HomeMy WebLinkAbout0011 AGAWAM ROAD - Health 11 Agawam Road
Marstons Mills
TOWN OF BARNSTABLE
il D SEWAGE#q�00`7-(13
.GE /gAP,S'T6P,5 ,H((I S ASSESSOR'S MAP&PARCEL Y3— -7--0
INSTALLERS NAME&PHONE NO. 6 CMICO ` 7-j s-c.960
SEPTIC TANK CAPACITY 6 X t S Tt cry 161y-0 9r4 t/
LEACHING FACILITY: ((type) -1NFAMMOTtt_3050_ (size) � o 6
NO. �
OF BEDROOMS
OWNER
PERMIT DATE: �8 COMPLIANCE DATE: 3 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility del, tAo 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) �f Feet
FURNISHED BY
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No. 6G00-7� `
Fee
'_HE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
.PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for l 5po!gaY *p.5tem Con.5tructton Verna
Application for a Permit to Construct( ) Repair ) Upgrade(t) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. f/ /Q9AwA Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel O•• ��►►—ee O� �1
3
Installer's Name,Addreee�,'dltdYqqel.l*NCO Designer's Name,Address and Tel.No.
350 Main Street
W. Yarmcut MA 02673a-
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3�a gpd Design flow provided gpd
Plan Date Number of sheets Revision Date .tJ�14
Title OV ,%Ce.
Size of Septic Tank Type of S.A.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ,
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 nvi ental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hiald,
S' ned Date
ZZ
Application Approved b Date
Application Disapproved by: Date
for the following reasons
Permit No. �d / _ 1� 3 Date Issued 3 �e 7
r�
No. C .._- <.. Fee
• t` Entered in computeri
'THE COMMONWEALTH OF MASSACHUSETTS
Yes l
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,,MASSACHUSETTS
Application for Dioonl *pgtem Con!6tructfon permit
Application for a Permit to Construct( ) Repair) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components f
Location Address or Lot No. /� �19AL J� m Owner's Name,Address,and Tel.No.
/ (r
Assessor'sMap/parcel 04/3 — 00-261
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
AIr�yf C) a
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ►
Design Flow(min.required) :33U gpd Design flow provided � gpd
Plan Date /G 7 Number of sheets Revision Date !!Q 1_3
Title
Size of Septic Tank P,Yi_I/i�7�/GUO "Type of S.A.S, -
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) e-fE 6,4 7
Date last inspected:
..._Agreement:
r' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has_been issued by this Board
r S' -d CCCC CAL C Date a�`' 7
Application Approved �- Date 7
Application Disapproved by: Date _
j for the following reasons
.. Permit No. .2LOC / f � 3 Date Issued
--------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired � Upgraded ( )
Abandoned( )by
�i
y at &
/`/G/IQGi�LI ) l'� �, f�'7 � has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. :2o(-"2 dated
Installer �1 ✓�C Designer v r /0,—Q
#bedrooms 3 Approved design flow gpd
The issuance of this permit shall not be coo strued as as guarantee that the systewilI function as designe 0
Date / / Inspector
� v
No. �. �d Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
1=igpo5al,6p!5tem Con6truction Permit
Permission is hereby granted to C. nstruct ( ) Repair (� Upgrade ( ) Abandon ( )
System located at �/ dY -/AGe,,4161--7
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the dat t.
Date I
�/�� / � Approved b�y
I
i
Town of Barnstable i
°�'"E' ►. Regulatory Services
g Y
Thom, as F. Geller,Director
� wuvsreacs, •
MAM
. � Public Health Division
Thomas McKean, Director
- 200 Main Street,Hyannis,MA 02601.
