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HomeMy WebLinkAbout0030 LITTLE POND ROAD - Health J, O � � �� L � �ow�c� �vqd _ - - - _ - i I I __ - 1 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 LITTLE POND RD Property Address RO(LAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 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. Important:When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your DAVID WARD cursor-do not Name of Inspector use the return key. WARD -T-5 Company Name rb PO BOX 1934 Company Address MANOMET MA 02345 City/Town State Zip Code 508-747-9593 S1674 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 1/09/2009 Inspector's Signature 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. 30LIT MM09•08/O6 _1/0 �� Title 5 Official Inspection Form:Subsurfa Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. City/Town State Zip Code Date of Inspection 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 CM'R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 30LIT MM09-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 rA Commonwealth of Massachusetts ti. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 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. 30LIT MM09-08/06 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 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 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 to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. 30LIT MM09•08/06 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 �M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 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 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. 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. M 30LIT MM09-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is MARSTONS MILLS MA 02648 1/09/2009 required for every page. City/Town 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? ® ❑ 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)] 30LIT MM09•08/06 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 �M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of becrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): NA 9 ( y 9 Sump pump? ❑ Yes ® No Last date of occupancy: 1/09/2009 Date 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 holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describer: 30LIT MM09•08/06 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 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: BOH 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: 2/4/99 BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 30LIT MM09-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every[page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Server(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (cn condition of joints, venting, evidence of leakage, etc.): Septic Tank ;locate on site plan): Depth below grade: 10"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: 1500 Sludge depth: V. Distance from top of sludge to bottom of outlet tee or baffle 22 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dime.isions determined? ROD 30LIT MM09-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM , 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. City/Town 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.): TANK AND TEES GOOD NO SIGNS OF FAILURE 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): 30LIT MM09•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 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information i.