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HomeMy WebLinkAbout0490 PITCHER'S WAY - Health 490 PITCHERS WAY, HYANNIS ,a A= � 1 e � e � e e f F } �x TOWN OF BARNSTABLE LOCATION ��� �� � SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. tSEPTIC TANK CAPACITY �A\0 0 LEACHING FACILITY:(type), �0 D' �k Z. Ct'P(size) `Ci NO.OF BEDROOMS Ll OWNER PERMIT DATE: b COMPLIANCE DATE: 1�.,�•f"o I-�7 _ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �3.C� Feet Private Water Supply Well and Leaching Facility,(If any wells exist , 1 on site or within 200 feet of leachingfacility) (�/ Feet ty)- � Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,� W� Ak-o Sk = S'4 %t)c `Vo e-4�L G S 4 46 !� Fee I Do No. V (�1v/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYicatiou for �Diq gar 6pgtem Cougtruction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Ei omplete System ❑Individual Components Location Address or Lot No. -�cL© Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J 1`t C'1V g S Installer's Name,Address,and Tel.No. Des' ner's Name,Address and Tel.No. cis eC9 NC_ a�f3� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 U gpd Design flow provided Q 4 L� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A:S. �Description of Soil � � �1 e d\U,Iy Cc J ^L• 0"ivi Nature of Repairs or Alterations(Answer when applicable) c. U, L A— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date Application Approved by Date /r�a� r--� Application Disapproved by: Date for the following reasons Permit No. 1, —_——_—_Date Issued —� b f � 1 0 aw Fee 0V�7S —� . No:• "I (/ 1 tom. .� "` t ' THE C(-.iMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH'DIVISION, - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Apt "cation for afztogal *pztem Con!5truction Permit Application for a Permit to Construct O Repaif Upgrade O Abandon O EAl/Complete System❑Individual Components Location Address or Lot No. Lk CAO p�S� �( Owner's Name,Address,and Tel.No. ` Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures . J Design Flow(min.required)P U gpd Design flow provided (. y L4 gpd Plan Date d )u b7 Nu ber of'sheets% •Revision Date Title ' Size of Septic Tank TylF of S.A.S. HBO I Description of Soil Q,� M t°C] M .Cn�.ct W a Nature of Repairs or Alterations(Answer when applicable) (� ��,�CdsQ eSCy����' iS� Etc, y.. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore•described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe ` Date I0 Application Approved by Date _�1—�G"7 Application Disapproved by: Date for the following reasons Permit No. 'Loj l— L� [. Date Issued I b i - 102 -----------------------------(--- -. ———————— - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( t/) Upgraded ( ) Abandoned( )by M(�,j V �%J", i at �� has been constructed in accordance � with the provisions of Title 5 and the for Disposal System Construction Permit No. (��� "`� dated l Installer CCb N6 \°'Ccr Designer 5 0 #bedrooms �, S Approved design flow L) L U gpd The issuance of this permit shall not be co strued s a u rantee that the s ste �l functi desi ned. Date 4�� Inspe for ———————————-———————--f No. 061'—I Fee ' o D ! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1wi.5pogal �§p!gtem e7ogtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at � �c t-L LUe.�,( N,Z,4 ,��„� S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this.,perm' . Date 1 / /(/d"7 Approved by �J- s F Town ®f Barnstable 4 � F Regulatory Services Thomas F. Geiler, Director 8 ._Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Dike: 508--862-4644 fax: 508=190-6304 Installer Designer Certification Form Date- o� 0 �� Sewage Ferm�it ��-7- q S'L_Assessor's Nlap\Parcel�� -0 2 S f, Designer. :51ZrPH6­1� Installer: Se o-r7_ iA-4, Address: ,z3 Address: 77 p/ oc—_ 5'` JOn 'a-7 _-5e,677— � �- was issued a permit to install a (date) (installer) septic sySterr, at based on a design drawn by ;E (address) dated o 7 (designer) 1 certify that the septic system referenced above was installed substantially according to die design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. i� I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component Of the septic system) but in accordance with State & Local Regulations. Plan revision or cereified as-built by designer to follow. l �OF (Installer's Signature) (Designer's Signature) (A_f De gner's Stamp Here)_ M ASE RETURN TO BARNSTABLE PUBLIC HEALTH DlVI5l01®T. CERTIFICATE j OIF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIV D BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TH NK 9COU. 1� QASedticTesigner Certification Form Reviscd,doc f Town of Barnstable P# Department of Health,Safety,and Environmental Services ,o�7Hf7�wti Public Health Division Date o� 367 Main Street,Hyannis MA 02601 • BARNSTABM • / 9�'AjF►. v"��� Date Scheduled a� Time f Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: S 7�- Witnessed By: bC I—elty .ri z�Qc �rzo KS + EvRia nvFoun� T1Q Location Address Pi rc H�C-14 S 9 J,A T, Owner's Name b/Of.-d- r� Address Assessor's Map/Parcel: Aq l—ocz Engineer's Name � � NEW CONSTRUCTION REPAIR Telephone 9 61B 36 Z 6 /3 L Land Use 4'C-S%b ^—L. Slopes(%) 'Z. Surface Stones A-1 o Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well fit Drainage Way ft Property Line w t It Other _s SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in pro ity to holes) C;n C) ^� CD t' C) �. Parent material(geologic)007711'4S h Depth to Bedrock Depth to Groundwater: Standing Water in Hole: >�� Weeping from Pit Face N/A Estimaieu Seasonal High Groundwater �/A UETER1ViINA�'t�N Ft3R SE�.SONA.L Ii�tr�]['�A7�ER TALE .,.:. Method Used: ; Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#___•.. Reading Date:-- Index Well level Adj.factor Adj.Groundwater Level PRCQLTx+ON TEST z>at� 3 T►me: � . _.. . Observation O C Hole# Time at 9" Depth of Perc `Xli' Time at 6" Start Pre-soak Time rci. ID 4,1� Time(9"-61 i End Pre-soak -'3y Rate Min./Inch —�— Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public'Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant 1 t BEEF () SFI. NW 10N 01 _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulderes. F Consistency,%Gravel) b L-S of .:DEEP.0BSEI2YATIQN aQI E LQG Hole#- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) I (USDA) (Munseil) Mottling (Structure,Stones,Boulderes. o e L� l�S' H Is ID EE '.OBSEI2VA:TIQ1Y HOLE LQ HQe: Depth from Soil Horizon Soil Texture Soil Color Soil biller Surface(in.), (USDA) . (Munsell) Mottling (Structure,Stones,Boulderes. i Consistency,%Gravel) f PEE�' BSER`V�iTION HOLE LAG HoXe#� � Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) I Flood Insurgnce Rate Map: / Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what is the depth of naturally occurring pervious material? Certification I certify that on///"/ 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tWertise and experience_described in 3 10 CMR 15.017. Signature. __ Date 7 TOWN OF BARNSTABLE LOCATIONtlY® ?l4C A GLOW SEWAGE # !2 7 VILLAGE AJa/wI5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Oki C SEPTIC TANK CAPACITY /.S D LEACHING FACILITY: (type) ,3 (size) 330 NO.OF BEDROOMS BAR OR OWNER �Wll :�f -e 1440 i PERMITDATE: 9--? — 2� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet. Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If,any wetlands exist within 300 feet of leaching facility) Feet y Furnished b r i O i, Af I 1 t! 1 j mad o c X X X x/ �® .F� //X O �- 01 / s,� I ti ^ No.A Fee$ 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Diopooal bpotem Construction Permit Application is hereby made for a Permit to Construct( )or Repair JX)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Winfred Ademara Winfred Ademara Assessor's Map/Parcel 490 Pitchers Way Hy. 490 Pitchers Way Hyannis,Mass Installer's Name,Address,and Tel.No.5 0 8—77 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—77 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 1Box 66 Centerville,Mass. Type of Building: Dwelling XX No.of Bedrooms 2 Garbage Grinder to ) Other Type of Building Res; No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3X110=330 gallons per day. Calculated daily flow?x I I Q—2 2. gallons. Plan Date 9.16.196 Number of sheets Revision Date Title Description of Soil T.namVgand to medium fine sand Nature of Repairs or Alterations(Answer when applicable) om i t t}��e s T01. I n s t a 11 i n g 1-1500 gallon septic tank, 1 -Distribute nn hnx_ and three 33n RgrharQrR packed in 2. 5 feet of stone. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this jo6jHea%h. l Signed Date 91(� 9 Application Approved by \ Date d Application Disapproved for the following reasons Permit No. Y0001;4� 7 Date Issued �e No.�""' . �/ Fee 40. 00 THEJCOMMONWEALTH OF MASSACHUSETTS-, # PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS - Zipprication for �Digpaal *pgtem Congtruction 3permit A I t Application is hereby made for a Permit to Construct( )or Repair kX)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Winged Ademara Winfred. Ademarax Assessor's Map/Parcel 490 Pitchers Way Hy. 490 Pitchers Way Hyannis,Mass Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 S—7 7 5—3 3 3 8 J.P.Maconber & Son Inc. J.P.Macomber & Son Inc. Box 66 Cente v 2 Box 66 Centerville,Mass. Type of Building: Dwelling XX No.of Bedrooms 2 Garbage Grinder_(Jo) Other Type of Building R An e No.of Persons Showers( ) Cafeteria( ) s Other Fixtures Design Flow 3 x 1 1 0=3 3 0 gallons per day. Calculated daily flow 2,11�?0 gallons. Plan Date 9/6/96 Number of sheets Revision Date �µ s Title -' - Description of Soil T namv -a8nd to meth t,,m fi„A pa.,d 3 t.as Nature of Repairs or Alterations(Answer when applicable)Om i t t; n A-t e n n n'1 I n s t ra l 1-1500 Ball on serit'i c tank,1-T)i st-ri but i nn hoxx and tbreee 330 T?er% ;i;,Q .S packed in 2 5'`fee't of stonP Date last inspected: Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewagedi,;sbosal systeml in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until at:ertifi- cate of Compliance has been.issued by this Bo of�Heal r � r Signed Dat4 CY<106_ Application Approved by Date fg, 62*� Application Disapproved for the-following reasons Permit No. 196 400. Y/ Date Issued s THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS "" (tertifirate of QCompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replacedTD)on by J_P.Ma nombAr & Snn In , Installer at 4.90 Pitt-liArqWay A M has been construc d in accordance with the provisions of Title 5 and the for Disposal System Constructi. rmit No. w dated '' l Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THA THE SYS- TEM WILL FUNCTION SATISFACTORY. ------- ------------------------Fee -- No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS Migpooal 6potem Construction Permit Permission is hereby granted to T P MA n o m b p r R. S n n T n n,, , to construct( )repair,TX,-�)an On-site Sewage System located at No.# 40C1 !?Jtclinjos r zr Hvannis ,Mass Sveet and as described in the above Application for Disposal System Construction Permit. No. ' Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: '� '� —Approved C_ / { - PP b Y GYM oazd of Health i Y CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) • I Joseph P. Macomber Jrhereby certify that the application for disposal works construction permit signed by me dated 9/6/9'1 , concerning the pr,)perty located at 490 Pitchers Way Hyannis ,Mass . meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • DATA: 9/6/96 SIGNED : - LICE SEPTIC SYSTEM INSTALLER IN T TOWN OF BARNSTABLE NUMBER ` ?='� (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. R r7 1-1500 gallon Septic tank. O 1-Distribution box 3-330 Rechargers With Drip pipe Minium of 2. 5 ' of stone all around 490 Pitchers Way Hyannis,Mass . • DATE;__�L1.4Js .__ PROPERTY ADDRESS:--.,_:___,,,____,.______ 490A Pitchers Wax,_______ On the above date, I Inspected the septic ,system at the above address. This system consists of the following: 1 . 1500 gallon septic tank 2. 3-330 rechargers 3. 1 -Distribution Box Based on my Inspection, I certify the following conditions: C/ O 4 . This is a title five septic system. ( 95 Code ) 5-...The- septiFc-tank--is -in dire -need' -of pumping.Told realtor: Did_.not want to-pump-it at this time. - - 6. The leaching arekis in working order. 3-330 cultec rechargers packed in 3 ' of stone. This is a three bedroom design. SIGNATURE:„/ _ Name:_,i,_P `jijssmtttr--U ------ Company; Jose,ph_P_Ak.e_ +blr_b Son , Inc . Address.,_ Box_6 6------------- A--Con t eryill a Ha ._02692-0066 Phone:_ 508 _______ THIS CERTIFICATION 00ES NOT CONSTITVTE A OVARANTY OR WARRANTY JOSEPH Pr MACOMBER & SON, INC, ' Tsnks•Cesspools•Leichflelds Pumped i, Instilled Town Sewer Connectlons p.0. Box 66 75•J338efY114, M 102632.0066 RECEIVED JUN 2 12000 TOWNE OF BARNSTABLE HALTH DEPT. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY COXE Secrtury ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PrapwtyAaaP'as: 490 A Pitchers Way AddreseofNO nafOw� Winifred Ademara Data of :Hyannis, Ma NanesofInspector;FR�s4PrlrrHJoseph P. Macomber Jr. I am a DEP approved systwn kupector purwwn to Section 16.340 of Th3e 6(310 CMR 16.000) C,mp,nyName: Joseph P. Macomber & Son Inc. IAiaing Address: Sox Centerville, M 6 3 2-0 0 6 6 Tetepl►crw Nurnbw:5U8=7'rTb=3 3 CERTIFICATION STATEMEM I certify that I hays 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: Passes _"Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails n lrupecta's Signature: ==ZAM KLfizil,(/ Data: The System Inspect shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wftNn thirty (30) days of completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner snail submit the report to the appropriate regional office of the Department oM-tvkonmetual Protection. The original should be sent tobw system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COh1MENTS i revised 9/2/98 PaeeIorll tr� Printed on R"Ied Paper t f SV&SVRYAC9 SEWAGE DISPOSAL SYSTEM IN3IEC'1I0N FOFUA PART A CFRT71CA ON (oorrdnu*4 PropwTyAd&&": 490 A Pitchers Way, Hyannis. Ma. Owrbwl Winifred Ademara D.a of tnap.cdon: 6/1 4/0 0 NSK-CT10N $ufatrtAnY: Ch ck a e, c, of o: A. SYSTEM PASSES: I have not found any Information which Indlcato►that any of the f►llur► con4dau do►cr(bod In 310 CMR 14.303 oxlat. Any hark crltsria not ovaJusted wo Indlc►ted blow, COWjUDhTa' Se tic `tank is i _ -rea or Said i-hal r1;d net uzazzt tQ c]Q it; at .the present time. B. SYSTEM CONDITIONALLY /Asses; ` Ono w more system oomponana as dosor(bedIn the 'C"d"Rao' ►oodon nood to bo ropl000d of repaLred. The ant.m. p comoodon of the replacement w repair,as approved ley tho board of Health, wW paaa. tnd7cato yes no, or not detormined(Y, N, w ND). DoswWo baala or detKminadwt In all 4utan068, if 'not do%orn*wd', oxpWn why not. The septic tank la metal, urJosa the owner w opwotw has provided the system Inapootor with a copy of a Cor"C.4%e o CompUonce (onachod)Indloadnp that the tank was InataUod wlWn twenty(20) year►prior to the date Of the Irtapoctvon the ►optic tank, whether or not metal,Is orookod,atrueturally unsound, ►howo aubatandal InNvadon w axftrvatlon. oe : follvro N Imminent. The system wW pass lnspocdon If the oxlotino sopde tank to replaced with a Complying septic taro approved by the $card of Health. Sewage bockvp or breakout or Nph otado water level observed In the dlstrlbvdon box le duo to,broken w obatrvcud pip or duo to a broken, settled or uneven dlsulbudon box. The oystom wW pass InapoctJon If(wtat approver of the $oard of Health). broken plpo(s)we replaced obawcdon Is romovod dlstrlbudon box Is IoveUod or replaced • The #Mom roquhod pvmpbtp-r wv than'iour-dmoo tryearttue to broilenor obotrvoted plpo(ol. Th vyvtem wirryaas— ln4poctlon If(with opp(ovei of the soul of Hoolth)t broken pips(s) we roplocod obstruction Is removed I revised 9/2/98 n{e2orIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (con*vjed) PtopwtyAddresa: 490 A Pitchers Way, Hyannis, Ma. OWTO : Winifred Ademara Dou of kuW—fit: 6/1 4/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conc"ons exist which require further evaluation by the Board of Health In order to determine If the system Is falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CUR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.YYILL.PRQ37=THE PUBLIC UMTKAND SAFETY AND THE Be480NM8�I` Cesspool or privy Is within 50 feet of surface water Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMD93 THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE E#IVIRONMENT: The system has a septic tank and soil absorption system (SAS)end the SAS Is within 100 feat of a surface water Supply or tributary to a surface water Supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply w . The system has a septic tank and-soil absorption system and the SAS Is within 60 feet of a private water supply wall. The system has a septic tank end toll absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply well, unless a well water analysis for collform bacteria and volatile organic compounds Indicates Out the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nivogen Is equal to or less than 5 ppm. Method used to determine distance ZM (app►ox nwtion not v&Ud).- 3) OTHER d revised 9/2/98 Pagt3or)) i 1 1 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORD y PART A CERTIFICATION (contirwod) Property Address: 490 A Pitchers Way, Hyannis, Ma Own«: Winifred Ademara Dete of Inspection: 6/1 4/0 0 D. SYSTEM FAILS: You must indicate either 'Yes' or 'No' to each of the following: _ I have determined that one or more of the following failure conditions exist as described 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 fail Yes N Backup o+sawa9e InwhelNty-er•11eten+eon'►ponartt•clue Qo an overloaded orvlegged SAS.or•eesspOd. •i--�-� Discharge or ponding of eMuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level In t4 d 2stributlop,b%x.obove outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cvvvpVV is less then 6' below Invert or available volume Is less than 1l2 day flow. Required pumping more than 4 times in the last year no due to clogged or obstructed plpe(s). Number of times pumped Q. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy Is-within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less-then 100 feet but greater than 60 feet from a private water supply well with n acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis to coiiform bacteria, volatile organic.compounds, ammonie nitrogen and natrate nitrogen. - E. LARGE SYSTEM FAILS: You must Indicate either 'Yes' or 'No" to each of the following: The following criteria apply to large systems In addition to the criteria above: Ided 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 I health and safety and the environment because one or more of the following conditions exist: Yes No _ the system Is within 400 lest of a.surface drinking water supply _ the system•ie-within 200 wrlawddr> q•w+ser+u►y1Y -- " _ :oo'/ the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area;IWPA)or a mapped Zone II of a pu water supply well) The owner or operator of any such system shell upgrade the system in accordance with 310 CMR 16.304(2). Please consult:the local regi office of the Department for further Infognation. revised 9/2/98 Page 4or11 "w •4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART B CHECKLIST PropertyAddrea.s: 490 A Pitchers Way, Hyannis, Ma Ownw: Winifred Ademara Dart&of U%sp.ctkm: 6/1 4/0 0 Check If the following have been done:You must Indicate either'Yes' or'No' as to each of the following: Yes No / _ j/ Pumping Information was provided by the owner, occupant, or Board of Health. _ ,1• None of the systsmeon*aaants k&maj~paw4wKt4*Pat-Jsast two•we&ke ea6411e•wystem hasbwoge c;*I y.eamal floe rates during that period, Large volumes of water have not been Introduced Into the system recently or as pan of ttus Inspection. _ As built plans have been obtained and examined. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The she was Inspected for signs of breakout. All system components, o luding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of battle or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on:- _ Existing Information. For example, Plan at B.O.H. _ Determined In the field(if any of the failure criteria related to Pan C Is at Issue, approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owrw Land.occupaats,Jf d[tlarant trocLosttaer).ixara.praiddad.wlth i^ran=■tioaon ti-p.n, at..,..ate,., f SubSurface Disposal Systems. revised 9/2/98 Page sorit y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .v.: PART C SYSTEM INFORMATION Property Addr*": 490 A Pitchers Way, Hyannis, Ma Owrw: Winifred Ademara Deu of lnap.c>ion: 6/14/0 0 FLOW CONDITIONS RESIDENTIAL: Design low:_aO g.p.d./bedro Number of bedrooms, d • n Number of bedrooms(actual)— 1 Total DESIGN flow r Number of currant residents,: Garbage grinder(Yes or no): Laundry(separate system) ofoo _, If yes, sopat4a.1rupactlon.requlrod Laundry system Inspected ye or no) Seasonal use ryes or no):. Water meter readings,If avAl ble (last two year's usage(gpd): v /9J wg- Sump Pump(yes or no): v Lest date of occupancy: -00 COMMERCU►VtNDVSTRIAL• Type of establishment: Design flow: AM cod I Based on 16.203) Basis of design flow Grease trap present: lye• or nol Industrial Waste Molding Tank present:(Yes or no) Non-sanitary wait* discharged to the Title 6 sy�s: (yes or nol(f� Water meter readings,It evallabie: Last date of occupancy: OTHER:(Describe) Last date of occupancy: eta GENERAL INFORMATION PUMPING R ECORT ar �oN cd�nformstlon: System pumped as,part of I;ff action: (yes or no) v If yes, volume pumped: gallons, Reason for pumping: I SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes. attach previous Inspection records,If any) I/A Technology etc Attach copy of up to date operation and maintenance contract Tight Tank �R Copy of DEP Approval Other owje — APt'RO) 1 CIE o? c'!11 Ju to InWe ilf ;X n• nd aouroa of iwlormadon: •-•K�4• Sow"odor detected when arriving at the site. (yes or not e& revised 9/2/98 Page 6orit SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM »: . PART C SYSTEM INFORMATION(continued) Prop"Addre": 490 A Pitchers Way, Hyannis, MA D"TW: Winifred Ademara Dou of Inspection: 6/1 4/0 0 BUILDING SEWER: (Locate on site plan) 41 Depth below grade:4�4 Material of construc at Iron 240 PVC Oother(explain) Distance fro pnvate water supply well or suction line Diameter Comments: (condition of Joints, venting, evidence of t"ka o.-etc.) Joints aDDe r fight -No emi Bence of le-akage - SIEPTIC TANK: (locate on site plan) it Depth below grade: Material of construction:jzconcrete&metal Fiberglass Polyethylene) Dther(explain) If tank Is Instal, list age is.age.confwmsd by Certificate of Compliance to(Yes/No) Dimensions:X1P2 A4j2 Sludge depth: V/ _ Distance from top of lud�t to bottom of outlet tee ortafflr. AC Scum thickness: Distance from top of scum to top of outlet toe or beffle: l Distance from bottom of scum to bottom of outlet t or beftie:}7_ How dimensions were determined: d r Comments: irecommendation for pumpin condition of Inlet And.outlet tees or-baffles, depth of liquid level In re lation,to outlet invert,-structureFintsgrity, d e of leaks s etc.) condition the septic - _ r-y 2=--jrPal^C Inlet & outlet £�� are fin,plaZ.' a an c is s ruc urall s -evIdence or leakacre.The, tank-Ghm, r3 he plimped as soon poss-ible. Heav .Told realtor. They said `n`o.NoIr GREASE TRAP• at this time. (locate on site plan) Depth below grade:40 Material of constructionwAconcretefhmetaYOFlbsrglasW&Polyethylene4otherlsxplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet toe or baffls:—'&. Distance from bottom of scym to bottom of outlet too or•baMs:—do' Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outiat Invert, structural Integrity. evidence of leakage, etc.) Grease trap revised 9/2/98 Page 7orii SUSSVRFACE SEWAGE DISP03AL SYSTEM INSPECTION FORM PART C SYSTDd INFORMA noN (contirvied) Progw y Ad&*": 490 A Pitchers Way, Hyannis, Ma. . ten«: Winifred Ademara Om of V4pec6on: 6/1 4/0 0 TIGHT OR HOLDING TANK.-_A2&(Tank must be pumped prior to, or at time of, Inspection) (locals on site plan) Depth below grade: Material of construction:econcret%/&meta14&be(g(ass#APolyethylon#4/&othsr(ezp(a(n) Dimensions: Capsclry: gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes No Dete of previous pumping: Ad _ CommenU: lconditlon of Inlet tee, condlt)on of alarm and float switches,etc.) is c)r hnl a; nn I-ankii; Ee net prCS DiSTRIBVTION BOX:e hotels on slit plan) Depin of liquid level above outlet Invert: Comments: (not•It level and distribution Is equal, evidenoe of solids carryover, ev(dence of leakage Into or out of►ox, otc.l — D i• y over o evi e a ; ni-n nr ^� ^f -I,^ ^� Sebtic tank qhn„ld he are pass± g bver to- the box and leaching• area.' PUMP CHAMBEA:,Q/(4e- (locate on site plan) Pumps In working order:(Yes or No) Alarms in working order(Yes or No); Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) ump c am i s not t ra�^.+v revised 9/2/98 hilfIof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conlinued) Property Address: 490 A Pitchers Way, Hyannis, Ma OWW: Winifred Ademara Data of kapecdon: / 6/1 4/0 0 SOIL ABSORPTION SYSTEM(SAS):_/ (locate on site plan, If possible:excavation not required,location may be approximated by nondntrusive methods) If not located, explain: Type: � fT leeching pits, number: ��•71 —0i zo, Is aching chambers,number: Iseching galleries,number. leaching trenches,number,length: lesching fields, number, dims ons: fif overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding;damp soli, condition of vegetation, etc.) bone or T - CESSPOOLS: (locate on site plan) Number and configuration: Depth top of liquid to Inlet Invert: Depth of solids layer: Im- Depth of scum layer: Dimensions of cesspool: Materials of construction: Aux Indication of groundwater: inflow (cesspool must be pumped as part of inspecdon) esspoo s are not present Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of,vegetation, etc.) CessDoc)l -; are not PRIVY:AlpNe. (locate on site plan) Materials of construction: /UR Dimensions: Depth of solids:�� Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) revised 9/2/98 page 