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
l _
Date: b Sewage Permit# " Assessor's Map\Parcel d 3 iz 7 W,
Designer: 1 �i✓� Installer:
Address: I Address: A & B CANCO
02�3 W. Yarmouth, MA 02673
On 3/db/07 /�fG� C,.4Azo was issued a permit to install a
(date) I a/ �(�i,n,,st/aller)
tic system at I 0 'VR y'9_M based on a design drawn by
(address)
V_ MAW dated �4L
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved 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 component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
N OF 414
(Installer's Signature)
t'EFi
Nei. 1140
I
(Designer's Signature) ' (Affix tamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic,'Designer Certification Form 3-26-4doc
1/4/2021 ShowAsbuilt(1700x2800)
A TOWN OFBARNSTABLE
LOCATION // 46AA /JA RD40 SEWAGE HdOO7-113
VILLAGE MAIZZVOYS,"141$ ASSESSOR'S
.,MAP&PARCEL
INSTALLERS NAME&PHONE NO. 4 r U Cs7NCD —7'7S-- A6a
SEPTIC TANK CAPACITY EXt57iui /6ya.�Al
LEACHING FACILITY:(type) _,qlS��t 3 it.a-
NO.OFBEDROOMS 3
OWNER 2LMCS
PERMIT DATE:y1�B4 7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d-1 44-7 Feet
Private Water Supply Well and Leaching Facility(1f any wells exist
on site or within 200 feet of leaching facility) Fee[
Edge of Wetland and Leaching Facility(If any wetlands exist /
within 300 feet of leaching facility) /f Feet
FURNISHED BY �/S7icx-CJ
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https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=043007017&sq=1 1/2
I
Town of Barnstable. P#
Department of Regulatory Services
' ' Public Health Division
DateLAM
/
%6 per 200 Main Street,Hyannis MA 02601
/ /® Fee Pd. /®o
Date Scheduled Time —
i
• I
,Foil Suitability Assessment for Sewage Dis al
Performed By '/' " `� `��% Witnessed By:
LOCATION$ GENERAL NFORNIATION
L,-.Woa Address'. `. VJ� ® I Owner's Name GORD0N r• G 41 M ES
4wt357DAIS M I LLs Address i 464w go NA1
11
Assessor's Map/Parcel• 0+2-100 O17 I Engineer's Name /)A-9&,A M tiLj e-/'
!NEW CONSTRUftON REPAIR j Telephone# S 36d 'a9aa
Land Use Slopes(g'o) Surface Stones
Distances from: Open Water Body fr Possible Wee Area }&- Drinking Water Well
i)rainage Way g /o ft. Property Line `� j ft Other
ft
i
SKETCH:(street name,dimensious'of lot,exact locations of test holes&pert tests,locate wetlands in proxitnity to holes)
gelit.) Te
0V ice- 0 0111616�
I
i
I
F I '
�j
Parent material(gedlogic)( /a Grid vY y�(w16'S� Depth to Bedrock '
Depth to Groundwaiar. Standing Water in Hole:' Weeping from Pit Face y --J '
j
Estimated Seasonal Thigh Groundwater s -
DtTERKN TION FOR SEASONAL HIGH WATER TOLE
Method Used: Depth to saU mottles: in. yw
Depth (14erved stand ing;in obs.hole: ___in. Dep c
Depth toiweeping from side of obs.hole: i in, Groundwater Adiuetment
i Atli.Ciraundwaterlevel.,,,,_
Act,taotor;,,,�,._
Index Well# Reading Date Index Well level .... r
trn' r"
- Date Time
PERCOLATIOON TEST
Observation I Time at 9" � ....----
Hole#
Depth of Pere Time at b" ---
ITime(9"•6") -------
Start Pre-soak Time.0 f
io'ii
End Pre-soak
L Z Wry• i►�f�..
Irate Minjbch !
i
Site Suitability Assesment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original .Public He'�lth Division Observation Hole Data To Be Completed on Back------
***If percola ion test is to be conducted within too'of wetland,,you must first notify the
uA,-".gfghle CAnservation Division at least one(1)wedk prior to beginning.
DEEP OBSERVATION HOLR LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
bnA it6ticy,%G ve
fq_132 Ma)jlm lo V,e 7
Swwv
DEEP OBSERVATION HOLE,LOG Hole#
Dcoth from Soil Horizon Soil TeYti:re Soil Color So:i Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
tConsistency.%Gravel)
0 -ca
- Sand
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiste c %Gravel)
OBSERVATION
DEEP B HOLE LOG Hole#
E O S N
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
nsistency.%QmMCD
Flood Insurance Rate Map:
4h!:yP$fN1 year fl�x±!1 honndry No__ vesy__`�,.
Within 500 year boundary No! Yes,..
Within 100 year flood boundary No Y Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring per i� aterial exist.in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring p vious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department.of Envir nmental Protection and that the above analysis was performed by me consistent with
the requir train pertise and experience described in 3:10 CMR 15.017.
Signature v Date v ®�
Q.\SEPTIC\PERCFORM.DOC
1� r TOWN`OF BARNSTABLE
LOCATION �• SEWAGE # �' - ��
VILLAGE/�&fkn P4,0//S ASSESSOR'S MAP LOTJaA.do 7
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
-SEPTIC TANK CAPACITY AGt i.;� Cf/ 7-API X-
LEACHING FACILITY:(type)c;Z /'I l /oay (size)?✓ 4�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
r
DATE PERMIT ISSUED: -7 o
DATE COMPLIANCE ISSUED: - f
VARIANCE GRANTED: Yes No 1�
i> ��
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. #. , ,
r
Par 0/"7
No... .�.'. Fss... .._ -
THE COMMONWEALTH OF MASSACHUSETTS AppRIM
BOARD OF HEALTH 881nstable Conserved,)C:::�nt
TOWN OF BARNSTABLE �C
Appliration for Di ipwial Wurkii C omitrurtinn rrmit Date
Application is hereby made for'a Permit to Construct ( ) or Repair (6-1--an Individual Sewage Disposal
System at:
��..A A.M..--- ...........
