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HomeMy WebLinkAbout0041 BLACKTHORN ROAD - Health 41 BLACKTHORNE�- f TOWN OF BARNSTABLE LOCATION ! D l Ac Lk lh e rAA& SEWAGE# / 7 VILLAGE ,/Y) n 1 /1 S ASSESSOR'S MAP & LOT O�6—0� � INSTALLER'S NAME&PHONE NO. i- C—A d c? SEPTIC TANK CAPACITY ./o U U LEACHING FACILITY: (type) - Z44611-A,021C S (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) r Feet Edge of Wetland and Leaching Facility(If any wetlands exist ' within 300 feet of leaching facility) Feet Furnished by ` ' 'r 1 Y✓ J �a 13, 4-3 f2-3 '=- TOWN OF BARNSTABLE C�C� LOCATION 4/ n i,4c r��9 rwe, SEWAGE # VILLAG ASSESSOR'S MAP &LOT O q6"0-r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) laz,!!�IXA (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT'DATE: ( ' COMPLIANCE DATE: I — 4 — '� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I � . 47 re a '- i 13. 2Z 4-3 't / - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT i�IVE® Z p n � yy W T.1 t d �< NOV 2 7 2002 TOWN OF b-- LE HEALTH GcNl. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A o O 4(P CERTIFICATION MAP PARCEL ' O Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 LOT Owner's Name: OWEN KEENAN Owner's Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Date of Inspection: 11/15/02 ] Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA. 02536 �j I Telephone Number: 508-564-6813 FAX 508-564-7270 `-�— CERTIFICATION STATEMENT 1 certify that 1 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditi.onally asses _ Needs Furt Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 11/15/02 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use ul (Jill( lime. 'Phis inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined" please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a -Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to 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 '/z 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 n/a. X Any portion of the SAS'.,cesspool or privy is below high ground water elevation. X Any portion of 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 1 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,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, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.l (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yeti" in Section D above Ilse• Inrge syslem has failed, The Owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMIt 15.304. The system owner should contact the appropriate regional office of the Department. A 'Page 5 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 Check if the following have been done. You must indicate "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 Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of fie system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up`' X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S ' Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 5 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): nth ® 0-� j 000 Sump pump(yes or no): NO (� S(� �6D Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): 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/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM 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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1975 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrzte_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000 GALLONS" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 3" 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: 15" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a 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: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(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 Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Continents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a R Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a 1 leaching fields, number: LEACH FIELD n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): PIT AND FIELD ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. LEACH FIELD WAS EMPTY AT TIME OF INSPECTION. SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must ire pumped as part of inspection)(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 inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, 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 Page 10 of I 1 