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Home My WebLink About0074 GRAND ISLAND DRIVE - Health oo 74 Grand. Island Rif Osterville F/R A = 072 012 s e e ° U 4 F a o v i q Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary, Assessments ,M 74 Grand Island Dr Property Address Wj Pj Karin Carter Owner Owner's Name information is ra required for every Osterville Ma 02655 6/26/17 page. City/Town State Zip Code Date of Inspection t= 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 7 v on the computer, 7 use only the tab 1. Inspector: - key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Q Company Name 8 Johns path Company Address S Yarmouth MA - 02664 City/Town State Zip Code 508-364-9587 S113522 - Telephone Number License Number B.-Certification I certify that I have persona Ily.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 �r 6/26/17 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ,�10 (/S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewag sposal System•Page 1 of 17 i Commonwealth of-Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Forme -Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 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: ® 1 have not found any information which indicates that.any.of,the failure,criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon septic tank as well as a Concrete distribution box and 8 H2O High Capacity infultrators. System is functioning as designed. 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•3113 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 .'' 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 ' page. City/Town 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 orobstructed 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 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•3/13 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 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name - information is required for every Osterville Ma 02655 6/26/17 page. Cityfrown 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. El NAny portion"of cesspool'oi 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 El ® 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection ®rrYt Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Cisterville Ma 02655 6/26/17 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? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at theBoard 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): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 l5ins•3113 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 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. City/Town 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 El Yes ® No information in this report.) . Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 239 GPD Detail_ Sump pump? ❑ Yes ® No Last date of occupancy: — date—Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El 'Yes ❑ No ;) Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): r General Information Pumping Records: Source of information: Not provided 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Titles Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address _ Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: New septic tank in 1999 . Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.):. System is vented at the roof line Septic Tank (locate on site plan): Depth below grade: 1.5 _ feet r Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 H2O If tank is metal list age:;-. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: (sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Cisterville -Ma 02655 6/26/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (c(int.