• . Location-Add rrss or Lot No. ------ .............
O,cncr ress
a .'�_. ...._.�13�'1��. .S'0.....!'Yta P�._..__. ..�., , lm..
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms---- 3------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons.....:...................... Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------------------
------------------------•------------- ---••----------•---•----•----..................
..._......_...
W Design Flow............................................gallons per person per day. Total daily flow._..........._._....__..........._..........gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench--No. Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY---••--------------------•--•••----•-------------•----•••-----••--••------ Date........................................
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground Water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+ ------------------------------------------------------------
0 Description of Soil.........................................................................
W
U ---•----••-----••--------------•---------------...........-•---•---.....---•------------------------------•-------------•-•-----•-------•---------------------------•-----------•----•-•••........•-•---
W
U Nat} of Repairs or Alterations—Answer when applicable....1.10.S.f+ �-�.___I_---- - ---------0.(7�?...._Li� _o�...... ►Z+2
o�T �-le S- ,s.ke.M-----------------------------------------------------------------------------•---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued b the board of health.
Signed . . .......................... .....°7...4.(V....q3.....
Dare
Application Approved By ............... - T� 5-- ................................................. ..' :- e-.. -.-
Application Disapproved for the following reasons: .........................................................................................................................................
--------- ------------------------------------------------------------------------------- ------ -------------------------------------------------------
------
------------------
*------------
.....................
...........
........
Date
PermitNo. ....... ..� ....................... Issued ....................................................................
Date
^.,.•-ti,.s-+...._..--...- �.-.i......._-....�----'J`--��"'.-^^�.-�1+�.-...-...M....,.....,....-sy,-,.,,..w.n.a-.�--rn--..-+wr.�t..��_P`.-i`."" ^...,.aa--i.-...--,.,.�.4�'v- .-. "1
No. F>�$....:. .c.�.....
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for Dirymial Wnr1w Tomitrurtiun Vrrutit
Application is hereby made fora Permit to Construct ( ) or Repair (L�J"an Individual Sewage Disposal
System at
... �..._.__ ----------- --------------••--•--..-•--•-•....-•---•.---- ----•-..------•-•-•-•••.-•----......--•---
--- ----------
�, /� f Location-Address or Lot No.
(..'r rv�-c
owner Address
Installer Address
VType of Building Size Lot............................Sq. feet
.-t Dwelling—No. of Bedrooms-__-_---_��______________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures ---------------------------------------------------------------------------------- •-- ---------•----••-••--••--••--....-
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity....____...gallons Length________________ Width---------------- Diameter_............. Depth................
x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------._...._...___ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
►-' Percolation Test Results Performed by......................................................................... Date........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ....--•--•-•-•-••••-•-------•••----•----•-----------------•-•-------••-•-----• .... ........
•.....
-..........
----------------
--•------------
------
•-•-
0 Description of Soil........................................................................................... .........................................................................
x
.....-----•--•----•--------------------------------------•----------------------------•-------------------------------------------------------------------------..._.......--•---......--•--.............
w
U Nature of Repairs or Alterations—Answer when applicable_..1/�-StA_f f_...,._'--_�_-p.....iaoo...._C:__q..A......5�to)te
...QR----- iS f -•----- i.w.e...=5- S�Yi_�ef-"
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued b the board of health.
Signed ...................J:..- ....--l9 . ...... .......'"...D " .....
Dare
Application Approved By ............... 1 --7'�✓..... �/_ ...
c ...................................................
�re
Application Disapproved for the following reasons: .......... .................................... . . ................ -..........................................
.................... ........................ . .. ................ ....................................... -- -------........................
2 Dace
PermitNo. ------ . ��-. J.��d....................... Issued . . ............................................................
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ILTTErtifirate of Q-TT amplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( v)
by ... . ...At.�....... .,A.4KO.................................. . . ....... ... ...................... .... . . ..........................
" Installer
at ....!]........ - .A. /A ........ .rQ L-------�'�of a 4 46�-----"&t . ... ...............................
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .. Cf��..-.....3_9 4 - dated _..._.._............._........._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................- l ........ .. . .._, ..................................... Inspector ......_...... ..:.
---- _.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No...2.c-�..':��� FEE.......—'�.._v...—
Dhipoiittl Worb Tunitru lion "truth
Permission is hereby granted--- .f_. ...........?�A_rh_t o----------------------------------•---.......---------------------------------................
to Construct ( ) or Repair (✓) an Individual Sewage Disposal System
at No....}-1•-•----• ACiA(_kJA`-11N.-•--...Rj&=--- i
- --M(t )!�A {
f street �j5 � __ Dated-------.7_-__ 6... .as shown on the application for Disposal Works Construction Perrr>tit N lo�C.�_._:.. - .0.---------------------------
DATE . ••--
p l/ Board of Health
..---------- 7.:)�.L-`/ .................................