9orit r � SV&SVRFACE SEWAGE OISPOiAL$YSTD4 INSPECTION FORM FART C iysTDA iNnRiA.AnON(oondnued) 490 A Pitchers Way, Hyannis, Ma Q~: Winifred Ademara Dou or Vapec4on: 6/1 4/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: IncJuds 496 to at laaat two permanent reforanw landmarks or benchmarks locate all well, within 100' (Locete where publlo water supply comes Into house) S 36� II II \i� �• hill \ Zq revised 9/2/98 Pe{elo orll SUBSURFACE SEWAGE DtSPQSAL SYSTE7A WSPECMON FORM PART C SYSTBA ylFORMATION(condnuod) Property Ada"&: 490 A Pitchers Way, Hyannis, Ma Owner: Winifred Ademara Data of k apectlon: 6/1 4/0 0 NRCS Report name Soll Type_ Typical depth to groundwater USCS Date webalte visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slops Surface water Check Collar Shallow wells f Estimated Depth to Groundwater Feet Plesse ndicate all the methods used to determine High Groundwater Elevation: 2DObtalnsd from Design Plans on record bserved Site(Abutting propert bservation hole, bassmeat sump etc.) Determined from local conditions Checked with local Board of health _C ecked FEMA Maps Checked pumping records _ZChecked local excavators. Installers Used USGS Data Describe how you established the High Groundwater Elevation. ( tag be completed) Used; Gahrety & Miller Model 12/16/94 revised 9/2/98 Pa{e))of11 �••-�' 'may r , a•wRnT -nT��Te- nr ww•nA+Twlnnl�.Rrw+ww►11r•'wwrn+Ar\1/n!•w��n1�•n rT`n--r-T^n� . r..•' TURN OF ,gnu,�STng�,� WARD OF IIEALTII F_SUBSURFACE 9EWGE I)( f'USAL�SY�9TF.M INSPECTION FORM - PART D •- CERTIFICATION �^ - I -TYPE OA PRINT CLEARLY- 1 PROPERTY INSPECTED STREET ADDRESS 490 A Pitchers Way. Hyannis ASSESSORS MAP , BLOCK AND PARCEL 0 OWNER' s NAME Winifred' Ademara i PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jrg COMPANY NAME Joseph P. Macomber &r`Sbn, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 streft Town or City stat♦ LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508) 79T 157.8 w � CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspeetion . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : V System PASSED ' The inspection ;+hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of Lhis form , System FAILED* The inspection which I have con ticted has found that the system fails to Protect the }iublic health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this Inspection form, d1Inspector Signatur Date rf .� copy of till certification must be provided to the OWNER, the BUYER One where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, th'e owner or""operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CHR 16 - 306 . partd .doc V 7y THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOV N THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided i a 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. I )unc 8. 1995 Acting Director of the ton of Water Pollutio�Courol �.�€ 23148 P3 ctS v�i-7 09 9-1 0-2008 a 13.E 2 599:1 DEED RESTRICTION Burnham WHEREAS, Mark Lemon & Jayne E.Lemon a/k/a Jayne E. of (owner's name) 490 Pitchers. Way, Hyannis, Barnstable County, MA (address) is the owner of 490 Pitchers Way' located (address) at Hyannis, , Barnstable County, MA MA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of , et al, duly recorded in Barnstable County Registry of Deeds in Plan Book ` , Page Or on Land Court Plan Number WHEREAS, Mark Lemon & Jayne E. Lemon as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health-to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to rn granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal.of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on f this property, is requiring that the agreement for the restriction on the number of r bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, • - '* Bk 23148 Pg 157 #47509 10 Lemon NOW, THEREFORE, Mark Lemon & Jayne E. does hereby place the (owners name) following restriction on his above-referenced land in accordance with his- agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all-successors in title: 490 Pitchers Way, Hyannis, MA may have constructed (address) upon the lot a house containing no more than ou K (/�) bedrooms. Mark & Jayne E. Lemon agrees that this shall be permanent deed (ownees name) restriction affecting located on - MA, and being shown on the plan recorded in Plan Book Paged Or on Land Court Plan For title of see the following deed: Book 13085, Page 286 Or Land Court Certificate of Title Number. Executed sealed instrument 10th day of September, 20.08. Ow �r's signature M Lemon Owne sig ure Tayne E. Lemon a/k/a Jayne E. Burnham Owner's signature COMMONWEALTH OF MASSACHUSETTS Barnstable , ss September loth , 20_U Then personally appeared the above-named Mark Lemon and Jayne E. Lemon a/k/a known to me to be the person who executed the foregoing instrument and acknowledged the same to be thwAr free act and deed, before me, , i.sa G. Mellor Notary Public A ® ,` .AJc My comrnisiou expires.<�: Apri BARNSTABLE REGISTRY .OF DEEDS f' DATE:__ JISLOQ-- - PROPERTY ADDRESS: ---490-Pitchers- JWay______ --- ------- • _-_Hyannis• • Maj_0?6QZ____ on the above date, I Inspected the septlo ,system at the above address. This system conslsts of the following: 1 . 2-6X8 Cesspools Based on my Inspection, I certify the following condltlons:. A 7` a ".'-') 2. This is not a title five septic system. 3 . This is a sewage system. Forty plus years old. Both cesspools are dry and slightly rooted. 4. The house is presently vacant. 5. Cesspools appear to be on 490A lot. ; 6. The cesspools are structurlyly,ATURE:., sound and in operatiing o at the present time. Macomb Company: Joa•�h_P- ------ —1 Son , Inc . Address_ Box_66-_____ Centerville L`Ha ._02632-0066 Phone:... S08_775_3338___,___ THIS CERTIFICATION DOlrs NOT CONSTITUTE A QUARANTY OR WARRANTY JOSEPH -P, MACOMBER & SON, INC. Tanks•Cesspools•Leachflelds Pumped L Installed Town Sewer Conneotlons P•o• Box 66 CenlerYllle, MA 02632-0066 " 7 775.3338 775.6412 RECEIVED t , J U N 2 12000 TOWN OF BARNSTABLE HEALTH DEPT. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENvmoNMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION PropertyAddraas: 490 Pitchers Way Nameofowner Winifred Ademara Hyannis, Ma Address of Owner: Date of hsp.ction: L�,�/,, Name of inspector: (PRLa1>�l9OSeph P. Macomber Jr. I am a DEP approved system irufpactor pursuartt to$rattier 16.340 arf Thin 5(310 CMR 1 S.000) canpar,yNafT1e: Joseph P. Macomber & _Son,_Tnc. µ.,&V Address: BOX6 b CentervilliT, Ma. 02632-0066 Telephone Nurnberg U 8- - CERTVWAMN STATE7MEM 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-sits sewage disposal systems. The system: Posses Conditionally Passes Needs Further Evaluation By the Lo I Approving Authority _ all trtspecrtor's Signature: Data: The System Inspect shall submit a copy of this Inspection report to the Approving Authority(Board of Heahh or DEP)whNn thirty (30) days of completing this Inspection, if the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department oKnvironmenttd f1rotectfon. The original should be sent to Vw system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 `ot Pnnied on K"led Papa •r SV&3l1RlACE SEWAGE DISI0& L SYSTEW 1143KCTM FORM PART A CERTU%r—ATION (oorrdnueCI PropeM Ada..,: 490 Pitchers, Way, Hyannis, Ma Owr"'. Winifred Ademara °erto of Vwpecdon, 6/1 4/0 0 P13f°ECr,0N t VMMAAY: Chock A( 8. C, o/ a A. SYSTE3d►ASSESIj I hays not found any Information wNch Irtdlcotee that any of the faUwe oor4doru deocrtbod In 310 CMA 14.303 ox1aL Any to uttsr(a not.ovaluotsd are InQlcotod below, comiLDM, Cesspools are slightly o be on 490A lot - s, SYrr1U CONOmONALLY PASSES: One w ma# system#ompononu s# d000rtbed In the 'CondldwW►aao'osodon Mod to be roploeed or ropalred. The system. . compJedon of the repla#smont w ropalr, as approvod by the SoaN of Health, wW paao. 6+4cots yes, no, of not detsrmlned(Y, N. w NO), 0eocAbe baalo of detwnyJrtadoA In all Irutanoea, If 'not detorminod', eupJaln why not jo The sepdo tank le msW, unless tho owner w opwotw has prov(ded tho system Lupeotor whh a wpy of a C+r"c.410 CompUsnce (ettachod)t"oodnp Vwl the tank woe(nataUod wlWA twenty (20) Yous pr(w to rite dau of tt-.e wp.cv- the ospdc tank, whsMer w not mote, Is orookod, strvewrsJJy unsound, show# ►vbotamW Inftivsdon w sslVvadon. o faJlvro Is ImrrJnent. The system will peso Irupeodon If the oxl#dno oepdo tank Is roploeed whh a eomraryv+o sepvc tar approved by the loud of Health, /Sewopo backvp w Wookovt or Nph otado water level ob#orved In the dl#vlbudon box i# due to Wotan w o0m ctea J or Ave to a broken, ►etdod or uneven dl#Vlbudon box. The oy#tsm will peas Inspection If (whh approveJ of the 10+ro Medth). Woken pipets we replaced ob#wodon Is ronwvod dlsv(budon box to levelled w replaced / rl The s yn o m f o Quk e d pumpbtp•mon t?tan}ourdrne a t+yO ar du a to broKsat a obTtry of o4 p1 pe l s). The Ty*wm w+rvs„r Inapectlon If(with approved of the 11106rd of H#dthlt broken pipe(#) wo roplacid ob#wction I# romov#d M revised 9/2/98 htriorn r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cotttlnued) PropwTyAd&*&&: 490 Pitchers Way, Hyannis, Ma. ow„«: Winifred Ademara Dais of tnspectson: 6/1 4/0 0 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 Its WI.Ing to proud the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETOWINES IN ACCORDANCE WITH 310 CUR 15.303(1Xb)THAT THE SYSTEM IS NOT FUNCTIONING W A MANNER WWCH.YVILL.PRagCT THE PUBUC UMTK AND SAFETY AMD THE E ClZ1BO MB1fT-' 4 Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUS CC WATER SUUPPP,IERIER.ANDTMANY))DEETERMPa3 THAT THE SYSTIEM IS FUNCTIONING IN MANNER THAT PROTECTS THE PUBU HTH AND The system has a septic tank and loll absorption system stem(SAS) and the SAS Is within 100 feet of a surface water wpply or p tribvtary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is wlWn 60 feet of a private water supply weu. The sys tem has a septic tan k and soil absorption system and the SAS Is less then 100 feet but 60 feet or more from a or com private water supply well, unless a well water analysis for coilform bacteria and volatile g ank pounds Indicates tnar tA- well Is free from pollution from that facility and the presence of tsmmonla nitrogen and nitrate nitrogen Is equal to or less than 5 ppm. Method used to determine distance 4— (approxlmatlon not valid).- 31 '�OTHER ppT��H E R ASO revised 9/2/98 Pallt3orII SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECnON FORM . PART A CERTIFICATION (cortdnued) Prey Address: 490 Pitchers Way, Hyannis, Ma Owner: Winifred Ademara Darts of inspection: 6/1 4/0 0 D. SYSTEM FAILS: You Qtust Indicate either 'Yes' or 'No' to each of the following: I have determined that one or more of the following failure conditions exist as described 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 fail Yes No yBackup ofeewaye Irno49,614ty-er9,01191 cornponenf due Ko an overlwded orciepQedBflSor-ceaspool. •j------ • Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool. Static liquid level in the dirltution�box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth In cesspool Is less then 8' below Invert or available volume Is less than 1/2 day flow. XRequired pumping more the 4 times In the lest year hM due to clogged or obstructed pipe(s). Number of times pumped 3•. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy Is-within a Zone I of a public well. Any portion of a cesspool or privy Is within 60 feet of a private water supply well. Any portion of a cesspool or privy Is lose-then 100 feet but greater then 60 feet from a private water supply well with n acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis to -coliform bacteria, volatile organio•compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must Indicate either 'Yes' or 'No' to each of the following: The following criteria apply to large systems In addition to the criteria above: -49 The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system Is a significant Ovest to I 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•ls-within 200 test ol+-iris►Lary to wrfao���k> 4 water+u►PIY -- the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area:IWPA) or a mapped Zone II of a pu water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consuh the local regi• office of the Department for further Infognstlon. revised 9/2/98 Psge4orII .I SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART B CHECKLIST P.opwTyAddr*sa: 490 Pitchers Way, Hyannis, Ma. Owrw: Winifred Ademara Date of Irtspecdon: 6/1 4/0 0 Check If the following have been done:You must Indicate either'Yes' or 'No' as to each of the following: Yes N Pumping Information was provided by the owner, occupant, or Board of Health. None of the systemcompownts Maw:been pamped4opat•J"st two•w&"s aadths•tystam haabeaawcaiasrgwrd flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. — rl As built plans have been obtained and examined. Note if they are not available wit N/A JL Z _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The she was Inspected for signs of breakout. y���p_ All system components �luding the Soil Absorption System, have been located on the site. l The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of baffle or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing Information. For example, Plan at B.O.H. Determined.in the field (If any of the failure criteria related to Part C Is at Issue, approximation of distance is unacceptable) 115.302(3)(b)1 s= _ The facility owner II&M. ccupants.lf dlftaraai frmti.