HomeMy WebLinkAbout0190 FLUME AVENUE - Health i
190 Flume Avenue
° Marstons Mills P
t A — 061 013003
No. 4210 1/3 YEL
Pand aflexID
� ,C 1 i
10%
SEWAGE INSPECTIONS
LOCATION 190 fume Ave ;
DATE 8111103 /
=LglsL- 0n,5 (r1-9.9,6, t7a,6�3. ASSESSOR'S MAP & LOT 061-013-003
-INSPBCT0R ,7o.6eRh %. Nacom z.,z a2.
SEPTIC TANK CAPACITY 1500 gaigon,6 I-/30x
LEACHING FACILITY: (typc�-330 2ecgazgeaz (sizcp3 'XI I 'X2'
NO. OF BEDROOMS 5
,,BUILDER OR OWNER Gliiiiam Pike
" OWNER MAILING ADDRESS
Same -
P
1
r �
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00. for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 [Town Hall)
li '. ;l� {Ida%NA' s! DATE. =a
'q `� � C �- �r���=•- Fill in please:
�hikl�l+ �+ � •, APPLICANT'S YOUR NAME/S:"";0 act ,-
; W BUSINESS YOUR HOMEADDRESS: 1 �(
'
TELEPHONE # Home Telephone Number .Sod - &P 1, -;:� �
aT' Y:dr+T�ll� Fitt: 4'r
NAME OF CORPORATION: Pct d « L
NAME OF NEW BUSINESS 5el TYPE OF BUSINESS 09 J5
IS THIS A HOME OCCUPATION? YES NO . _
ADDRESS OF BUSINESS 7�, r.. ;,n3 S / Q''0 • ( MAP/PARCEL NUMBER-j-L70G5 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1: BUILDING COMMISSION 'S OFF
This individual has in&MO y pe mi re uirements that pertain to this type of business.
eA
uthorized Signatu e*
C MENTS: U -
2. BOARD OF HEA TH
This individual has been infor e f e pe it requIC2ments that pertain to this type of business.
I
Authorized nature** " MUST�;OMPLY WITH ALL
COMMENTS: 4,,
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature** .
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town
(WHICH-YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this Corm
at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
r DATE:
Fill in please: —
u APPLICANT'S YOUR NAME:
BUSINESS YOUR HOME ADDRESS:
TELEPHONE # Home Telephone Number: .
NAME OF NEW BUSINESSC41UATYPE OF BUSINESS
IS THIS A HOME OCCUPATION? ES N O
Have you been given approval from the buildin division? YES_..NO U ,, JJ L ���
ADDRESS OF BUSINESS MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may,need. You MUST GO TO 200 Main St. — (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this
town.
1. BUILDING CO ISSI ER'S OFFICE
This individ al s en4n r e of ny ermit requirements that pertain to this type of business.
A rized Sig re**
COMMENTS:
2. BOARD OF HEALTH
This individual has inform f h ermi r uiremen that pertain to this type of business.
Authorized Si ture**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
r
DATE ; 8111103----
PROPERTY ADDRESS:190 Fiume Ave- ------- ---- --
02648 AUG 2 3 2003
TOWN OF BARNSTABLE
HEALTH DEPT.
on the above date, I InSPOCIod the aeptlo sy»tw at the above Oddrels.
Tnis system consists of the following:
1. 1- 1500 ga.2.2on 3ept.ic tank. '(3 1 0 03
Z. 1-Dizs bz.igut.ion Sox. PARCH
3. 6-330 CuPtec,3 .in ze�z.iez. t.CT -
8aseo on my inspection, I certify the following conditions: 4
4. 7h.iz .is a t.ii-ie live zept.ic ay.a.(em.
5. The zept.ic 3y.5tem .i,s in /22o/2e2 wo sk.ing o/ide2 at
the /Ae,sent time.
6. Pumped the zept.ic tank at time o/ .in.612ect.ion.
SIGNATUR
5�'
Name _ J__ P__Macomber_Jr _____
Corhpany : j4agph _p _ MoS4mt p d_ Son, Inc .