otl"I- ©-1-- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS,MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet..Locate where public water supply enters the building. I ack A eel A o p �D C ,v ear D A A� a Lill �E in Page 1 I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 BLACK THORNE RD MARSTONS MILLS, MA 02648 Owner: OWEN KEENAN Date of Inspection: 11/15/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. Fee / No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes _ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprtratfon for MtZpaal *Votem Congtruttfon Vermtt Application for a Permit to Construct( )Repair( )Upgrade C,.,�Abandon( ) ❑Complete System individual Components Location Address or Lot No. ql r�J�/J ///� Owner's Name,Address and Tel.No. Assessor's Map/Parcel � � /t � /V 1 -��4� } FT N7-4 K;i4- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /�5, 0L�,Ij Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other 'lope of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow -3_-�U gallons per day. Calculated daily flow 1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank S�e' -S T - t000 151& Type of S.A.S. Or, Description of Soil C0 A if f-e- S�44,CV5�1 Nature of Repairs or Alterations(Answer when applicable) -, S�I�v ,,0—QG j- e � . 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 Environme and not to place the system in operation until a Certifi- cate of Compliance has Signed i Date � - 414S Application Approved by Date Application Disapproved for the following reasons Permit No. C?g- 7 9 7 Date Issued ll ZY N . r 7 m.« Fee THE COMMONWIL �V MASSACHUSETTS Entered in computer Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Miopogar *pMem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade ,, Abandon( ) El Complete System individual Components Location Address or Lot No. (f1 W )k Oryv 12CI Owner's Name,Address and Tel.No. <--- Assessor's Map/Parcel Ue D !=i AlTR r /� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. / ,5, oV d sf J"y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank s a 1 Type of S.A.S. 94 c �n Cr, Description of Soil V� CC�� ,. Nature of Repairs or Alterations(Answer when applicable) ��- ���( ]!/— .T- r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' of Signed t Date Application Approved by {{ " e,1r Date Application Disapproved for the following"reasons t t,ut Permit No. 9— 7 I? Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Q BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( � Abandoned( )by at <. ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2 5— 2 9 7 dated �11— 2�e,9 2 Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste ill functio as desig Date Inspector — --- ------------------------------- `� , — - No. — / 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1iopo0af *pztem Construction Permit Permission is hereby granted to Construct( )Re r( )Upgrade( tendon( ) 11 p System located at C/' l r�1 c k� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Y-'/a110� Approved by ��,(/,T 116i99 NOTICE: This Form Is To BiUsed For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AMID APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERT IIT (W=OUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated i`�`{ ��j concerning the property located at "f 'I �' meets ail of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business es associated Aith the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. L.- There are no wetlands within 100 feet of the proposed septic system K There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed • /)here are no variances requested or needed. the bottom of the proposed leaching facility will not be located less than five feet above the •/ ma.dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimntor ethod when applicable] • If the S.A.S. will be located with 250 feet of anv vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the ma:(imum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface-Elevation(using GIS information) ✓ ' B) G.W. Elevation the pia K High G.W. Adjustment DU ERENCE BETWEEN A and B SIGNED : DATE: (Sketch proposed plan of system on back]. q:heslth folder.cezt 2�..P- ,�---1 «�, . �� � . s l fi .s 1'sy�ti' I i N r �n•�,`�o�' \ `1 �. tU 0\ 0 / � O #3/ 6.7G F CERTIFIED PLOT PLAN l L O C A T I O N: _�L F Ao—_5 .5 /Z-,, L-.5 SCALE: / '30 DATE _pEc. 0, /97S REFER EN C E BEi�V�' Lo7- y�/ �9s S/-/o .D :_o5) D A Tev�� I HEREBY CERTIFY THAT THE 81-11 L DI NG R E G L Ara t E' Y0 SHOWN ON THIS PLAN IS LOCATED ON THE G ROUND AS S HOWN HE RECiN AND T H A T I T Oo�S _ C O N F O R M T O T H E F-� Z ON IN G BY - LAWS OF THE TOWN OF OF �y� BALNS7yBG� _` W H E N C O N 5 T R U C T E gJ GEORGE N LOW,JR. BARNSTABLE SURVEY CON -SULT' .ANTS, lNC �� �/ST A) � y WEST YARMOUTH MASS � SU6R%J� Fay. .. