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HomeMy WebLinkAbout0175 CARLSON LANE - Health LA CARLSON- L W.BARNSTAB10.028 l B a TOWN®F BARNSTABLE ocA I�zON SEWAGE t# 'LLAGE' G✓. �/�►s �_ ASSESSOR'S MAP& LOT--. -----.-- NSTALLER'S NAME&PHONE NO. EP"nC TANK CAPACrry EACT.-LUNIG 1, FACILITY: (type) 6i446C✓S - ---- (size) rO.OF BEDROOMS.,_. ilJ"1LDER OR OWNER ERh I TI)A'TE: COMPLIANCE-DATE: paration Distance Between(be: 7aximum Adjuste d'Groundwater Table to the Bottom of Leaching Facility Feet tivtate Water Supply Wdl and Leaching Facility,(if any wds,exist on site or Within 200 feat of leaching facility) eet Jge of Wcdand wid Leaching Facility(if any wetlands exist Y within 300 feet of aching.facility) � i~eet wrnishcd by aNp,n/f/�` �< �.! f CA 00 fii l- - 73 ` 78 n � r _ TOWN OF BARNSTABLE LOCATION 17S 6me-lank ekJ SEWAGE #d0a 9 a301 VILLAGE 44 lar-ilal/e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) FOO G� L C ���3 (size) /3,1- YcA �ea NO.OF BEDROOMS_ BUILDER OR PERMTTDATE: 5, I o 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) �3�jJ Feet Edge of Wetland and Leaching Facility(If any wetlands exist ' within 300 feet of leaching facility) Feet Furnished by L dwy Ca>z 6wi�e�ry4 �i rV-14 1A ' �2 f-7'(, d q3- S< `6'` 43- &i ` r 1 © � 1 1. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name L for inmation is Barnstable ��s-IV ej�,(�J MA_ 02668 2-28-11 information a aa fnr vru 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. A. General Information 1. Inspector. I� Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 valuation by the Local Approving Authority 2-28-11 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Di p sal System Faye--wr 17 I , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of 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): 4 t'` 1 t5ins-'11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 official Form Inspection u p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town 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 Y 9 P 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: ** 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 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 '/ day flow t5ins•11/10 Title 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 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 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`fifes"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 El 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2-28-11 D ate 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: t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: p g Source of information: Owner--pumped 2008 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page,. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: " 24 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"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 gal Sludge depth: 12" t5ins-11/10 Tittle 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 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 ` page. City/Town 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 20" Scum thickness 1 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 151, How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. 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•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name required fo is Barnstable MA 02668 2-28-11 required for 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.): 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is Barnstable MA 02668 2-28-11 required for every page. City/Town 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.): Good condition with water at working level and no sign of back-up from chambers. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 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 �M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-500's ❑ 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.): Leach chambers in good condition and empty at inspection with no visible stain lines. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town 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•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town 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 CA IC d;,, ey 'Le'.t-e_k , �- -1- 73 ` 4e-1-" 7,? ' r r t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high round water: 50' p g g feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 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 �.y 175 Carlson Ln Property Address Todd Machnik Owner Owner's Name information is required for every Barnstable MA 02668 2-28-11 page. City/Town 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 Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: •➢ VYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for &5po-qal *p-5tem Construction Permit Application for a Permit to Construct( )Repair(C4 Upgrade( )Abandon( ) El Complete System E Individual Components Location Address or Lot No. l y Owner's Name,Address and Tel.No. Assessor's Map/Parcel yT,%/e `57?,�-e, Installer's Name,Address,and Tel.No. ,Gl�"" Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder("&�V Other Type of Building C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �6® gallons. Plan Date S /. D Number of sheets Revision Date Title C1' 0a ^1SV e Size of Septic Tank ISVP Type of S.A.S. --5`0PZ7 4WI 4 Description of Soil 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 issued b his o of ealth. f/ Signed 0 Date 5_!/ Application Approved by Date Application Disapproved or the following reas s Permit No. Date Issued ZANo. � 1. w ' .,. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered'incomputer: r VY- PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLES MASSACHUSETTS r ZIppYication for Migoar *pgtem (Construction Permit a Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) EJ Complete System fIndividual Components Location Address or Lot No. /'7►5 Cjfls��, h Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �/ Vt Designer's Name,Address and Tel.No. 1;�ei CD`IST Type of Building: Dwelling No.of Bedrooms '7 Lot Size sq. ft. Garbage Grinder Other Type of Building RP21 �PeCeNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 5 151, Number of sheets Revision Date Title 1 S)fP lan �� /ZE C0/�Sl�il w� _ /`e5 A of Size of Septic Tank /ADD Type of S.A.S. /y ADD �4 �PQC Description of Soil K�1 i19�� s ��zX�3X,? 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: fA t Agreement: The undersigned agreeseto 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 is ued b his Board of e .1th. Signed � i9 �_ Date Application Approved by /!Vt4r /1, l �r �� �l �� Date Application Disapproved for the following reasons / 9t ' Mt � l Permit No. Date Issued 1-5 r •_ r � f _ WeA 105 ,,n +r �;:�,, THE COMMONWEALTH OF MASSACHUSETTS \• � �V11 �BAR'NSTABLE, MASSACHUSETTS S.ft-ttifiCate of Compliance THIS IS TO CER, FY, tha then-site Sewage Disposal System Constructed( )Repaired (� Upgraded ( ) Abandoned( )b Ael I-� </ / COBS�' at K CP'r 1SD'p n. Lt/ , �A//95 �� j thasrbpeaconstructed in accordance with the provisions of Tidl 5 and the for Disposal System Construction Permit No dated Installer ' e)0+10 jW Designer��iJn�G�. The issuance of s ermit hall not be construed as a guarantee that the s� 11 f nc '. as designed. Date�3��Inspector �� _— v — No. — — ————————————=———=————————Feed 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpoq;at *pgtem Construction Permit Permission is hereby granted to Construct(� )Rep it(✓)Upgrade( )Abandon System located at / ?S GG4'r`15©-1 14 e tl 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 mustibe codipleted ithin three years of the date of thi ermiR�_X Date:_ /t Approved by ) 1 1l 6� V ,r TOWN OF BARNSTABLE LOCATION /7S 2le` ' ekJ SEWAGE #diX y S22 VU LAGE W �a.x:.^><���� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 64/d/iL .�&KIXOSJ ya�-Wz*- SEPTIC TANK CAPACITY /SZV u C LEACHING FACILITY:.