HomeMy WebLinkAbout0024 GUNSTOCK ROAD - Health 24 Gunstock Road, Ostervilie _
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74 TOWN OF BARNS ABLE
LOCATION SEWAGE #
VILLAGE �C' y���-- ASSESSOR'S MAP & LOTA('I-133--
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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
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I A R b� _
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COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary.
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/ CERTIFICATION
V' 7
Property Address: 2S GUN STOCK RD OSTERVILLE, MA 02666
Name of Owner SCHOLLE CIO PHILL MCCARTIN REALTORS
Address of Owner: 872 MAIN ST.OSTERVILLE MA.02656
Date of Inspection: 10/10100
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 608-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems?.The system:
X Passes
_ Conditionally Passes
_ Needs Further Evalua' n By the Local Approving Authority
_ Fails
Inspector's Signature: pl `t Date:10/11/00
The System Inspector shall s mita copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If t e'system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS agx
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M.
I,
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL
LIFE.RECOMMEND KEEPING ALL TREES AND BUSHES OFF SYSTEM TO PREVENT POSSIBLE ROOT DAMAGE.
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traviced 912/98 Pape 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any inform ation,which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not
evaluated are indicated below.
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 o
the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not.
nIa The septic tank is-metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the
septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure
is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved
by the Board of Health.
n/a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o
due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
n1a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass
inspectiowif(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
• i
X
tVi :
revised 9/2/98 Paoe 2 of 11
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O,PHILL MCCARTIN REALTORS
Date of Inspection: 10110/00
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 the public health,
safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I:
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
s
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has aseptic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary
to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic,tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance n1a (approximation not valid).
3) OTHER
n/a
revised 9/2/98 Paoe 3 of 11
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
rt
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 failure.
Yes No „,
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nla.
st
_ X Any portion of the Soil Absorption'System,cesspool or privy is below the high groundwater elevation.
_ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone I of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
_ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water
quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
ty. .
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:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health
and safety and the environment because one or more of the following conditions exist:
Yes No ..,
_ X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area(interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply
well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of
the Department for further information.
r
revised 9/2/98 Paoe 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B `
CHECKLIST
IA
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner: SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.
X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that
period.Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available;with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X _ The system does not receive nori-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System,have been located on the site.
X _ The septic tank manholes'werd uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material
of construction,dimensions;depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site
has been determined based on:
X Existing information,For example,Plan at B4O,H,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)]
X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
� .
1
is
revised 9/2/98 Paoe 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
+ SYSTEM INFORMATION
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
FLOW CONDITIONS
RES113FNTIAI
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):n/a ,
Total DESIGN flow: 330 gpd
Number of current residents:0
Garbage grinder(yes or no): NO
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): NO :
Seasonal use(yes or no): YES
Water meter readings,if available(last two year's,usage): n/a gpd
Sump Pump(yes or no): NO q•,r
Last date of occupancy: n/a
COMMERCIAL/INDLISTRIAL n
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203) t
Basis of design flow:n/a '
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no): NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION-
PUMPING RECORDS and source of information:
n/a - -
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a!,.,,,.
TYPE OF SYSTEM a 4 ?
z,
X Septic tank/distribution box/soil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system(yes or no)(if yes.attach previous inspection records,if any)
_ I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a ,
APPROXIMATE AGE of all components,date installed(if known)and source of information:
THE SYSTEM IS 17 YEARS OLD. ,R
Sewage odors detected when arriving at the site:(yes or no), NO
revised 9/2/98 Paae 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02666
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00 ,.i•?< i
BUILDING SEWER:X '•
(Locate on site plan)
Depth below grade: 30" A 4
Material of construction: _ cast iron _ 40 Pvc X other(explain)
Distance from private water supply well or suction line: n/a
Diameter: n/a
Comments: (condition of joints,venting,evidence of leakage,etc.)
TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 24"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1000G L 8'6"H 5'7"W 4'10""
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee'or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFULL LIFE.
,,f£
GREASE TRAP:
(locate on site plan) L_
Depth below grade: nla
Material of construction: —concrete_ metal_'Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:nla
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle nla
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of.inleFand outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc'), E r°
n/a 11.'k1E " ay
4,
revised 912/98 Paoe 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) m
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design Now: n/a gallons/day
Alarm present: NO
Alarm level:NIA Alarm in working order: NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER: _ u
(locate on site plan)
} T I
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments: oil,
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
•4t',.
revised 9/2/98 Paoe 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(1)1000 GAL 6'X 6' „
leaching chambers,number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)Na
overflow cesspool,number: (n/a)n/a "
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) "
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE
INSPECTION.
CESSPOOLS:
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a _
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments: s
(note condition of soil,signs of hydraulic failure,t.level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
n/a.
X
3cl ,
- r
revised 9/2/98 Paoe 9 of 11
F
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE C/O PHILL MCCARTIN REALTORS
Date of Inspection: 10/10/00
SKETCH OF SEWAGE DISPOSAL SYSTEM: z
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
o Q c cL
ol 6
17
p
iL revised 9/2/98
Paae 10 of 11 - .'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 GUN STOCK RD OSTERVILLE, MA 02655
Name of Owner SCHOLLE CIO PHILL MCCARTIN REALTORS -
Date of Inspection: 10/10/00
NRCS Report name: nla
Soil Type: nla
Typical depth to groundwater: nla
USGS Date website visited: nla
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_,
SITE EXAM _ Slope
Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet n/a
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
_ Determined from local conditions '!
Checked with local Board of health
s
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS-12 FEET
revised`9/2/98 Pacie 11 of 11
Commonwealth of Massachusetts
` Executive Office of Environmental Affairs
Department of 'ECC V 7
Environmental Protection
S EP• 1996
Wtlllam F.Weld � H Govemor
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OF OA
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domm!woner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
. t 1;
Property f:141N� a: . . 1.4 Address of Owner:
Date of Inspettiu:r: ��� Z_: ®S (If different)Ina
Name of Inspector: T p / -/L
Company Name, Address'and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:-
/Pass j
�� t
Ces
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
v_ Fails '
Inspector's Signature: Date: �= Z Z—.��
The System Inspector shall submit a copy of'his inspection report;to`the.Approving Authority within thirty(30) days of completing this 1
inspection. If the system is a shared system or has a design flow of_1.0,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. s
The original should be sent to the system owner,and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
w
Al �SYSTEMMPPASSES:
Ll I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
" Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALUY PASSES: i
f i
One or more system`components need to be'replaced or repaired. The systern, upon completion of the replanement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic :ank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is.
imminent.'The system will pass.inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One WIMer Street a Hasten,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292-5500
Printed on Rwyded Paper
P .
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
W-� CERTIFICATION (continued)
Property Address:
Owner: ,
Date of Inspection: '
B)SYSTEM CONDITIONALLY;PASSES';(continued)
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system\requiredmping more than four times a ear due to broken or obstructed pipe(s). The system will pass
inspection if(with appro I of the Board of HealtV
broken pipe(s) are r placed
o struction is re oved
C) FURTHER EVALUATION IS REQUIRED BY THE
RD OF HEALTH:
Conditions exist which require further e� luation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environ ent.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH D ERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE P BLIC HEALTH AND SAF
waer
ETY AND THE ENVIRONMENT:
Cesspool or privy ' within 50 feet of a surface
Cesspool or priv is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL U LESS THE BOARD OF HEALTH (AND'P\UBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUN TIONING IN A MANNER THAT PROTECT�THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The sv em has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surfa a water supply.
_ The system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well.
_ T e system has a septic tank and soil absorption system and is within k feet of a private water supply well.
_ e system has a septic tank and soil absorption system and is less than\00 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen andd nitrate nitrogen is equal to or less than 5
ppm.