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H T 3`.. .+......O F.....- ' � .���rXirtt��un:�flar ��,��r�a�tt1 �ark� ��tt�#r�trttun �rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal $ stem at: r Locatio Address or Lot Vch Owner Address Installer Address UType of Building,,, Size Lot..#=*_4. /......Sq. feet Dwellinge No. of Bedrooms.__---__.-__--"____•__-__________________Expansion Attic ( ) Garbage Grinder"_( ) Other—Type of Building ---------------"__--____-__- No. of persons............................ Showers (I ) — Cafeteria ( ) PLO Other fixtures �_I_�_►_ ------------------------------------------------- W Design Flow, '.i, - ...._...gallons per person per day. Total daily flow--------------- WSeptic "Tank Liquid capacity-14W---gallons Length....... Width-_)........ Diameter................ Depth-.-.-____-.----- xDisposal Trench—No.,_:__................. Width--------------------- Total Length--------_........... Total leaching area.......-------------sq. ft. Seepage Pit No..................... Diameter.................... Depth belo inlet___ _____ ........ Total leacl ut a"ea....._.-----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) 4 •"o 'e �© .� '7 ... "-' Percolation Test Results Performed by--------------------------------------------------------------------------- Date-""--•----------------•-------------.-.. a a Test Pit No. 1.................minutes per inch Depth of• "Pest Pit.................... Depth to.ground water_--------------------- I:,, Test Pit No. 2---------------minutes per- inch Depth of Test Pit.................... Depth to ground water x .. f wa ter--..-.-.-___-_-.-_--.-. - l ` �"�l irG - al - �Descri �n of S I ------------•-- - - - ---- ---=- ---"---- ` .... ' -- W 0�--- --------------------=------------------ -----------------------------------."-----=------------------------------------- ------_ 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 Article XI 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. gned.- -• . ................-•.. ... Date Application Approved By---" ..... ...... �'' � -+�d -.> J •- iid'' r Date Application Disapproved for the,:fallowing reasons:-----------..................................................................................................... ---------------•-----------"-•--"•--•-------------•-----------•-•------------•----•---------•-----•----- Date jt . PermitNo......................................................... Issued.....................................................t i Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF JOEALTH µy ......OF............. .. r7 ........................... Tertifirtttr of IT.nmphaurr THISj CERTI That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) q ` --••- Ins II ti at,,. - 'l --� -"---'--------------- . x has been. installed in accordance with the provisions of Arti5e5I f " -le State Sanitary ode as described in the application for Dis osal Works Construction Permit. No.-__----_-__-- �.............. datet__ .t'r__ ..f�' ` THE ISSUANCE OF THIS CAT.�,FICATE SHALL NOT BE CONSTRUED AS A�GUARANTEE.THAT TIME ' SYSTEM WILL FUNCTION SATISFACTORY. DATE------------ ., ---•--�---.-- ••-- ....................-7 inspector-•--------••-•-•-- -- - - f--••-•-------------"•----•--•---------- V t I: THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH a ! , r r ' .....�. .....OF..-. .V _ 0. .............. FEE A4............ �xktt �tr�tr�il�at �rrmt� Permissio reby granted_+ 'e ------- to Construc 00 or e air ( divid 1 age Disposal stem .at NO... . .........., Stre t as shown on the.application for Disposal Works Construction P No.".`.. _ ::._; -.'.ed_ --- -------- -- {?.* f ........................ Boar of HealtU DATE'• FORM 1255 HOBBS &'WARREN. INC.. PUBLISHERS , - ' ,. it THE COMMONWEALTH OF MASSACHUSETTS BOARD F H T of .... ................... ........................... Apli iratinn -for Uiipnnttl Workii Tonntrnrtinn Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal. System at: I 11 1 S .�-�--------�-3./...............��°�-`-��`---�----------�`- ---------���.