(type) e'4-,,g 6�-3 &) (size) NO.OF BEDROOMS BUILDER OR PERMITDATE: > > 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 / Feet within 300 feet of leaching facility) Furnished by Dukay 6.4 rrrrv'•�ra� I D P14 w CA Q i �l 1 j TOWN OF BARNSTABLE LOCATION Pd�J �, ` SEWAGE VILLA , ��/������� ASSESSOR'S MAP & INSTALLER'S NAME fa PHONE NO. LOT SEPTIC TANK CAPACITY LEACHING FACILITY:(type) S,-� �. (size)/3.I��,jx� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No CERTIFICATE OF ANALYSIS Page: Barnstable County Health Laboratory Report Prepared For: Report Dated: 4/14/2004 Order Number: G0424694 Todd Machnik MAP � 727 Main Street A2 PARCEL : OZ'g Osterville, MA 02655 LOB" Laboratory ID#: 0424694-01 Description: `�yatetyl)rinkingWater._— Sample#: 24694 Sampling Location:•-175_Carlson Lane West BarnStable.MA' Collected 4/7/2004 Collected by: T Machnik Received 4/7/2004 6L Routine �1.. ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab / Nitrates 1.5 mg/L 0.1 10 EPA 300.0 4/7/2004 LAB: jIfetals .Copper <0,1 mg/L 0.1 1.3 SM 311113 4/8/2004— Iron Iron <0.1 mg/L 0.1 0.3 SM 311113 4/8/2004 Sodium 14 mg/L 1.0 20 SM 311113 4/8/2004 LAB: Alicrobiology Total Coliform Absent P/A 0 Absent 307 4/7/2004 LAB: Physical Chemistry Conductance 360 umohs/cm 1 EPA 120.1 4/7/2004 pH 8.1 pl-l-units 0 EPA 150.1 4/7/2004 Note: Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: <f727-- --- --- --- -- Director) RECE1VEp s. >;.: APB 2 2 2004 } r TOWN OF TH DEP HEAL ABLE Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 JUL-01-2004 08 :56 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01 ' Town of Barnstable Regulatory Services Thomas F. Ceiler, Director Public Health Diviision Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Ot'ilce: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# Z�V LZ,�OA,ssessor's Map\Parcel //0 C Designer: 46wc4 Installer: Ad /'11 Address: , i19�iaST Address:. On D0f/'4v �Cd�1� was issued a permit to install a (date (installer) septic system at _L—,,-- , __based on a design drawn by (address) AwOCW 6erlAeceoll it dated (d signer) I certify that the septic system referenced above was installed substantially according to the desi$rt, which may include minor approved chariges such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �6/62" - _ �„SH OF�Sn ARNE H"WcyCr (In ler's Signature) OJALA .. CIVIL N No. 3079 �o OP JI kliesignerys Signature) (Affix UftPAWOEmp Here) PLEASE RETURN TO BARNSTMLE PUBLIC HEALTH DMSIQN CERTIFICATE. QF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-AMILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TH&NK YOU. Q:Health/Septic/Designer Certification Form 3.26.04.doc Bottle Number: 857201 Date: 07/17/98 Of, B,y�� BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT r SUPERIOR COURT HOUSE BARNSTABLE,MASSACHUSETTS 02630 e 0 q S S PHONE:362-2511 LAB 337 Client: AGOSTINELLI , STEVE Collector: EDWARD MEEHAN Mailing 44 ST. JOSEPH ST Affiliation: WELL DRILLER Address : HYANNIS , MA 02601 Type of Supply: W Telephone: 775-0066 Well Depth: 95 FT Sample Location: CARLSON LANE-LOT 9 Date of Collection: 07/16/98 Town: WEST BARNSTABLE Date of Analvsis : 07/16/98 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100mL ABSENT 0 pH 6 . 6 Conductivity (micromhos/cm) 155 500 Iron (ppm) < 0 . 1 0 .3 Nitrate-Nitrogen (ppm) 0. 5 10 .0 Sodium (ppm) 17 20.0 Copper (ppm) < 0. 1 1 . 3 BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE `GIVEN: * Water sample meets the recommended limits for drinking water of all above tested parameters . Thomas F. Bourne, Laboratory Director Barnstable County Hzalth and Environmental Laboratory Superior Court 'House, Route 6A P.O. Box 427 Barnstable, MA 02630 (508) 362-2511 ext. 337 Volatile Organic Analysis Analytical Method: 524.2 Collection Date: 07/17/98 Date Received: 07/17/98 Analysis Date: 07/17/98 Client: STEVE AGOSTINELLI Mailing STEVE AGOSTINELLI Sample Location: LOT 9 Address: 44 ST JOSEPH STREET CARLSON LANE HYANNIS MA 02601 WEST BARNSTABLE Sample ID: 857901 Laboratory ID: 857901 Sample Description: PRIVATE WELL Compound Amount MCL Reporting Detected (ug/L) (ug/L) Limit (ug/L) Benzene BRL 5. 