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
_ Backup of sewage into facility or system component due to an overloaded or dogged 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.
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f
PART A
CERTIFICATION (continued) ,(
Property Address: D— ,� d
Owner: li�t9
Date of Inspection:
D]SYSTEM FAILS(continued):
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
R ired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Num r of times pumped
Any portion>a. sspool
f hlAbsorption System, cesspool or privy is below the high groomter elevation.
— Any portion or privy is within 100 feet of a surface water spp lyor tributary to a surface water supply.
_ Any portion I or privy is within a Zone I ofa pubx wellAny portionol or rivy is within 50 feet a private water supply well.
{
_ Any portion of a cesspool or pri is less tha 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. IMhe ell has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic c mpounds, ammonia nitrogen and nitrate nitrogen. f
Ej LARGE SYSTEM FAILS:
The following criteria apply/to large systems in addition to he criteria above:
The design flow of�,st`em is 10,000 gpd or greater (Large Syste, ) and the system is a significant threat to public health and safety
a/en nt because one or more of the following conddv\exist;
m is within 400 feet of a surface drinking water supply .
em is within 200 feet of a tributary to a surface drinking water.supply
em is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
ater supply well)The owneny such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner: ct ion: ' J wt�pj
Date of Inspect
FLOW CONDITIONS
RESIDENTIAL:
Design flow: al ons
Number of bedrooms:
Number of current residents:_
Garbage grinder(yes or no): Al
Laundry connected to system (yes or no):
Seasonal use (yes or no):!O
Water meter readings, if-available:
Last date of occupancy:
COMMERCIAUI NDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
Grease trap present:-(yes or no)
Industrial Waste Holding Tank present(yes or no). _
Non-sanitary waste discharged to the Title 5 syste : (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of oc ncy:
GENERAL INFORMATION ,v
PUMPING RECORDS and source of information: t
System pumped as part of inspection: (yes or no) 3
If yes, volume pumped Gallons
Reason for pumping:
TYPE O2F SYSrTEM
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)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known)and source of information: `� 3
Sewage odors detected when arriving at the site: (yes or no)
(revised 8/15/95) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SEPTIC TANK:_
(locate on site plan)
Depth below grade:
Material of construction: oncrete_metal _FRP other(explain)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: a•-�
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:
Comments:
(recommendation for pumping, condition of inlet and outlet tee or baffles, depth of liquid level,in relation to outlet invert„structu
integrity, evidencg of leakage, etc.) c i►t `'-' -'t'�"�
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _PR ,other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top o utlet tee or,baffle:
Distance from bottom nf ccum bottom of outlet tee or baffle:
Comments:
(recomme�'dation f r pumping, condition of inlet and outlet tees or baffles, depth of liquid level in.rel\n to outlet invert, structural
integrity evi e of leakaee, etc.)
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: `��t,!l 0-'n-k V '
Owner:
Date of Inspection: _ :2-2--
TIGHT OR HOLDING TANK:_
(locate on site plan)
Depth below grade:
Material of construction: oDcrete_metal _FRP—other(explain)
Dimensions:
Capacity:_ ' allons
Design flowi gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition o arm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: (5
Comments:
(note if level and distribution is equal, vid ce of solids carryover, evidence of leakage into or out of box,
Dell
PUMP CHAMBER:_
(locate on site plan) —'
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condi ' of pumps and appurtenances, et .
(revised 8/15/95), 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: .�
Owner: U `LL-V
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: �`�" • ''�'°""`'�" "
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, sig s of h draulic fa' re, (e=ofding, conditignjof veget Lio tc.)
