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HomeMy WebLinkAbout0043 SANDALWOOD DRIVE - Health _j 43 SANDALWOOD DRIVE, COTUIT .- A= 010 018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 43 SANDALWOOD DRIVE "a Property Address i4r ,ANN WEBBER Owner Owner's Name information is required for every COTUIT t/ MA 02635 12/4/17 , page. City/Town State Zip Code Date of Inspection W, ZA ils:j 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:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not KEVIN BURKE use the return Name of Inspector key. THE BUILDING INSPECTOR Company Name 15 CHESTNUT ST. Company Address WAREHAM MA 02571 City/Town State Zip Code 508 291 2228 SI 13730 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector'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 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 14)�4 uS 1 1 • 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635. 12/4/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ 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 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposa System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. City/Town 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc•rev.6116 Title 5 Official Inspection 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 M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. City/Town State Zip Code Date of Inspection 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 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection 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 M 5 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. City/Town 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? ® El information 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): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 GPD t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No 'Last date of occupancy: 12/4/17Date 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? ❑I Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection 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 M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form: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 M °yt 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1979 ON FILE BARNSTABLE B.O.H. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 29„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.): JOINTS STRUCTURALLY SOUND NO SIGN LEAKAGE Septic Tank(locate on site plan): Depth below grade: 20" COVER HAS 1 FOOT RISER 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 GALLON Sludge depth: 2" t5ins.doc•rev.6116 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 SANDALWOOD DRIVE Property Address 'ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown _ State Zip Code Date of Inspection D. System Information (cont.) cont.Septic Tank p (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5„ Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? FIELD MEASURED 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 STRUCTURALY SOUND BAFFLES IN GOOD CONDITION LIQUID LEVEL FINE NO SIGN OF LEAKAGE OR BACK UP DUE TO THE AGE OF THE SYSTEMS I WOULD PUMP EVERY TWO YEARS Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene '❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments z 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 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: 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.doc•rev.6/16 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 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owners Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NOD BOX 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.): 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Si Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 6X6 ❑ 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.): NO SIGN OF HYDRAULIC FAILURE VEGETATION NORMAL GRASS 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 ❑I No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ' —eX Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is COTUIT MA 02635 12/4117 required for every Page- Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately —C. ar.► I to fat a9- t5'ins doc•rev.6116 THIS 5 Official Inspection Form:Strbsarface Sewage Disposal System•Pape 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 FEETfeet 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: 7/22/1998 ON FILE B.O.H 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: I PULLED ENGINEERED DRAWING ON SURROUNDING PROPERTIES 54 SANDALWOOD DR 61 SANDALWOOD DR ALSO USED TITLE 5 FORM ON 43 SANDALWOOD THE PROPERTY THAT WAS INSPECTED Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a ` `� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 SANDALWOOD DRIVE Property Address ,ANN WEBBER Owner Owner's Name information is required for every COTUIT MA 02635 12/4/17 page. City(rown 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 ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file { t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Executive Office of Envirorunental Affairs Dept. of Environmental Protection Jolui G>f:><ci One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket M—025:36 (50.8),564-6813 1 WILLIAM