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HomeMy WebLinkAbout0223 CAMELBACK ROAD - Health 223,j Camelb'dck Ri dfi Mars,"tons A �4/ 154 i �r. i �'� u +�`?•to 4° �� r� w ^ry K \ I TOWN OF BARNNSTABLE LOCATION SEWAGE# ,ZV%5P VILLAGE Al. ty1tI15 ASSESSOR'S MAP&PARCEL RS NAME&PHONE NO. cam'f`Qc n1uJ) SEPTIC TANK CAPACITY GiCX) LEACHING FACILITY:(type) 90'r (size) _LOW Q'i NO.OF BEDROOMS 3 OWNER PERMIT DATE: C( filf�-DATE:M8-5k �'P`1/08 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) , Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300..feet of leaching facility) Feet FURNISHED BY 52 R#tCB £ F 22 29 _ 20 2 26 a Camelback Road Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . C/Q� 223 Camelback Road Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 LibertyStreet, Wilmington MA 01887 May 19, 2008 required for g every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Impotent: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority May 19 2008 Inslpector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. . 08-120 Judkins.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 yew Commonwealth of Massachusetts lag Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for State Zip Code Date of Inspection every page. Cityfrown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Tank is not in need of pumping at this time leaching pit has 3' of standing water with no high stains. 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.- 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: ❑ 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 08-120 Judkins.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for y g y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: 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. 08-120 Judkins.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19 2008 required for Y g Y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached tc this form. 3. Other: D) System Failure Criteria Applicable to All Systems: I You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-120 Judkins.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'° 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 08-120 Judkins.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 o1 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M .•'°~ 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Real!r Trust Owner Owner's Name information is required for 24 Liberty Street, Wilmington MA 01887 May 19, 2008 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? a ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑` Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 08-120 Judkins.doc-0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May required for � g Y 19 2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: 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: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 110,000 gal. _ 9 ( Y 9 (gpd)): 150 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: CurrentlyOccupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holdingtank resent? Yes No P ❑ ❑ Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08-120 Judkins.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for y g Y every page. City/town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 3/7/88 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-120 Judkins.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts gar Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for Y g Y every page. CitylTown State Zip Code Date of Inspection D. System Information (conQ Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" - Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured 08-120 Judkins.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for Y 9 Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are intact and clear, liquid level was found at bottom of outlet invert. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 08-120 Judkins.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r 223 Camelback Road, Marstons Mills MA.02648 Property Address The Judkins Family Realty Trust Owner Owners Name information is 24 Liberty required for y Street, Wilmington MA 01887 May 19, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert . 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-120 Judldns.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for Y 9 y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit had 3' of standing water with no high stains. 