� MARSTONS MILLS MA 02648 1/09/2009 required for every page. CitylTown 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 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.): WENT TO SAS FLOW WAS GOOD FROM THE D BOX Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 30LIT MMOG•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. City/Town 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: ® leaching chambers number: 3-500GAL ❑ 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.): NO SIGN OF FAILURE 4"WATER IN SAS 30LIT MM09•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name informations required for MARSTONS MILLS MA 02648 1/09/2009 every page. City/Town 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 croundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of ccnstruction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 30LIT MM09•08/03 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ r Subsurface Sewage Disposal System Form Not for Voluntary Asse ssments me nts 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is MARSTONS MILS MA 02648 1/09/2009 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: kbech of the swage disosal system nchmarkseLo ate alpwells within 100 feetincluding ties to at least two permanent reference landmarks o Locate where public water supply enters the building. i I IL to ;N �p �o I- 30LIT IVM09•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4.M 30 LITTLE POND RD Property Address ROCLAND TRUST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 1/09/2009 every page. City/Town 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: 1321"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: 1999 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: You must describe how you established the high ground water elevation: TEST PIT NC WATER 30LIT MM09•Oa;06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE LOCATION' 3 O A0,f/W SEWAGE #' 79 3 Y VILLAGE /VI L -5�Oi(I S Mr-/Ll SASSESSOR'S MAP & LOT r.T s' // INSTALLER'S NAME&PHONE NO. J /y1 A Z©14,ogelT r SG►rV i SEPTIC TANK CAPACITY Sd LEACHING FACM=: (type)9A'o y c YA49e1? 5 (size) S'00 64:� NO.OF BEDROOMS BUILDER OR OWNER. PERMIT DATE: I "1. �_COMPLIAN DATE: 2 4 q Y 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� t �u t ys- N 3o 3o �o .� \ ti TOWN OF B/AF'NSTABLE •C, r/ LOCATION O �Trle 100W X /f V, SEWAGE # 79 37 VILLAGE 1VI A k 5 7'OA/.S MILL 5 ASSESSOR'S MAP &LOT (7161r•O I/ INSTALLER'S NAME&PHONE NO. A C0✓q,6eK r S'O V SEPTIC TANK CAPACITY /✓SO® LEACHING FACILn Y: (type)9)15�ozd Ch',4, f 1S eg'S (size) da UO 6A4 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 1 -2 7 y COMPLIAN 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 SAD ys , C TOWN OF BARNSTABLE LOCATION 3D Gi/�� /l� SEWAGE# VILLAGE 14i11S ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. S. 10- 1W4 cv/1 SEPTIC TANK CAPACITY /S.0 G LEACHING FACILITY:(type) f/yzo- 44^ &1/ 1 (size) 3- S6b Go NO. OF BEDROOMS 1f OWNER o��` �,.� 4/1 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 9 feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) 1)A feet Edge of Wetland and L-aching Facility(if any wetlands exist within 300 feet of leaching:facility). a/� feet ` FURNISHED BY „ G No. l 1 Fee$ 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYfcation for Oiopaaf *pgtem Construction Permit Application for a Permit to Construct( )Repair(X�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 30 Little Pond Road Owner's Name,Address and Tel.No.5 0 8—2 5 5—8 5 0 9 Marstons Mills ,Mass . 02648 Thomas Reilly Assessor's Map/Parcel d to © 4 P. O B o x 1021 O r l e a m s ,Mass . 0 2 6 6 2 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J,P.Macomber & Son Inc . J. P.Macomber & Son Inc . Box 66 CeNterville ,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X X Xlo.of Bedrooms_ 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 410 gallons per day. Calculated daily flow 4 x 110 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15 0 0 H 2 0 Type of S.A.S. Description of Soil Medium •tingt sand to coarse sand Nature of Repairs or Alterations(Answer when applicable) Replacing caved in septic tank with a H2O 1500 gallon tank- One Distribution box . Adding 51H20 _ LD pac e in o stone .Will vent . .� y. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue#by this Bo d o ea . Signed Date 1/2 6/9 9 Application Approved by Date /—Z 7— Application Disapproved for the following reasons Permit No. ,3 Date Issued �' 7 V No. / (. .. �..