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLE
L ON I 0�c �� �C� w p►rn (LA SEWAGE # -
VILLAGE_ ASSESSOR'S MAP & LOT Oy3_ 0770/2
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY \ C7 O U
LEACHING FACILITY:(type) (size) 0 G
NO. OF BEDROOMS�PRIVATE WELL OR BLIC WATE
BUILDER OR OWNER ` Vc e v C ,5 Gw. Q 2. y-,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 5 — Y " Sr
VARIANCE GRANTED: Yes No
I_
t
�� 1
�� s
�� �3%�
U
� � �
� r�;
�.� �,-
_�-
SSES:SORS MAP NO:
PARCEL NO.: 7- 4�7/Z
...._.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD pOF HEALTH
.....................OF.........
ApplirFation for Bi_vpos al Works Tnnitrnrtinn rnmit
Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
System at:
Lit. Z! A � !.......... -Z . .�o.......ray _�;de� �o_�F.u��l�b. ...���4A1. -�'�ls
-...
�o�n C �n c ion Address or LoNo.
......................................... q ':_4..:.... a........... 5 C en v i� ............................................................
cA4P_,,q Cc caner ^ Address
Installer Address
d feet Type of Building Size Lot...........................S q.
aDwelling—No. of Bedrooms._......................................Expansion Attic ( ) Garbage Grinder (00)
p., Other—Type of Building __R9� No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .---•••......-----•----------- .
w Design Flow....A5..................................gallons per person per day. Total daily flow......�4`�................__.........gallons.
WSeptic Tank—Liquid capacity.1.1.00_.gallons Length 7-q._.._.. Width.1-4-k...... Diameter________________ Depth..!:.............
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area__--.•--_-____.-_-_-sq. ft.
Seepage Pit No..o_^s?-_..____.. Diameter......In......... Depth below inlet..3.v5....._... Total leaching area..LSI.......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by........................'-•-------.....--••-•---------••'......---•------- Date........................................
.4 Test Pit No. 1---Z---------minutes per inch Depth of Test Pit....ti Z.......... Depth to ground water___-�9 .............
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 Description of Soil----1-�-----------�'-�------------------=-----------------•---...-•-------.._....------•--------------...-----....------ .........................................
p fo Lt o n s,36 tci i I �' S-�n
x
w
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
..-----•------------•------------------------------------------•------------•-------..........----•----•----•-•----•-------------------------..........................................................
Agreement: w
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT:,'' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation u it a Certificate of Compliance has been issued by the board of health.
Signn .........--^ ---.....•---....-•................ � 1. 19$
\ , Date
Applica ion Approved By--...-••----'---• ��..�.... •-'-'�------•................... ...........
Date
Application Disapproved for the following reasons--------------------'•--••-------...--------•-----------'----•-------------------------------•--•-----........._
-------------------•-•----------------------•---....--------...--•-------...--•------........------•-••----•--'•-•--•-------•--------•-------------....................................................
Date
PermitNo.------. ---------------------•--•--- Issued-.......................................................
Date
No,Q_. •_ --- Fss . .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ot,J n--- -------..._..._OF........
AVVliratiun for Disposal Works Tonstrnrtion rrrmit
Application is hereby made for a Permit to Construct (x, ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot__...+._.....A.-J. 9.W A m .........C0 kA:{ 5.4
L tinAddress r`?_�I�n �. 1"�� 2Oc1 t...0. e ��+ Ce,....,°�v,•, _..... �� -
Owner .L. ................................Address
Installer Address
Type of Building Size Lot............................Sq. feet
U g— _.___Expansion Attic ( ) Garbage Grinder `(J n )
H-1 Dwelling No. of Bedrooms-____�-_________________________________ �I
aOther—Type
of Building *?AC-P_____ No. of persons____________________________ Showers ( ) Cafeteria ( )
d Other fixtures ................................
Design Flow__55____________________________________gallons per person per day. Total daily flow.....?5_�-•'0..............................gallons.
WSeptic Tank—Liquid capacityl_lS1Q_...gallons Length_=.4......... Width'J!_-.S;z....... Diameter________________ Depth.4...........
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.o'�---------- Diameter.....lD.......... Depth below itLet_a.I_'a:......... Total leaching area_11:1.........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1__&______...._minutes per inch Depth of Test Pit---_Z___________ Depth to ground water..NO_______________
fi Test Pit No. 2................minutes per inch Depth,,of Test Pit.................... Depth to ground water........................
Description of Soil..l -ass n 6 Z------------------------------
U ---•-------•-•--•------•--------•-----------------•-•-----•---------------•--•--•-••---------•----•----••--••-••--•--•---•----•••---••---•-•-----••----------••--••••-•--•._...--------••••-------••----
W
-------------------------------------------------------------- ---------------------------•-------•------•-•---•--_._...------------•••--•-----•-----••----------------•-------•---------•--••-•---•----
V 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 i-T _E of the State Sanitary Code—The undersigned further agrees not to place the system in
operation u aI a Certificate of C issued by the board of health.