Acaress : �Q _&-6L------------
cejuerYL UP,- rja _ _Q2632- 0066
Pr,one : __508- 775_ ) 218 ________
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SONJINC.
Tanks•Cesspools-leachllelds
Pumped & Installed
Town Sewer Connections
p.0 Box 66 Centerville. MA 0263
775.3338 775.6412
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 190 Fiume Ave
Owner's Name:U iiam /01 e
Owner's Address: Same-
Date of Inspection:
1
Name of Inspector: (please print) 7ozeph 10. Macom&e z a2.
Company Name: 1, P, Macomgea & Son Inc.
Mailing Address: Ro x 66
Cc, fPo _ MriAA- 02632
Telephone Number: 508-775-3338—
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of 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:
-Z/asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
i
The system inspector shall s mit 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
""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.
I
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 190 7-Oume .Ave
(7a2a oaz Niiiz,
Owner: bli.t?.P.iam Pike
Date of Inspection: 8111103
Inspection Summary: Check A,B,C,D or E/ALWAYS-complete all of Section D
A =Passes,
0 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:
sh n 4 a of i s 4 u 6 i a Lb in /220/2e2 WO Zkinq O/tde2 a. the
B. System Conditionally Passes:
Qom- 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
distribution box is leveled or replaced
ND explain:
AO 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:
2
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Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 190 77.Pume Ave
Nag.6a`_o2e
Owner: &)iii iam Pike
Date of Inspection: 8111103
C. Further Evaluation is Required by the Board of Health:
41) 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:
tb 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:
V6 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.
VO The system has a septic tank and SAS and the SAS is within a Zone I 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 109 feet but 50 et or more froni a
private water supple well". Method used to determine distance l/
"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:
3
I'�
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Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 190 7.Qume Ave
Ma2z.tonz Ali PPS, Math.
Owner:U i.e ,iam Pike
Date of Inspection: 8111103
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
ackup 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
,flogged SAS or cesspool
;j�Required
/ Static liquid level in the dis 'bution box above outlet invert due to an overloaded or clogged SAS or
esspool 6' CU'
iquid depth in.ccsspc��s less than 'below invert or available volume is less than 'h day flow
_ pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped il_A9.ewTi7;
//Arty portion of the SAS,cesspool or privy is below high ground water elevation.
J Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
ater supply.
y portion of a cesspool or privy is within a Zone 1 of a public well.
_ y portion of a cesspool or privy is within 50 feet of a private water supply well.
�y 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.]
Xld (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
_ the system is within 400 feet of a surface drinking water supply
� he 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 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
"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.
4
Page 5 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 190 Fiume Ave
a/tz t one 17.c T T6, a.6.6.
Owner: 0-i-etiam P-ike
Date of Inspection: 8111103
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
ump m
ing information was provided by the owner, occupant,or Board of Health
IV/P 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 pan 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,Akluding the SAS,located on site ?
d Were_
_ e 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:
Yes no
✓ 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 I5.302(3)(b)) pp
5
Page 6 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address!90 T.2ame Ave
a2.s on.s 117777.3, lltazz.
Owoer. 0-i.P•P.iam Pike
Date of inspection: 8/11103
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):,� Number of bedrooms(actual): :i p
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x N of bedrooms): 9>V10'=�6a
Number of current residents: 6
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system_(yes or no): (if yes separate inspection required)
Laundry system inspected(yes or no):
Seasonal use: (yes or no): 4)0
Water meter readings, if available(last 2 years usage(gpd)):Z001-272, 000 ga 22one-74 5, Z 1 G/�[�
Sump pump(yes or no):�4)6 — � 000 ga-e—Pon.3—6 5 4. 80 Gl')D
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): tf _SPd
Basis of design flow(seats/persons/sgft,etc.): AJ/�
Grease trap present(yes or no):d2g
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system (yes or no):,&L4 )
Water meter readings, if available:
Last date of occupancy/use: IVW
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: %um ed at time o ins eet ion.
