HomeMy WebLinkAbout0010 JOBY'S LANE - Health ol
10 JOBY'S LANE, OSTERVILLE
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs John Grad
D.E.P. Title V Septic Inspector0epar tment of P.O. Box 2119
Inver onme'ntal Protection Teaticket, MA 02536
wuu.m F.weld (508) 564-6813
povemor
Trudy Foxe
9�cretery,EOEA
Davld B. Struhs .
Commissioner
SUBSURFACE SEWAGE.DISPOS TLAYSTEM INSPECTION FORM ,P
CERTIFICATION
Property Address: \t) Jrjb S(sz(�r,, W v�\� Address of Owner: �� ,3
Date of Inspection: CJ f b'C1 (If different) �,
Name of Inspector: W �w Q N
Company Name, Address and Telephone Number: 4t
9 IV
z
CERTIFICATION._STATEMENT
I.cenif)• that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete ag of the time of inspection, The inspection was performed Based ors my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
�lfasses
_ Conditionally Passes
_ Needs Further Evaluation fly the Local Approving Authority
_ Fails
Inspector's Signature: Date:
W
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system Or has a design floe 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 anu copre� sen', to the buyer, if applicable and the appro.ing authority.
INSPECTION SUMMARY:
Chec(A, B, C, or D:
A) SYSTEM PASSES:
L---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.
BJ SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replaot'ment or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
_ The septic tank,is metal, 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)
One winter Street a Boston.,Messschustirtts 02108 a PAX(617)666.1049 a TN.phone(617)292-UM
10 Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address-
Owner:
Date of Inspection:
BJ 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 required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD 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 THAT THE SYSTEM IS NOT'F.UNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ,-
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC.HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ I rip s�sten, rids a >euUC tanh anui 5uii ib�,orpLion systeni ali(,l 5u;Pp!'l p' i";u.iia' ic, a".
surface water supply.
The s\s!P-,' has a septic tank and soil absorption system and is within a Zone 1.of a public water supply well
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. `
The s-)stern has a septic tank and soil absorption system and is less than 100 feel but 50 feet or more from a private water
presence -teirla and nitrogen volatileorganic
compounds
e1alil c in, that
the well is
free from fromthatfacity and the f ammonia nd ntat€ togen equal toor 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)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
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.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of.a cesspool or privy is within 100 feet of a surface water supply or tributary.to a surface water supply.
_ Any portion of a cesspool or privy is within a Zone I of a public well.
r 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 froma 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.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flo"• of system is 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:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
public water supply well
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3 '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property As:MOA'Q(—
Owner:
Date of Inspection: J
SIIoICt
Check if the following have been done:
�mping information was requested of the owner, occupant, and Board of Health.
Vt1,o'ne 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.
�.(�Rs built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up. ;
fihe system does not receive non-sanitary or industrial waste flow
Vfhe site was inspected for signs of breakout.
mil system components, excluding the Soil Absorption System, have been.located on the site:
_�. he septic tank manholes were uncovered, opened,'and the interior of the septic tank was.inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods
The far,!,ty ;.-31a nrr_,In if diffPrPn( frnrrl mvne,) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
a . .
(revised 8/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1�j
Owners 44go
Date of Inspectiore
FLOW CONDITIONS.
RESIDENTIAL
Design flow- gal ns
Number of bedrooms: w
Number of current residents:
Garbage grinder (yes or no):LQ
Laundry connected to syste (yes or no): g
Seasonal use (yes or no): Q�
Water meter readings, if available:
Last date of occupancy:
COMMERCIAUINDUSTRIAL: (1
Type of establishment:
Design flow: ttallowday
Grease trap present: (yes or no) .