CESSPOOLS: _
(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 (cesspool must be pumped as part of i pection)
Comments:(note condition of soil, signs of hydrau 'c fa' ilure, le el of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of constructi Dimensions:
Depth of solids:
Comments: (note, ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property.Address: —VU.4&� rt.-L,"
Owner:
Date of Inspection: -7r-z—2 q
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
33 C�
�e, _cQ `3b
e 7:1
DEPTH TO GROUNDWATER
4r-
Depth to groundwater: feet
method of ermination r approximation:
(revised 8/15/95)
f , 1
S 7 1
xai ..4.1'
Az
.n•.P.......,
..,t,. '. -.. ���"'• ���' . .'��' 't["�r���^r'�'.�e"s°�k'9�.' "i".': ...<,'�'"°.""'�,"`" ;."`"< _. ".�r�'�,"T .,._..��•:?,:�'2:'�""�`.4...e�"'1 .. -.,.•.-.F- ,t ^fi;GTp�'^x''�'".e,''^��"?'�-:,V`;".,.
LOCATION ` �' SEWAGE PERMIT NO.
o -
VILLAGE
INST.A LLER'S NAME & ADDRESS
R UILDE R OR OWNER
F
DATE PERMIT ISSUED f _ 7 3
,a.
.a
DATE COMPLIANCE ISSUED /� �
a
�t` � $fie�
�pUM>�
13'G '� ,.
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b'' � 3�,
33
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.�yq
................ ,.
THE COMMONWEALTH OF MASSACHUSETTS
f BOAR® OF HEALTH
Appliration for Uigpvii al Workg Tutw1.rnrtion 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
SysteV at;_- r
......ZP 1._.21..:�&ilg� .., - . . _ �. / ...... ..................... _
/ Lo yion-Add ss e--— t'� t N . 110
�L
L.ram- tl.l(.?l! ... tl l C••�-- � 1� ! �------- .....1..�•_.�Y�_ _Zv/
�ywn,.� ddress
#� � 4v
sta
Address
U Type of Building Size Lot.LD,.c _Sq. feet
Dwelling—No. of Bedrooms.............3..........__.._...._.....Expansion Attic k'Ye Garbage Grinder VYP
'04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria
P4Other fi2j es ....................................................
W Design Flow.................`__- -------..____.. allons per person per day. Total daily flow__._.._..��,i_.�. ..._._._.___..__._gallons.
Septic Tank—Liquid capacityJ60. llons Length................ Width-............... Diameter---------------- Depth................
Disposal Trench—No. .................... Width............._...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._._...j_..._.._... Diameter..__..... Depth below inlet.................... Total leaching area.Z_i .�Y.......sq. ft.
Z Other Distribution box ( ) Dosin a ( )&estl
Percolation Test Results Performed b ... .��� � �? _ _.__ Date_X j Test Pit No. 1. ..mmutes per inch Depth of it__..��....... Depth to grou ....... 9
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.....
----------y...............
..... --...--•--- -•---.... ......---•........
O Df scriptiog of, W - ' t �r - � �H-• �� ��p -.............
Ull.-» '----r- vz t .......... ---------- ---------------------------------------------------------•---.......--------------
� - J-/Y_?Pr ! 1 P� G ----------------------•-----------------------•----------------------••-•-----.--.
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-•-----------------------------------------------------------------------------------------------------------------------------------•..--------------------------...------------------..._.......•---•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 2ILTI:i: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in,
operation until a Certificate of Compliance has beet by and of health.
Application Approved By........ . •. ---- ............................................................ ....7 ate --3:.
--
Application Disapproved f o the llowing reasons-------------------------------------•-----------------------------------------•-----------••••-----...--------
...............••---..........---••-•-••------------------•--•-----------••-•••-••------.......---------....-•-•-••-•••-•-•••----•---•---•------•-------•----•-•-•-------------..._..-------••---•--_....
Date
PermitNo......................................................... Issued_.......................................................
Date
No......................... FES.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r'.� '--------------OF...- l?r�. a...f..a.. �__,I-_77...A!FI;=:........................
Appliration for Disposal Works Toni$rnrtion umi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at /
/�'
.... �....._� . �°°.... u..,r!. ....................-.1.... .... -•-•=y= :: .. I .� ........................