Compliance has been
P P 9- -
Signed. `�?_p� ... =---- - D-------------------------------•--- Eq�'�
Date
Applica ion Approved`By............... .:..._......
Date
Application Disapproved for the following reasons_____________________________________________•_-_•-_----•------•----------------•----------------•-----.....-----
......-•----•-•................•---•-••••••-------•-----••---•-......•-•-----.._..---•...--------•-•--...._...-•-•-------------•--•-••-•---••---•--•-----•-----••---•-----------•-...--------••----_.._..
Date
PermitNo......IK6......32............................-- Issued.......................................................
Date
1 ��
g
THE COMMONWEALTH OF MASSACHUSETTS
'oll�
BOARD OF HEALTH
01
Trrtifiratr of ToanpliFanrr -
THIS IS TO CERTIFY, That the Individu 1 Sewage Disposal System constrRcted (J�) or Repaired ( )
byAj(-�-�---Co r.►c.,�_ ..---------�'- --Uo>G 3 -C
• --------------------------------------------------•---.._...--------_...--
Installer
has been installed in accordance with the provisions of i-L.LI : j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit _____________ dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS ® AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................. .` y....-•......k............................. Inspector....._. .....----..._..-•-•------•-.....------•--••--.....--•--•-----------••-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�Yo._. '.:-_._ _7..._. .t .n.........:............oF........ '. n�5- � ..----._........ :........_.
FEE........................
Disposal Works Tonstrmlion Prrmit
Permission is hereby granted_!1_C-_L_._..__ 60n� `'w c-+t6�
to ConstrucX (�) or Repair ( ) an Indivi ual SeH'a�e Disposal, System
at No...L0--.......4:-!-•...(3_Fl-mpt .....iQ'4......Co.\1.n...`
ci Street ,.--Z L C-�s
as shown on the application for Disposal Works Constructs _;_�_�_____ Dated............I. ....
•------•----------••----• ==�- ------•------------•----_______••-
$'� 2�� �''�y,� Board";•ot alth
DATE__ -k<_,
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS wi•.,,, -
`y.,
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POPE-?G4PE eN(;INEER/N Toe VO.
DATE•
TOP OF FOUNDATION
' CONCRETE COVERS @GHe ETE COVER
.� .
4"CAST IRON 2��MAX. '",rnr r
OR SCHEDULE 48
PVC- PIPE I�"MAX. '
' 4"��CHEDULE 40 PVC-(ONLY)
;J PITCH I/4"PER.FT PIPE - MIN.-
PITCH 1/4"PER.FT. LEACH
PIT'
�IN RT / i PRECAS
•� ELKl� o. a LEACHIt.
°'• SEPTIC TANK , ItJVERT INVERT PlT OR
..e INVERT EL.�.s.X6.Y. ., elox EL81X'G. y= EOUIV
EL.88X.�.. /04D:. .... GAL' 'INVERT
e EL2.SX/,� INVERT 3/4"TO II
Ile i I I EL�7.xo is_�V: WASHEI
t
► 'PROFI LE OF
i Ali GROUND WATER TABLE
SEWAGE. DISPOSAL' : SYSTEM
P-
5 ^ O NO SCALE J
SOIL . . LOG TNESSED BY :
DATE .7/2.�/8�? TIME.. ... . . .... f/PrI. ./r . BOARD OF HEALTH
TEST HOLE I . TEST HOLE 2
ELEY.'J�X.D. . . . ELEV. .. rlCO i . . . . . . . . . ENGINEER
z Top ko6 M
-3 s v sv 1 L 1-3 DESIGN DATA
y '
G r; M D / i MOER OF BEDROOMS >3. • ,
E
a
SFj_N Q "I2 i TOTAL ESTIMATED FLOW .. ??, , GALLONS/DAY
1 OTTOM LEACHING AREA ?� • . . SO.FT. /PIT
�► IDE LEACHING AREA . . . l�
►Z: - .FC - 78 0. SO.FT./ PIT
�3 GARBAGE DISPOSAL . . . .i? (50% AREA INCREASE)
►u
rs TOTAL LEACHING AREA ,, , p f-"7, SO.FT
• 16
I PERCOLATION RATE .4of,$ S "? MIN/INCH
!149..WATER ENCOUNTERED I
LEACHING-AREA PER PERCOLATION RATE .. . . .., SQ.FT. '
NUMDER OF LEAC ING PITS
APPROVED . .. . . . . , 130ARD OF HEALT" • -R r.)_ ?
DATE. .
!•AGENT OR.INSPECTOR I 5' l Q/A 3b�Z 619/0
' TF: •� kSS qy�� -
q��T= •�•� •/�• . . . . . . . /IATEQiA� wok i0 FT i,v A.Ct
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.!I r�EQ,�! .Cl!•�To r v�-��xv, �.c. .o�
PETITIONER
1.