*Aw r).viw& uaWdad.wkh 1af=lz■Voaon th,P—p_t mgin••^•^C Qf SubSurface Disposal Systems. revised 9/2/98 Paessorit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �. PART C SYSTEM INFORMATION Propw yAddresa: 490 Pitchers Way, Hyannis, Ma Owner: Winifred Ademara Dear of kupecdon. 6/1 4/0 0 ROW CONDITIONS RESIDENTIAL: Design flow:a_g•p•d•/bedro m. Number of bedrooms (/[esi n`I 7 Number of bedrooms( :actual) Total DESIGN Ar Number of current residents: Garbage grinder(yes or no):_ Laundry(separate system) a or&_,; If yea, separatakapsctlon.required —. Laundry system Inspected a or not Seasonal use (yes or no): Water meter readings,If sv lable (last two year's usage(gpd): Sump Pump lyes or not: 1 j A006 Last date of occupancy: COM MERCIAL/INDVSTRIAL: Type of establishment: Design flow: d ( Based on 16.2031 Basis of design now crease trap present: (yes or no)AW Industrial Waal@ Molding Tank present: (yes or no)—at Non•sanitary waste discharged to the Title 6 system:I 1 or nol/�� Water meter readings,If available: Last date of occupancy:-,A OTHER: (Describe) Jw Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS andtyce f Information: ML System pumped as part of In action: (yes or no) If yes, volume pumped. gallons Reason for pumping: TYPE OF SYSTEM Sa p ' c tank/distribution boxlsoll absorption system Single cesspool Overflow cesspool Privy Shared system(yes or not (If yes, attach previous inspection records.If any) I/A Technology 11F. Attach copy of up to date operation and maintenance contract Tight Tank 117t Copy of DEP Approval Other APPROXIMATE AGE of all components, data Ineta{lediif known)-and souroe 04wformadon: Sewage odors detected when-arriving at the site. (yes or no)4 revised 9/2/98 PaQrt;ofIt r L i SUBSURFACE SEWAGE DISPOSACSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oorrtirx►ed) P►op"Address: 490 Pitchers Way, Hyannis, Ma D`"nw: Winifred Ademara Dou of Inspection: 6/1 4/0 0 BUILDING SEINER: (locate on sit@ plan) Depth below grader Material of onsti ctio test Ir n 40 PVC other(explain) t Distance fro priv to waterisufplf well or suction iine Comments: (condition of Joints, venting, evidence of f"k"o,-etc.) Joints appear tight No Pvi ainnne of 1®akage. Syc SEPTIC TANK: (locate on site plan) Depth below grade-A Material of construction concreto4 met&V&Fibergless VAPolyethylene&other(explain) AIA If tank is LnoW. list age Is.age.confwmed by Certificate of Compliance (Yes/No) Dimensions: Sludge Distance from top of sludge to bottom of outlet tee o►baffle: ryAr Scum thickness: AM Distance from top of scum to top of outlet tee or beffle:_ M Distance from bottom of scum to bottom of o Oat tee or baffle:_ How dimensions were determined: / I Comments: (recommendation for pumping,condition of Inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structuralirttegrity, evidence of leakage, etc.) Main cessp Both cesspools are dr re ruc u a y2.2 u GREASE TRAP: (locate on site plan) Depth below gradeAM p Material of construction o concrete49metaUl�Flberglass Polyethylen@ other(explain) AIA Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or beffle: 40 Distance from bottom of scum to bottom of outlet tee or•baffle:Ate Date of last pumping: 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.) Gr a revised 9/2/98 Page 7orII SUBSURFACE SEWAGE DISPOSAL SYSTEM LNSPECTION FORM PART C SYSTEM INFORMATION(con*%jed) �*° Ad6is 490 Pitchers Way, Hyannis, Ma Darin wf Winifred Ademara � ����� 6/14/00 TIGHT OR HOLDING TANK:(Tank must be pumped prior to, or at time of, Inspection) Vocals on elte plan) Depth below gredt:41h Material of construct on4idconcretot metal&F)berglaaa&Polyethylen4,othertexplaln) Dimensions: Capacity: gallons Design [low: gallons/day AI►rm presant Alum level: Alarm In working order:Yes No&# Oste of previous pumping: AM Commenu: [condition of Inlet its, condition of alarm and float switches, eta.) Tight or hal rli na t—�...kv—e:1-q net pr 04STRIBIlTION BOX:6& oocats on slit plan) Oepth of liquid level above outlet Invert:_ Comments: Inge If level and distrlbv%lon Is equal, evident of solids carryover, wldence of leakage Into or out of Itox, etc.) — - is ribLtion hnx iQ not—pr-"efft PUMP CMMBER:J/C oocsts on site plan) Pumps In working order:(Yes or No) Alums In working order(Yes or No)_A:U Comments: inou condllon of pump chamber,condition of pumps end appurtenances, etc.) rhAinhar is revised 9/2/98 Pa{eIof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(con*xmd) PmpwtyAddress: 490 Pitchers Way, Hyannis, Ma Owrw: Winifred Ademara °""of hap.ctton. _1 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, If possible:excavation not required,location may be approximated by nondntrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number: leaching trenches,number, length: leaching fields, number, dim• slons: overflow cesspool,number: Alternative system: Name of Technology: Comments: Inots condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand No Botn cesspools are dry T4rntca isIra C Solis are ciry. Vegetation is norma . CESSPOOLS: (locate on site plan) Number and configuration: Depth top of liquid to Inlet invert: Depth of solids layer: Depth of scum layer: I Dimensions of cesspool: Materials of construction: indication of groundwater: inflow (cesspool must be pumped as part of Inspection) Did no Comments: ote condition of soil, signs of hydraulic failure,level of pending,condition of-vegetation, etc.) Same as. above PRIVY: (locate on site plan) Materals of construe on: Dlmenslons: Depth of soildc,� Comments: Inots condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Privy revised 9/2/98 psgt9orII 3V&3VRFACt SEWAOE DISPOSAL SYSTEM INSPECTION FOKM PART C SYSTDA INFOPJ ATION Icondn+adl PropwyAdd.e": 490 Pitchers. .Way, Hyannis, Ma 0~: Winifred Ademara Dgu°'kapoadon: 6/1 4/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at[fast two permanent reference landmarks or benchmarks locate all wells wltNn 100' (Locate where publlo water supply comes Into house) y j X X X � i� � /�X x X ✓ X �C X i revised 9/2/96 Pa{eloofIt SUBSURFACE SEWAGE DISPQSAL SYSTEM INSPECTION FORM PART C SYSTEM YiFORMATION I-mk r d) PropemAddir*": 490 Pitchers Way, Hyannis, Ma. Ownw: Winifred Ademara Darts of 4up*c%;on• 6/1 4/0 0 NRCS Report name Soll Type_ Typical depth to groundwater USGS Date webshe vlsitsd ObservatJon Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells�r- Estimated Depth to Groundwaterrpv Feet Plesse Indicate all the methods used to determine High Groundwater Elevation: _Obtained from Design Plans on record �bserved Slte IAbutting propert observation hole, bassmeat sump etc.) Determined from local conditions Checked with local Board of health _Checked FEMA Maps Chocked pumping records I/Chocked local excavators, Installs($ Used USGS Data Describe how you established the High Groundwater Elsystion. (MUd be completed) Used; Water Contours Map. Gahrety & Miller Model 12/16/94 I revised 9/2/98 Page It of11 ,a•r►.TT�nr/r-`rT• T.1T RR•n1.RTn.