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped:e'0d0 gallons-- How was quantity pumped determined? 51 m"-1
Reason for pumping: Keavy .scam & eotid.6 .Payea.a /22e.6erzi,
TYf,ZOF SYSTEM
Septic tank,distribution box, soil absorption system
Single cesspool
Overflow cesspool
,04 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)
�[7I'ight tank [ Attach a copy of the DEP approval
Other(describe): .16t
Appr ximat ge of 11 c mponents,date installed(if known)and source of information:
1 A
Were sewage odors detected when arriving at the site(yes or no):�d
6
Page 7 of I I
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 190 FPume Ave
aa,6 onz I7�PPa !'lae�.
Owner:Gl�PP.tam l .e ce '
Date of Inspection: 8111/03
r�=
BUILDING SEWER(locate on site plan)
Depth below grade: M it
Materials of construction:dacast iron Z40 PVC Vt other(explain):
Distance from private water supply well or suction line: 410-
Comments(on condition of joints,venting, evidence of leakage, etc.):
29-iaiA no.nnn�n Lighil_ No n»,iNvnro al ODnlroa 7h.e ZY-6tem .i-s vented
thaough the houze vents.
SEPTIC TANK: (locate on site plan) /6720 ,,¢Z,6vs
�ly
Depth below grade: _� .
Material.of construction:Yoncrete tO metal�fiberglas�polyethylene
other(explain) ,{�,Q
If tank is metal list age:,2Y is age confu-med by a Certificate of Compliance(yes or no).-d (attach a copy of
certificate) l
I
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 0 _
Scum thickness:_ 6
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee qr baffle:
How were dimensions determined:l2t-),9//i' /
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of.leakage, etc.):
Pump the ZeR.t-.c tank eveaq 2 yea2z InPet 9 out Pet tees ate
1_R nPaee. 7he tank .ts htauctu ai-y .sound and .3hort6 no euide no
o/ Peakage. `.
GREASE TRAM locate on site plarg
Depth below grade:,&dl
Material of construction 4Aconcrete4l.,:�-m eta I Afiberglass.f//i polyethylene.fl/9other
(explain): ,fJA
Dimensions: ,1�0
Scum thickness: 14,144—
Distance from top of scum to top of outlet tee or baffle: AV
Distance from bottom of scum to bottom of outlet tee or baffle:_�w
Date of last pumping: IVA
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Gzeaae t/tan iz not nee.3en
7
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Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continue))
Property Address: 190 T eume AUe
a2.6 one 77777, daze.
Owner:U.i,eii am P ' p
Date of Inspection: R/I 1/0 3
TIGHT or HOLDING TANKtV�(tank must be pumped at time of Inspection)(locate on site plan)
Depth below gmde: .VA'
Material of construction: VAconcrete dAmctai 1).4 fiberglass, 1polyethylene ,�Lothcr(explain):
Dimensions:
Capacity: I zallons
Design Flow: allons/day
Alarm present(yes or no):
Alarm level:--AZ& Alarm in working order(yes or no):
Date of last pumping: IJA
Comments(condition of alarm and float switches, etc.):
,7-ight on o .cny tarzkz a2e no / 2eeen .
DISTRIBUTION BOX: 2(irpresent must be opened)(locate on site plan)
Depth of liquid level above outlet invert: �y
Comments(note if box is level and distribution to outlets equal,any evidence otsolids carryover, any evidence of
leakage into or out of box, etc.):
D.iet2.igut.ion Sox hae one .eateaae No evidence o zo-e.dz ca22y
evidence of ieakaUe into oA out o4 the Sox
PUMP CHAMBERAI",(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no,): 4-
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Piim.o rhom0.pn iA no.t n/lp,Spnf
8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C Z
SYSTEM INFORMATION(continued)
Property Address: 190 Pume Ave
Nan.st on s N.i P 7s, ft.6.a.
Owner: bl.i2$iam %.ike
Date of Inspection: 8/1 I 0 3
SOIL ABSORPTION SYSTEM(SAS):2locate on site plan,excavation not required)
6-330 cu2tec 2echa/t e2,3 .in herzie,6.