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments LAM ,•''y 74 Grand Island Dr - - - - - Property Address Karin Carter Owner Owner's Name required for is every Ostervllle required for eve Ma 02655 6/26/17 page. City/Town 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. City/Town State Zip Code Date of Inspection Q. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of.liquid level above outlet invert Level and at normal level 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: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Addres s - Karin Carter Owner Owner's Name information is required for every Osteryille Ma 02655 6/26/17. page. City/Town State- Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number:. ❑ leaching chambers number: ® leaching galleries number: 8 HC infultrators. ❑ 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 ponding no break out Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments b 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. CitylTown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments:. ,M ,•'' 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. City/Town 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is requiredred for every Osterville Ma 02655 6/26/17 o page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1999 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF 13ARNSTABLE E� LOCATION 7,r, SY IJ SEWAGE 9 I VILLAGE ASSESS &LOT �72 INSTALLER'S NAME&PHONE N0. w , SEPTIC TANK CAPACITY EACHING FACILITY:(type) �K f 5T fGt L(size) �� I OF BEDROOMS a DER OR OWNER `SO V PEW1717DATE: 2111 Lev COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feel Furnished by A I t a�► i http://www.townofbamstable.us/Assessing/HMdisplgy.asp?mappar=072012&seq=1 .6/14/2017 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Grand Island Dr Property Address Karin Carter Owner Owner's Name information is required for every Osterville Ma 02655 6/26/17 page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 17 of 17 No. U� I FEE COMMONWEALT14 ®F MASSACHUSETTS �- Board of Health, �39M S�t.�e�.L MA. APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to,Construct( ) RepairX Upgrade( ) Abandon( ) - ❑Complete System/Irndividual Components Location CA1 A 1-1 Owner's Name Map/Parcel# �-a Address Lot# Telephone# Installer's Name ` ,Cr Designer's Name Address` ^k-�1'CzXI ,� a MA Address � M Telephone# _ ``-- Telephone# Type of Building 'C� \ Lot Sizes sq.ft. Dwelling-No.of Bedrooms —�^� -�pp_�� — Garbage grinder (. Other-Type of Building ��C JK4Y1 R No.of persons Showers Garbage t.) Other Fixtures Design Flow(min.required) �� gpd Calculated design flow P' Design flow provided gpd Plan: Date (T�i`Q Number of sheets Revision Date Title Description of Soil(s) r1 Soil Evaluator Form No. Name of Soil Evaluator ` Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further to no to,, ace to m operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date �y Inspections � -.ri.-.�`�.-• ��. .. 3- �f r �„'"`"',(�"�"S`�i�,.n.`!`�' ....ts•3�Wy,�+�.,yK'R'�f4i'7.�"`i.`.��""`'''�^�•i�i i..!'Ju.7 if.• "t'"•�, "••�_^. , V t as �iy No. �V�7` Q FEE SD + ' Board of Health, 15C!r n 5A-r-\0 .e MA. APPLICATION FOP, bISPOSA� "SYSTEMCONSTRUCTION PERMIT Application for a Permit to Construct( ) Repairx Upgrade( Abandon( ❑Complete System Individual Components r Location rAl` & e.-A M6k c,,-N e1 1)c irF Owner's Name '_16('fit-, cc t rc,(-,2l- i Map/Parcel# � ( rl` Addresses � w Lot# Telephone# ' Installer's Name r5ik� Designer's Name Address''' Address � > r- +�• .�r^��c" �zx� IM Telephone# Telephone# Type of Building hC� t(�1 �G` Lot Size sq.ft. ! Dwelling-No.of Bedrooms C,--�\X �o� Garbage grinder (I,yA- Other-Type of Building ` C ►.cam No.of persons Showers (V6cafeteria 0,)f Other Fixtures \ rz ^'ct ace � C.