HomeMy WebLinkAbout0045 ABEGALE SNOW ROAD - Health 45 NOI: \u Snow Road
W. Barnstable
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CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory (M-MA009)
r � .
Report Prepared For: Report Dated: 03/27/2014
Brennan
Brennan Order No.: G1479099
45 Abegale Snow Road
W Barnstable, MA 02668
Laboratory ID#: 1479099-01 Description: Water-Drinking Water
Sample#: Sample Location: 45 Abegale Snow Road W Barnstable, M Collected: 03/24/2014
Collected by: Received: 03/24/2014
Test Parameters
ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE .
Total Coliform 0(46) /100ml- 0 0 MF-SM9222B RG 03/24/2014
Water sample meets the recommended limits for drinking water of all the above tested parameters. Note: The total
coliform analysis was subcontracted to Envirotech Laboratory.
Attached please find the laboratory certified parameter list. Approved By:
(Lab Manager)
a`
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, P0. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
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. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Chad Hathaway
use the return Name of Inspector
key.
H.P.S.
� Company Name
P.O.Box 151
Company Address
Forestdale Ma 02644
City/Town State Zip Code
774-274-2581 12866
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 -
3/24/14 --
Inspector's Sign re Date ° M
The system inspector shall submi /Copyof 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.
1
t5ins.3/13 Title 5 Official Inspection Form: bs ace Sewage Disposal System•Page 1 or 17
l
Commonwealth of Massachusetts
OF Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
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 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not'evaluated are
indicated below.
Comments:
1500 gal tank pumped as part of inspection. tees in place. no leaks or cracks. Dbox small amount of
carry overs no leaks or cracks . leaching chambers where dry at time of inspection. no high water
stains to indicate past failure.
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.
Check the box for"yes", "no"or"not determined" (Y, N, ND)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.
❑ Y ❑ N ❑ ND(Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 17
n
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
lw 0-
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ 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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
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
t5ins•3113 Title 5 Official Ins
pection Form:Subsurface Sewage Disposal System•Page 3 of 17
M
Commonwealth of Massachusetts
UVTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every west Barnstable Ma 02630 3124/14
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance: 200+
**This asses system if the well water analysis, performed y p y , perfo ed 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 must
be attached to this form.
3. Other:
sample was taken and sent to barstble lab. as required by town.
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 %day flow
t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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.
❑ ® 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
❑ El Area
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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail
not metered on well
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment: current
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:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of oc:upancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: owner
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? tank size
Reason for pumping: maintenance
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)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GSM s 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2001
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.5'
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 40+feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 14"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: 0
Sludge depth: 0
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is
required for every West Barnstable Ma 02630 3/24/14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 0
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle 0
Distance from bottom of scum to bottom of outlet tee or baffle 0
How were dimensions determined? 00
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 pumped at inspection
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every west Barnstable Ma 02630 3/24/14
page. Citylrown 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.):
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):
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M z 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
in good condition no cracks or leaks
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No"
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
leaching chambers are dry
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ 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.):
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, 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.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
G M , 45 Abegale Snow Rd. -
Property Address
Brennan
Owner Owner's Name
information is required for every West Barnstable Ma 02630 3/24/14
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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:2) 3'5 ' j) 3-)'V
3) 43 't," 3) 4IGt
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0 6 3
i a d y
Er
9
o WR I�
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4M '0 45 Abegale Snow Rd.
Property Address
Brennan
Owner Owners Name
information is required for every West Barnstable Ma 02630 3/24/14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
i ® Surface water
® Check cellar
® Shallow wells
Estimated dept) to high ground water: feet
Please indicate all methods used to determine the 9
high round water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 2001
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:
no g/w on plan test holes no g/w 120"
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
45 Abegale Snow Rd.
Property Address
Brennan
Owner Owner's Name
information is West Barnstable Ma 02630 3/24/14
required for every
page. Citylrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Info-mation—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Sep 26 02 03: 55p 5087780770 5087780770 P. 3
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VILLAGE ASSESSOR'S MAP & LOT 8$s
INSTALLF.R'S NAME&PHONE NO. ��f �� °`"� "- 002
SEPTIC TANK CAPACITY QD
LEACHING FACILITY: (type) U �+�l y' C�Ynw� (size)
NO.OF BEDROOMS
I BUILDER OR OWNER
G
PERMIT DATE: (h`' l Z—A�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
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0[ppitratton for latooeal 6peum Con!5tructtott Vermtt
Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) EJ Complete System ❑Individual Components
LocaU'gp AdSrFs�gr Lqt_I 3 nw IO/wnefs's� e,AddreD an el,�i[yp�.r7�Q7 —(`l)2�y (�J
Assessor's Mapp//Pararcel�h� (,in;- 10 1(V(O �ry!I V -1 /�7O) )" /
Installe—r's N e,A T ress,and 1.No. �13 Des gner's N�,Add r and Tel.No. w
P.U,gUr wk Kukrjt Y�. (�V(:*tl f"fu)n 0 Tt, .1 14 G1
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Z)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures'
Design Flow H P10 gallons per day. Calculated daily flow HHC,> gallons.