Industrial Waste Holding Tank present: (yes or no),
Non-sanitary waste discharged to the Title 5 system; (Yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION „
PUMPING RECItDS and source of information: �c c S} - `J _ eco q giO
System pump as pan of inspection: (yes o no)
If yes, volume pumped gallons
Reason for pumping:
TYPE- OF,S,YSTEM
V 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:
Sewage odors detected when arriving at the site: (yes or no)—Do
Izevised 8/15/95) S r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: (\ 1V , \SL-C'r'o—
pate of Inspecti 21 \Qir
S�t O1
SEPTIC TANK:1e---1-
(locate on site plan)
Depth below grade: al
Material of construction: crete _metal _FRP —other(explain)
Dimensions: 't 0 4t y►t rl
Sludge depth: F.,t
Distance from top of sludge to bottom of outlet tee or baffle: o t�
Scum thickness:—
Distance from top of scum to top of outlet tee or baffle:_ Lol
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition. inlet and outlet tees or baffl s, depth of liquid level in relation to outlet invert, structural
integrity, e'vide-ce akage, etc.) J 2 . 1_ .:Alt S_
GREASE TRAP:ja\p'r
(locate on site plan)
Depth below, grade: -
Material of construction: _concrete _metal _FRP other(explain)
Dimensions:
Scum tiuckne».
Distance from top of scum to top of outlet tee or baffle: '
Distance frorn bottoms ni cro-1 t- bottom of outle! tee or baffle
Comments: • .
Irecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrih,, evidence of leakage, etc.)
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM-
PART C
SYSTEM INFORMATION .(continued)
Property Address: 'C)�o �5Owner
Date of Inspect o � •
TIGHT OR HOLDING TANK: -
(locate on site plan)
Depth below grade:
Material of construction: _concrete metal FRP other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee; condition of alarm and float switches, etc.)
DISTRIBUTION BOX: (Ypt
(locate on site plan)
Depth of liquid level above outlet invert:
{ r
Comments:
(note ii levei and distributwn i,equal, e,'detice of solid ca:r��,er, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:���.
(locate on site plan)
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc,)
t
(revised 8/15/95) 7 '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:, 1 V �J ....
Owner. %
Date of Insp \cJ O
tab
SOIL ABSORPTION SYSTEM (SAS):Li
(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: gwkCr1 `Qo' ' (JIR',
leaching chambers, number:_v
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (no -co dit�on of soil gns o y`auliccffailure, level of ponding, condition of vegetation,etc.)_ L,00( t\ �JLI M\�
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 ground.:a;c
inflow (cesspool must be pumped as part of inspection)
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.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: ® S L.�i r�►Z_,
Date of Inspect,
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
I
� Q
' b
A �3
Ac ,
eC V
DEPTH TO GROUNDWATER
Depth to groundwater: U} feet
method of determination or approximation:
(revised 8/15/95) 9
TOWN OF BARNSTABLE '
LOCATION L'r/ SEWAGE #94;—� sf
a
VILLAGE 6 ASSESSOR'S MAP & LOT 440
i INSTALLER'S NAME & PHONE NO. � �� � `
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL ORy -PUS WATER
BUILDER OR OWNER :Z_f
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No \ ,
-�,��;��
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�k
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l ��
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No. ................- Fisa............ ......_...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 ...........oF............ ................
Appliration. for Disposal Varks Tanstratiuri Frruat
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
}:..c? ET-e' 1!4 t..., :.,:.M ..............................................
Location_Address or Lot No.
............... ...................................................... _...-•----.. . ................_._.....
w Robert Our Co., ner Great Western Roa6ddrWorth Harwich
a ..................................... Inc.......•U .................................................... .......---.. ...........---••-............ ......s1�...... ..........................
Installer Ad
ppqq T e of Building g Size Lot..... feet
.-� Dwelling—No. of Bedrooms...........3..........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons"."..
Showers
CW YP ng ......................•----• P ( ) — Cafeteria ( )
a Other fixtures
W Design Flow.............I.I.a.....................gallons per person per day. Total daily flow....... ��� U....--......gallons(
WSeptic Tank—Liquid capacity.1 allons Length...�S._cQ._ Width:.l-�,._1Q_ Diameter..._... _... Depth...?_ '..
x Disposal Trench—No...l........_... Width..........(_-__..... Total Length.................... Total leaching area........_...........sq. ft.
3 Seepage Pit No...Q . Diameter.......... ... Depth below inlet.....:.�.... Total leaching area._T.. 2 2sq. ft.
Z Other Distribution box ()0 Dosing tank )
`" 2-8(0
Percolation Test Results Performed.b)...�..._ ..�1.�.��-�-I:�............:.... Date..........�.:.���........_.........