Lo/� on-Address -. { -1P _a t 1�I
.......... �.:y r° � ---- ....,e;=-'l��{ �.����.1 c-..... �....1 '
Owner -.�_ W. ddress
Installer Address s i"
Type of Building Size Lot_1_`?;_!�. ..Sq. feet
U Dwelling—No. of Bedrooms______________ __ _ ___________________Expansion Attic ;-yo Garbage Grinder V✓
'4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
QI Other fixtures -----•--•---------------- ------------------•----• .
W Design Flow.................�_.. _._________________ allons per person per day. Total daily flow__.._._._f;____�._0..................gallons.
WSeptic Tank—Liquid'capacity:l L54 allons Length................ Width................ Diameter................ Depth................
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------ ............ Diameter_ ........ Depth below inlet____________________ Total leaching area_Z- '1ol_..._.sq. ft.
Other Distribution box ( ) Dosing tagk ( ) {-
'-' Percolation Test Results Performed by ;�"./� �_ `�!f t"'3`'_..r_rr` ___.____ Date__ �',.-2, _ _:__ ......
,/
Test Pit No. 11,E .<-_._minutes per inch Depth of Test Pit_.._}_ _________ ,Depth to groin Ovate ..____.sw
_.__%
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.................s..............•....-�......•......_.._•..... ar ---- ......----
Description of Soil - ` - � — i-- = tl---
! r `
U Nature of Repairs or Alterations—Answer when applicable................................................................................................ _
---------------------------------------------•---•--------•---•--------------------------•'-••--....---•---••--------------------------------------•-----•---•--••-•-•-•--------•••--------•--'-'------
Agreement:
r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the of provisions LITIE p ° '� 5 of the State Sanitary Code—The undersined further agrees not to place the system m
operation until a Certificate of Compliance has been issued/�b �hoard_,of health.
Signed _. I _ - .... ..............................
ApplicationApproved By.................................................................................................. -'--------=-----------------------------
Date
Application Disapproved for the following reasons:-----•-----------------•-------•-----------------------•--------------
-------------•----••--•-•--_.._....-------•--•--•---------•-------•-•-•-•-----•--------•---'-•--•------••-•-----•---•---------•----••---•------...---.---•------•-••---••----•-•---••--•----•------'---
Date
PermitNo------------------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtif iratr of Tontpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-•---------•--•-•---•--•----•---••-•-•------•--------•------•----•----------------•---•••- -------------------------••-•----•-•------•-------------•---------•---------•-----•-------•-----------
Installer
at_--•--------------------•---•-••-------•----------------_•__________---------------•------------••----------------------------••-------------•-••-•----------•---------------------------------------
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......................................... dated------------------------------------------------
THE ISSU NC OF THIS CERTIFICATE SHALT. NOT BE CONSTRU S A GUARANTEE THAT THE
SYSTEM 1N1 F 77CTION SATISFACTORY. =
DATE__1�.... . .......................................................... Inspector. ••. •-•-••------••-----------•-------------•-----'-••-•--------._.......__.....
THE COMMONWEALTH OF M SACHUSETTS
BOARD OF HEALTH
...........................................O F.................._.._.-...__..._..._....._-.-....._........__........_...._......_..
No......................... FEE........................
Diopmal Works 0611no#rurtion anti#
Permissionis hereby granted............................................. -------•----••••-•-•--•••••--•---•---••••--••-•••--••-•-••--•-••-•-•---................__--•---
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo...............................................................................................................................................................................................
street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
.............................................•--•------...----•-•----------.....------•-•--------•------
Board of Health
DATE--------------------------------•-••-----------••-------------------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
f: f -74
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93
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8
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oDo99\ � �. I 68.99
� yNofas -q . \� 6G 3 ° 43
Os c�GN !v l�! — ..`l 9�' pig v�MG'�✓•T T 91 ,
EvCaB
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4o��g�o4 40
hD SURD
LEGEND
EXISTING SPOT ELEVATIONOx0 �NOFM�s CERTIFIED PLOT PLAN
EXISTING CONTOUR-0 —• L v� t4 G�i✓s rvc.: c rz �.