- _ /��s/ rye � / : Locatio Address or Lot y,/ „' •I Owner Address V ( --- Installer Address Q Type of Buildin�. Size Lot_.3__1(_�.._.__Sq. feet U Dwellings"No. of Bedrooms--_______-_�_______________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons-_________._________________ Showers (I ) — Cafeteria ( ) a' Other fixtures ----------_............................................ W Design Flow_.__ aJ ........gallons per person per day. Total daily-flow________________�'U...-..._-..-gallons. WSeptic Tank-Liquid capacity_l'_ gallons Length.......fa_..... Width--__e►'........_ Diameter________________ Depth-_-_______-__--- x Disposal Trench—No. ____________________ Width___________________ Total Length.................... Total leaching area_-__________-.-_____sq. ft. Seepage Pit No--------------------- Diameter____________________ Depth belo,��`v inlet_._ _..._._.__.__.. Total leacltilt atre:t------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) CV I X U �'�7— � � aPercolation Test Results Performed bY--------------------------------------------------------------------------- Date---------------------'-----------------._.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-_-___-__-_-__-_____---. (� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_-_---_____________--.. G � --It Descri tion of Soil ,." _ Gr" ---- 4 = S-, _: W ,� - =-- � --------------------------------------_---------------------------------- U Nature of?:e airs o�terations—Answer when a licable.__________________ Agreement: The undersig ed agrees Finsetallthe aforedescribe Individual Sewage Disposal System in accordance with the provisions of Article NI 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. agn/ed - --- Dat-e ---Application Approved BY '. Date l Application Disapproved for the following reasons:_-•-•------------••----•-----------------------•-------•----________---•-•--------•--_-______-•---------------- .._._..-•-------------------------=------•------------------•---------------•---•------•---- --------•----•------•-•------------.-.---•---•-------..---.__..---------------------....._._...------------ -^� Date - . ..: Permit.No......................................................... Issued- ------------------ •-!''6...-----.... Date Lv#:. N .. j..��. Fxs.._.. ....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF.- �,.!.4 ?Mg.e. v..----.--------.._.-_...-------•--._........... �vU Appliration for Mgpaaal Works Tnntrnrtion ramit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: ocation-Address or Lot o. ....................... f�/• 1 {owner Address -----........................ Installer Address � Type of Building Size Lot_______�.........&-i .........Sq. feet ., Dwelling m-No. of Be&oom ___ __ _ ___________________________Expansion Attic ( ) Garbage Grinder ( ) W •-- aOther—Type of Buil6ng ".b__ f'�! -- No- of persons-------,�,................. Showers ( ) — Cafeteria ( ) dOther fixtures .......-----------------------------------------------._.••- •----•-----••--•----•--•---•••---••--••-•----•----•---------••--••-----------------••-- W Design Flow____.J;.�______________________________gallons per person per day. Total daily flow.___._.__`•F-36_________.:____________gal Ions. . WSeptic Tank—Liquid capacityf�P___gallons Length/D_�6_ Width_J:__-_______ Diameter________________ Depth__�z_/_s3. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------/--------- Diameter....�_.'3..__.__ Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed ______________________ Date___. /ZP ky....... W 1 Test Pit No. 1...... per inch Depth of Test Pit...4?........... Depth to ground water.... (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------•---- •- - ____--------------••-----•-----------•------------------------•-••--•----------- ODescription of Soil_ t,sGi._._s.��i -7--...__..��.rw....... .. --------------•-------------•-------------------------•----•-•-•--•------------- x W ---------------------•-----•...••----------•-.._--•----•-------•-•------•---•----•-------------•-------•----•---------------------------------------------•------------------------------------_------ 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 iTTI, . 5 o_ the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the and of health. Signed -- -••- ---- - . . .-•---- -- ... ----•-----•-•--------•• ��/ � _... --- ......../ ate ApplicationApproved By....... _ =.......... - -- ---------------------------------- ----�� ---------------- Date Application Disapproved for the following reasons---------------•-------------------------------•--------••---------------------------•-•---••••-•••----......