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+ pRO,apoXOr 1 � ,42 ' P oH - E +�
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is
IM PER CARE eNCI tIEER/Nq "46 M9.
DATE.' Po.
TOP OF FOUNDATION /
�.' CONCRETE COVERS --. @gHeff TE COVER
'�CAS
4 IRON 2,,
�'n"'''T "
OR SCHEDULE 4d2��MAX. • T�arrsr, - oXo
P.V.C. PIPE 4"',SCHEDULE 40 PV.CJONLY� AX.
r -7-
•• PITCH 1/4"PER.FT PIPE - MIN:' I Y LEACH 'PITCH 1/4"PER.FT
IN R . / PIT PRECAS
EL#� t;�j�... a LEACHIn
' SEPTIC TANK ; INVERT INVERT : . Q.; PIT OR.
•° INVERT EL�z .fY�., elaX ELg?X�Zo >_ ;:'• EOUIV
EL.g7X.7.8'. � :.. GAL:. "INVERT •, F-F- ��
INVERT • • c�a :' 3/4"TO I I
EL87Xo M k�i WASHEI
/o . / W. STOLE.
/o DIA 3l
'PROFILE OF E�= 9 _
(/ _
� (� GROUND WATER TA13LE
SEWAGE. DISPOSAL : SYSTEM
hO SCALE,
SOIL LOG WITNESSED BY
GATE . 7/Z.�j��.? TIME. A . . . . . . BOARD OF HEALTH
TEST HOLE I TEST HOLE 2
ELE -'J% X.6! . . . . ELEV .. .. . . . . . . - Ti'flor3� . . . . . . . . . . ENGINEER
I- *7r7l777A7-r
2 y Tso p Log pn
2 uv 1 _ 1-3 DESIGN DATA : ..
6 .; ME D -y/ NUMBER OF 13EDROOMS ,
TOTAL. ESTIMATED FLOW c33
e GALLONS/DAY
9 BOTTOM LEACHING AREA •
io 7 . . S0.FT. /PIT
SIDE LEACHING AREA . . . 10-y • -• SO.FT.% PIT'
r3 GARRAGE DISPOSAL Mo- ..(50% AREA INCREASE)
r' TOTAL LEACHING AREA SO.FT
!b
I PERCOLATION RATE .4474 S 2• MIN/INCH
WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .. . .
- . SO.FT.
NUMBER •OF LEAC ING PITS PSG
APPROVED
r • • BOARD OF HEALTH
. . 7. . o�PD. .�3Q r/647-
•AGENT OR.INSPECTOR �74 36-Z 61970
i.A7Y-- '�F �F.al�c9BlEJ. �S�pNAL Sqy�
. . . . . . . 17A7CXM, Aok /0," is
f�6 q wfI/7 ,QD
nn i A/QEcTio,✓s. /}.✓O To N .
PETITIONER '�ri�EQ'd •CU..�TO n. ,v�:��lrv. �t• o<' �� • �� �A�y �.
., . ��/EALv Gk
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12 T H rot N OD
DRIVE 2091
WAY
111
D A D --�
3 w.v WA T"
P,
30
CRA Pk e,ERINI .Toe iVa.
P,O.A30 if AM,
PATE•'
reis ro A /6
EL.�IXR:. . . . ' ..
TOP OF FOUNDATION
�
@8lgq ETE COVER.' CONCRETE COVERS
. 4"CAST IRON 12°MAX. `
• , OR SCHEDULE 40
P.V.C. PIPE nr�n' I� MAX. •
' 4 SCHEDULE 40 PV.C.(ONLY) Avt
- 1
• PITCH I/4"PER.FT PIPE MIN: LEACH •
°,• PITCH I/4 PER.FT PIT
, —(N�[ R / PRECAS
'•0 EL#f <FP�... a LEACHit.
SEPTIC TANK , INVERT INVERT : . a.: PIT OR.
,e INVERT ELF�7;I4A-YK,. DIST. ELVX4-2 c� EOUIV
/ :. . Box >z :•
GnL'.. 'INVERT �-� .�•
EL$7.:.yy. INVERT m ww �: '• 3/4"TO I f
EL .7WASHEf
:•
/01 STONE
t 'PROFI LE OF
IVO GROUND WATER TABLE
SEWAGE. DISPOSAL SYSTEM
.hO SCALE, -
Q
SOIL LOG WITNESSED BY :
DATE .7/Z�/ .C� TIME. .. _ Typ7. BOARD OF HEALTH
TEST HOLE I . TEST HOL
E 2
ELEV. ./`�.X,a. . . . ELEV. .. .. ENGINEER
z Top LobIn
s u sv f DESIGN DATA :
S NUMBER OF BEDROOMS ,
G ME D y
TOTAL ESTIMATED FLOW3,�, GALLONS/.DAY
8 S .N z
9 DOTTOM LEACHIJG AREA
,o I . 2� . . SO.FT. /PIT
SIDE LEACHING AREA . . .