Plan Date 44-ol Xurnbcr of sheet RevisiorvPate
Title `^f`.S' i GF767FJ ll,.�. s l//+� /�/l7►P�'C�•7.C17
Size of Septic Tank /Sto Type of S.A.S. JSw
Description of Soil d a ;lon &m
Nature of Repairs or Alterations(Answer when applicable).
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been ' ed th' card of Hea th.
Signe C Date
Application Approved by Date
If 71
Application Disapproved f r the following reasons
Permit No. Date Issued
elel
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer; .Yes �
x ,PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Z[�prication for'Migo�ar *pztem Cow5truction Vermit
�0o ,
Application fora Permit to Construct(X)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
ti
Locatio Addr sst�p�yy L t No. p 3 hGiJ Owner's Name,Addres and Tel.
<'Assessor s Map/Parcel
~ j j, ( l»� ID I I v rrL /� CJCz'i/
Installer's N j e,Address,and Tel.No. ?y I)esi ner's Nar`�e,Add and Tel.No.
('S � �.7�cJ' �GL�fti (t.Gr��. (CSC/ �(i/�7.
fi
Type of Building: i r
Dwelling No.of Bedrooms ! Lot Sizes sq. ft. Garbage Grinder(NO)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1 �C7 gallons per day. Calculated daily flow ��� gallons.
Plan Date 44 0) XumbFPf sheets/ ` Revisio ate
- Title /i/k S" c G f.7 h6-, (?c4-,s r, 11rn. '. /WE,"
Size of Septic Tarik I.QZC� Type of S.A.S. �� "'���i
Description of Soil !!JP f1
_s
-Nature of Repairs or Alterations(Answer when applicable) ✓,�
. i
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 f the Environmental Code and not to place the system in operation until a Certifi-.
k «
cate of Compliance has been ' sued thi oard of Heal h.
Signe /1 //UIi A �-> Date
Application Approved by Date
`* Application Disapproved f r the following reasons
Permit No. UU Date Issued r
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( )
Abandoned( )by v.
atrY-- A(9«� 'r t ~ l�J ci r�1yF �' h�s��e constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No ,••� dated - tA'/
Installer Designer 1
The issuance f thip permit shall not be construed as a guarantee that the syste wt uncfion as desi heod.
Date /°l 1 2 Inspector '�
y—.----r---------------- -- ------ ---- ._ .
No. �, � Fee ✓-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Xh6po0a[ *p$tem Construction Vermtt
Permission is hereby gia�nfed3to CAVst uct(�,'�):�Zepair(t,,�,)iJ, gralle( )Abandon( )
System located at 77__ ��
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit
/ r
Date: ! J yI�� Approved by
• 1 r
f
ENVIROTECHLABORATORIES,INC. `
MA CERT.NO.:M-MA 063
449 Me.130
Sandwich, MA 02563
508(888-6460) 1-800-339-6460
FAX(508)888-6446
CLIENT: Markwood Corporation LOCATION: Lot 3
ADDRESS: 110 Breeds Hill Rd Abigale Snow Rd
Unit 10 W Barnstable ma 02668
Hyannis MA 02601
COLLECTED BY. D Pennini/DA Scannell SAMPLE DATE: 5/2/2001
SAMPLE TIME. 12:00
WATER SAMPLE TYPE. New Well DATE RECEIVED: 5/2/2001
LAB LD. #: 0105059
WELL SPECS.: 109,
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date AnaWed
Limits
Coliform bacteria /100ml 0 0 9222 B 5/2/2001
pH pH units 6.5-8.5 5.96 4500 H+ 5/2/2001
Conductance umhos/cm 500 67 120.1 5/2/2001
Nitrate-N mg/L 10.0 < 0.005 300.0 5/2/2001
Nitrite-N mg/L 1.00 < 0.003 300.0 5/2/2001
Sodium mg/L 28.0 7.2 200.7 5/3/2001
Iron mg/L 0.3 < 0.1 200.7 5/3/2001
Manganese mg/L 0.05 < 0.008 200.7 5/3/2001
Volatile Organics See Report
Chloroform ug/L 100 3.8 EPA 524.2 5/11/01
Tdchloroethene ug/L 5 1.7 EPA 524.2 5/11/01
COMMENTS: Low pH indicates high corrosive characteristics.