FINISHED SPOT ELEVATION ALB
FINISHED, C O N TO_U R 0 ----- '` ^' �� - `` V C`
o SE. 00 IN
APPROVED BOARD OF HEALTH o.io95i�p ) .\.
SS/O.NAL�� QEvI sE-j -7/I q /,8 3
DATE AGENT SCALE, / �= 3 DATE
L DRED E ENGINEERING CO. IN 4 �
CLIENT I CERTIFY- THAT THE PROPOSED
'RiEGISTER REGISTERED JOB NO. R0 04 BUILDING SHOWN ON THIS PLAN
CIVIL LAND t 4 CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYORDR,BY �1 ' OF BARNSTAS E MASS.
712 MAIN STREET . CH. BY, J.R.E•
HYANNIS,, MASS.' -
SHEET/ OF bArE G. LAND SURVEYOR
24 FT. M/N. IV O /F E/T/!GR T/,IE SEPT/C TAN k OR
�EAC/,I//YG P/7` ARE MORE T/YA/V /2"BELOJN
�rRAPJF A 24'O/AM ET.ER CONCR!FTE COVE-AP
SHALL eF BROUGHT TO GRA OE.�,4,V --X rR
CONCRETE 4�PNC P/Pz �j-.4Yy CA ST //PO/Y Co{/ER SAIAL L LSE C/SE0
• MIN. P/TCK /F//V DR/✓E1•VA Y
EL=-` C>l.5 COYERS
;• 2•i�i M/N.
A ;a p AOE COVER CLEAN ..SAN 0
BA C.4e/=/L�-
_ a -AYER
/R,ow Ps'. i op 0 •moo o4v O
MIN.R/TiGV G/1"L • . . o s •• • > WA SHE& 57MVe
D/ST. o • • fee • e� a �
%4'PER SEPT/C. TANfE
• o •• OZ'PTN • • WASNAFP STONE
_ o • o • o o• 1 j e o •
� S7x .zs 377 � •�o� • � o e • o • • • opo PRECASTSEEpAGE
p j 3 • s•: e • • e e • • • • • o .o r P/7
/ s •e � • • • e • • • • a o
lAtV A—r 4rARVAT/4Ng rT ce�Rs� rsr .�f 9 o'G�Lf O'q y ,. . e EL z. 89.'B
/NY.ERT AT O!//LD/N6 q 3'S FT 6 F7: D/AM. T.
/HEFT.- sEvr/e TANK; :FT io
'' -L FT. O/i4lef CC�S �1BL/LATJO/V� �
A/lTLET P SE -T/G TAN/ q 3 f FT ti, ;
s. •'
.. w
5 � i
�IVt.ET D/STR/BUTrGIIf`9ox s'm of _
� GJQOfJNLi NG<ITER Ti48LE '
SECT 0/V
OClTLE7"D/STR/BtfT`/ON BQX9 2. 5 FT PES2 Q w�$cc3ru PS
S�1�VAGE O/S�G�SA L SY.ST�M
/q/LET LEAtCNlJvG I�/T .S FT 7X&Vt.�TION 2j
LEACf 1/N�s "PIT pJMENS/ON �t g FT f
DIES/6I►1#CR/TER/�4 sc�oLE %4
K4
s .