�*R��'Sir, � t Design Flo (min.required) `! gpd Calculated design flow . CDesign flow provided gpd Plan: Date ' .4 Number of sheets Revision Date Title I �{ _—� t C7,C7[?f:zof's" Description of Soils) Soil Evaluator Form No. `!` rA Name of Soil Evaluator j A Date of Evaluation WP- DESCRIPTION OF REPAIRS OR ALTERATIONS C �G(`> �C E-G? �GCII�G,'� Vr1{.,. � v U The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to�place a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed w X n. , Date [/,'Cf ✓ LOY Inspections s No. UCJ - i FEE COMMONWEALTH�V'EALTH OF �'ASSA'1 HUSETTS � Board of Health, TJ Cam,r dy.5�"�aY�. MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded (!Abandoned ( ) by: K s)6-;:� 5 .s rp m e . 8 at 7 4-4 (-)rc,-o-4 `"t� .,n VOvtarP ��"��ft,0il 7- has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 040 Ll 't dated 4 Ja t j l Approved DeA n Flow (gpd) Installer \ \) , Designer: 4 Inspector: /k�� i. 1 tL }. Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. _ Un l��t'�� FEE y l r COMMONWEALTH Of MASSACHUSETTS Board of Health, �—h.,..S` _ ' Am. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(,..-)- Upgrade( ) Abandon( ) an individual sewage disposal system at Q (n V-sk, L f (W j ovt /l- C /'�5�t as described in the application for Disposal System Construction Permit No. nl y / , dated q/ Z I q . Provided: Construction shall be completed within three years of the date of thipermirt. All local conditions must be met. F l J Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �l Board of Health _IJ �I J. ��} / - 07/19/2014 19:49 FAX 1� 001/001 Town of Barnstable oyTHE ;;� ., ' Regulatory Services a t Thomas F. Geiler,Director • a►axern�, • Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA.02601 Office.- 508-862-4644 Fax: 50$ 790-6304 Installer& Designer Certification Form Date: 4/22/04 Designer: ___Shay Environmental Services Installer: Roberts Septic Service Address: 34 Thatchers Lane Address: 5 Trenton Street East Falmouth, MA 02536 Yarmouth, MA On 4/20/04 Roberts Septic Service was issued a permit to install a (date) (installer) septic system at 74 Grand Island Road Osterville based on a design drawn by (address) Shay Environmental Services dated 4/19/04 (designer) XX I certify that the septic system TANK REPLACEMENT ONLY)referenced above w is installed substantially according to the design, which may include minor approv d changes such as lateral relocation of the distribution box and/or septic tank, 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 compone it of the septic system) but in accordance with State & Local Regulations. Plan revision r certified as-built by designer to follow. tN OF,k,4 (Installer's �gnature} �� CARMEN SHAY I 'A °'sr.. * ( es gner's Sign (Affix at p Here) PLEASE TURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICAT OF COM LIA,NCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND A - BUILT C RD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISIO . THANK YOU. Q:Heahh/Sep ic/Designcr Certification Form APR-22-2004 THU 07:21AM ID: PAGE:1 TOWN OF BARNSTABLE CL LOCATION , SEWAGE # �� j VII.LAGE 0_61 V—Ve—ki k '� ASSESS LIYVLOT INSTALLER'S NAME&PHONE NO. �r I SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �`�� i ..(size) ?c jNO.OF BEDROOMS �✓ BUILDER OR OWNER 0 ! PERMTTDATE: 11 Uy COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwv r Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Lea hing Facility (If any wells exist on site or within 200 feet of leaching facility) Feet I Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ouo-e-\ IS sd i � P lm � TOWN OF BARNSTABLE LOCATION 77 l\ r�r -�k S ifs/ SEWAGE # vii"LAGE U��1�-10��\"�.