)Z. ��.� , SQ.FT./ PIT
f Zoo .
'3 GAR13AGE DISPOSAL ..(50% AREA INCREASE r4
TOTAL LEACHING AREA �,7 , SOFT
fb
PERCOLATION RATE AiIN/INCH
._ LEACHING AREA PER PERCOLATION RATE .. . .
WATER ENCOUNTERED ! SQ.FT. ' .
NUMDER •OF LEAC ING PITS
z
APPROVED . .. . , . BOARD OF
HEALTH JP, 6PD�
DATE. . . 1 ! a:?I�� : .��-25f�� �, =.ipf
!•AGENT OR, INSPECTOR t. 7-4 3CZ 61-9/0 3
NAL S4�i`
• ,! /ll�TE.2iA� Fo,Q io FT iN �•.
,Q z
PETITIONER '�ri`TEQ� .C(/.�Ta r. /�E;�l�f/. F•C. •o,�' �� 4`�`� ,.:
wiNQjl'14( $,?U�1� , .�l/6L S•. . ' �wEALV ok
i
LO•CiTION �y SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S N=AME, & ADDRESS
. - 49" x
B U I L DE R OR OWNER '
DAT..E PERMIT ISSUED '
7 1�-
li DATE COMPLIANCE ISSUED 2, , '" "'77
.e /'_
` '`� �� •'
a �� *��:
. ' �.
y•
1 � �
ua
LEGEND t .
o�oF
P
PROPOSED CONTOUR
OF P F .-7 4 ® PROPOSED SPOT GRADE
—
GATE O-P; \ — gg -- EXISTING CONTOUR
+ 96.52 EXISTING SPOT GRADE O
/I \ —W— EXISTING WATER SERVICEP'\ ------
p 4Ltp V .
09 TEST PIT Q DOtITE'
Y
90
- f ,, —� \ l I `\ 9 aIt -s
O.Bl
LA
WATEWATER �= ' _/ / ------- \\ LOCUS MAP N.T.S.
— 'g W \ C _ --j — 90
C-, —— '�TER �'\
GENERAL NOTES:
\ —,\ / / { 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
\ _ 1 BOARD OF HEALTH AND THE DESIGN ENGINEER.
AREA = 19356 S f f — �� — // / U \`\ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
\ TH-2 \ / / \CA LOCAL RULES AND REGULATIONS:
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
i \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
\ \ _ DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
\ 20 {} \.\ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
O '\ y C ENGINEER BEFORE CONSTRUCTION CONTINUES.
\\ �\ \ G `\` ALL ESIGNONS BASED ON ENG ENGINEER IS NOT ASSUMED2S RESPONSIBLE FOR THEFAILURE
1 ^M {IC \ ` \, 6. THE D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF of
o R D V V \— \•, HEALTH FOR PROPER INSPECTIONS DURING .CONSTRUCTION.
TH— {t R_ �1 F FNDN \\ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
10 P O q.9 \\ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
9 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
\ \ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
\ \ CONSTRUCTION.
\ --- \ 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND FILLED
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
\•,\ 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED. A PROPERTY LINE SURVEY
\ 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
2
1 98 5 \
ft
10 OF
DARR EXISTING 1,000 GAL —
o M SEPTIC TANK
N ' 1 ° y BENCH MARK
Isl CORNER OF CONC PATIO
NITAR �-ELEVATION = 90.73 . PROPOSED SEPTIC SYSTEM UPGRADE PLAN
BARNSTABLE Gis DATUM 11 AGAWAM ROAD, MARSTONS MILLS, MA
MAP. 043 Prepared for: Gordon Grimes
SURVEY REFERENCE: LOT,0071017 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
DEEDBK:13557 DARRENM.MEYER,R.S. Zoo—Tech 6nrimimental 1"=20' DMM
PLAN OF LAND BY PAUL A. MERITHEW, PLS PO BOX981 (508) 364-0894 DATE CHECKED SHEET No.
DEED PG:287 E4STSANDwicH MA 02537
DATED: APRIL 30, 1986 508-3622922 02/16/07 DMM 1 Of 2
k
ELEV. TOP
FOUNDATION
(Existing)
= 91,.49 � �F.G FINISH GRADE=90.5
.a
EL: 90.5 F.G.EL: 90.5 F.G. EL: 90.5• � ,
MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
w
;Y COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT
L = 65
W/IN 6" OF FINISH GRADE
L6" .• „ 4" SCH 40 PVC
L = 7'
10"I ® S= 1% (MIN.) a ° ° ° ° ° °
(MIN.) TEE'S ARE TO BE
" 4" SCH 40 PVC I NV.87.0
INV.87.65 INV.86.83 °
EXISTING OUTLET GAS PROPOSED DB-3 °
BAFFLE H-10 DISTRIBUTION BOX
INV. 87.9 EXISTING 1000 GALLON SEPTIC TANK
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
GAS BAFFLE TO BE INSTALLED ON PIPE INVERTS PRIOR TO CONSTRUCTION CatIrCHQ 410 L 9" MIN.