08-120 Judkins.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street Wilmington MA 01887 May required for � g y 19, 2008 every page. Cityfrown State Zip Code Date,of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of pond ing, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 08-120 Judkins.doc•08f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 • ' -4\, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °Y 223 Camelback Road, Marstons Mills MA 02648 Property Address The Judkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19, 2008 required for y g Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. r r r r r r r r ♦ r / ♦ / r r / r r r r / r r r r r r / r r r r r r r ♦ ♦ rrrr / / ♦ ♦ r r / ♦ / ♦ ♦ ♦ / ♦ / r r ♦ ♦ r / / ♦ r / / r r / r r r r r r r ♦ r r ♦ r r r r r r r r r r r r r r r rrr ♦ i r r ♦ / r r ♦ ♦ rrrr ♦ rrrrr rrr r r r r r r r r r r ♦ ♦ rrrrr r r ♦ ♦ r r r r r r r ♦ r r r r r r r r r r ♦ ♦ r r r r r r r r r ♦ r r r r r r r r r r r r 2203-N, ♦ r ♦ r r r ♦ r r r / ♦ ♦ ♦ , r r r r r / ♦ rrr ♦ r r ♦ ♦ r 52 rr r rr / rrrr ♦ rrr ♦ r ♦ rrr ♦ ♦ / ♦ r r r r ♦ r r r r r ♦ , ♦ r ♦ r r ♦ / ♦ ♦ rrrr , , ♦ „ , , rrrrr ♦ rrr , 22 20 2 26 Camelback Road ' Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..yt 223 Camelback Road, Marstons Mills MA 02648 Property Address The J_udkins Family Realty Trust Owner Owner's Name information is 24 Liberty Street, Wilmington MA 01887 May 19 2008 required for Y g Y every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 55 and topo map shows property at el. 100. 08-120 Judkins.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OftHE A Regulatory Services (: BAMSTABIZ : Thomas F. Geiler,Director MASS. 039. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIODisclaimer Private Septic Inspections.DOC � ��-- y � i' HOBBS&WARREN in THE COMMONWEALTH OF MASSACHUSETTS FORM30 C&W BOAY OF TH CITY/TOW � F a � ARTMENT �\ ADDRESS ��1 ' ,1M Sey`e s TEUEPHONIf e Address _ Occupant ��'"`r Floor Apartment N No.of Occupants ��`^ No. of Habitable Rooms_No.Sleeping Rooms_ No.dwelling or rooming units _N . lories_ Name and address of owner IF marks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: Or BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). (� Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sop.Ten.,Gas,Oil, Elect.: S Flu s,Vents�s: Kitchen Facilities nk e Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLLATIONS HECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(Se ver) "THIS INSPECTION REPORTS IGNED AND CERTIFIED UNDE THE PAINS AND PENALTIES OF PERJURY INSPECTOR TITLE ol > _ �-y r DATE � �' TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s)pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, sous to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410:150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every'stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. LC , � 1 ( 4ptiF_4 zza TOWN OF.BARNSTABLE LOCATIONA SEWAGE VILLAGES pe9ij ASSESSOR'S M P Cz LOT „j INSTALLER'S NAME & PHONE NO. {''�L� ) �P� �.�J1, S SEPTIC TANK CAPACITY 6 LEACHING FACILITY:(type) (size) d NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER -BUILDER OR OWNER (:�€�G!„�9 J- �' 7°S �0 ��` d,�S ! DATE PERMIT ISSUED: O� f DATE COMPLIANCE ISSUED: . �— 2 S 2 VARIANCE GRANTED: Yes No • i ' /Val 0, cl I� TOWN OF BARNSTABLE LOCATION 3 SEWAGE # VILLAGEdY�/y�S,/ //�® ASSESSOR'S MAP LOT INSTALLERS NA ME AME PHONE NO. SEPTIC TANK CAPACITY /® LEACHING FACILITY:(type) /� (size) y NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COISPLIANCE ISSUED: VARIANCE GRANTED: Yes No pp vr� No06 16;? THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............OF...�� 2 "P�S ......-.. Appliration for Disposal Warks Tonstrnr#inn f rrmit Application is hereby made for a Permit to Construct (+) or Repair ( ) an Individual Sewage Disposal System at: .......... .`-!..----.._._.�> .............................. Ia.- Address MA a ........... .._.7% ....... ..7`. �irf^^fi/.�.f............................. Installer Address St 123 U Type of Building 3 Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( } — Cafeteria ( ) dOther-fixsures ............... .............................................. ........................... .............. W Design Flow............................................gallons per person pe day. Total daily flow-----------���__......