� ASSESS 'S & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY EACHING FACILITY:,(type) �.OF BEDROOMS �✓ .LDER OR OWNER- O PERMITDATE: 11LOY-_—COMPLIANCE DATE: / ot/ . Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland,and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o ' c ,10 ® o �. �1 a TOWN OF BARNSTABLE LOCATION 42-M &40L SEWAGE # lcb 7 ' VILLAGE - � � �r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. y5 -�� 141#O C'9'oe S SEPTIC TANK CAPACITY ,/:�0 0 3 LEACHING FACII.TTY: (type) W�40:5OF BEDROOMS '. DER OR OWNE PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist` within 300 feet of leaching facility) Feet Furnished by � . f_ � �. �. �l ..-� . , . - . ., � - � ---P-�--------�--.--.._._ r ,_ Q i No. �l 'Ar :- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE; MASSACHUSETTS 0[pprication for Migaal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Y<omplete System El Individual Components Location Address or Lot No. 7 6 P—, Xs q rive Owner's Name,Address and Tel.No. osFr-Fr 3a Assessor's Map/Parcel o I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ftv,(Q-G(A(jo5e f,ML 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 gallons per day. Calculated daily flow 6 7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank GV R 041 Type of S.A.S. 915ILb Description of Soil of fag 7 pdcO Nature of Repairs or Alterations(Answer when applicable) I c�l \ VS C20 ` 'l 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 nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has Signed Date Application Approved by Date -3 Application Disapproved for the following reasons Permit No. fc g—/S'"Z Date Issued S' Fee 8 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ - Yes PUBLIC HEALTH DIVISION--TOWN OF BARNSTABLEs MASSACHUSETTS 2pplication for Dfgaar *pgtem Construction Permit Application for a Permit to Construct( )RRepair( )Upgrade( )Abandon( ) omplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. cs<<=�t;� �� A t7 N rt S, Cc� Assessor's Map/Paic el , `�^� —O Installer's Name,Address,and Tel.No. d+ 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 Design Flow_�60 gallons per day. Calculated daily flow [cam 6 7 gallons. Plan Date Number of sheets Revision Date A. Title Size of Septic Tank 15o0 13fJ�lGzt//� Type of S.A.S. I�, ��OCi>�i_SL&,(c(-Ti�{j c;�t Description of Soil S PVV- CC)IA d F Nature of Repairs or Alterations(Answer when applicable) . t\-4�5i4 V-S 00 G1 A\V cj Sif 1<' (I _ cDc LA �-- Q— �_�,�C ��'r �,� �Gi I(�L`i`I"L- iMr � :�t. 1�S 1d y SlL( r) C A ct(� /tf�� e JA t,,..--- /mart t Date last inspected: Agreement: a 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 nvironmental Code and not to place the system in operation until a`Certifi- cate of Compliance has beea-issue f-1 leakh-- t � Signed Date Application Approved by 0iff �- Date 3 ' - Application"Disapproved for th following reasons Permit No. l`^9—��Z Date Issued VZ_ Aft % THE COMMONWEALTH OF MASSACHUSETTS `t BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,.that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by 6- �'--4�{�e- _Sl -- at :7f LA t!SQ-14 LL S L A K2 0 DV-f,-,C, 0 5- t"ri.ti 1 I l e has lieen constructed in accordance with the provisions of Title 5 and/the for Disposal System Construction Permit No. i 4atetd-, Installer f Designer __r--, n The issuance of this permit shall not,be co str ed as a guarantee that the sys em will,function as de'O'd. Date ~= � L Inspector %. , A . ! I;� «_ No. --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Digpoaf bpmem Conmrucion Vermit Permission is hereby granted to Construct( )Repair(,) )Upgrade.