If SAS not located explain why:
/o . d, S .12age 10
Type
t/ leaching pits,number: 1d n i
leaching chambers,number: ;-Jk 4rU.Cree
d leaching galleries,number: O
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:Q
innovative/altemative system Type/name of technology:_7.1 J,J`Ll ger
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
No z.i ynz o� h ydrtautic /a.i.2u2e
o2 aond.inr/. SO.iT ate riny eqe a ion .es noltfflae.
CESSPOOLSI(j�(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: Q
Depth—top of liquid to inlet invert:
Depth of solids layer: �J�Q
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
l e-AAnnol.t rinn no# /21tpApni
PRTVYof,ZV,&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.):
Via/ ,�iS O /?20/,Ont
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C Z
SYSTEM INFORMATION(continued)
Property Address: 190 fiume .4ve
a2,3 onh .c ,s, a.6.6.
Owner: U iitiam Pike
e
Date of Inspection: 67TT773 r
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.
.•s
vF, a
of ,
i
r 1
A B C
10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:7 90 7.eume Ave
a2'3 on'3
Owner: 0.iii iam Pike
Date of Inspection: 8/1 1/0 3 ,.
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 64�_ feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from s stem design plans on record- If checked,date of design plan reviewed:
N.A, ?�Pheckved
ered site abuttin roe / bservation hole within 150 feet of SAS)
with local Board of Health-explain: A4
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:�' Ak'fV4 61
You must describe how you established the high ground water elevation:
!aed: Gahze.ty R Ni..P2e2 Nodee. 12116194 r2ound wate2 e.Peva.t.ions agove
,ea a_Veve P.
!.3ed: 11S�S:QP-Afllzurdi nn wP.P / dairz �, anv 199?
!,sed. 11S
— —
wa•teL e eva .ionn.3.
6-330 cuiP ec
2echa�cge2.6 .in
�sea.ie1s.
r
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom
Of the leaching pit and the adjusted groundwater table is 4/ d0
feet.
11
TOWN OF BARNSTABLE q
• LOCATION 9� »v �. SEWAGE # / �i^3 7b/'
VILLAGE UaSSESSOR''S 0,�fMAP & LOT
INSTALLER'S NAME&PHONE NO. 4-a r,K
SEPTIC TANK CAPACITY I Sd e
LEACHING FACILITY: (type) (6) Ck LX- (size) 32 D
NO. OF BEDROOMS
BUILDER OR OWNER
�. .
PERMIT DATE: (� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
• I
•wrtnr+ —n•r�r•.•rr•e.►ranr•n�r�.n s�rrr�rwr.�rt�rrr�inn r.s*w�u*+�-�s►�tin+ �T-t.rn—.....r..,
TOWN OF BOARD OF HEALTH
S011SURFACF SEWAGE DISPOSAL SYSTEM IN �FCTION FO M - PART D •- CERTIFICATION
-TYPL OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 190 ;r.Qvme Ave t�alz�3.-o2,6 Na.6.3,
ASSESSORS MAP, BLOCK AN-0 PARCEL 0 061-015� 003
OWNER' s NAME O i-e-e iam Pik,&
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
--------------
COMPANY NAME J P Macomber & SoR Ind-.'
COMPANY ADDRESSBox 66 Centerville Mass. 02632
Strvvt To►n or City state LIp
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that the information reported is true , accurate, and
omplete as of the time of .inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
• % Ilc� l
Chec one :
.y System PASSED ,
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 16 - 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have con Meted has found that the system fails to
Protect the public health and the environment in accordance with Title
.5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
Inspector Signature Date 4f-
D(
ne copy of this certification must be provided to the OWNER, the BUYER
where applicable ) and the I30ARD Or UnAL1-11.