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
<=less than Date ZU�
>=greater than Ronal J. Saari
TNTC=too numerous to count Laborkory Dire r
Page 6 of 9
R.I. Analytical Laboratories, Inc.
r�
CERTIFICATE OF ANALYSIS
Envirotech Laboratories, Inc.
Date Received: 5/03/01 Approved by:
Work Order# 0105-04991 R.1. Analytical
Sample#: 003
SAMPLE DESCRIPTION: 0105059 LOT 3 GRAB 05/02/01 @1200
SAMPLE DET. ANALYZED
PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST
Volatile Organic Compounds
Bromodichloromethane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Bromoform <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
Dibromochloromethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Chloroform 3.8 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
1,2-Dibromoethane('EDB) <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Benzene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
1,2-Dichloroethane <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Trichloroethene 1.7 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
1,4-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
l,l-Dichloroethane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
1,1,1-Trcchloroethane <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Bromobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Bromomethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Chlorobenzene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Chloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Chloromethane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
2-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Dibromomethane <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
1,3-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
1,2-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
trans-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
cis-1,2-Dichloroethene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
Methylene Chloride <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
l,l-Dichloropropene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
1,2-1)ichloropropane <0.5 0.5 ug/1 EPA 524.2 5111101 14:58 JL
1,3-Dichloropropane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
tran-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
2,2-Dichloropropane <0.5 0,5 ug/l EPA.524.2 5111101 14:58 JL
Ethylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Styrene <0.5 0.5 ug/1 EPA 524.2 5111101 14:58 JL
!,1,2-Trichloroethane <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
1,1,1,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
1,1,2,2-Tetrachloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Page 7 of 9
R.I. Analytical Laboratories, Inc.
CERTIFICATE OF ANALYSIS
Envirotech Laboratories, Inc.
Date Received: 5/03/01 Approved by:
Work Order# 0105-04991 R.I. Analytical /
Sample#: 003
0105059 LOT 3 GRAB 05/02/01 @1200
SAMPLE DET. ANALYZED
PARAMETER RESULTS LMT UNITS METHOD DATE/TIME ANALYST
Tetrachloroethene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
1,2,3-Trichloropropane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Toluene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Xylenes <0.5 0.5 ug/1 EPA 524.2 5111101 14:58 JL
1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Bromochloromethane <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
n-Butylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Dichlorodifluoromethane <0.5 0.5 ug/l EPA 524.2 5/11/01 14:58 JL
Trichlorofluoromethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Hexachlorobutadiene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
Isopropylbenzene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
p-Isopropyltoluene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
Naphthalene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
n-Propylbenzene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
sec-Butylbenzene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
tert-Butylbenzene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