0 0.5 Bromobenzene BRL 0.5 Bromochloromethane BRL 0.5 Bromodichloromethane BRL 0.5 Bromoform BRL 0.5 Bromomethane BRL 0.5 n-Butylbenzene BRL 0.5 sec-Butylbenzene BRL 0.5 tert-Butylbenzene BRL 0.5 Carbon tetrachloride BRL 5.0 0.5 Chlorobenzene BRL 100 0.5 Chloroethane BRL 0.5 Chloroform 1. 3 0.5 Chloromethane BRL 0.5 2-Chlorotoluene BRL 0.5 4-Chlorotoluene BRL 0.5 Dibromochloromethane BRL 0.5 1,2-Dibromo-3-chloropropane BRL 0.5 1, 2-Dibromoethane BRL 0.5 Dibromomethane BRL 0.5 1,2-Dichlorobenzene BRL 600 0.5 1, 3-Dichlorobenzene BRL 0.5 1,4-Dichlorobenzene BRL 5.0 0.5 Dichlorodifluoromethane BRL 0.5 1, 1-Dichloroethane BRL 0.5 1,2-Dichloroethane BRL 5. 0 0.5 1, 1-Dichloroethene BRL 7. 0 0.5 cis-1,2-Dichloroethene BRL 70 0.5 trans-1,2-Dichloroethene BRL 100 0.5 1,2-Dichloropropane BRL 5. 0 0.5 1,3-Dichloropropane BRL 0.5 2,2-Dichloropropane BRL 0.5 1, 1-Dichloropropene BRL 0.5 cis-1,3-Dichloropropene BRL 0.5 trans-1, 3-Dichloropropene BRL 0.5 Ethylbenzene BRL 700 0.5 Hexachlorobutadiene BRL 0.5 I BRL: Below Reporting Limit MCL: Maximum Contaminant Level I .� page 2 ee Sample ID: 857901 Laboratory ID: 857901 Compound Amount MCL Reporting Detected (ug/L) (ug/L) Limit (ug/L) Isopropylbenzene BRL 0.5 4-Isopropyltoluene BRL 0.5 Methylene chloride BRL 5. 0 0.5 Naphthalene BRL 0.5 Propylbenzene BRL 0.5 Styrene BRL 100 0.5 1,1, 1,2-Tetrachloroethane BRL 0.5 1,1,2,2-Tetrachloroethane BRL 0.5 Tetrachloroethene BRL 5.0 0.5 Toluene BRL 1000 0.5 1,2, 3-Trichlorobenzene BRL 0.5 1,2,4-Trichlorobenzene BRL 70 0.5 1, 1, 1-Trichloroethane BRL 200 0.5 1, 1,2-Trichloroethane BRL 5.0 0.5 Trichloroethene BRL 5.0 0.5 Trichlorofluoromethane BRL 0.5 1,2, 3-Trichloropropane BRL 0.5 1,2,4-Trimethylbenzene BRL 0.5 1, 3,5-Trimethylbenzene BRL 0.5 Vinyl chloride BRL 2.0 0.5 Total Xylenes BRL 10000 0.5 Methy-tertiary-butyl ether BRL 0.5 BRL: Below Reporting Limit MCL: Maximum Contaminant Level 7b7/79 Thomas F. Bourne, Laboratory Director BOARD OF HEALTH TOWN OF BARNSTABLE (Urtifirate Of Comphanct THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by---- -- ------------- — --------------------------------- Installer at---- --------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----_____—___Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- Inspector--_--- - - - - ----- Fee--- s-� � BOARD OF HEALTH TOWN OF BARNSTABLE Appticat ion ArWell Con0ruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: -- --------- ovation — Address Assessors Map and Parcel Cf Owner A dress 1-"z '�'�Y '- --e-z-6 0- ----------- Installer — Driller f Address Type of Building � 1 Dwelling ------------------ Other - Type of Building No. of Persons-------------------------------------- Type of Well 7 - �Cu/� D-1 .�i__ Capacity-0-f Purpose of Well--- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a r ficate off pliance has been issued by the Board of Health. Signed — --- — - ? date Application Approved By — `-- ------------ —1 7 P date Application Disapproved for the following reasons: -------------------------------__—__—___-- ----------— - -- - - ----- c� date Permit No. / —�.5 ----- Issued - date - -'- ..�,.•..��_. ,..:y-..•.,.:.:..+..��.._ �..._ _.,_.y.._'...u�a--. ,,,r•..w«x:�.^�i*�at* '�^.`�..'�'p.,., r.«,.. y _.v t..-. ....._- ,.�Kfw„�;^`.._. rn- �.,...y.y�.T,,,c� _.� --------------- f Fee----------------- f BOARD OF HEALTH TOWN OF RARNSTABLE Applicat ion-*r Well ConOruct onpermit . Application is hereby made for a permit to Construct ( ),.Alter ( ), or Repair ( )an individual Well at: ocahon ''Address' .'Assessors Map end-•Parcel Owner Address T--/f'"- ---)--Z--- ------------ Installer — Driller Address Type of Building ��� 1 Dwelling -c+ '' r���------------------ Other Type$ "Building-------------------------------- No. of Persons------------------------------ - --- Type of Well—7 _�CliGc�u�� D% (/i Cc _ CapacitY13_-/ i�.