OUTLET TEE AS MANUFACTURED BY
2) D-BOX SHALL BE SET LEVEL AND TRUE TO FILER PER T/TLE 5
TUF-TITE, ZABEL, OR EQUAL GRADE ON A MECHANICALL COMPACTED SIX BREAKOUT EL = es.5s
INCH CRUSHED STONE BASE, AS SPECIFIED IN
310 CMR 15.221(2) INV. ELEV.-86.0
3) REPLACE EXISTING 1,000 GALLON SEPTIC �4•_ /_/ „
TANK WITH 1500 GALLON SEPTIC TANK pour w4 - ;a; 24 30 5"
SEPTIC SYSTEM PROFILE
IF FAILED, DAMAGED, OR UNDERSIZED. INI/ERT
_ 4) INSTALL INLET & OUTLET TEES AS REQUIRED BOTTOM EL.= 84.0,
1. 48"
CUL TEC RECHARGER 330 SEPARATION 5.2 FT. L 148"
BorroM of TH-2 EL 78.6
SOIL ABSORPTION SYSTEM (SECTION)MODEL 330 R STAND ALONE USE H-20 LOADED COMPONENTS MODEL 330 I INTERMEDIATE _
SMALL RIB LARGE RIB SMALL RIB LARGE RIB SOIL LOGS DESIGN CRITERIA
" NUMBER OF BEDROOMS:, 3 BEDROOM
lo
5 SOIL TEXTURAL CLASS: CLASS I R N yG
MODEL 330 S STARTER MODEL 330 E END DATE: FEBRUARY 13, 2007 DESIGN PERCOLATION RATE: <2 MIN/IN I R
SMALL RIB LARGE RIB SMALL RIB LARGE RIB ` SOIL EVALUATOR: DARREN MEYER, R.S., CSE DAILY FLOW: 110 G.P.D. \ 1140
WITNESS: DONALD DESMARAIS, BARNS B.O.H. DESIGN FLOW: . 330 G.P.D.
I O
6" D/A. INSPEC770N FOR P� t l � LEACHING AREA GRINDER:
NGI A10
TRIM TO ACCEPT ( )
a2.t6
HVLV F24x4 , 330 = 445.94 S.F.
Elev. TH-1 Dept, Elev. TH-2 Depth •74
FEED CONNECTOR 7. 5 90.3 0" 90.8 0" USE THREE (3) CULTEC RECHARGER 330. UNITS (H20 LOADING)
4" DIA. AVAILABLE , A S ND 4/� A SANDY LOAM
N STANDARD DUTY .25' e9.47 a 10• SANDYIOYR 4/2 WITH 4 FT. STONE ON ALL SIDES: 25' L x 12.33' W x 2' D
ONL Y.
LOAMY/8 89.97 8 1W BOTTOM AREA: 15.45 x 12.33 = 308.25 SF
SANDY LOAM SIDE AREA:
1oYR s/e (15.45 + 12.33) X 2 X 2 = 149.32 SF
3 .5" • • • �'� C1 49" 85.8 a e0" TOTAL SQUARE FEET PROVIDED = 457.57 vs 445.94 REQ'D
24 „ 3"
�7 MEDIUM P MEDIUM
52" SMALL RIB LARGE RIB 4L 0. JN SAND 82.3 SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
CUL TEC RECHARGER MO CHAMBER STORAGE 7459 cl•1'FT '-sY'/' 2'5Y'/3 11 AGAWAM .ROAD, MARSTONS MILLS, MA
ALL RECHARGER J30HD HEAVY DUTY UNITS ARE MARKED WTH A COLOR STRIPE FORMED INTO THE PART ALONG THE LENGTH OF' ME CHAMBER. Prepared for: Gordon Grimes
CUL TEC, Inc. PH.- (203) 775-.4416 IMTM CUL TEC Contactor®and Recharger0
PH: (800) 4-CUL TEC Plastic Se tic and Stormwater Chambers 79.3 132" 78.8 144" Engineering by: Surveying by: SCALE DRAWN JOB. NO.
P.O. BOX 280 P DARREN M.MEYER,R.S.Poeox981 E goo-Tech 11•avironmental N.T.S. DMM
FX.• (203) 775-1462 DATE SCALE File Nome
878 Federal Road www.cultec.com PERC RATE <2 MIN/IN. ("Cl' HORIZON) EASTSANDWICH,MA02537 (508) 364-0894 DATE CHECKED SHEET NO.
Broo<�e/d CT06804 USA CULTEC XXXXX N/S LUIS NO GROUNDWATER OBSERVED 50e3622922 02�16�07 DMM 2 0f 2