* If the inspection FAILED, the owner or"'operator shall u d
within one year of the date of the inspection, unless allowed ortrequiredm
otherwise as provided in 3.10 Chjn 15 . 306
partd .doc
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1
TOWN OF BARNSTABLE c
LOCATION 9Q �wp•.o �. SEWAGE # / 5 -,3 7&/
VILLAGE �� I SSESSOR'S MAP & LOT�I&
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK.CAPACTTY �.S6d
/ F
LEACHING FACILITY: (type) e4 y" GEC- (size)
NO.OF BEDROOMS
BUILDER OR OWNER,( i0` �� •i w
PERMTTDATE: 362 COMPLIANCE DATE:
Separation Distance Between the: 1
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`fires
Furnished by
GZ
el- fl� �k /I�pa cE
No. Fee 41
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Z(ppYtcatton four �tgpogaY *pgterrY Cor_,�_5�tructtor� Permit
Application for a Permit to Construct(^✓)Repair( )Upgrade( )Abandon( ) Ltdeomplete System El Individual Components
A M� Location Address or Lot No. j,—o Owner's Name,Address andd Tel.No.1 /,
Assessor's a /Pazcel � • �/�5 .5 �UGj• ��/`/��v
1 p CO/ 0/3,063
Installer's Name,Address,and Tel.No. (�, n\/ /!jl `' Designer's Name,Address and Tel.No.
Type of Building: �j 7?c
Dwelling No.of Bedrooms Lot Size / O sq.ft. Garbage Grinder((la
Other Type of Building rah No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow t d o gallons per day. Calculated daily flow -6-50 gallons.
Plan Date 5--to— Number of sheets Revision Date
Title 4,07- /a )'-- V AU Al ULL_S
Size of Septic Tank Type of S.A.S.
Description of Soil 21 P4ejAl
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the con
s
tr ction and maint ee�f'ftie afore described on-site sewage disposal system
in accordance with the provisions of Title651f t n ' ental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss y th of Health. ?
Signe ` Date J
Application Approved by Date 9
Application Disapproved for the following reas s
Permit No. Date Issued (0 ? 3
:w No-r ,0 Qw Fee 1
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
a r?q
ZIPPrication for ;DigPo.5a1 *pgtef� Construction Permit
Application for a Permit to Construct
(✓)Repair( )Upgrade( )Abandon( ) Vomplete System ❑Individual Components
Location Address or Lot No.0 9 Q T_L U/rf,_ fi * Owner's Name,Address and Tel.No,
1 Assessor's Map/Parcel �, 013,063
U1'Y5
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
l�
Type of Building: ���
Dwelling No.of Bedrooms 5 Lot Size;')/ sq.ft. Garbage Grinder(/v)
Other Type of Building GOtuc No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow //6 U gallons per day. Calculated daily flow `� 0 gallons.
Plan Date 5 l U— V7 Number of sheets Revision Date
Title L-0 /0 F L U AI F- 4U E. Al Al 14,`_5
Size of Septic Tank 7 Type of S.A.S. (_
Description of Soil J 5 do
s
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the constr ction and man �aaee-of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 f n ' ef'i ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss e by t ' of Health.
Sign Date l "�
'Application Approved by Date
Application Disapproved for the following reas s '
Permit No. , Date Issued �0 2 3
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CE _ I , th t the -site • wage i po al System Constructed(V/ )Repaired ( ) Upgraded( )
Abandoned( )by
at 9 rZo; Z a en constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Iff dated
Installer Designer 14
The issuance of th's pe s a not be construed as a guarantee that the t wi 1 fu ctionis� esip cA. /
Date Inspector
.y
———— ————------------------------ --
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
loiopooal Pp5tem (Construction 'ermit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System to ate at A /9D 09E 4 U€ 44. M ICL S
s
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: Constructi n ust a co leted within three years of the date of p rmit.
v
Date: Approved by
II. I
Pn'1
' NDr—D 9' I v PM
oFr Town of Barnstable
Board of Health
• BMWSTABL&
9c� ' 367 Main Street, Hyannis MA 02601 .
RFD MAC a
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-775-3344 KT — Ralph A.Murphy,M.D.
Sumner Kaufman,MSPH
BOARD OF HEALTH MEETING AGENDA
June 22, 1999 7:00 P.M.