F.WELD Governor � ARGEO PAUL CELLUCCI L o Lt.Governor Cello 04 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ��j� PART A CERTIFICATION It gllB9q Jg ! / tiDFp3 qe' �� Property Address: 43 Sandalwood Dr.Cotuit Map010 Par 018 Lot 1 Address of Owner. Date of Inspection: 1177/98 (If different) r 4 V Name of Inspector: John Graci Cormier:C/O Pam Autery Box 1643 Cotuit Ma 0 635` I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) � Company Name,Address and 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: x Passes This Inspection Is based on criteria dented In We V _ Conditionally Passes code 310 CMR 16.303.Myfindings are of how the system is performing at the time of the Inspection.My Inspection does _ Need Fur Passes Evaluation By the Local Approving Authority notimpyany warranty or guarantee of the longevity ofthe Fells septic system and any of Its components useful life. Inspector's Signature: �1 Date: 7120198 The System Inspector sha submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the'failuee criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N,or ND). 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 Co7hpliance(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 conforming septic tank as approved by the Board of Health. (revised 04l27197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556A049 • Telephone(617)292-5500 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 Sandalwood Dr.Cotuft Map010 Par 018 Lot 1 Owner: Cormier:C10 Pam Autery Box 1043 Cotuit Ma.02635 Date of Inspection:711719a _ Sew.aoe backup or.breakout.or. high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OFiHEALTH: 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ _ Backup of sewage in 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 cesspool. — SAS is in hydraulic failure. (revised 0497)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 43 Sandalwood Dr.Cotuit Map010 Par 018 Lot 1 Owner: Cormier:CIO Pam Autery Box 1643 Cotutt Ma.02635 Date of Inspection:7117198 D]SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 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. 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. El LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The 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 health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revlsed 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 43 sandalwood Dr.CotunMapolo Par018 Lot 1 Owner: Cormler:CIO Pam Autery Box 1643 Cotuit Ma.02835 Date of Inspection:7117199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x — As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _t_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x 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. x _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revlsed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Add ress: 43 3andaiwood Dr.Cotult Map010 Par 018 Lot 1 Owner: Cormier:CIO Pam AuteryBox 1643 CotuitMa.02835 Date of Inspection:7117199 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 9•P•d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nra Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: rda Last date of occupancy: rda OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped 2 years ago. System pumped as part of inspection: (yes or no)No If yes,volume pumped:a gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1979 - Sewage odors detected when arriving at the site: (yes or no) No Ireylsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 43 Sandalwood Dr.Cotuit Map010 Par 018 Lot 1 Owner: Cormier:C10 Pam Autery Box 1643 Cotult Ma.02835 Date of Inspection:7117199 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:x concreate_m eta l FRP Polyethylene_other(explaln) If tank is metal, list age nia . Is age confirmed by Certificate_ of Compliance No (Yes/No) Dimensions: Le•5••h5•rw4.10- Sludge depth:1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness.e Distance from top of scum to top of outlet tee or baffle:e" Distance form bottom of scum to bottom of outlet tee or baffle:rVa How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Sepec tank and all components are structuraey sound.Recommend pumping septic system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: nra Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n1a Scum thickness:nia Distance from top of scum to top of outlet tee or baffle:nla Distance from bottom of scum to bottom of outlet tee or baffle: nia Date of last pumpingn't. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) We BUILDING SEWER: (Locate on site plan) Depth below grade: ve•• Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction linetown Diameter: nla ' Qimments:(conditions of joints,venting,evidence of leakage, etc.) pevlaed 04R7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property Address: 43 Sandalwood Dr.Cotuit Map010 Par018 Lot 1 Owner: Cormier:CIO Pam Autery Box 1643 Cotuit Ma.02835 Date of Inspection:7117199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: We Capacity: rda gallons Design flow: rva gallons/day Alarm level:_nra Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rYa PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_No Alarms in working order(yes or no)Yea Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) rnfa (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add ress: 43 Sandatwaod Dr.Cotuit Map010 Par 018 Lot 1 Owner: Cormier:CIO Pam Autery Box 1643 Cotuft Ma.02635 Date of Inspection:7117198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: 1000 gallon leach pit leaching chambers, number:n1a leaching galleries,number: n1a leaching trenches,number,length: rda leaching fields, number,dimensions:n1a overflow cesspool,number:nla Alternate system: n1a Name of Technology:_nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit was structurally sound and functioning properly.The leach pit had 2.6'of water In It at the time of the Inspection. " CESSPOOLS:_ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: nla Dimensions of cesspool: ria Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) nfa Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc:) rda F PRIVY:_ (locate on site plan), Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION(continued) 43 Sandalwood Dr.Cotuit Map010 Par 018 Lot 1 Cormier:C/O Pam Autery Box 1643 Cotuit Ma02635 7117198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Papa ! of 10 (revised 04f17197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOrM PART C SYSTEM INFURMATIUN(continued) 43 Sandalwood Dr.Cotult Map010 Par 018 Lot 1 Cormier:C/O Pam Autery Box 1043 Cotult Ma.02635 7117198 , Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revlsed0027l97) page 10 at It `i, F.s..... ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appluttttlatt for Dhipnstt1 Works Tomitrurttnn ramit Application is hereby made for a Permit to Construct"( ) or Repair ( ) an Individual Sewage Disposal System at: ' 4%V ...... L.- !.Z.................................................... ....... Location-Addres •• or Lot No. ti !S 1: G .. r..� _""VIP..................... ......... ............... Owner Address q � ...................................................... -•••....................•-•••-••-.....----•-..--..._.•--•----.._... *------------- •------------ Installer Address Type of Building �j Size Lot_o1,a 0_��,_Sq. feet Dwelling No. of Bedrooms...........O__�___........................Expansion Attic ( ) Garbage Grinder Other—Type of Building No, of persons____________________________ Showers — Cafeteria a Other fixtures ..-----•-----•-•--•---••---••------- -- --- ---------------------------------------------------•---•-•------------------- W Design Flow l/.G?.... gallons Pe "lit d Total daily flow------... ---------•---•-�lons• WSeptic Tank—Liquid capacity&zt&_.gallons Length_8�_.___. Width_`1-- 10_ _ Diameter________________ Depth_ x Disposal Trench—No_ ____________________ Width___.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO._._.__.e�_____.__. iameter__�_.._.___..__ Depth below inlet....�__e__._._. Total leaching area.G2- .sq. ft. Z Other Distribution box (6') Dosing tank ( ) `-' Percolation Test Results Performed by_l�aC3rs>i��,1�_�eQ_.__��-d.��A.✓ --..R'S_t....... Date___���dN_ ____ -Z� 1 � Test Pit No. 1_._!___minutes per inch Depth of Test Pit.../.2..._____ Depth to ground water.._ LZq Test Pit No. 2. ___minutes per inch Depth,of Test Pit_1_Z_'_________ Depth to ground water---- lure.._—____ 9 --------------------------------•-•-•---...._......--------•----._.....---------•---•••••-••-•--••--......................................................... Description of Soil......-Q--`--3-y--..:Lowf ...__ ,cs.E ..----,57�as:-m .'-------- Z9P2_.__.._SAYvb U R ��- $.4 .... _ `t�_� __ l0V..---•--�.I(�3r1 ----•----•-------------------------•--------•------•----- --- - ---- W ........................................ =:---- - -_1_1_7 Y,-----------..-•----------.--.---..-----......-.............................. U Nature of Repairs or Alterations—Answer when appl cable..___ ________________________................................................................ -------------------•_..._••••--•-•---------------------•--•-•-----•-•-•-----:--------•••...._...----•------------•---•--------•---------•-•------------•-----•---••-----•--_.___-----•-----------•----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI:�.;,;. 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. -Si ed_l_ ... ..............••-•---------•-----=------•...-•-------•.....•--•-•--- -----•------Da e_......-- Application Approved By...... .%__ 1 �.__ lt'_............................... Date Application Disapproved for the following reasons:......................................_......_................................................................ _ -•...............................•--------•-••--•-•-••---•--•------------------•------......_..------•------••-•-----------•••••------•-------•---------___._.---•--•-----------•------•-------...._.._. Date PermitNo......................................................... Issued....................................................... Date 4.. No.......... - F.......3.©............. S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............0F....... 4 i.Z4_d/ ................................ Appliration for DiSposFal lVorks Tono rurtinn rumit Application is hereby'made for a Permit to Construct''( ) or Repair ( } an Individual Sewage Disposal System at:; ..5 1. 2 ? •�'s.. 2f.).. .. ... .. ............. ...... ......N.o-. ---•------- -----e- ............... .......C". ocation Add* or LotA -."I.