0.1 0.3 SM 31 HB 4/7/2004 Sodium 24 mg/L 1.0 20. SM 3111E 4/7/2004 LAB: Microbiology Total Coliform Absent P/A 0 Absent 307 4/6/2004 LAB: Physical Chemistry Conductance _.160 urhohs/crri t EPA 120.1 4/6/2004 pH 5.7 pH-units 0 EPA 156.1 4/6/2004 Note Sodiumlevel-alb ove the average.Those on low sodium diet may wish to contact ph ysician. Approved By: L� --- ( Director) P f,x Z Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 COTUIT n STIK 2� (FND)OA I �-o ILL PRUD C.B. OCUS 9 I (FND) 509.14SO � SALOT 35 ASSESSORS 3 vo� LOT 39-86 e�THE SEPTIC SYSTE,v �' LOCUS MAP PROPOSEDWAS DRAWN FMA( THEADDITIONSC B T9WN OF BARNSTABLE �� y �� PLAN REF. 36319D (FND) SEPTIC INSTALLERS CARD y� � PROPOSED ASSESSORS MAP- 39-87 r DECK ZONING: "RF" PROPOSED ADDITION �- SETBACKS.• 30'-15'-15' CB i DEED REF 148344 (FND j PLOT PLAN OF LAND LOT 25 LOCATED AT.• LOT 36 ASSESSORS 565 SAMPSONS MILL ROAD �- LOT 39-94 ASSESSORS �� ASSESSORS CO TUIT, MA. LOT 39-146 LOT 39-87 9 AREA=90780fS.F. g`�9 PREPARED FOR., WILLIAM & PA ULA DE JONG N +++�Aj" •w MARCH 28, 2005 LOT 24 �ls TC ASSESSORS o�° STEPHEN ► REV LOT 39-93 4 DOYLE N >' REV #37559 _ ASSESSORS a Mo s ,a�± REV. LOT 39-145 LOT 23. ++v�� YANKEE LAND SURVEYORS v�-�..--"4-D�D A ASSESSORS GRAPHIC SCALE & P 0. BOX 265 TS LOT 39-92 50 0 25 50 100 UNIT 1, 40 INDUSTRY ROAD LOT 22 _y_ MARSTONS MILLS, MA 02648 ASSESSORS ASSESSORS - - TEL•- 508—428—0055-FAX--508—42 —5553 LOT 39-144 LOT 39-91 1 inch = 50 ft. SHEET I OF 1 JOB !' 53855 JF } Al { 1,.00'0k x dek M.ZZ 2fi O" 5 6"- 4'-0" 2'-1" 4'-5" 2'-1" 4=4" 2=1" 4'-0"_ a CV yox, M M N N ;-- T------------- eh I � 14 I I iti O�f 14 DECK `4 q 3,6„ 2. U'l rvvm ,-r -------------- '" `- p y 20:�„ N 3-9 N _. --- r gas stove,bring in gas pipe&vent 8 foot up throuh wall N -------------i —3 33-8" _ -0 10=8"-28'Sn(Rail T-11" 2.O« o i 2-10"� o I x I b b ro .2_ 0 I E a v v !/, ; nt 2 2" pt1^ M a p ,4, ----------------- t)n w ,: 3_ (Rai?C—C a, I DECKS i ,,. ..._._____...-_._.....-...---._.........._ —,�' i I4'A (R .N N Q 13'-9" fo 2-2n a • DECK / 1 ------------- f y O 0 \S/Sy O 2-2„ �F 1 25'--O" OD 36"W J IRx 10,0 48'W v ` 13Rx 10.007 _-_._. 5" = Willem Jan de Jong 26 March 2005 r EL. — 790 20' �Y lVF OF JFOLWA27ON' COAIrUM COMS' 2'IrtPA? OF ' . GROUND EL.. 78 cv -. APPROVED: BOARD OF HEALTH _ P �D77z i . — . P171�1.1/4 Pal? F1: - ,. 4- SCIM= 40 P-VCLZ7 Moir LDW Pl11CB 1 8 P�'R ll: �IOY JT Ems=78 2 . . 1 DATE` AGENT �" 1O- PAST r EL.= 78.B :: _ cOR sw� In Blvmm EZ._ 7B 2 sm s ::::::es: sDVVjmr ,° AMUIY.tta'1V?' • L7 . . EL.— o 7B 5 - IUD MPNC TIA� o° , c e/4. fl9 1 1 r . . �d.S�'D 1Va 1,000 GALLONS EL.= 75 9 EL.= 75.2 0 ° c`fl EL 69.2 • . .