Town Hall Building
Second Floor, Conference Room
367 Main Street, Hyannis
------------------
I. Variance Requests/Old Business:
Coletti representing his client Jane Johnson, 309 Prince Hinckley
W,-rH coNolres,s Road, Centerville 15,087 square foot lot - Requests permission to
construct a 2 bedroom dwelling, variance required from the nitrogen
loading limitation rkd
s. g ,� g
t ar 1)eec R f: lCbon SHaI(
II. New Business:
(zq 7:i&-- Jon Dell Priscoli, Cape Cod Central Railroad - Requests a variance for t#e
WI-ro CCUD,T.pA1S grease on the dinner train. r
Q 2 i� -l.�e �r2aye �5 sl.,a(i fie, ia�*,IIXd ^ Sri Sa,•p(x_S Sl,a11
C�ttst l h0..� "t2,.e
Patrick Butler, representing his client James Spellman, Olive Garden tom;, -t,,,k uj kl
W .fi+ cc" Restaurant.-.Requesting a variance from the Town of Barnstable
Regulation 14 for outdoor dining at 1095 lyannough Roa�, Hyanni^1s. y«�
—�P.vyeN �I�n /r5v,'rCQ �" 51nv,i �' Sa.Pc=n::�✓1 Ixh"r�-.� (x�k;;$ or-�,u���s�,
A�-r — Thomas Maclellan, P.E., representing his client Michael Buckley .-. Pam;,
Requesting a variance to upgrade septic system close to wetland at 24
nfFrancis Circle, Hyannis.
G plan v - `ocvv'dk z L5 t a(
Applications for Disposal Works Construction Permits: _94-la,w_ recc x_S
Cam" James Bowes, Bayside Building Co., Lot #10 Flume Avenue, Marstons (�3D � „Mc
vdtTti "� Mills - Requests permission to construct a five bedroom home on a Sl<<t�
25,778 square feet lot, open space subdivision with 9.4 acres of open
space in a G.P. District. 0 Cti bzA—c-- 6W G"-t3N(A--c'&
_'za r, z.eLl a) �� I;;),-
IV. Swimming Poo "fii ation Re uests:
Susan Tilton, Weekes Crossing Community Asso
Percival Drive, West Barnstable.
Cc-L(2AW[� CAI Ptnbrnon —SOr,,�� Co,� t .Ls�z ��o� �o�jca� �(O�i Mc3in
WA—ilk
—_L4z
TOWN OF BARNSTABLE c
LOCATION 9Q 3 �a t•+o 4-1 SEWAGE # / ! ',3 71� rn
VILLAGE.- ,s��9�' MTU.&SSES//SOR'StMAP & LO % Q ^�X
INSTALLER'S NAME&PHONE NO. T a Yi kd C .7
SEPTIC TANK CAPACITY I Sd 0
LEACHING FACILITY: (type) (6) Ck Gam- (size) j 3 d
NO.OF BEDROOMS
BUII.,DER OR OWNER ,` -
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
VJ
�o
'1,01Y11 01 11,1I1'11SUIVIC r "
Department of Ilestl(It,Sitfe(y,and C,nvironmen(nl Services
Public 1lealt I l)•visiun Dn(e - — _
(o13 (jo
3G7 Main SI apple 02
t�
atswarAolA I
Mead � Time J1;j fee 1'd._ /.�-
19. a Date Scheduled Soil Sr .Y —
titabilit Assessment for Sewage Dispo
' Witnessed By: )JWl>�
Performed By: L
LOCATIONS: GLNLItAL tNi'01tN1n`t10N
Owncr'sNamc Indian Lakes Dev. C.
Location Address
Lot 10 Flume Ave AddressP.O. Box 95
AA-M Centerville, Ma. 02 33
Engineer's Name
Assessor's Map/Parcel: Map 61 Pcl 10 (Part) Baxt428_&&13Ye Inc.