1,2,3-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 5/I1/01 14:58 JL
1,2,4-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 5/11/01 14:58 JL
1,2,4-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 14:58 JL
1,3,5-Trimethylbenzene <0.5 0.5 ug/1 EPA 524.2 5/11/01 14:58 JL
Methyl Tertiary Butyl Ether <I i ug/I EPA 524.2 5111101 14:58 JL
n-Hexane <10 10 ug/l EPA 524.2 5/11/01 14:58 JL
SURROGATES RANGE EPA 524.2 5111101 14:58 JL
4-Bromofluorobenzene 118 80-120% EPA 524.2 5/11/01 14:58 JL
1,2-Dichlorobenzene-d4 114 80-120% EPA 524.2 5/11/01 14:58 JL
LEGEND ASSESSORS MAP: 88 PARCELS: 1 & 2
PROPOSED WATER WELL ZONING DISTRICT: RF
-16--- EXISTING CONTOUR MINIMUM YARD SETBACI<S:*
X 16 EXISTING SPOT GRADE FRONT = 30' SITE LOCUS S'OAIL
--16-- PROPOSED CONTOUR REAR = 15' show Ro
THI SOIL TEST HOLE
SEE TEST HOLE LOG(S) FLOOD ZONE: "C" BARNSTABLE sF� ���
a UTILITY POLE COMMUNITY PANEL 25001 0001 D
e JULY 2, 1992 F
0
O CATCH BASIN GROUNDWATER OVERLAY DISTRICT: AP
PLAN REF: BOOK 558 ?A/GE 13 LOCUS MAP
NOT ALL SYMBOLS MAY APPEAR IN DRAWING SCALE. MM
PLAN REF:. BOOK 556 PAGE 38
Ln
�133
BENCHMARK 0(-� :I _3 4 �' �(� �� *VERIFY WITH TOWN OF ICIALS
3 i
•� � CATCH BASIN
ELEV - 128.26'
EM _
C, INA A M N _
_ d- " ACCESS COVER (WATERTIGHT) TO
ACCESS COVER TO WITHIN 6 OF FIN. GRADE WITHIN 6" OF FIN. GRADE
/ / = ��LECTR _�= TOP OF FNDN AT EL. 122,5'
PROP SED 1�lX fgAotL� GROUND SURFACE AT EL. 1120.6't '
W I ' s L _ GROUND SURFACE AT EL. 121.0 t /-GROUND SURFACE AT EL. 122.0 t
�' >
�k• 3-_ 0-V� MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM
ILIT
BUSTER I l �� O -� RUN F!PE L VEL 2" DOUBLE WASHED PEASTONE
ELEC, T>rL,, CATV / �--�� �
�9Z11 -� PROPOSED 1,500 FOR F;RST 2 119.0
Ei� �` - P_ 1 19.37 �-�. GALLON SEPTIC
1 18.76'
. 1 119 0
i t ELL TANK (H-i 0} A o a 3°5' o SIDEs
co �«� 118.53 118.5
n' BATTLE 1 '18.7 2 o ENDS
DEPTH OF FLOW = 4'
�p TEE SIZES: _„ �6" CRUSHED STONE1 22102 MECHANICAL 2 r14INLET DEPTH = 10 MIN BELOW FLOW LINE COMPACT ON. ( [. ]) $ fts - 116.5'
1 1 5 OUTLET DEPTH 14" MIN BELOW FLOW LINE
3/4" TO 1 1/2" DOUBLE WASHED STONE
OT3 '' `J -� (MIN 2� SLOPE) (MIN 1% SLOPE) (MIN 1q SLOPE} .
s t- --- --- ._..._„3 - 5.5
`� FOUNDATION 18' SEPTIC TANK 6� D" BOX 5 LEACHING FACILITY
---- '/ R P 6�. N -
- - %I If�T ►1 x oc BOTTOM OF TEST HOLE AT EL.
( SYSTEM PROF'I.
\ ,Z�s (NOT TO SCALE) k
D DWELLING 9 1 PLOP E 1 , o A o 3) q
qDN = 122.0 I N c
PROPOSED DWELLING
TEES T )
TOP OF F NDN = 122.5
T.H6
DEPTH (IN.) ELEVATION (FT,)
DEPTH (IN.) TH5 ELEVATION (FT.)
I a
„ ow 121.5
121.0
_.,
120
z t Zze-_ D- BOX ,3�.. \ 1 YR 2/1
I \ �\.,_\ ' ��� 7" 10 YR L/ 120.42 7 _ _ 120.42 _
FINE SANLI DATE: MAF�Ct'i 20,' 2001 Flilw SAND
P
,
�. P LS YR 6 �2 r A E 1C s ENGINEER: ARN H. OJ LA
N E ,
z - � EN., EE /c
-� 1 YR 6/2 ._ 120.75
9
w _
----szc 120.25 WITNESS. GLEN HARRINGTON, RS
EXCAVATOR: BORTOLOTTI B t
LOAMY SAND Lf::-,MY SAND
9 -` ---� -- - 2.5 Y 5 6 2. 5 Y 5/6
- - - _ --
c - - - /
SOIL CLASS:
„
36 118.5
o 40 117.67
PERC RATE; <5 MIN./INCH
r
19 r C
R C
1 RO G I IN�ITRATfl S - �- ti� 'r '
N- AR D
.A �:; SE SA
8 F 0
E-
•, M OARSE_SAND
ED C
F T N A S 2 T �� ,r / .zF t I H .5 S 0 F1�._T._._AT �--�, /
1 2 COBBLES
" 1
9 & COBBLES
E
AN 1 N � ti
2._ Y 6
2.5 Y 6 2
120 111.5
c
11.0
Est 12 0 1
- --- / W T R FOUND "
A
FOUND
NO E
zc ---- ��t-� NO WATER OU D
/ ;,
,., � NOTES:
50,609 SFt /LOT 3cc"t i-
11 A R
i
TEST HOLE LOGS
6 C Et
ON
o UTILITIES SHOWN c R ROUND U IL ES
IN UNDERGROUND
F EXISTING G U DE N S� LOCATION 0 E
ttt
1 . THE LOC
--------- NOT -ro SCALE),
ON THIS
T ANY EXCAVATION
HI PLAN IS APPROXIMATE. PRIOR 0
at
THIS
s
REQUIRED 72 'THE E
1 H EXCAVATING CONTRACTOR SHALL MAKE E EQ
SITE, THE E G
SAFE 1 -8 8-344-7233 AND ANY
T FI ATI N TO DIG S E $
HOUR NO I C 0 ( )
PIP R EQUIPMENT
A E
i OTHER UTILITIES WHICH MAY HAVE CABLE, 0 Q
1sA I �fNFI/TRAT 15
(1) 0 (6) HIGkI EA C L C
WITH 5' OF STONE AT Tt-t SIDES, 2�'�A THE IN THE CONSTRUCTION AREA FOR VERIFICATION OF LOCATIONS,
ENDS, N.D_7�"--GENE SEPTIC SYSTEM DESIGN DATA 2, MUNICIPAL WATER IS UNAVAILABLE.