-..' Fee$ 5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Mi_gogar *proem Construction 3permit Application fora Permit to Construct( )Repair(X�Upgrade( )Abandon( " ) E]Complete System ❑Individual Components Location Address or Lot No. 0 Little Pond Road Owner's Name,Address and Tel.No.5 0 8—2 5 5�8 5 0 9 Marstons- Mills ,Mass . 02648 Thomas Reilly Assessor's Map/Parcel G s-' d P.O B o x 1021 O r l e a m s ,Mass . 0 2 6 6 2 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J,P.Macomber & Son Inc . J. P.Macomber & Son Inc . Box 66 CeNterville ,Mass. 02632 Box 66 Centerville,Mass . 02632 Type of Building: Dwelling X X YNo.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building="' No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 410 gallons per day. Calculated daily flow 4 x 110 gallons. Plan Date Number of sheets Revision Date Tile I` Size of Septic Tank 15 0 0 H 2 0 Type of S.A.S--8--3 3"0'-C'Ti" T1C Hif O Description of Soil Medium tingt sand to coarse ,sand Replacing caved in septic tank with Nature of Repairs or Alterations(Answer when applicable) P g P a H20, 1500 gallon tan)t. One Distribution box. Adding Z=H20 � paCke in of sto'ne .Will vent . Date last inspected: „ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title.5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this Bo do Heea ' Signed l. Gi%! e Date 1/2 6/9 9 Application Approved by Date —Z 7` Application Disapproved for the following reasons Permit No. 9 9.3 Date Issued 7" --------------------------------------- t THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS Certificate of Co..mpriance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X X)Upgraded( ) Abandoned( )by J.1':Macomber Son Inc . at 30 Little Pond Road M a r s t o n s Mills ,Mass, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7'3 dated /— f Installer J•P.Macomber & Son Inc . Designer J•P.'Macomber & Son Inc . The issuance of this p^e�rmit shall not be construed as a guarantee that the system w-il 'unction as designed. Date r1�. �� Inspector --^———---------- r -----------------Fee 50. — No. 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS V-f ligogal *p5tem Construction Vermit Permission is hereby granted to Construct(,-N)ReparrT X )Upgrade( )Abandon( ) Systemlocatedat 30 Little Pondk Road Marstons Mills ,Mass . and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this ermit. Date: Approved by e,— r 1 orvro1 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, Joseph P .Macomber Jr ., hereby certify that the application for disposal works construction permit signed by me dated 1/2'6/99 , conceming the property located at 30yLittle Pond Road Marstons Mills meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will pQt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground-Elevation(according to the Engineering Division G.I.S. map) z2L� - r� B) Observed Groundwater Table Elevation(according to Health Division well map) SIGNED r DATE 1/26/99 LICENS EPTIC SYSTEM INSTALLER 1 THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted). q:health roldcf.ecn 0 - `• f ^. P r ___ c q . TOWN OF BARNSTABLE TTle LOCATION 3 0 1 o6Q f/Gl/ RV- SEWAGE # 99 3 �I VILLAGE 114 A k S T a�l/S -M//— ASSESSOR'S MAP & LOT cT -f•0l/ INSTALLER'S NAME&PHONE NO. /VI /9 co mlge/C r SON SEP-1 IC TANK CAPACITY /✓mod O LEACHING FACM=: (type) �1oW eH,o,K�e/�'s (size) S'00 644 NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: I--11 — 2 7 COMPL TAN 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 i Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � d 30 ,2O 0 TOWN OF BARNSTABLE LOCATION L� o'Me Pnz SEWAGE # VILLAGE 1%lS1_0A1S l'11Y ASSESSOR'S MAP & LOT . A 1 INSTALLER'S NAME & PHONE NO. J C ff)� 1A, `kkx SEPTIC TANK CAPACITY /,§�O GO-110A1 LEACHING FACILITY:(type) /Off 0 &IloAl (size) x k-7// NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER r BUILDER OR OWNER 1' V'CArl C® had 64-tgfe_ ca DATE PERMIT ISSUED: ,/'® /' f-7 DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 Flms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Tou�.ti1................OF............ AR.....5'T.............................................. �0 Appliration for Bwpasal Works Tongtrurtion ramit Application is hereby made fora Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: LlTFL.E POND RE - 13ARMSTABLE+MIP�: 'LOT L 11TLE POt�LD E;*1:8- ...............__..... .............. ...._...... - .......•-•--- - - ot ocation-Address CRfZl� t��- TiZ1dST' 1..1111.E Poq }p o _ -----------------•......----.----- ..........--••----------•--....--•-_------ ' ner I.._.._....-•-----------•----•---•- Address a .. w .�-, =-- RN5TR�3 �1►!!Ptt STQN..S_.Mj.t!4:Q t � Installer Address �t� U Type of Building Size Lot."r4'}QOO+Sq. feet Dwelling 3 —No. of Bedrooms............. .............._...........Expansion Attic (Lila) Garbage Grinder (too) Other—Type� yp of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..---••-----•-•--•••------......• . -----------•••---•----•••-•--------------•------••--•----•••-•-----••------------•-----•-•........-------- W Design Flow..........65.......................gallons per person per day. Total daily flow..........3-3.I ....................gallons. W Septic Tank—Liquid capacity1)40QQgallons Length.8."�t'�_. Width.q'..10n Diameter________________ Depth_ � ." x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.____-__I----------- Diameter......lj��........ Depth below inlet...- t.,. .)l.. Total leaching area.;;.;;._7...sq. ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by...QAPE-C.PQ...Stsl�,�E('-•CQ�(,$�L itlf�ate.._4."-7_"'. a Test Pit No. 1.....�.......minutes per inch Depth of Test Pit..t4.. -4....... Depth to ground wat :1 ._ rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w �e�.. ... ��qD� . W ......._ ........... .... . .................... c 3,> O Description of Soil-"1�P-#. -QT. ....D`�-'4 --• �'OT'SOI L f 5kt f~3��011-, ` .,a F.IJ Y;:1 I/� q -- f-4r------ �' ...... 1�+._G:O!?'1PACT'S/LT CLA. -1!!tA. LEDi_ ^{ii_S0T1 ✓EL------------•-------------------------•-------......------------ � _ �( r,o ,,o U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------s !?:�.�: ti�1 ✓ 01 Agreement: 07 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the proviEions of TIT?:c. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in er ion u it a Certi of Complia en ass ed b the bo of health. Sign . --•--•......... ..... App ica on Approved By...... ---I�J uat ................. Date App, • ion Disapproved for the following easons:---------•--•-------•-••••--••--••••---------•------•---••-•.....---•----•-•••-----•--•.............................................. ---------------------------•------•-•--.......--- ---••-------•••....--------••-------••-----------•----••-••••--------•--•---••--••------••--•-........................................----------- t .....................Date z Permit No.......... ✓.�-=----------------•--- Issued..-•-=---------•--•-•- -----•--- Date L R R +. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ----------------OF.............?AKW TABLE" ......_..... Appliration for Disposal Works Tontrndion runfit Application is hereby-made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: L11T'L:12 FOND RD- �ARh15CA$LEO M& __LOT ' I.IIT�E .......................................ND F_ -rS ................_...... -.........._......._..- -.-_------------------- • •.ocation-Address 1 or't '0' ..F e T_. .^T F....�':'............ ......."t'r'1.,.E. 1 M p---"-1`-7-'�--1- P.................................... 2tnee " - Address - -. .....•••-----•-•-••-•...--•-••-----. Rt'S"t"t?l��s, �l►�iPSN.'- 1�t1!_u k1fl�a 5 Installer Address Q Type of Building Size Lot.4' `}a©!.+.Sq. feet U Dwelling—No. of Bedrooms..............�..........................Expansion Attic (4D) Garbage Grinder (#AO) Other—T e of Building a —Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..................................................................................................................................................... Design Flow........._ '-�. .6".......................gallons per person per day. Total daily flow.........3-Q-0....................gallons. WSeptic Tank—Liquid capacitylOQ_00gallons LengthS.W'.. Width..:_..1 n.