---- ------•-------------------------•••--•••--•---••--------•-•---•-•••-••-••-----•-•-....--------•----•-----••----------•----••----••---•-•----•-•-------•--••-••--••••---- ............................... Date PermitNo.......................................................... Issued_....................................................... Date NC . .. .. FRIA A................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF.�/e.??-/ e!.e----............................................... Appliration for Disposal Works Tontrur#ion thrntit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: "l Location_;,#ddress / or Lot No. .�'.y✓/t/ +._._..a.�.? ...{..Csdt:!.<`c..l:f_'✓r% Off.......... !�.�.......................... Owner � Address WLltf_�i%4 _ _l_i_r!i/1__/! N.t��1................................................. � ._._ ....:........................................................✓;.---.------•-------------------' Installer Address Type of Building Size Lot�n..._. �.........Sq. feet V Dwelling No. of Bedrooms.:...A_. ..............................Ex ansion Attic�••� g— p ( ) � Garbage Grinder ( ) aOther—Type of Buildings .A. -Y' /_ No. of persons.......(.................. Showers ( ) — Cafeteria ( ) Other_ fixtures ------------------------•--------•......-••----- •---•------••--••---------•-----------......••--------_...--•-••---------•-.....-••--••----•_..... W Design Flow---- ...............................gallons per person per day. Total daily flow.........` 3a........................gallons. WSeptic Tank—Liquid capacit/! -_-gallons LengthZ,5L6--.... Width_�........... Diameter................ Depth-k.._�'_... x Disposal Trench—No..................... Width......._,...---..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------1---------- Diameter... ........ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) / 0-4 Percolation Test Results Performed byl'e%o" �...!...Gr{'=`:`..... -J_ Date.... ? ............. Test Pit No. I.....;2.......minutes per inch Depth of Test Pit ........... Depth to ground water..-_^!a"� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•------------------------------•-------------- »........................................................................................................ 0 Description of L /��cY ,✓ +....__4flN U .............................-........................................................................................................................................................................... W UNature 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 TITTE j of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board of health. e'' �.✓ Signed .... a !._ y .. ate Application Approved By..... ._._...».... .. . .. . Date Application Disapproved for the following reasons------------------------•----••--••---------------------------------------------••-----------------.........----- .......-•...................................•--.....------------............---------....-----------•---------•----•-•--•-••---•------•---••----------•-••--------•.................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................OF /..�.T.,J.r!'�l%��J-G ..62................................. Trrtifirab of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( '�) or Repaired ( ) Installer ate>......c_-�:L2....... ............................................ ...------. ...., "rc ✓5---/1!.................................. ... 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 N 22..,S_Z.P................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �,.✓ /✓, -sr r ,L C] AAA, ........ FEE... .............. Disposal Works (9onqtrudinn Uprrutit Permission is hereby granted.. �=fO == ' " -- to Construct (X ) or Repair ( ) an Individual. Sewage Disposal System at No '"( .c, "u'g f/c/C _ i L�: lS 1.,: -•--•..................---------------------------•--------•-------------------------•....--••---•-•--...--••----..._. Street as shown on the application for Disposal Works Construction Permit No.............y........ Dated.......................................... ---------------------------------1400 - p Boas o ealth DATE---------------! ••- !?VV FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - J�, j 7 Fimic .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT ... OF....... .... .. ....... .. ... . . ............ ............................ ........ 11 Allpfiration for Disposal lVarkii Tomilrurtion 11amit, Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at fS�System ....PdZ?e ..........................e4�e=-*.3,5...................................... L ca,.* X-d'dr ...1. or Ar ...................................................... Owner Address ----------------- ...... --------------------------------------------------------------------------------------- ............ ........... ------------ .. Installer Address Type of Building Size Lot...a?Veltar.Sq. feet. (:�welli�ng—No. of Bedrooms.........3..............................Expansion Attic Garbage Grinder Wt� ZYfffe—r—Type of Building ............................ No. of persons____--_-___.________________ Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... Design Flow_- ..... -J` ......................gallons per person per day. Total daily flow---- ....... ..................gallons. 1:4 Septic Tank J--Liquid capacity/.4T9gallons Length_____________i.,... Width.____._____._.__ Diameter__-_____________ Depth_-__.______..... Disposal Trench—No. .................... Width----_..____.._._-_._ Total Length_______-.---._..._._ Total leaching area...................sq. f t. Seepage Pit No...I---------------- Diameter... .... Depth below inlet................... Total leaching-,area.'ID-1.....sq. f t. Z Other Distribution box Dosing tank ( I a Percolation Test Results Performed by . ..................... Date___v L-3..'.Zcf;�............. .. .. . ....... Test Pit No. I................minutes per inch Depth of Test Pit_________-•--__._-. Depth to ground water___________._____._..._.. 04 Test Pit No. 2................minutes per inch Depth of Test Pit.______.___-_-__.... Depth to ground water........................ ------------------------------- ................ -- -----::Z----"-------------- ---- 0 DeKription of Soil ........ !9F c4a ------------------------------------------------ ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ............................................I................................................................................................................................... ...................... Agreement: The undersigned agrees to install the aforede"scribed Individual Sewage Disposal System in accordance with the provisions of TITLE'�LEj 5 of the State Sanitary C The undersig further agrees not to place'the system in operation until a Certificate of Compliance has been * sued by the boar 4fhealth Sied ... . ..............a- !�.. ...........................7 ...... ---- ---- Application Approved By.....'f ......... ...... Date Application Disapproved for the following reasons:...............................................................................................*---------------- -------------------------------*------------*------------------------I-------------I................................................................................................................. i Date PermitNo......................................................... Issued....................................................... Date ovNo............. f Fzc$.. 5...""_ THE COMMONWEALTH OF MASSACHUSETTS BOA R D F F H E A LT a = , .._...... :.............OF............... .:........... — r ............ fir #ion for 'llispnoul Works Tonstrnrtion Firutit Application is hereby made for a Permit :o.Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Locati n-Addr ess ° - o................................................ t.No. ... - .!J7 o4?2. - ,L.. �i .._.���..- .....:...�_rt_ x...s..` .....__� /c Cam- Owner Address a ................ Installer Address Type of Building Size Lot__j!�'�_Sq. feet welli No. of Bedrooms..........-3...........................Expansion Attic ( ) Garbage Grinder pa Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria Q' Other fixtures ________________________________ Q ...--=--•--------------•---••-------------•---•-•-•---- W Design Flow;_._.5.. ..........................gallons per person per day. Total daily flow........�Y_3_G?....................gallons. WSeptic Tank/Liquid capacig94N!__gallons Length................ Width---------------- Diameter--------------:_ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No/.................. Diameter_X&.. Depth belo inlet.................... Total leaching ar sq. ft. Z Other Distribution box { ) Dosing unk ( ) 4 Percolation Test Results Performed b .._ _ �_ ._ _ Date_."