MTest Pit No. 1....`Z.minutes per inch Depth of Test Pit....... Depth to ground water...../ .....
Lz, Test Pit No. 2.....:..........minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 .......on o ............ ... S •••---•••••--------
..........._...................._.............. ........................................._......
Descriptif Soil...(... .... ... , ...........................•.............
v ....... � ..._l.:�l._ ..._..---•................•••-•--••----
VW ....••..................•--•--•-•..........•-•••----•-••-••-••-•••-•••-•--•-•-•.....---•............-----•••--••••••--..-•--••......-.......___...:.___-_......................._.......................
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 LITL: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed........... .�-X........�.........:............
_.... ...._
�— Date /
Application Approved By........ •--•• ....�2— �-b
Date
Application Disapproved for the f ollowin re ons:.............:.........................................................•------_--........_......--•_-.....___
.......................................;......._.....---•.....-•-......._........._...................................._.._..........__..........._____........_........._.......... ............
Date ..
PermitNo.............•---•------...._______....--------•------... . Issued........................................................
Date
No.........-•--•.._.....». Fsa......... :....._...-
,r� THE COMMONWEALTH OF MASSACHUSETTS
/ _ t.
BOARD OF HEALTH '
..........T. KJ...........OF.............
T�z T .................
Appliratiun for Disposal Wurku Tate trWiun f.ermit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address - or Lot No. ............................
o. .............................
• -•---Z_ .. !.. ......... .....................
ddr
Co. Inc.Owner
Robert Our
a , _Great Western Road forth Harwich
Installer Address // �,�,,
Type of Building Size Lot......(01 4 l.Sq. feet
.-� Dwelling—No. of Bedrooms.._........-�...........................Expansion Attic ( ) Garbage Grinder ( )
a` Other—Type of Buildin ( )
4 yp g -----------------------•-_-- No. of persons--.--...---•--........_..... Showers( ) — Cafeteria
QOther fixtures ........................................................................__....._.._.._......................�
Design Flow............I.1 .....................gallons per person perday. Total daily flow................����-'........... lons,
WSeptic Tank—Liquid*capacity_ gallons Length... Width_�--�_.E 1'?�. Diameter........`_... Depth..__:._.4..
xDisposal Trench—No..................... Width..........:........ Total Len ................�.. Total leachingq.P �. � - � .... area.....--•-•--••---...s ft.
3 Seepage Pit No.... '.. Diameter.......... ... Depth below inlet......!?... Total leaching area. '12sq. ft.
Z Other Distribution box (<) Dosing tank ( )
0-4 Percolation Test Results Performed by... ................. Date...........7-:-��- 2,_e(0
1.4 Test Pit No. I....!.2 .minutes per inch Depth of Test Pit.......). _. . Depth to ground water.-.--.!�-i 7A.....
f=. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
O Description of Soil...).1 ....A.....
-----� N-......: .....................................•......_
-------- ----------
v ----------------- -----•...................••......... .......... ..........
w
VNature of Repairs or Alterations—Answer when applicable................................................................................................
....................................•---...-•---•-•----------•-------------•--..................................------------..............--•--......-----•--...........-----------•••-•--..............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
�r
Signed.....
_ ........................................................... .......................... ....
Date /
Application Approved By_....__. ..! -P ..... ...A�.Q�?.. .-:.-•--------------•---•-•-- -•--�2....6.'..b.....
Date
Application Disapproved for the foflowing`reasons:......................••---•-----------•--...........-•••-•.........----•--•---........-•_. ............»»..
.. ........................ .......... •............-.......------•-------------------------------------•--•.........................._
Date
PermitNo...................................................»»» Issued...---••---......................_.._..................
Date
"117 let.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. OWN...................OF..................BARNSTA'BLE.......................................
CIrr#if irate of T-amplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
by.........................................•--.Robert.Our Co Inc. ... .................................----- ......_............................................