NEW CONSTRUCTION
X REPAIR Telephone N 1
Slopes(%) - Surface Stones
d
Land Use
Distances from: Open Water Body ob___._____ft Possible We(Area Jay ft Drinking Water Well 'ZSo R
Drainage Way_ gg —R Property Line R Other R
SKETCH: (Street name,dimensions of lol,exact locations of lest holes&perc tests,locale wetlands in proximity to holes)
Avg
k �
C4
cLh'
264.36'
P
Parent material(geologic)-_Z.__L
Ucpih to Bedrock
Wceplog from I'll I'nce—�.--_—
Ucplh to Groundwater. Slanting Walcr in I tole:_ —
Estimated Seasonal Iligh Groundwater _ —------ -
1)1�,1T1�n-1�l�c��att�.ly r�oxt nsONAL iairpH WATVAi
Method Uscd: _--___.---------- hl. Uc rlh to soil
Ucplh Obscrv'ed standing in Olt.;.hose —__.------_.._---_ i
Dcplh to wccping Anna siJc ofobs.hoic: _—._—.___In. <iunmdwnlcr Adjustment_-----.._--•-__�_n
hide,"(Lvell H_,__•-__ •Rrlding Ualc:
IuJcx 44'e{I Icvcl ___-- Adj.f ll for— Ad}.(3roundwaler Level
1'ERCOLr1'1'aON '1'1�51 time b s4 'Ilrne .10 A
Observation 'I ime at 9" _
I lute H
r' �If Thee at G" _
Ucplh of Pcrc _.�-• — —
R....P......nk'r'rm•RO Vii A'�?���I�,,,, Z,7A- V(1X 'rbne(q".(,") -
r_nd Pre-sunk ___.rTldv' =•----
n.nic.Min./Inch IIIN 21wr�.1 021.d`75
Site Suitability Assessment' Site Passed ✓ — 511c failed:--__.— Additional Testing Nceded(Y/N)• —
Original: Public health Division Observation hole Unta To Be Completed Oil
Copy: Applicant
I)EEI1013SE1tVAVTIONII0LC LOG Ilnle# �
Dcptet from Soil I lorizon Soil 1'cxture Soil Color Soil lhcr
Surface(in,) (USDA) (Munsell) Molding (Structure,Stones,Doulderes.
2t�b r 0 Consistency %gravel)
(`lt?�nn U
1 OWL —tr,
J
a
'J'L 132r �i2 &�E 16 '7l 0 `o
DEEP OBSERVATION HOLE LOG
Ucpth from Soil I lorizon Soil Texture Soil Color Soil Other
Surface.0n.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
%
DEEP OBSERVATION IIOLC I.OG Bole
Soil I lorizon Soil Texture Soil Color Soil Other
Depth from (USDA)
(Munsell) Mottling (Structure,Stones,Doulderes.
Surface(in.) °
DEEP OBSERVATION HOLE LOG Hole#
Dcpth from Soil I lorizon S(USDA) re Soil Color(Munsell) Mottling (Stnrcturreetler Stones,Doulderes,
Surface•(in.) °
r
Flood Insurance Rate Man: /
Above 500 year flood boundary No_ Yes
Within 5o0 year boundary No� Yes
Within 100 year flood boundary No V/ Yes
Depth of Natuil y urring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? _
If not, what is the depth of naturally occurring pervious material?
�ertlfcation � v
I certify that on 1 (date) I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was performe by me crisistent with
the required training,expertise and experience described in 310 CM 15.017. C)Q 0 ,(4-443
r ®
NaTm 6 TOTAL Um;TS 1 S'T AF.?J.,1 END, d:4 1NT3MEDJA'S p�pg. .fL ' r " ,-----�— � �— FL
UME 9
1. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. z3as OL 10 -
N
2. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. 5•�s6�=5�6 — 191.08' t
3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL t-ts WASHED STONE
..
WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT a \ I I \ �`.
MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED - I s P r`
PT < v
ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. � � #2r.+
100 SIEVE AND 5% OP, LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED
BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. it F4 C��!� �G�
4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS PLW �� rlo scA�E \. �V=Y j '� ' J'
PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE
THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE �P /! / Q
WATER DISTRICT TO DETERMINE UTILITY LOCATIONS.