�_�_ _`.. �______________. Test Pit No. 1................minutes per inch Depth of Test I .................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------_.........*__ Dept*hjo ground water........................ o m o y �, x DTWriptio of Sil - ---- r�` _ .�_..---- ` / ----- s ,.. 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 TITIZ 5 of the State Sanitary e—The unders` ed further agrees not t place the system in operation until a Certificate of Compliance has be ,, __,sued by the boaof health. . /s'� ++�►(�y n .- a-.- ... 3 - Date Application Approved By--- ----------- ................ �` ""is " '? ., Date Application Disapproved for the,,,following reasons:--••-----•--------------------------------------------------------------------•-------------------------....__ _._....-•-•-------------------------------------•--•-•---•-•-------------•-••----••-•-- Date PermitNo. ' ='--------------------------- Issued_....... .............................................. j• Date THE,COMMONWEAda[H OF MASSACHUSETTS BOARD O HEALTH l t�.... ..............................OF........... ��4r����,, k .............................. } Tntifiratr of TontpIittnrr .I .TO�EI�ehat the Individual Sewage Disposal .Sptem constructed or Repaired ( ) by ........ ------------------------- ........................- ----- ------- .....::_ is ................. _ ,�¢ -�2t Imo--alr sx— at.----=----- ----sue -Qt P' t., J� ---- ..s . • .. . has been installed in a ordance with the provisions o� i ` of. ** State Sanita Code as described in the application for Disposal Works Construction Permit 1\ dated "h :.z THE ISS,UAN6E-•OF"T_H"IS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......`......................................................................... Inspector................`S................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH o......................... FE'?.___-___-___-__...... �in�rn��t1 ,� inn ttrtinn �erntit Permission is ligreby granted t ------------------- ------- = to Constr t ( —Repair ( ) a ndi al Sewa is�p a1 Sy p 6�P��. � Street as shown on the application fof Disposal Works Construction TkImit N .. Dated_.__ _- ,G,r_.'_?fit'.....-_.. •--- • �. r�- .................... B and of Heal DATE------ ----------------•--------•-•--------•--•-••-•-----•-----•-•----.._..--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 49 , f �� �S EX/Sl• / 'STD,tJ 3 C -;.5 ; 1 q { 77�7 �� � TES T HOLE 4-15 8 /oo ,, /25' 00' ' � _ /on• �' _. _---- ._-- PEl2 TOL�/N �ECO/205 Eoy F ©f' %ate g i7r�3 T: D f9 7-,E . f�' _ems✓ �° '_ M//V/MUM 6uILDIA16 --5ET6/90 /G ,2EOU/ ,2EI` 1,E- 77S F�2 v�/T 3 S / D E /5 /Q E/9 Ae 0 - - t�7 �, O E3 ED,c2 o MS ZilY':� ! O t';." G'/'/ G u� > '_ C7 t='S �f. ��5�Cj/V' /CL O�✓ i? �pAL / �i9 y sEPT/C S y5 TE�I CONSTRUCT/ ON SNP L L ��- C OL ,c,� T/O/t/ T�� 7 C O NF o RM To /�A S S ENV//2 O ti//`? E N TH L i2�c 5 CU` TS /1/I//1/ /�✓Cf-/ C 0,0 E .3Z- o9 /U d T O W/V O /c f�E A L T H R E- G- U L- ,-9 T'/ O n/S . I/. TO TOP of G P.90F /�Bo!/ L Ei9Cy FO UNDf97-/01,1 = /d, ,S Al O S C /9 / /MPE'/eV/ou5 co✓6R ✓ M19AJHOLE�COVE� TO EXTEND TO To FIRE ENT FINES u WITHIN /' OF FIN/SHED GRfJDE FROM //,/F/LT2RT/NG M/N/MUM I S7-0/,/E .f 2�f"covE.es f D/5T. t lyi9SyE0 STo�/E B O X 2I"W/DE AL G 19,2421J/1,1;) 4 'Cr95T/.eoN `t' D/H. WATER ,A-7 /6�r 4 P/TCH 'l FO oT /O"M/N• /,¢„ %4"�Fo 0'7- / PI-M �..Q FO O-r �IQ.L L O/V LEACH e.e� STO NE Gf� LL0N INVERT P/7" cc E0U /NVEQT C w P ffi C /T Y A e DUN D SEPTIC Tf1NK � � 9 , O/ � ZO C� <WATERT/GHT� INVERT //AVERT S . z � ' �B %YIAX. //vvE,e-r � Gf}128HGE G/e/NOE.e `f'y1//l/ 42/ST TO iY1AX., L D C /9 T/ O Al ' lzly,a 7 q,6:'Z 6 y Lc kAa ; L,!Fti o/sl R/7,. .%� f�ec e)/=" D' D A TE• r� J �, : ' �' C. OiJ C e E 7,E57 C 67,4/C. S 7-,e e c O B E I AI G LOT �.�'r �I S S HD ln/Ny�'_ f: i?.� i, _."+ � v�,.—;� a + O Al , LAN ,e E c o/e o E!D /N THE sTfgBLE COUNTY ,eEG /s>-,ey O/C DEEDS ' i r S E P T/ C TA IV k T o B E M/N- �a /MvM OF /O' FROM Fo U/VDA- 0� T 49 N D L,E f3 C N P / TS . /q�� LEACH / NG P/ TS 'TO B E A /�1/N- 3 op '- /M UM OF / o" FR OM �,e OG�/2T'Y ! f" S 0. y�� d�`7"��, ��5�5. . . L. / /�rEs � Iv o s EPT/ C .-ram NK Z CE/eT1FY THAT THE �OvJG �i' ft>Jr/ �/UD 20 ' FROM FOU7V ,D /9T/ON. SHOWN oN 7"-14 /5 PLAN /S ON 7-14 E G R O U N D H S S H O W N H E R E0AI , 1,19ti1O 7-H ,477- / T Con/1=0/eM - D� T> 7`LE 163 CKQu7-0 TEB ULDNG SEA / 2E- TH ?N/E n/Ts O � — _ p f9 TE B O F�/2 D O F H L.TH OA7 ,E REG. LP /V D SU VEYo2