Installer
at.......- ...................ot 18 Joby'....Lane....Osteryille .......................................•--........................---••
---•••.---• ..... •••-•..._..
has been installed in accordance with the provisions of TVI LE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..S t?.`.«M............... dated....�....�_.Z
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. --
DATE........................... 1..r=1,Lf�fir.........----•-•---......... Inspector.....- .................
R6.•......... :s:a43nL•H e•y%aS k�GtPfl`o!@E+04.G@ p E^'O(.+OEFG a l.6[�ki6E.L i•(%E-f nC ibr•<+i: u.0 S•C"F,:bx N_4.'F+.9 Q-If'S'�`C&C n A1,B R£N K+P.FC•�.E�tlA F t%m.p(:.
THE COMMONWEALTH OF MASSACHUSETTS
QQ BOARD OF HEALTH
300 .............TOWN..................OF...................BARNSTABLE.......................-•-•-...........
No...................... N
F> .......•................
Displasuf orb_Tonutrurtiatt Permit
Permission is hereby granted............Robert..Our..Co...., .Inc,. ............... ....... ...... . ........
to Construct (X ) or Repair ( ) an Individual Sewage Disposal System
at No..............................................................Lot 19 Joby-»s lane Osterville........... .....
................... ...............-•-......-.
Street
as shown on the application for Disposal Works Construction Permit No..�--1'.?'._UD Dated...._..Z .............�...........
x L'
....................................•----------...----------...................-••-••-•-...-••---......_
Board of Health
( c^
-TOWN OF A55E55OR5 MAP_;a 1 ao LOT
ZONING : RG
TOP OF IO'MIN-
FOUND. 5ETBACK5: FRONT:Pp 51DF50 /O, RER� 'UI — -Lc �—
SE//P7lQQC TANKf e �D15T. pOX-E:'7 LEACHING FACILITY
-- -I'M1uGRourvo cove 2 ------- --
t
'I�57h GAL.
m(A QA
q(>7
SECTION- SEGJAGE +
TEST HOLE LOGS P DESIGN FOR
TEST 5Y: PE�mot Ga,c RC.R TE A <2MlN. /N• �...,�A
DATE : - FLON RATE
W/TNES.g: fir_ t�i `B•�. 5EPT/G TANK .S&,)
-REQ'D. SEPTIC. TA K
EL•- , LEACHING FACILITY
$10E WALL '177,a'' % .�)=Q�I-ZGID L�— al
I5 •� - aorrolrl lio \,Z -79 5G/D `�,--
TDTAL y�, /� 5F. =541 l G/DV.
2EkC
- Mao - � � ���1 ._. .•
NOTES
1. D4TUIJ(MGL):t TAKEN FROM C07 Is1T QUADRANGLE MAP
2. MUNICIPAL- WATER (l'J AVA•ILA6LE
I L7E51GN LOAD/NG FOR ALL PRECAST UMlr5:AA6140-10-44
IRE JOINTS 514ALL SE MADE IVA7FR 7 '147•
tVt/ h� G ✓ ��.0� ���ii 5. CON5TRUCTION METAILS TO BE IN ACCORDANCE hUTH t f (_tt�G'`I �)�� `� J �t C`-► --
COMM.OFMA5S. STATE ENV1i?oA1j1ENPAL CoOE TITLE �� ✓�,-, =40.001 CM9I0
-�,6 OF ^ 6, r1415 PLAN FOR PROPO5EO 1dORK ONLY AND 5140U+-0 NOT.
r SE USED ROPE r OR
(� (,.{? F P R Y. �rl. sTAECING.
'lit ,
1 '�,.< , . SITE AND 6EIJAGE PLAN
��, (Mown calol✓ englneel Inn 1 cECENo: Locus • LoT i1
. ..
f CoNTovQs -(Ex�gT.)
CIVIL ENGINEERS ---- REFERENCE:
,� LPtNl7 SURVEYORS II i (PROP) .,—moo PREPARED'
--- -- CONc.BouNo ® C6 FOR
vA a ---- - - t 1 t IG►� r - ;, '
. R.�3z.►J�c,, E.. TEST 90LE
c p
1 • 1 t
�, q2� Ma(n S . armou a
board Of health DATE 3 -SC LE"
1 8�
J013 NO. APPROVED: DATE.: MA =