•. . DIAM . . • •••-• "VACANT POTS �... May PIT ,,,� Y OAD s o V`0 •� BOT.?i M OF TMT,HOLE OR USGS PROBABLE WATER TABLE' Fes= 85.2 R rLL AD oo� . ONS 125• PROFILE OF SANIp SEWAGE DISPOSAL SYSTEM ' NOT TO SC ALE Sg4.14, ELEVATIONS ASSUMED 1 z ,t 34.0' 1 ' P 7913. o . I 15 SOIL LOG WITNESSED BY: JERRY DUNNING DATE 2 DATE s sz HEALT o cER R TEST HOLE 1 TEST HOLE 2 Tvw1v of BARNSTABLE EL= 77.2 _ 77.3 BILL LMA"AN P.E .� TOP & TOP & LOT 36 77 PERCOLATION RATE _<2 AfIN./ INCH 90 7B1 S.F �O 0-1 UBSOIL 0 1 SL"BSO DESIGN DATA: NUMBER ;.OF BEDROOMS 3 x , _ �IlEDIrIM ` , HEDIUI! , *-' 1 COTUIT COTUIT 13 GARBAGE DISPOSAL NONE AND o SAND S �- _ TOTAL ESTIMATED,FLAW GPD 10 1 GAL AY rBIZ) , LOT 44 EL=85.2 -- / --�- SEPTIC ;TANK CAPACITY 1000 GAL - LEACHING AREA :RE UI] EMENTS G Q NO WA TER ENCOUNTERED SIDEII'ALL AREA 2.5 GAL 'S.F: o p / BOT.?10M AREA ; GAL S pF 9 1,10 ss S49 3 3 o LEACHING CAPACITY ( BOTTOM & 'SWEVALL) GA4 DAY. T ,� y tt s- 0 - 78 BOT710M 2lXl0 . 4X7.EOER H N o _ . co �a 2397 -• SIDE WALL fMOMAT.5 471 s. 219 o , s i E RESERVE LL�'ACHING CAPACITY GAL DA 1� N _. � ., r GENERAL :NOTES E 1. THIS PLAN LS FOR INSTALLATION.OF NEW SEMC PROJECT LOCATION.• ASS LOT `87 43 5 SAMPSON'S JAM ROAD LOT : . . 3 COTru 9 h 2. PLAN SCE L C. PLAN 38319 D 1 3. THIS PLAN IS' MR INSTALLAHON/REPAIR OF SEPTIC SYSTRK AND NOT M BE USED FOR SURVEYING OR ZONING PURPOSES. APPLICANT`_ DICK SCHRAEDER : y BOSS BUILDING 'CO. ..:, 4. WORKMANSITYP AND ATERIAIS SHALL CONFbRV T 10 D.R P.ALL ,� _ � P.O. BOX 309 T1 r 5 AND TTIE-TOWN- OF BARNSTABLE RU.LES.AAD RLPGVLA27ONS C �lA,ENTERVILLE :« FOR THE SUBSURFACE DLSPOSAL OF SEA'AGR , LOCDS , 5. ALL COVRRS TID SANITARY LT 5 SHALL BE BROUGHT ?1D A7THIN YANAFE SURVEY CONSULTANTS �► 12 OF F7NISIM'D GRADE. P.0. BOX s285, -143 ROUTE 149 8. AWTING AND FINAL GRADES SHALL REMAIN HSS=ALLY T1YE ; ARSTONS � . AAA 02848 LOT 42 SASE UNLESS NOTED BY FINAL. COJM UR5 7. ALL CO�KPOAMM OF,?�SIE SA TARY SYST" SHALL BE CAPABLE rP OF, W1THSTANDMG H--10 LOADING UNLESS<THEY ARE UNDER , OR W1720 ' 10'.OF DRIVIF.�' OR PARKING AREAS. H-20 LOADING ' 4 SCALD.` 1" 40' 712/92 SHALL BE USED UNDER OR WTIHWN, 10 OF DRIVES'. OR PARKING. h , UNLESS NOTED. --- - �� REV. REV 8. ANY MASONRYl UNITS USED M BRING COVERS TO GRADE SHALL g , BE JfORTARED .W PLACE. JOB ND. 50178 SHEFT 1 OF 1 9. NO DETF.RdIINATION HAS BEEN MADE AS TO COMPLIANCE W1TH ( DEEDED OR ZONING REGULA??ON3: O ANER/APPLICANT IS ?YI LOCATION : MAP R, OBTAIN SUCH DET KRMINATION FROM,APPROPRIATE AUTHORITY. W, EL.— 79.0 20 IVP OF YVWWA27OX C01"OWT COYim 20141y" tip GROUND El.= 78 • '• OR �Mr CFO Z2�fLZ .�4PPR0 VED. , BOARD OF HEALTH •. P.>P� P EL-77z -.•. P�1i.� �"!:Pal? 4 SCMVW 40 P.PGR�. . . Pia' - , azolr�, :U PIl1�'!Y 1� BOI Pj'!? F1: .EL—78.2 DA TL' 21 mu L"c PRar„rsr AGENT . . _ 78.8 EL.— CPL®a OR EZ.