•
N[lA9BER OF 9EDROOMS
D/MENS/ON•
nry SO/L LOG
GARdAG.EOISPOSAL UN/T SO/1. TEST
TaT.4L EST// TEG FLa- 7 33 o G.4t.1DAY SOlL TEST / SO/L 'ST 2
NUM �P QF I,EACMIAW P/TS / EtEY.. 9 3.`� AWAAPr OATS OF SO/L TEST / ' �`•��3`
BE
S/DE LGACH/NG PER P/T _3Y� PT. r RES4ILTS h//T/VESSED BY
BOTTOM LEa+9CN/N6r PER P/T L l 3 SQ. FT PERCOLAT/ON RATES / LEsS MJ/V•IINGI+f
t? u�'1
TOT At LEACH/N6 AREA 4 M AEICCOLA7yON RA7E/k2 T s4� M/N. INCH
r?ESERf✓E GEAG'f/!N6 A.4E/e 'z-6 'SQ. F7•.
OFAf, re 7'1f
.�C
OF M . 0�3 AL G Sir r✓�� 6> F�
'�L = g4. 3
io :�'•.` R$E to SRµ FIf1F WN�rE
H N .109510�� 29 N �'�''i2` �o w° ELDREDGE ENG//V.E )VIAcr CO,/NC.
28874�0 .o �FGISTEN6��Q. � ELs 81.¢ 7/Z MAIN Sr. e3
QISY��` oQ SONAt 0 NO GROtINr? yY�4TER ENCOIJNTFREO CL/ENT: «� `� DRTE 4 / g 8 3
A'Q SURD GROUND yVATE.Q A T ELF .' J
`
OB NO: 414 SHEET zOP�' �
Completed by
HIGH GROUNDWATER LEVEL COMPUTATION
Site .Location: BmWQ►M 2�,alap-
Kx-,^1J Lot . No. -74
Owner: (Ef3EL-fit 'S lv►J Address: f-I--�A),.j
Contractor: PS Ai',os/i= Address: `g �'�`'E
N o t e s: Lar yec—D A-5, s-ru&A P M D / its u P g (��Mo D UsE -EL-94 o A�, '•�//�'-r -
STEP . 1 Measure depth to water table • • • • • .• • • • • . • •
to nearest 1/10 ft. -
date
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine: 1W
2.30
A) Appropriate index well
r
B) Water-level range zone C
STEP Using monthly report"Current
3
Water Resources. Conditions"
determine current depth to 13.9-7
water level for index well . . .. • . Q 83
mo yr.
STEP 4 Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water-level
zone (STEP 2B) determine
water-level adjustment -.... . . . 6. • • • " .
---------------
STEP 5 Estinate depth to high water
by subtracting the water-
level adjustment (STEP 4) . 9 • I
from measured depth to water
level at site (STEP .1) • • • • " ' " '
�4 ITT 3 o f 3
d La-r 774-
G :9p
5,acoo s. F
[co W(DT-I A
F S. B,
AT
It MST
+.N
aV �
+ � � 93 .ON
wa�x«,r [�.—r 19,
7 3
�.
4�.X
38 ' 1
! Q DEf3RiS Qz 9 g
ef31Dr-1 r g �'
Tf3M C-L 4 WJ4
a_
tor, a9g � I � �
OF 64
ft=4 Q D hoc
su
LE.:GEND-
EXISTING . SPOT .ELEVA'TION Ox0 ���,�H OF CERTIFIED PLOT PLAN
EXISTING CONTOUR --O -- �
FINISHED SPOT ELEVATION
o� ALB L0 7� GcJNSTCJC/` 7e
FINISHED CONTOUR O e .. m .S I'' V l .. ! -
SE I N
APPROVED s BOARD OF HEALTH 0.10951�p
9p l�`G/ST.E� �� e` �• y` i�r • s w O r�
-W
'cFssIONAI: L ..�J .I��. ..I.
DATE AGENT - SCALE'- ./ �� ' DATES
L®KEDGE ENGINEERING CO. IN CLIENT
I CERTIFY' THAT THE PROPOSED
EGISTERE /REGISTERED1. JOS N0, 9'9 BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
DR. 6l �.
ENGINEER URVEYOR OF BARNS E � MASS,
7I2 MAIN STREET• k' CH.:SYS J:1Q.�•
HYANNIS, MASS:,,* 3
SHEET OF A E G. LAND SURVEYOR