(�j)Abbandon( ) System located at 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: Constructio must be completed within three years of the date of thispe t. Q 9 j' iU Date: 3 � S / �/ Approved by e 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL ----t WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated �� , concerning the property located at `� �, tc�,k-(2�S wkc`fl c� meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system i•/ ere is no increase in flow and/or change in use proposed (/ There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the mum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] ff the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) D B) G.W. Elevation J J +the MAX.High G.W. Adjustment. ► _ ° DIFFERENCE BETWEEN A and B SIGNED : DATE: J [Sketch proposed plan of system on back]. q:health folder:cert iT r �' �. �� JUG•(/ 1 ` n �;y r ;7 iC � � -.[ >/ ✓ i j. '� Q G;, i O ! � _ (/" �o� V �--7 L ^� (l �/v ` 1 �VVV VVV '� _. G r�� s�� ,�� TOWN OF BARNSTABLE LOCATION ; SEWAGE # VILLAGE ASSESSOR'S MAP & LOT . INSTALLER'S NAME&PHONE NO. / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO. OF BEDROOMS e BUILDER OR OWNS PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet Z T F �c� _-Cv I to � • N N ED pl C L vGil- N 1 L 44'-0" I0'-5 V2• 2-10 V2 11V, 1yr�`� 2.'-0' e'-0" EXISTING H06ee U p 0 U gE AL L P.T.2X&a" a C i r r r w 112.ANLHOR r r - i so-Moe'-o'OL. cONc.FOUND. 4 r- ---------------- ' '--------------- FWI1 ON 2ox12 �T colic.FOOTING nw.L-• . r______________ ' DLAD r r n __________________ ___ ________________ ____________ r_______________________ r _ __ D'c011c.'T- O r ______________________ MA"ON 011HO C.Q(c.FOOTING FVFET pQ I D/4%11 T/D L.A. 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W N< L1L � ur x Z� t�L Q U o L L.. job a 0196 Ilrte , 0GT.11.90W Kib f 1/4•f-0' Aee11 PAM M. t 5 E G O N D F L O O R FRAM I N G P L AN ROOF FRAMING PLAN m f OO AL G. 1/4• • I'-O' 60 AL G. 1/4' • 1'-0• 1 A-6 e PORCH ENTRY HALL DINING ROOM aorovE ewsron ooae—: a�w,`�`i,yo°ffNp1 Fi 5TUDY LIVING ROOM *,{ ® U KITCHEN M � O rOO VE BEDROOM I K LAUNDRY ROOM rl ((((//�` BEDROOM F�l H 6ARA6E E N E CARTER REO 74- OKAND 15LAND PKIVE OSTERVILLE , MASSACHUSETTS 4 BEDROOM BEDROOM 01 . �. BEDROOM 6ARAOE ROOF (: ARTER KESILENCE 74- GRAND ISLAND DKIVE 05TERVILLE9 MASSACHUSIETTS ENTRY HALL I7ININC� ROOM UP REMOVE EXI5TING DOOR--T AND GUT 5'-O"OPENING IN WALL. le i t KITCHEN z C�k -F cz 10 O O O l BEDROOM LAUNDRY ROOM BEDROOM I SECTION A —A 1500 GALLON H-20 SEPTIC TANK *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (O Least 24 Inches tall) PROFILE VIEW OF EXISTING LEACHING SYSTEM - 10' min, from Schedule 4 PVC w/Charcoal Odor F lter NOT TO SCALE house to septic tank �t rp :;�. "*e`'` y - Existing Foundation 3-24• DiAM. ACCESS MANHOLES SEPTIC TANK SHALL BE FACTORY CONSTRUCTED OF SOUND Septic tank covers must be DURABLE WATERTIGHT MATERIAL''AS PER TITLE V CODE 15.226. wr i T.O.F. elev. 100.00 3" of 1/8" - 1/2" Washed Peaston within B in, of finished grade ode over SAS - 14.00 - ifi.00 10' -a• , Grade over Septic Tank - 17.00 Grade over O-Box - 14.00 3/4" to 1 1/2 Washed Crushed Stone s '° 0.02 B HOLE �zry T4 i/OIW 1510�111!Qr CENTER ACCESS COVER OF SEPTIC TANK TO BE '' °ySta Top Load - Elev. - EXISTING i''. RAISED WITH THE APPROPRIATE RISER TO WITHIN ° L9Y r- - _ M1 i, ( 4 in 6" OF THE EXISTING GRADE AS PER TITLE V. H-20} DI57. BOX Top of SAS - Elev. �ti,fx) (Approx.} S,e0.01 or Greater ,, .... 1 EXIST, PIPE N vl NEW 1,500 GAL INLET FROM FOUNDATION Nj N 52' S= .010• per foot Effective Depth ` / `� ``� " x ' �'a SEPTIC TANK + ou THE ACCESS COVERS FOR THE SEPTIC TANK, H-20 20' c� t DISTRIBUTION BOX AND LEACHING COMPONENT }. - • r II oe.ems. m o z 8 Units 2 6.5' = 52.00' SET DEEPER THAN 1 FOOT BELOW FINISHED "` CONCRETE FULL FOUNDATIO II F s tr 1' 4' 4 GRADE SHALL BE RAISED TO WITHIN 12" OF :f C «:�f*�r '�''T.