3. ALL SEPTIC WORK AND MATERIALS TO CONFORM TO 310 CMR
SEPTIC DESIGN: GARBAGE DISPOSER IS NOT ALLOWED)
( 15,00 TITLE 5 AND BARNSTABLE HEALTH REGULATIONS.
1 PRFOT.
T 8 E 0
PITH 0 BE_ MINIMUM PIP C 4. MIN U E
P - 440 GPD /
1 11 G D M 0 4 BEDROOMS FLOW: BED 00
DESIGN )
SEPTIC TANK: 440 GPD ( 2 ) 880 5, DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H--10.
SEPTIC TANK
6, PIPE JOINTS TO BE MADE WATERTIGHT,
C SE
S A 150C? GALLON
U E
I7° WATER TEST D-BOX FOR LEVELNESS.
H LEAC LNG:
AN NOT TO BE
FOR PROPOSED WORK ONLY D
I 0 THIS PLAN S
8. S LA
BO
TTOM:
TTOM: 41.5 X 9.83 = 408 S.F.
v�
N STAKING.
F T LINE S G.
�. USED OR LO
_.
SIDES: 2(41 .5 + 9.83)-X 2 205 S.F.
( T H. 40-4 PVC,
I SYSTEM TO SC PT S
< �fi TOTAL: 613 S.F. X 0,74 LTAR = 454 GPD > 440 O.K.
9. PIPE FOR SEPTIC S E
e 10. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
c 0 �- INFILTRATORS PERMISSION OBTAINED
SITE PLAN F 6 HIGH CAPACITY IN L s AR F HEALTH AND PERMISS 0 OB E
US 1 ROW O INSPECTION BY BOARD 0
N
S 2 AT THE ENDS,
AT THE E ,
A 1 30 TN E5D ,SCALE: H F STONE T.5 0 0 F HEALTH.
H.
FROM BOARD 0 E L
d
04t) AND 14 BENEATH 11. NO VEHICLES OR CONSTRUCTION EQUIPMENT ALLOWED OVER
PROPOSED SYSTEM,
Al
0 OSED
G�
M APPROXIMATED FROM QUAD
1 VERTICAL DATUM 0
(3) s-00
2.
z.
S �U
1
r
G
f
TITLE 5 SITE PLA
N
OF
s - -4 41
off 508 362 5
i x 6 98 80� 508 3 2 SNOW ROAD
LOT 3 ABIGALE
i H TOWN OF:
N THE
inc.
down ca e engineering, WEST BARNSTABLE
p
E
tN OF
1.
F R•PREPARED 0 .
tN•Of 011j.
LENGINEERS
I E
CIVIL E G
C W
R to
TIM PEA RSON MARK OOD
H.
of �
RNE
s'.
WA n o
A
LA
H.
OVSURVEYORS
I �c -, LAND
No- y �3 OJALA
a079 30 0 30 60 90
y Noa 26��+8 � .
-
F�' TERE\���Q �� IST �v`" y BOARD OF HEALTH main St, Cil"I1'lOUth CY1G 0267`J
939 a
- - MA _ 30' APRIL 2, 2001
-- 1 --L ARNE H. OJALA, PE PLS DATE: APPROVED DATE SCALE: 1 DATE:
00 09 3