��f 1—— Purpose of Well---�� ------------ .Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a C r icate .of pliance has been issued by the Board of Health. Signed --- - �date � date Application Approved By -------— -�-�7_9 date Application Disapproved for the following reasons: ------------------------- ------------------ date Permit No. �' 1 --- Issued — -- ------- ------- - f `► date BOARD OF HEALTH TOWN OF BARNSTABLE t Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer at -= of has been installed in accordance with the provisions of the Town of Barnstable Board Health Private Well Protection a � i Regulation as described in the application for Well Construction Permit No. ----------------Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- —- , -- Inspector- - —-- - s�'ali�ili4�lx�eL.J4?�•.i!iN��/ai9iM'aiv4i�sai»Nib!he.iea•aMiaRiAi9a9.asae6eaoa.a?aw�aTG2a4�Koaoo4aei�'eTGlNP.34iea!ira-i-eiei! l.i9a�isyfiP6lo+_alaaa`ii��•a•s�d'�e M4a•G.t!?�p t BOARD OF HEALTH TOWN OF BARNSTABLE Ivell �on5truct ion 3permit No. --- Permission is hereby granted — —___--_— to Construct �, Alter ( ), or Repair ( ) an Individual Well at- Street as shown on the application for a Well Construction PermitNo. — ------- Dated-----�— 1-- vD DATE Board of H alth — y FNo-.-------------------- ee------------------�-- BOARD OF HEALTH TOWN OF BARNSTABLE Applirat ion for Vell Congtrurt ion Permit Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: - ----- ---------------------------- Location — Address L cT + Assessors Map and Parcel. ---- Owner �\®� Addr;ss3 a Installer — Driller Address Type of Building Dwelling--------H-2_vj�-`---------------------------------- Other - Type of Building--------------------------------- No. of Persons------------------------------------------------------ Type of Well Capacity Purpose of Well--- - - - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Ceytificate .of Com Tian has been issued by the Board of Health. Signed -=-- pzz ---- - — 7--- - ----------- date Application Approved By -- --—-- —------------— --- — --------------- date Application Disapproved for the following reasons:—-- ------------ -----------— -- ---___- ----------- ----------------- ----------------------------------------------------------------- date Permit No. ----------- - ——--------------- Issued --- -- -- -- -- --------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con5tructioupermit Fee--- Permission is hereby granted---- -3!1-1 '-- - ---to Construct (✓j'Alter ( ), or Repair ( ) an Individual Well at: No. --LcQ=r ---�L r'Isc n ---Lc`-n=Q- �-=- c`l r�Sfr - ?-�---P-� -'--------- Street as shown on the application for a Well Construction Permit ------------- Dated--— ---------------------- -------------------------------------------- ---------------------------------------------------------------------------------- - . ..._...- Board of Health DATE------------ ----- — - BOARD OF HEALTH TOWN OF BARNSTABLE (' Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (Altered ( ), or Repaired ( ) _ r_LLLi- - -----_- . - - -- --- -- n Installer at —LIJ- -----—--------—------------------------— has been installed in accordance with the provisions of.the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- ——-- -- — - -- — -- Inspector------------------------------------------------------------------------- ~A ;r - --- ------------ s Fee--------------�-- S BOARD OF,HEALTH ` TOWN 4OF BARNSTAB.LE f r , ApplitationArVell Conkru tionVertmt Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: 11-t---q--- —� '�"- --Lc7, �a _ t c 1�1 ------------------------------------------------------ Location — Address L/ Assessors Map-and Parcel Owner Address .. ,. ... .,30... 