FAt:aiED C1ZADE
COMPACTED FILL Z; a~ /� r' r
56'MAA.— 12"h+,N. o ��` r
T Jt je /
SINGLE FAMILY- 5 EEDR001=%tS "t E jf S� �sr r .� ` �` TOT
NO GARBAGE GRINDER f k a
3/4" TO 1 i/2 `« tee �6'' �� r r,,
DAILY FL0�4' = 110 >; 5 = 550 G.P.D. / � ` r,. 30, l+
US_E �/
r 55 a: = 110QST06E idsP) � r
SEPTIC, TANK O ,. 200�0 �. .
USE 1500 GAL. SEPTIC TANKLOIT\ �,
Ld ! +t
10
HICHAMM R OR NO SCALE r✓ / ^p)f, p
ALL PIPES TO BE SCHEDULE 40 PVC PEP.FOR,"TED
WITH CAPPED ENDS
r,
USE 1 - 4" DISTRIBUT'tON LINE IN 6 RECI'ARGER UNITS I CERTIFY THAT THE PROPOSED FOUNDATION
+PI 2 G4' WASHED t \`
r,�. A 1_'�, STONE TRENCH ,4S SHGV>,'.N COMPLIES WITH THE TOWN OF BARNSTABLE SIDELINE
nC h REQUIRED c AND SETBACK REQUIREMENTS AND IS NOT LOCATED
LE�.�,t-Ili�.� AREA RE..,U.R�D
43 S.F. WITHIN THE FLDOD • AI
550 G.P.D./.74 = 7 a J
4 S.F. ID-',ALL S ftr DATE: ' :,'
2(44 I 12) -A2 = 22 A..EA R.L.S.
(12 n 44) = 528 S.F. BOTTOM OM AREA Sb THIS PLAN IS NO ON AN INSTRUMENT SURVEY AND
752 S.F. TOTAL PROVIDED THE OFFSETS SHOULD NOT BE USED TO DETERMINE LOT LINES.
SCALE; 1"= 40'
PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 _< ,` 4^ c PIDT PLAN
SOIL CLASS 1
BAXTER & NYE INC. =; y�s� fl9A�p
#P-9212
LOT 10 FLUME AVENUE
COVERS LOCATED TO bMTHIN '
MARSTONS MILLS
6' OF _
F.F. ELEV. = 67.0 '' PIT #1 ELEV. = 61.0 PIT #2ELEV. = 63.0'
O HUMUS
0 HUMUS
A LOAMY SAND A LOAMY SAND i r'� A MAY 10, 1999
�vFs.`a.. �v. J'.+•+ _6" —6"
..v = t 50 t '! �• FJ B LOAMY SAND B LOAMY SAND �„
63.0 t�v. = m 4"D?ghE�r� 11 q� —3' —3'
62a SEPTIC TAW , v 7�:L �13`, ,oP�y LEACHIJ�c c�A�aEm HERRING RUN AT INDIAN LAKES
K2.6INV. Box�, I—J T PERK TEST —4' PERK TEST ` '"
n.PsrJ =62.4 » . rv. a6 �2 tv. =62.Q a i ^F y: SUBDIVISION #762
1 w � AP 61 PARCEL 10
�To„E E4sEi / ASSESSORS M
1 MIN, Cl COARSE Cl COARSEJY��\n
BOTTOM ELEV. EL =60.0 SAND SAND .s`r+`, LJ"J''� BAXTER & NYE INC.
yl.?�f r r .
l0YR.6/4 1OYR.6/4 ' ✓ ;T-
i G a al LAND SURVEYORS CIVIL ENGINEERS
OSTERVIL,LE,MASS.
COARSE C2 SAND C2 COARSE SAN `-• S C^ IM
i
i0YR.7/6 10YR.7/6 �� .,�-' :. �`• ��/+�<z
—11' NO WATER —11' NO WATER
NO SCALE — —
ELEV. — 50.0' ELEV. 52.0'
..�
y� BA (SIDE BUILDING CO. INC.
► 'ems"
#97012TYP
t