__.......Vio s. WSeptic Tank—Liquid capacityV? -gallons Length'S_� ��.._Width ��_..Diameter................Depth_.__..'....11.. x Disposal Trench—No.....................Width....................Total Length....................Total leaching area......._...._. sq.ft. Seepage Pit No.................... Diameter'..:::`....... Depth below inlet!."_P�.__.Total leaching area.�:.�L..7..._...setr•P 4po Z Other Distribution box Dosing tank ( ) �Q�o JJ a Percolation Test Resul`� Performed by............... !.._ l�!��NP—!Nc5•h _...... Test Pit No. I...... ........minutes per inch Depth of Test Pit.....l.�L!._.._..._ Depth to ground water.NQtQ C=:...... i L, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------_------------- P4 1 I r"r` ' -- .... Description of Soil. i_ ....__.......b ...... .. t l i-....................................•-•---.....__._.... -----•. -------------------------------- -_ �11��-.--------......--""----------.....-------"--""-------------"-------...--------.............---•-------.............__.. ...............-------------------�J L----- -C �� ''` ' ------...-------"-----------------"------•------•-••-•---"------•----------....-•-•--------•---------•------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b a oZhe *� heSigned_. .._....._. / •Date Application Approved By......... L.lr r_r ...... Date Application Disapproved for the following reasons:.............................................................................................................. ..............................................................-_.........._............_...........---...............-----.._........-----............----........---.................._.............-•••- Permit No.....Sl.a...1.2.)................._-_._ Issued....j .).c _ ?.......Date....._ Date THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH t Trrtifiratp of (gom�lionrr THIS IS TO CERTIFY, That the Individual,Sewage Disposal System constructed (f) or Repaired ( ) !~ bY__ .........-..............:' _ E:- '. __. y_....... ".e 1'?".� -✓. ' .. ........._....................... i nstaller _ .... at..............:..:... ........r-4 ,3._......{YL.S�..E=:`::::.....:.:...� ---_-.---•_-.-.--------: .......... .__ ......:.1:..aY._....e:.l.::.r:_ ...-•..... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...Kic:..... ............... dated.......................` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION QQ SATISFACTORY. DATE......................... ..�.._Q-=. ........................ Inspector................ ��-----------_----•---.---.---_..._--..-..------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .-r �l. ,.....• OF...............:......................................... No.................:. _.. FEE......... Disposal Works Tonstrudian ;prmit Permission.is hereby granted-{... :.. :..:::........ " ';". ::.`............: `.r .........................::.... ...................._--.. to Constuct (,') or Repair ( ) an Individual Sewage Disposal System atNo.........L._I..:...:................ _: -----_--•----_�.. ------•---•-•---_--------•-•--••- ;-' :.r - Street . as shown on the application for Disposal Works Construction,Permit No:'_r:_��:5�_.... Dated f.%_:...._ ............ ..........l.Lsi................. ........... ................................... - { - - Board of Health DATE........:.:.:.........• ......... FORML.................................... ] FORM 1255 HOBBS &WARREN. INC.. PUBLISHERS oT TOWN OF BARNSTABLE LOCATION 9f `SEWAGE # VILLAGE.1—I&S1045 ASSESSOR'S MP 49z LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /® 6 LEACHING FACILITY:(type) 0-t (size) Id®U NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER CP Aj$ - ,C l f5 �✓�/ U DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 3--- l—_,'-5' VARIANCE GRANTED: Yes No �/ f �F� reu{ Nog .-..1© ..._ FEs........... ........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............................... ......OF... ` Appliratiun for Diopm al Works Tonstrurtiun thrutit Application is hereby made for a Permit to Construct / or Repair ( ) an Individual Sewage Disposal System at: Location-Add or o r O ner Address w 0....:rll-,,�-0's .__P.l- ------- ------------------�.. > �rL i/. / Installer Address dType of Building 3 Size Lot-�L__�_i25_t-.....Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria aOther fixtures --••-•---------•--------............................................................................................................................. W Design Flow...........