3Aa � � _ r� '•� lnstaller — Driller Address Type of Building "x ; _ _` n �c � Dwelling--------- --------------------- -- --- Other - Type,% .ullding-------------—------------------- No. of Persons---------------------------—-----—--------------- ;r f� 4 ` - c Type of Well=-- --_-rJ--�-a`-S - - Capacity ---------------— - ----- Purpose of Well - =f` Y1'-'` r- — -- -- --- -— - ;. Agreement• The undersigned agrees to install the aforedescribed individual well in accordance with the provisions oaf The Town of Barnstable Board of Health Private Well Protection Regulation = The undersigned further agrees not to place the well in operation until `a Ce, icate .of_Com- liance has:been issued by the'Boar.,,d of Health. t r r ' l�� I� • Signed - =— - ----- - ---- -------- -"��---- ---------- .�. ! date ; P Application Approved By— — ----- -- --—--- —---— --— ---------- date Application Disapproved for the following-reasons:----------------------- ------------------------------------------------------- ------------------- ---------— --------- --------------------------------------------------------------------------— ----------------- date -,.,,-Permit No. ---------- ---- Issued--------------------------------------------------—----------------------- " date BOARD OF HEALTH (TOWN OF BARNSTABLE r_ c ertif rate Of Compliance T' IS IS TO CERTIFY, That the Individual Well Constructed (Altered ( ), or Repaired ( ) WInstaller at__, g � _s__ �- + � - -- ---------------- ------ has been installed in accordance with the provisions-of the Town of Barnstable Board Qf Health Private Well Protection Regulation as described in the application for.Well Construction Permit No. --------------------------Dated---------------------- a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM#WILL FUNCTION SATISFACTORY. { DATE--------- ------- - ------ -- Inspector------------------------------------------------------------------------- BOARD OF-HEALTH 1NN- OF BARN=S.TABCE . r . VrIl Contructionpermit �. f -No. ---------------- Fee---- r. ----- Permission is hereby granted------------ ��_------1��-s- --- --------------------------------------------- +. to Construct 0.-, Alter ( ), or Repair ( ) an Individual Well at: No. --M Q "-��---C-G�r�s©=n --1_C.-n-�'- Lc�-= l nf°a- � ---,--M A--•--------- Street as shown.on the application for a Well Construction Permit ,... +No. = - Dated-=------------------------------------ t . `'..` 41 4,: ----------'-- ------- ---- - - ------------------------- •, �,..- Board of Health , DATE--j f'�--- ---- -- --- — f g ��, ;., :Z E< y� Fee 'lee r �/— THE CO'MMOMWEALTH OF MASSACHUSETTS Entered in computer: �( PUBLIC UBLOC HEALTH EpLTM DIVISION ' TOWN OF B W RN STp BL Eg M W S Sp CH LS TT Yes Rppl ication for X9igPo t *Pgtem Com9truction 3permgn Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.L cj T 9 17 S-6c,, &o t.7 L ti Owner's Name,Address and Tel No Assessor'sMap/Parcel ^`07 7 7.f-- 0066 t Installer's Name, ddress,and Tel.No. Designer's Name,Add ess and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size q. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank l�-� Type of S.A.S. 3—S-0 d, Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: , The undersigned agrees to ens a the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision of T le 5 of thRaIkWl�_p vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ed this BoHea Signed Date Application Approved by - ✓ Date 7 e>—% Application Disapproved for the following reasons Permit No. 11QF_ Z Date Issued Fee l �� THE COMMON ALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUS,,ETTS �2S 2pprication for �DigqpooaY*pgtem Conotruction' Vermit Application for a Permit to Construct( Repair( )Upgrade',( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.L 9 7 S'Cam,& Owner's Name,Address and Tel.No Assessor's Map/Parcel //O - 02 7 7r— Od 6 Instbller's Name ddress and Tel.No. Designer's Name„A'd ess and Tel.�No�.. /6 _? 107S— Type of Building: Dwelling No.of Bedrooms_ Lot Size q.ft. Garbage Grinder( ' ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures � . Design Flow gallons per day. Calculated daily flow y.