�Y.A.. --------------------- ------------------------------------------------------------•---------..................---....... Owner Address W Installer Address Type of Building. Size Lot.V_ ..0_s0.> .Sq. feet Dwelling 4- of Bedrooms.......... .........................Expansion Attic ( ) Garbage Grinder (,Vo Other—Type of Building ............................ No, of persons............................ Showers ( ) - Cafeteria ( ) W Other fixtures .......................................d .. Ts t :,:.•---------------------------------- Design Flow............ `,r�_a.__ .. 'gallons e esQn aYotal dailyflow...... � �-- ------------gallo.n..j. . WSeptic Tank—Liquid'capacity/Peza...gallons Lengthya..r.... W Diameter................ Depth5.a. . x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO........Z......... Diameter....`..... ....... Depth below inlet... ..I........ Total leaching area. ..e).'C3..sq. ft. Z Other Distribution box'(,,.,,- r Dosing tank ( ) Percolation Test Results Pe ormed by._R0_e 1f_ _�-R.-{r./A,69AP....JR.5......... Date---- �1.�,t Test Pit No. l..x'.'. :...minutes per inch Depth of Test Pit-_/.�-__''..... Depth to ground water.:.A t_0.AA _0--. Test Pit No. 2--fL: ir-.._minutes per inch Depth of Test Pitl.�............ Depth to ground water---NQ.&.C...... w .................... ----- •------•---- O Description of Soil----.. "'- au �•�°5.....- 41., S,pe�........ ..-. '.�.1 ?i�t� ......-�A&. ev ---- ...------ x ----------------- -- U Nature of Repairs or Alterations—Answer when appl cable._...'_______________________•............_._...................................._.._.......... k Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. a ed .................................... ... f Application Approved BY 41r4lj- .......................... --•- ............................... Date Application Disapproved for the following reasons:.......... ....................••---.........-•-----••--.....---••----.....-•-----•----•--.........-------•-••-....--•--•.............•-----•-----•---•--•----•----------••-••-••-•---------------------•....-•--- Date'a,, PermitNo................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f :A_ J...............OF.......�� G./?.�?!.?5 ' �� . '................................. Trrtifirab of Tompliana THIS�j TO C TIFY, That the Individual Sewage Disposal System constructed (V) or Repaired ( ) by..."-_...... -•-s---• .............................•-••----------•---- -•------------••-•-•-•---- -----............-----•------•---.-••---••--------_------ Installer Z"_1 has been installed in.accordance with the provisions of TI/2M 5 .Th.State Sanitary Code as described in the application for Disposal Works Construction Permit No....;.!'.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ...... ......................................... Inspect .�- It -` ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r q�y tr ........ OF....... --y.'&AJ.5,"Y 4.4?4.,�•".L.'......................... �i NO.. ............... .. `f EE 3d f Dioposal Works Tuons#rnrtion rrmif Permissionis hereby granted............................................................................................................................................... to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo.-- ' ...... .......P ............. > .......................................................... Street as shown on the application for Disposal Works Construction Per No. ....... .... . Dated.....I�`.. ._`. _ .......•... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS l ~ �. . TE ST N •0LE TUN E ?-a, 19 79 PAUL MURRAY .--IN S PECTOR EX15T. R.' !QS - 0- 3. 'LOAM ANO i LOT . 3 �- 4 ' MED%UM SAly R A N D I SO •,4 C. B. ASsum RA)VEL q7 C . - Its '. 4 '-la MEDIUM -SAND. J�POP TANK xq TEST E L E 1', - O r OiJN�_ ® �' NIQLt .� �. Box O L;JA TAR ENCoulvTt"Rr D RESERVE ^ '• LEACH- - ?a+o � ,. J - , `•LO`f ' ,f �3 U/wiwG. S ETeCEQu/, MwTs Z: % T2E�1 ' • . SEP T./G _ 3 y'S TE:n7 CoiV:$T2.(JC'T%O�/. .t , . . • SHA [_[. Cdi4_/.AO%2f%I TO • • C/V-✓/,e On:/M-L-n/T,.4 G �OP� 7<.TL� JZ: s: . • - . ,: - , +. •,+2'E.1�'1"SE'Z� '7-�" 7, 7 LG,4"G.�/' 2ITE ` G M/rV. P/Zor�oS �� _ dA'RAl:57-/V �EQ,UZG� LF�C f TOP OF, NEAILT// T��'GCUL<t'7"iOn/S ';020' 05 ' � " . /M�C.e t//o cJ5' Co✓E. Mp I c/OLE Co°irE,� TO EX:TEiJD':TO , TO.Zd-t/4hiT Fir�/E5 P OF2A7/nIC . 5TQAlE 4"C<tsr 80X Z/"w/pc ovee 4 G,�T '¢ OVA. �� ip"LGgC: -/ MAN. 0lT.CN 'w�- 0 � _YOO� . MP.V ;d /4."'�Fo'or• ' p' WASHEO S - - (Nl�F�t T TO n�E' -GA L ON/ l.V✓E2T 6 �� o1-LL /N Vf2T G A-,a 4 C•17 / SEAT/G TA A/, E[-EV• A 2 OunfO .7 7. �WA TG T.�G'hi T) : /N(/E,2T 4' `- pi r' /. /w.vE.AZr NO, GAL6AGE L . 61 J S% TE hL A n/ -P/QOPOSE-Z) E: LOCA7"/0/l/ _:�ARtl�TkBL (G•QTCi/r MA Sc�A/C �t F .4 SE DT/G TANS� 'I�/s'T2/ U77/ON BOX 9� $ O.U7 LET6� D Z_F_- NrN �0 '/T- •'ARTMUf1 COAY(' rST,2G�c/GT,?� OOfI FST rAR`PA , "!`�`.l0•. LaA"a./niG�. ' , B•� . /LZ. yW�' p_ ,' �' 9':D,C ly 01,,�4 n0'T.7 �� ZLOCA '�_� O✓.E G S�S T�iv1•Un<L E f/- 20 1 'L •CFRTIrY. THE a`)/LD7lV•G' .0. 0�1D/�vG PLAN -JS PROPOSED C.'N Ti4,P GI?Ot//'f? A o�tP try; SNO[,/M AND IT.. OGEES eompi•.`/ f+.>lTN --- TNE D!/1 r Cr Al~,-s v �p�1+.JR.: .. s. iA Or 77_7Z 7"OL_)N or UARN'STAI C3L4� �Lf�F$��p`�° � � _ ---•__ _ _ - - /� SURD A F���✓,�L