___._........_. gallons per person per day. Total daily flow..__._.__.F� ....................gallons. --•- % WSeptic Tank—Liquid capacitylQ _gallons Length' _—.b.__._ Width....'d.._.. Diameter................ Depth.: ........... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area•__-._4------------ ft. _-- Diameter-- .�.--3`_°_ Depth below inlet�ez'.".b�� Total leaching area..�'27 PO � Seepage Pit No.-------�-------- � ----- P ...- g ------•-----$� Z Other Distribution box Dosing tank ( ) a Percolation Test Result� Performed by... ..... .......N.... .. Date = � G� ��° l ... /-- -- --- ------ a Test Pit No. 1...... ........minutes per inch Depth of Test Pit..... ground water.OW.L=-...._. �rq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------ -- -- O Description of Soil..Q_'.....________ .._.. .. 1 x ....`..-.'.-'.a1- �_._.._... ��l.1.:�_ -------------------------------------------------------------------------------------- --------------- x •---------------•---••-•--•--•---- -�` '-----. 9 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 iITIZ4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/bee issued by the b of hea . . Q Signed.. / - ? .-- .......•. -•----- Date Application Approved By..------. --------------- (fir /'-•. Date Application Disapproved for the following reasons:.............................................................................................................. ..-----•------------------•......----------•-••�--••-.................................................................................................................................................. Date QQ �Q 1 Permit No......O.k .v-U-l------------------------- Issued.. - . ...-----••-------.... Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD_ OF HEALTH ............................................ , pplira iaan for Uhipasal Works Tanstratrtion Prrutit Application is hereby made for a Permit to Construct (/ ) or Repair ( ) an Individual Sewage Disposal System at: �_�,,,,,..�����•^^� C' Location Addr — .,.�"' �,.'' 1-:7 or No. .,,,, f;..•°l!�C�3 ✓ i=t,i' � :+ ; 't"�%�4 �t 'NA;/� W •• S ._....-•-••...... ........ .........I.......... .......... ......••••.. ___ ......••.... - -.....-- LOwner r J Address 1.4� Installer Address ? Type of Building Size Lot. .......................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other ufi3ures .................................. W Design Flow........... `..........................gallons per person per day. Tota'1 daily flow........... ....... gallons WSeptic Tank—Liquid capacity`!-�%�r'p.gallons Length"f .". _..... 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_� ._.__ q:~ft.,,r"�c Z Other Distribution box ( ) Dosing tank ( ); •� _ s € t '—' Percolation Test Results Performed by � ' ___.� '" �'�� sad IC l Depth .. Date. water._..`. '............ .. C» fit..) 1" ' J. a Test Pit No. 1-----� .-------minutes per inch Depth of Test Pit `............ p ground1°•lC? �Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ , _ase'"------------•....................... •--------------------------- •---------------- ------------------------ •-----•-•-----------•--•----•---- O Description of Soil..............................'..._.� .P... ____ '-?�=-? -?9 V --- ----------------- •-••---------------- •-------------------------- ----------------------•--.--------------- 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'ITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. = Date Application Approved By--••---',-�J........ 4_1 ....---••------ ---....:,_ •---------•.................. ' ' =' ---- Date Application Disapproved for the following reasons----------------•----....-----------------------------------------•-•••••-•-•••-•••--------. -•------.....•...« .........-•---••----•--•---•-------------•-------...----.......---------------•-•-•------------•--....---•-•--•---------•------------------•----...-------------------•--••-••--••-------------.......•- Date Permit No.... �� — ' t.1 4 ......................... Issued....L!.......f ` ..).I— Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !��Te...N ..1•................OF......�-�`�'fQ�-j M'� A..� ................................. ,.............. ..........I.............. .. Tntif iratr of Tumpfiatta THIS IS TO CERTIFY, That the Individual SewageDisposal System constructed ( ) or Repaired ( ) b .............................. ................. .