�°l• gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. S — Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: `` Agreement: . The undersigned agrees to en a the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision of T tle 5 of th9lEnlvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i . e this Bo Health. Signed V Date "- "Application Approved-by - Date T 1� Application Disapproved for the following reason Permit No. 3! Z Date Issued 12 '' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Conmpliance/ THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired( )Upgraded( ) Abandoned by at L v ffO--- has been constructed in accorda e with the provisions of Title 5 and the for Disposal System Construction Permit No.? dated 7— 7 Installer Designer The issuance of this permit shall not hp construed as a guarantee that the syst \will function as designed. Date o �� - Inspector --------------------------------------- No. Z' Fee �yy� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwigaai tem Construction Permit Permission is hereby granted to Construct Repair )Upgrade( )Abandon( ) Systemlocatedat LOY �, 7 (' L G'� . QA--wjDj , 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:Cons ction must be completed within three years of the date of t ' mut. } Date: Approved b C I r C TOWN OF BARNSTABLE LC.L:ATIO , VS, j SEWAGE # �9- Y, VII!-LAGS g �!/ ' ' __ ASSESSOR'S MAP & LOT INSTALLER'S'NAME & PHONE NO. Fee- 6202y SEPTIC TANK CAPACITY ISdl'V LEACHING FACILITY:(type) Cj ��C� �Z (size) /3XV.-)C'_, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERAIdf-(' BUILDER OR OWNER t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: / !g VARIANCE GRANTED: Yes No .. < < �� �E t � � �' �i � z r� b ���� P I � < �� 6 `/0 FORM 11 - SOIL EVALUATOR FORM PAGE 1 No. Date. �Z196 Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: Dwl; bwewf Q�5 -J49S2- Date: SI2.116 Witnessed By: :E6&ems ' Location Address or Lot Number: Owner's Name.Address and Tel.Number: V,)o* ymA' 2)14 CD410 CLOVA) 6z6,33 New Constructiom Repair: Office Review Published Soil Survey Available: No: Yes: Year Published: STI Publication Scale: 1:2S CDO Soil Map Unit: QVcc Drainage Class: Ekee6jej Soil Limitations: Surficial Geologic Report Available: No: Yes.. 7C Year Published: A86 Publication Scale: 100 Geologic Material (Map Unit): Landform: Flood Insurance Rate Map: Above 500 year flood boundary No: Yes: til Within 500 year flood boundary No:x Yes: Within 100 year flood boundary No:/ Yes: Wetland Area: National Wetland Inventory Map (map unit): oxe wk6 Wetlands Conservancy Program Map (map unit): Norld,. Current Water Resource Conditions (USGS): Month 0a fl J IPIVO 650` J-2.5j tZar'e_ A) Range: Above Normal Normal Below Normal Other Referenced reviewed: VY� 4� r �a FORM 11 - SOIL EVALUATOR FORM Page 2 Location Address or Lot No. 1-1SCa'Paba^ L - yj- s��k On-site Review ll;so— _A*1A ,baeezf "6 r�04 Deep Hole Number:7P-2 Date: 42�51s Time: e;00 Weather: Location (identify on site plan): CsG�1ou��c� Land Use: jftic&N1iA\ Slope %): -0 2.0110 Surface Stones: COOV'W) Vegetation: (W.Qed* z;A ly 61 Landform: Position on Landscape (Sketch on Back) Distances from: Open Water Body: feet 2001 -¢ Drainageway: feet Possible Wet Area:feet 200D Property Line: feet jp Drinking Water Well:feet 200� Other: DEEP OBSERVATION HOLE LOG TEST HOLE NO: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (inches) (USDA) (munsell) (Structure,Stones, Boulders, .erg Consistency, D--j'� �► LDAr�^*f Sr,..lp 10`I@ e.4 �} t.turie- gravel)1-cm,i 4-33u g 10yp_ b,b t'-wPecul 33„- Cl i e! OeN_" v Parent Material (geologic): sp��,`�"��, Depth to Bedrock: �0 Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: OA& Estimated Seasonal High Ground Water: FORM 12 - PERCOLATION TEST Location Address or Lot No. tSw, �,©✓�� — u9cs1 y� r�j� � _ COMMONWEALTH OF MASSACHUSETTS PERCOLATION TEST Date: Time: Observation Hole No: -_E Depth of Pere 11 11 96 Start Pre-soak 11 lio End Pre-soak J'Z:!Q�� �►rvh , Time at 12" 12; ssQD 601L-S Time at 9" p D Time at 6" :+�}•�� Time (9"-611) 13® sD Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed Performed By: Witnessed By: I6 y Comments: II i FORM 11 - SOIL EVALUATOR FORM Page 3 Location Address or Lot No. r 6ca216cY\ Determination for Seasonal High Water Table Method Used: Depth observed standing in observation hole inches IJA Depth weeping from side of observation hole inches &[A Depth to soil mottles inches of Ground water adjustment 0-2 feet A Index Well Number : [N-2.!