`1. Diameter................ Depth. .. -_._ x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I........... Diameter.....10......... Depth below inlet...47.... Total leaching area.Z`7...sq. ft. Z Other Distribution box ()4) Dosing tank ( ) Percolation Test Results Performed by._. ' P11. _.;�q0_.S-!kVf--5V._.mow N-SVI.TAOMate.... .77 Test Pit No. 1..... .......minutes per inch Depth of Test it------ . ........ Depth to ground wa (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground v� ..............' Pi ...............••---••-•-.........................---•-•-•......----•-............•..........--•-•••--................---= ..... O Description of Soil-7M_0t_''�8..... ��_, /.� -7-� p�4._f` yQ 1L.-•-----------------•--- `''a iiyrj ?A .'li.. 4 to CG..........vr ' ._.T SALT `_CG.A._ ..:./!!t�3?�. P---------------------- ----- ---------------------`' -•. -- v -- - - - � -- - - 5F3NQ.. '`.. _i/g4V. • >� V Nature of Repairs or Alterations—Answer when applicable.................................................. �.. Agreement: u0« 3-V-&7 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T Ll,: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in er ion u til a Certi of Compliance has been issued by the board of health. Signed...................................................................................... ................................ • Date A� ica on At r ved B ..... Y1 n-• ..-.- r Date App • ion Disapproved for the following easons:----••--•-----••-••--------•----•-----•••-••---••--••••------•••---•-•-------••---•-----•-• at.e------------- ................•---•--•---•------•-•---•...........-•----••...-••---------••-••------.......-••----•-----•.............----•-------.......-•-•---•----•--•--------------•--•-••----••••--•--•---------- 3 �•- Date Permit No......... Y........................ Issued........................................... at------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF....... .! '--?...................................................... (9ertif irate of Tontplionrr y --_.� TIFY, That the Individual Sewage Disposal System constructed�(- or Repaired (. ) �. _ Installer -----------------•--..........._...._.......---•---------.... ' at...................-=- ......... '- has been installed in accordance with the provisions of T_" '' f The State Sanitary •de as d **bed in the application for Disposal Works Construction Permit No..� 3 ................... da.ted_.... ".__�...._�___!__........._....... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION/ SATISFACTORY. DATE...................... CP...'./� ?. .................... Inspector................ .....yL .................................................. do THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f ..........................................OF...........:.. 'J ....... =........... \ No.---•--•................. FEE....!. _............. Dispr i q1 orko Cho otrnrtion erritit t Permissio is hereby granted....-^ - lS- to Construct ( ) or Repair ( ) an Indiyidua ewage_Disposal S stem j at No."--= '... -5--------- .t:T�.�- ....... �1Q - ..•----- ---- as shown on the application for Disposal Works Constructio Permit Street o �` _ Dated-4------ ..� -7- DATE ..._.. {' 1�' ..... oard of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS "'- SOIL TEST PIT DATA: SEPTIC TANK DETAIL: 1 000 GAL DISTRIBUTION BOX DETAIL: LEACHINGPIT DETAIL: REVISIONS� INDICATES INDICATES PERC. OBSERVED NOT TO SCALE NOT TO SCALE SCALE NO DAT E P- 554-Z TEST GROUNDWATER MANHOLE COVER LOAM A SEED, NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON, NO. OF OUTLETS: BROUGHT TO FINISWGRADEi OR PAVEMENT -IN-PLACE CONCRETE.TEES TP Lor 8 TP TP TP REINFORCED CONCRETE. SCHEa 40 PVC OR CAST NOTES! f I f I i t TO BE CENTERED UNDER MANHOLE COVER. GRD. EL.. 87. Q GRD. EL. GRD. EL. GRD. EL. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING I. DIST BOX TO WITHSTAND H-10 LOADING 2 �MIN OF 1/8 UNLESS UNDER PAVEMENT, DRIVES OR UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" T-11, GW. EL. AJO IALEP- GW. EL. GW. EL. GW. EL. [2 IN SHALL'APPLY. _j PRECAST TRAVELED WAYS WHEREIN H-20 LOADING STONE TRAVELED WAYS,WHEREIN H-20 LOADING WASHED, T SHALL APPLY. DIST. 0 Fs 61 L 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER 4f CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF C1 C:3 C= C=3 C= �C= cm C:3 13 .5.L4 5:5.40 1 L INLET PIPE EXCEEDS 0.08 FT/FT OR IN VC INLET PIPE COMPAc- :5fL_:--k PUMPED SYSTEM. MIN, (t= cm t= C3 a NOTE- GENERAL NOTES: Ci�A 1-f (Ako—,LE:0) 12 3. FIRST TWO FEET OF PIPE OUT OF DIST I , . 11 COVER X LEA&ING PIT 10 ' �' I'_ 1. THIS PLAN IS FOR DESIGN AND BOX TO BE LMD LEVEL. 0. 1. 6 ab c= c= c= C3 tn a �WITHSTAND H4O;LOADiNG Uj =3 UNLESS UNDER PLAN VIEW 0 CONSTRUCTION OF THE SEWAGE PRECAS REMOVEABLE T PAVEMENT,DRIVE Ott DISPOSAL FACILITY ONLY. L 7 NORMAL WATER LEVEL _COVER w 3/4'TO 1-1/2" 06 C:3 m c= c= c3 r-3 a TRAVELED WAYWHEREIN I I ODS AND 2. ALL CONSTRUCTION METH > H-20 LOADING SHALL 5 DOUBLE LEACHING PIT 61 6 MATERIALS SHALL CONFORM TO MASS. 0 WASHED m6 rm c= c=3 =r c3 I= c - APPLY. D.E.Q.E. TITLE 5 AND LOCAL BOARD STO PROVIDE Uj NE U_ INLET TEE WATERTIGFHT U_ OF HEALTH REGULATIONS. yp) S7R_ATi F el JOIP �yp) =3 C= C-12 0 0 r-3 t= C3 a -4r P;ECAST 4'-0" MIN. OUTLET EE 3. ALL PIPES LOCATED UNDER PAVEMENT EPTIC IL'_ LIOU10 DEPTH TEE I or- NOTE 2 OR TRAVELED SHALL BE SCHEDULE 4" INLET TANK 0 C7 C3 Ct3 C3 C3 n 40 OR EQUAL. L I A (le O:op, BOTTOM ON LEVEL STABLE SASE < OTTOM ON .2% TABLE LEVEL S CROSS-SECTION BASE /0 DIA. PLAN VIEW CROSS-SECTION VIEW /kID SECTION 1.44- CONSTRUCTION NOTES: DATE: DATE:' DATE: DATE: INVERT ELEVATIONS: 1. IF ENCOUNTERED, ALL UNSUITABLE SOIL SHALL BE. REMOVED WITHI-h A WIDE TEST BY: TEST BY: TEST BY: TEST BY: 4" INVERT AT BUILDING ZONE -AROUND THE LEACHING FACILITY 2-s AND SHALL SE REPLACED- WITH'CLEAN WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: j 4" INVERT AT SEPTIC TANKOO SA I ND AND GRAV.EL IN AC-CORDANCt-,WITH 4m INVERT AT SEPTIC TANK(out) TITLE M. PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: 05 4.' INVERT AT DIST. BOX(in) MIN./INCH MINdINCH MIN./IINCH MIN./IINCH 40 INVERT AT DIST. BOX(out) 11 NIF cb CENTERVILLE - OSTERVILLE I INVERTS AT LEACHING FACILITY: DATUM: FIRE DISTRICT VERTICAL DATUM: - ASSUMED IAJ 1/8)CT A P 7(1,-4) 6 5 , 4 7 SEE PLAN BENCH MARK USED: B077-6,k4 Or- c-67AC-N Frr -7 to— G7) k5\ V OBSERVED GROUNDWATER , C) ELEVATION z�- co" Z� Q1 _4v J�EL� ZONE: RF I %IA S FRONT 301 - Clz DESIGN CRITrt-:-:- ETBACKS; d) I v "IN, -7 _7� v, SIDE 15/ REAR 151 v A f DESIGN FLOW: BEDROOMS AT //0 G.P.B./D G.P.D. QN 4- 0? i I The BS C Group J f I REQUIRED SEPTIC TANK: x GAL. SEPTIC TANK PROVIDED: C 57,C-2 G AL. tot, NOTES: Iwo Cape Cod Survey Consultants PROPERTY LINES SHOWN HEREON WERE COMPILED I -r.4 Aj K 5 SIZE OF LEACHING FACILITY REQUIRED: FROM A PLAN RECORDED AT THE BARNSTABLE L DESIGN PERC. RATE: MINJINCH TE!s REGISTRY OF DEEDS IN PLAN BOOK 429 PAGE 58 /0 Irl Cm 04 1 r P.7--, 3261 Main Street I - -D- AND DOES NOT REPRESENT AN ACTUAL SURVEY ON I Route 6A, Barnstable Village MA 02630 THE GROUND. P MADE ON 1 617 362 8133 THIS TOPOGRAPHIC SURVEY WAS i 45 THE GROUND BY TRANSIT AND STADIA METHOD K9 PROJECT TITLE. SIZE OF LEACHING FACILITY PROVIDED: ON MAY, 1,970 W 1�v 7- Z5'710^.46- _\x SEWAGE DISPOSAL 417-7-j SYSTEM DESIGN e, 45 6�, 0 C 40A4 ILL -S-1rxz._ 00- cl) -,�77*�)/t4_ 79 0 r '000 COD FOR 0\ -5 7 0/> LOT 8 LITTLE POND SCALE: 1"-20831+ ESTATES LOCUS PLAN: IN 1 � LOT 9 03 B.M.EL-100.00' - C.BIDJ-1. AT NA NIF BARNSTABLE, MA 0 COR.OF LOT 7. CAPRICORN REALTY TRUST (MARSTONS MILLS) PREPARED FOR: Co -SSIONAL ENGINEER CIVIL LOT 16 DATE PROF'k LOT 5 LOCUS CAPRICORN REALTY \'c I 1� -1, NIF IX TRUST CAPRICORN REALTY TRUST N LITTLE POND RACE LANE 49 E7 L. DATE: FEBRUARY 27J987 F1 14 -1C LAKE Ti MYS7 COMP/DESIGN� 7 No. 29869 W, A; CHECK: S LO P-1 EF S/4&' DRAWN Rj1H TAX. 6 -6 ' PLAN VIEW DATE PROFESSIONAL LAND SURVEYOR SCALE: 1' ZO 8.M.EL=63.8r - C.B.ID.H. AT NA FIELD� WB. FILE NO. 3138606SS.2D COR. OF PLISKIN LOT. FEET DWG, N 0� 1247-6 SHEET 0, to zo 4-0 JOB NO' 3J386& I OF 7