= ----------------••--•---•---...------•----.........-----•-•----.....------------.... Installer at.......... ._ '_..__._.!R _ ._..._.._.?- �t - ty -- - --.-----^._ .....�-'.' �.....v....._.... "r:�-.................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__Ki, .............................. dated---------L_-___--•I.` .":. .(3_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONp SATISFACTORY. DATE--•........................�L:. Q.." ........................ Inspector................ �-----•-••---••---•-----.--------.----••---•--•--- 1 C� THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ..........�:. T ! :......OF...............'................. No..".`........�. ... FEE......................... Dispos a1 Work,5 Tonotrairtioat fautit Permission is hereby granted..../. '.:`).•�. _e�..._.4�- 'r:'_.�.__.__:. :`.:.. t' ''.l "+'� to Construct ( ') or Repair ( ) an Individual Sewage Disposal System Street � • as shown on the application for Disposal Works Construction Permit No._�1_+Vti�_.... Dated.:_ ----------- --------`----.-... { ........ Board of Health DATE. ±' . --• • ..... ................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS J k ,— GENERA 4, NO TE%5 IEs t k,6-;1.EtTl0OV,5 LSH WN Af O A.f O ' Cjr [J '1 T.7 4 1 r p•- t -s- f r !" a. , .� i � 1 ,-' 1 : -.. �'l T !-� Air�.. '�//1f�"Jr' frf llf! /�°I / _ . ..... - O ClN,G�'SS 4 Ta��"Fr'lN1�E s E 4 _1 � .�`.�.�. 1'/P�'>�' TcJ.t1 N IN THE SYSr,6,41 _O � � I _ 8�" G' sT fRc�N � ., _ ,.,•... ...... .. .. - -• V \ \ � VEP T / /,4. N -5 C/Y T/? R (O NO( / w 6 :I : .. k BE r o / Pi' sH �. � 1 N � n? :. 0 @ CDOOOa (1) (D i n Y � O N O !1 G' fi' f� 6 a � R.. Jrc,./✓T.�L.�hs ✓a9'tf�T� IeFi o � , O O C� r c O !J F'4 .. . D �/Pf'C! �R'v Fl3/4' rQ h` �'tfilYC.`� ZZ/ Nl 5 - � l LSA TARP £�` 9 0. r � 0oaOc� .. /N 4 P�•a4C4�C..t97"It.�N I -Fr IN 4,� .�t`fN TE `PEa�` CH 4R � , N .�( z3C?Afs'l-� OF H 444.THRLt,5r NOT r �"I- - TYP/CA,C, ,G,EA N/NG �'�• t�hIEN T �" S TE�9'15 �•�R oc T C L..Elee /vo: .iC, NOT O S •9 . . NC} G'/ �'h'/BUTi�1V C1� AtVt� �".4 �r dT �,� y �' Tfa/Y�Nf> f'ri'l�4Fr' CI Q f �` �/ �' .� �Pr�c T -: OBSERVATION RE/avFCJ,�i C'E'G' s . 7"yp1C,4.�, � �Nz ass Q rH�'t�wfsE rvo T�-� ,4 .� ,srsrS'.� uA�, �" AN �'�. EXCAVATED Ar�f .�lC 0 OBSERVATION PIT TO BE EXCAUA E �RC�.4.A rt4r� T 2 1 c. ��T �"CJ S�'.4.�,� �'d,�1,�'C1.MENTS SHr4�.�C, E' IN T �LtP IT BOTTOM OF P ,W PROPOSED 4aB tr' N �1 c c� 1 4 BELOW R I Tl _4 f�E ST ,T�" �1 �' �r�111.k's ,�'e�"/1Vf"flRC ,C' �'HRC�C/Gh?` 7" ,4 �''1��4/il'G��" d'1'`�TN T�..�'" �" ,4 S IL CONDITION .� p _ ELEVATION TO VERIFY O , _ , U ��-� ��„��Tr�r� w��,��r ��1r�� �rTN . /z - s4,�s7.4fc'Y O IN R A 1YGI�V EEfz'f/Y INCAND WATER .TABLE. ENGINEER TO BE r G N P _ 6� �' 7°" /i-' C ! TOP B T'_ .�(. fG' AY P �rY. ; }F��r �"�..�,�"�' � �` �"��, � ��` �.. C1 7"C..� NOTIFIED.--PRIORTO.CONSTRUCTION. 61�H H �' r9 �p1VCfs'�T�' /S 4,000 /''S'l,-. 7'C,5 T T/,E TO 5�O G TAlt1k' f I P TD HI/il P/T 7"O 8E Sty ,CrT !1 r4 AND C,EAG G S 7o ii LOT _ P 1 C� ,[aH/ /N SN QA , �'��"�' 27fi0 F1r1/ 6 / 145H G�'AG' �P Q��R' T.4/V/t" FiN/SH G,2AD,� C�VE,Q ie S.H.CR �" „ N 4 4 , _ E X 24 O +p GN//VG �'/r I E.G�`V 259 �C ,E A LOT 43 3 S Rw , L � 3 . s ' 4�0,Sgd 0 v(�' - Q)21124F . 14I/z , C� O C,� C�1 « Q7 r3 7 �L w.. A✓V b t / 3 5 a I` � � Q Ct CJ � 0 4 C,2U5H�`O STDN C<Jat+"CR�'T�' � 2B „ < Fc o o a Q1C 00a 7 _ -- f` Liar r abr ,{ rr-tr�Tt s r � r 13+0 c� '�i c/ ,�{ Be �+ C ,57,4441) _--- 7+0 .uEAcranc /4 1 i .._ _ _ � 19 ss t l 0 10 O o b� ' .. -*-- �i' O ' t , DELL t f PST N /' o AC` !/VG _ / 73 aD � � AVENUE � ,��. � A� D n, m C T $�E I/ S T SEPTIC ryl (�1 m , eon s f rr� TAW p _ A T,�M P OFl 7 � ,n CJ WATER 3ERYIC - R f _ f NUT TO 5C�f�..� , 3 l i , r 1 I : a 41 t ; P:f 6..L+, Ar / I'fY1"/l G- tJ r - 26.0 45 l 29 t `.. •:.. �• Q ,! 6`�l / �A F .�'UN f fp7 O 24 q .. ..... ,.. c� 7�, i 22 L� , ' "' DELL ' L g It ►/V ` /T ` I, .: nru�e�`� df ,��vRoca,�s �:�,. �- s ,..4.._ , ; � �t� F� �P � 4 X�'T�. Ai/ f ER�SON.S PAR QE t t ., T .�.. y+ Fes. ,ry �+ y�+ +��r,✓� � .- i -:... sit \.T PV C G>��f-ION G.t e .,. N � ,PEA'Sl�N PEF'GAY E /v T 7" J. _:, CyA�t.�.4 S r�' f�' � Est,EV 7` cg 4 � `J L? /G P�"f'i C�J,G.�T/ON TEST Ill �'� � p , k6.4CP11VC f ROV EP �r n �f - ff � ENGINEER : rr 45B SERYATIC?N P N SPO A G , � 12t_ _ ► W E /N Eft lY LOT 42 ..� _. � 4 H Hwy. s f t .�� AM OZ.5316 � 1�ri/ ..:.. !.. ,..., re q. q, '? .: - \�'� r ,.. �, 07 L t . , r 1 ps,:4tNIY BY �'XF�"c�t'`�`G e .91e t�'Y .C. ; cam:L:�r , • 1 Y i