� 78.2 sm" : :SOPSMS: =DVT! o JWMVALffff 7 0 . mrtc ruler 7 o c 1:000 GALLONS , EL. 75.9 — o -• EL _ B9.2 . �--- -=-� IV A� LO"VA pff TS 50 A f o BOT7 M OF TX57 HOLE OR USGS RO D cp 80 P BABLE WATER TABLE EL- L7 R f :: 1 , S �' `� , PROFILE OF P 501 T A M SEWAGE _DISPOSAL SYSTEM 3 14 ._ - _ : .. ----'" _ � • , ,� � �, NOT : TO SCALE 0 0 , , �C b , : ALL ,ELEVA770NS'ASS 20 E � � � _ p UMED ' 0 o .2 •r 7913 G - : SOIL LOG . WITNESSED" JM&Y DUNNING ¢ 9 THE SED BY. a DATE Q $S DATE392 HEAL 7H ocER ? 'T HOLE TEST HOLE 2tARNS TOWN OF TABLE EL 772 �'7.3 BILL:.LIEBERaIAN .fi.E 6 LOT 38 TOP do TOP & 0 _ - PCOLATI01 R,4TE �1fIN. INCH - _ . 0 — UBSOIL O 1 SUBSOIL � , 90 781 SF .. .- . DESIGN. DATA: x NUIMM . OF .BEDROOMS 3 .. 11[EDIUIM - MEDIUM / COTUIT COTUIT GARBAGE DISPOSAL 11a0NA' 0 SAND < s SAND t 330 : , . TOTAL ESTIMATED FLOW GPD IM 110 . LOT GAL A 44 - E'L-85.z 12 000 1 G � FP AL , TIC ?ANK CAP C , I A I7`Y G „ LEAC `� . , HING ..AREA RE EMENTS 0 C F o NO ,� Q N o WATER ENCOUNTERED _ SIDEWALL AREA 5 _. c4 AS t 4, GAL., S.F. A S I t 4 C, ^ K c^ 0 B T7lDM AREA GAL` S�y, o p 1,0 �/i 9 !, at�L WI LIAM s , , 3 0 0 549- � 'S LIEBERM�N 3 _ -LEACHING CAPACITY BO??1�M dr SIDEIPALL GAL,,�DyAY. > ERI (, J /L TN - W �, F o ,y : . 2397 0. 32098 2 „ :. o .. � , . _ BO??i7Af 1T.JY10 . 4A7.0 ;_ 78is F . P Q tp y .fi / S G E STE r t ca e. o s � .. SIDE.-WALL 17XrOA'l3M.5 471 , F o "I 9 1°I RESERVE,.LXAQWfG .CAPACITY 21 N - AU DA r , e. GENERAL NOTES , �I - . ,. , , PRO JECT LO A . . C TION ., ASS. LOT 87. . . ,_?7115' PLAN IS R INSTALL,4?70N . ,NEW SE1'77C. LOT 43 _ S ON'S �?LL AD ,. - . AMPS RO k z. PLAN REFERENCE L C. PLAN 38319 D , � : _. _ COTUTI , 1 M 3. ?7115 .PLAN .LS' R ;INSTALLA770.� N/ REPAIR' OP 5EP?7C SYSTFJ! AND `NOT:?� BE USED 1�7DR S URVEYING >OR $ONING, PURPOSES. .... , APPLICANT` : . . .- DICK SCHRAEDF.R ROBS BUILDWG CO. 4. ALL 1 f�RKAIANSH1P `AND MATERIALS SHALL CON1�'IDR� OPT 1'1 DER P. - P.0. :BOX.309 . - P 71TI L' 5 4ND 4 THE -TOWN:OF 8.4R1V5TABLE RIDS' AND_RE'rGULA?701VS. CENTERVILLE; FOR :T7IE.SUBSURFACE DISPOSAL, OF SEWAGE 5. ALL COVERS' ?'l7 SANITARY SNITS SHALL BE-BRO UGIIT .?10 A7TfIW f. YANKEE SURVEY CONSULTANTS 12 OF F1N15fIED GRADE. ». ,. m. p :. P.0. , BOX 265 143 _ 49 �. ROU?R 1 r . LOT:42 ,. , 8 EXlS??NG AND FINAL GRADES SHALL ,R�,ArN E<SSF.IVTIALLY.771E � . AG41�ST01V5 MILLS " 'e 02848 SAMl� GTTLESS NOTED BY FINAL: CON7IDURS. 7. ALL COMPONENTS' OF = SANITARY SYST.Eii! H Z C OF:072 WTANDING H- 0 ' 1 LOADING UNLESS THEY ARE VMM Y q SC p , OR Hip, ,10 .OF DRIVES OR PARKING- - AREA.Sn H-20 ,LOADING - _ . , , ..:' 1 _ 40 712192 SHALL BE USED UNDER OR A?THIN. 10 OF DRIVES' OR PARKING. to UNLESS NOTED. y YY. 8. AN MASONRY,:VM S' USED Tb BRING COCO�ER5 TO GRADE SHALL : BE MORTARED M PLACE. 9. NO DETER"A77ON HAS BEEN MADE AS TO COMPLIANCE 07M JOB NO. 50178—� ONWG .REGULATIONS: OWNER AP.I'LTCANT IS ?b � LOCATION 'MAP FsHlzT 1 OF 1DEEDED OR �Z � _ OBTAIN SUCH DETERJ&VAT70N FROM APPROPRIATE A UTHORITY. ,