+.�rtrnwrl+1AI►�n�nnn nRwlu lA'��n ran rTTrT-rn'� ...r..•' TOWN OF BARNSTABLF. BOARD OF HEALTH '^T ,SUIISU(ZFACF 9EHAGF DISPOSAL SYSTEM IN�9I'F�CTION FORM - PART D •- CERTIFICATION �^ - 1 -TYPE OA PAINT CLEARLY- 1 PROPERTY INSPECTED ' STREET ADDRESS 490 Pitchers Way, Hyannis ASSESSORS HAP, BLOCK AND PARCEL OWNER' s NAME Winifrec? Ademara s PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr, COMPANY NAME Joseph P. Macomber &~'`Sony Inc. COMPANY ADDRESS Box 66 _ Centerville MA. 02632-0066 Stroh Town or City state LIP COMPANY TELEPHONE ( 508 1775 - 3338 FAX ( §w ) � - ✓� R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt this nddress and that the information reported is true , accurate , and omplete as of the time of �inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : . A Systemti PASSED) The inspection i+hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con cted has Pound that the system fails to protect the jiublic health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . i nature Date l'f Inspector S g .=VV ne copy of this c rtlfication must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HBAL'I'll, + If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CHR 16 . 306 . partd .doc 1 SbjY �71 THE COMMONWEALTH OF MA.SSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided i a 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws_ Issued by The Department of Environmental Protection. )unc 8. 1995 I Acting Dircctor of the Veton of Watcr Pollution Control SxETcH Of SEWAGE DISPOjAL SYSixm, y includ# d## to at Iss, I two�::€^.•.^.cnt rpterercs landmarks or�;mz mmks �? lots(# all wills witNn M' (Locals where public water supply comes Into "-.0uss),01� _ I 36� II \ , 10 T zq revised 9/2/98 pace10ofII E { I L st A7 N Zq l- V6011g go hx—�lfi �h►n �na -iv�nai'� �l t �ftn CO e In 6,1 es V0,4ew HE-181 �'!✓�lC��itd7�l�v/ 2•l��VGVI/1G�' � �- ��►al�- ����10_ �� v '� _ _ �x� ►a rev ca • _19 �-- v _.,. �--I _ _- ��_�- 1� ��lC.lbli'��IV`f�i��,_'•�. �1�:f� vt�� j --- _ LQ SIM 5,7 i—i t I loll 1, � ro t ( �Xis`�+Yto -tr �vr�vtj_ � �xl��,�:C�..i�ll��:1;(•l 2 IGit"i Na �<<a�`-a�ca�w �: r�u�� � � _ --ex��k�,�-�� ea��-�- tiv►�n� -�l�e����v1� `► a ���1,, ����ti�ne1-,-I--�U-ve.u�2•rv� ,,. � Q C� f Nil ew OV 6amvl .........- 4. 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ONLY._INVERT-,OUT SEPTIC NK:'� 97,45 4 DIAM P/iT R� 'i' ST.1 ' 112* DIA.314 NYE N DI ,BOX. .96,V 2, -VERTICAL -DATUM,"IS'ASSOMED FOR BENCH MARKS'9 NE, NO :6ARBAGEGRIND INVERT OUT DIST. BOX:, 96.2 DOUBLE WASHED STO 3, MatR !96 1'.3 SET. _SEE�$IrE PLAN.''SEPTI NVtRT.,JN LEACH CHA 6 1 C TANK #EOUtREi I'6 HIGH CAPACITY INFILTRATOR 95.3 3 OUTLET BOTTOM OF LEACH-CHAMBER ­440 G P� D,- - :-200jvll-�- 880' GAL, -MA TER 1ALS AND J. ALL CONSTRUCTION METHODS AND�MUM= 'BOX _CHAM8 ADjus rED GRow&��-"#A TER., w1A ERS-#13.5*.t STONE-AROUND IDED., J500 6' JHE�� S SEP SEPTIC Y tEM SHALC,TIC TA PROV AL.— MIN. MA N rENA NCE OF�1500 GAL 'GROUND W4 TER: NIA F L(H-20) /O*lr 50'1 X_ 107d � oos ER yEb CON ORM TO MASS, �1'0 E.P. ITLE-5.,AND LOCA SEPTIC TANK IIILEz- I68. ''SOIL ABSORPTION,'SYStEM REOUIRED:6* CRUSHED � BOARD OF HEAL TH REGUL A ON$BOTTOM:OF TEST No TI"S TONE OR 5-'M I All�NCH COMPACTED' BASE DESIGN PERC :RATE.,( 4,' �'AL L SEP T C-S Y$TER COMP"CLASS I'PR OF L E : SO fL' TEXTURAL ONEWIS.'LOCAPED UNDER NO T TO SCALE.: �..'AREAS­,SU8JECt"T0 'VH R EA TER'EFFLUENT LOADING RA TE 0.74 GPDI$F, CULA ',`TRAF 16, OR,GRE IN "DEPTH SHALL BE CAPABLE'OF !WI TH-440 O'14 GPOl"SI - 595 S.F.j RE'Q&I RED THAN*I "WHEEL"'STANDING H-40.' LOAD$.,.PROVIDDt 6 H'I GH CAPACI TY,, INFIL TRA TOR 5. A4L� SEWER PIPE SHALL flE,-SCHEDUL ­40,�OR CHAMBERS WIJ.5'.t 'STONE AROUND. A-600 S.F�. 6 -S 00 F, ,,*, 0.74 ;- 444 GPD APPROVED EOUAL.SEPTIC -TANK AND,�D-BOX HALL'BE,REINFORCED pPk8*CAST­CONCRETE ANb :-WATERTIGHT. D-' BOX L MA O :BE W4 TER TES TED TO',CHECK FOR L E VEL WHEN THERE IIs Mb RE AW ONE, OUTLET.I IRT DRIVE 7. BEFORE,.,CONSTRUCTION CALL'� 'DI.G-�SAFE'.,6 ----------- -DIG-SA -AND LOCAL""WATER DEPT.666 FE, -THE cy � FOR LOCATIOWOF GROUND UT1011E .SEPTIC A REA ig [0_9 ER SMAL I -SYSTEM INSTALL L�46NFY THE DES16N ENGINEER TWO DA YS.'PR OR TO CONSTRUCTION 4 I OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE f CONSTRUCTION INSPECTIONS.:6 HlGk�CAPACITY rxl s rtNa INFILTRATOR CHAMBERS #S TONE,AROUND W/3 5 DWELL Imo EXISTING ,CESSPOOLS TO BE PUMPED DRY AND'-OAK SEPTIC 5 STEM D-Box BACKFILLED./N R OF 'HOUSE 42' r BM TOP CORNER OF.------------ EXISTING 36*M4PLE DWELLING TP rP*2 9L gi�500 GALON SEPTIC TANK OF CESSPOOLS 20 K OVIL V/000 S46i No.3 PLATFORM SHED C81DH F D DRlVE PAVE STOCKA 323-05 'S 66026'22*W ICRIDN FLUSH SOIL TES T PIT DATA & E /CD, 7 7 I A0 CA TES K7 NO CA rE S now PERCOLATION OBSERVED TEST 6ROUNDW4 TER 0 /O 20 40 4 0 P TCI--IE-R S 'WA MA R 2_9 PA R CE-L TP TP #2 YA 1\1 IV S RIZON TEXTURE COLOR HORIZON TEXTURE COLOR RARIVS , TA RL H � ,O* - 98.6 O* 98.8 LOAMY IOYR LOAMY IOYR A SAM SAND 413 7. . .............................. 98.0 6. . ........................ ......B LOAMY IOYR B LOAMY IOYR LEGEND"$AND 516 $AND 24". ............................... - 96.6 26 .................. RIK E C MEDIUM IOYR mC8 'CONCRETE BOUND-c Cl MED I UM IOYR L OCUS SAMD 616 SA ND 616 —W— 4ATER LINE ORA VEL -A LE- �OC TO BdE-R , 4 200 ,7 GRAVEL S HYRANf MIT GAS LINE OHW OVER HEAD WIRES U FR V- FY WAY 48' -A:G :L'. E N _G I 'NC LIGHT POST 3 �R o u UNDERGROUND ELECTRI 'Y a r r-nc> u t hpc> r, t '�MA , 2�6`7,5—E— C L iNE' b T UNDERGROUND,TELEPHONE 'L INE '3 2 3�, , < 508 NO W4 TER NO VA TER 88.6 2 120- 1 'UDEkdPOUND CABLEVISION LINE� �4 3 2 3 CrV (�5 0 8 DA TE. AUW$T_,2J, 2007 +40.4 SPOT .CLEVATION STING CONTOUR TEST BY., STEPHEN HAAS EXJ­�40—WITNESSED BY: PON DESMARAIS 'PROPOSED CONTOUR '� :�,PERC RATE:. f�'2: RCH SAH1CFW :CF* DRN 1�07-0; ELD -,CFWIEEK,75, I L Ofus p No;�A IIIII