-r� :� '• FINISHED GRADE. t9 ?C i+ r. INSTALL TUF-TITE GAS BAFFLES OR EQUALS _5M Irt m II tl w STEEL REINFORCED PRECAST CONCRETE Sao SYSTEM PROFILE a� II 0 ON ALL OUTLET TEE ENDS IDM3RAMdhftba,ec .ry®20"14vip.►lenT"+rVtV9ie, Not to Scale c ° ° u e Approx. Effective Length PLAN VIEW P'+ 1 SOIL ABSORPTIDN SYSTEM (SAS) c c e ln.of 3/4"-1 1/2" , Not to Scale 3-z4•REMowAeLE covERs —\ GENERAL NOTES compacted stone APP�ox• _ NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Effective vldth s r .. ,. ,, 4- 3- 1. Contractor is responsible for Digsafe notification _min•ciearonce I Ir n+�r and protection of all underground utilities and pipes. INLET a• min_T �2• min. Wet to outlet 6.mh. 2. The septic tank and distn ution box shall be set o•mh. Liquidievel- 1 OUTLET level on 6" of 3/4 -1 1�2" stone. j T7 I U 3. Backfill should be clean sand or gravel with no S -,• stones over 3" in size. u-0 min. 4. This system is subject to inspection during installation '. os by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance .....,,. .. 1 with Title V of the Massachusetts state code, the approved plan NOTE: SEPTIC SYSTEM EXISTING — ONLY TANK TO BE RELOCATED 5' and Local Regulations. ALL OTHER ELEVATIONS OF SEPTIC COMPONENTS EXISTING. eRoss SECTION END—SECTION 6. If, during installation the contractor encounters any soil conditions or site conditions that are different ( from those shown on the soil log or in our design installation must halt & immediate notification be N made to Carmen E. Shay - Environmental Services, Inc. CD 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. co 10. All solid piping, tees & fittings shall be 4" diameter 100 ' Schedule 40 NSF PVC pipes with water tight joints. I GG 11. MUNICIPAL WATER IS AVAILABLE AT SITE and Surrounding Properties. i WITHIN 150 FEET OF SAS . o NOTE: THE PROPERTY LINES & WELTANDS ARE APPROXIMATE AND I COMPILED FROM THE SURVEY PLAN GENERATED BY BAXTER, NYE & HOLMGREN OF OSTERVILLE, MA, DATED 02/03/03 ENTITLED " CERTIFIED PLOT PLAN OF 74 GRAND ISLAND DRIVE, Ir OSTERVILLE, MA", AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN IT SHOULD BE USED FOR NO PURPOSE OTHER THAN j PROPOSED NEW ,� THE SEPTIC SYSTEM INSTALLATION. 1500 GAL. TANK t �� NE IF , I H-20 _ � I FOUNDATION i l rn I I, FOR 3 CAR j GARAGE i NO WETLANDS ARE LOCATED WITHIN A 200' RADIUS OF THE SAS. i I PROPOSED `� 7 i II q1 "12.75' CLEANOUT / W/IN 4" OF GRADE / � I EXISTING 1500- GAL TANK �� ', / � ASSESSORS MAP - 72 PARCEL - 012 (APPROX) II /r / / / ZONING - RESIDENTIAL I , HOUSE #7 NO WETLANDS ARE LOCATED WITHIN A 200' RADIUS OF THE SAS. r a EXISTING I II 6 BEDROOM EXIST. I I HOUSE i ALL OUTLET PIPES FROM THE LEGEND D-BOX I DISTRIBUTION BOP, SHALL BE I ' I SET LEVEL FOR AT LEAST 2 FT. — 12• —" CONCRETE COVER 'I (' /r KNOCKO KNOCKOUTS DENOTES PROPOSED 88X0 ,5.5• 1 � �. � PORCH ,� � i — � ouTtET '+ r'I �-��{ 1z• INLET SPOT GRADE I ! �'// $• �- a 2• X 104.46 DENOTES EXISTING 1 A ,�,•____ _ SPOT GRADE j PLAN—SECTION CROSS SECTION '7 PL PROPERTY LINE _ 6 HOLE H-20 DISTRIBUTION BOX PROPOSED CONTOUR I EXISTING SAS FOR t`� I \-- �-�_ SIX BEDROOM HOUSE O t --- NOT TO SCALE I (APPROX.) O I �� , 97— — — — — —O7 EXISTING CONTOUR ' DEEP TEST HOLE & PERCOLATION TEST LOCATION j ------- —16 FENCE t`? / '1 LOT Z PRIVATE DRINKING WATER WELL 26,384 Square Feet I REVISIONS ' '1 NO. DATE: DEFINITION -r----------- I I l I 00 . oo, , PROPOSED (40F`00), � ., , PREPARED FOR R-� r OF �. O F N JOHN & KARIN CARTER #74 GRAND ISLAND DRIVE 537 SPRUCE STREET OSTERVILLE, MA PREPARED BY: PHILADELPHIA, PA 19106 OF rAR�IEN �'. SffA Y ENVIRONMENTAL SERVICES, INC. 89 P.O. BOX 627 IsTe EAST FALMOUTH, MA 02536 41V/TARI P` TEL/FAX 508-548-0796 SCALE: 1 "=20' DRAWN BY: CES DATE: APRIL 19, 2004 PROJECT#SD-558 FILENAME: SD558PP.DWG SHEET 1 OF 1