�;2 Reading Date: t4N Index well level:} Adjustment factor: �� Adjusted ground water level. NA Depth of Naturally Occurring Previous 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? Certification: I certify that on 5 (date) I have passed the examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date i FILL TP-4 tL � A5 a ,Do�� ' ;.. O � '' R o� 44 _ FORM 11 - SOIL EVALUATOR FORM Page 1 or 3 No -56 J Date: Commonwealth of Massachusetts Mass achusetts Soil Suitability Assessment for On-site Sewage Disposal L7/3/iic� �'.......,Q,L,cI,U, 'rT IR Date: S—Z.- . ..... Performed By: ..........................:.......... � .. ......`...... Witnessed B � ...........L r3,rciz.�; ... _ ....... 1 ' � ��ic, ............ 7 / 7 / . , 1Z '�:<. _.. Location Addrus or / ��--�- �h! G.+/9A/ Owrcr'sf�K..�J sN, l�l.i +% Lot I /� / p _ f}�J� Address,and l Telephone) ICGI L ew Construction Repair ❑ �"� Office Review Published Soil Survey Available:'No ❑ Yes Year Published yA�t.33'.............. Publication Scale .;.0 Soil Map Unit .-.. Drainage Class Soil Limitations ��. V. ..........1 ........................... Surficial Geologic Report Available: No ❑ Yes Year Published Publication Scale Geologic Material (Map Unit) ...............C. TS....... �'��..�'`� ... . .............. 4 Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No 9Yes ❑ - Within 100 year flood boundary No UYes ❑ Wetland Area: 1V119 / National Wetland Inventory Map (map unit) .................'�jl ....... . .......................................... Wetlands Conservancy Program Map (map unit) ,y /............................................................................ Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal XBelcw Normal ❑ Other References Reviewed: 11/66 6 �U�-t��'� ,�igTG�.z�- /r2 /A65U DEP APPROVED FORM-12/07/95 I FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number Time: Weather Location (identify on site plan) Land Use ........;IFS ID:Fb� Slope M 6 .14;% Surface Stones Vegetation Landform ....:.......:.mo;.�i�rl� Position on landscape (sketch on the back) - Distances from: Open Water Body ,-2-oo feet Drainage way z feet Possible Wet Area 4Z.00 feet Property Line . t Cv. feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon So(US A)Texture Mun eoil Color q Mottling (Structure, Stones, Boulders, Consistency, Surface (Inches) Gravel) 7?- 1 C� L / MINIMUM OFTR=�EQUIRED AT EVERY PROPUbLU 7Z_/�L C L jl�� �3 C% GL rr'/3it! C j0,�1/Z�,� (xillfiUti'L ir,�/sJ9t�frJ De thtoBedrock: > 2 >� e Parent Material (geologic) Sl�iL [� ILC p Weeping from Pit Face: !rz Depth to Groundwater: Standing Water in the Hole: /y��t g Estimated Seasonal High Ground Water: MM DEP APPROVED FORM-12/07/95 r FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 175- t�u� Determination for Seasonal High Water Table Method Used: ^!//� ❑ Depth observed standing in observation hole........ inches ❑ Depth weeping from side of observation hole ....... inches ❑ Depth to soil mottles inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................ Index well level ...... .. ..... . Adjustment factor ................... Adjusted ground water level ................................................... Depth of Naturally Occurring 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? YIF� If not, what is the depth of naturally occurring pervious material? F! Certification I certify that on _ 6-Z-f (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me on 'stent wi the required training, expertise and experience described in 310 CM 15. 1 Signatur Date r DEP APPROVED FORIM-12/07/95 r Title S: Draft Printed September 20, 1993 Appendix 4 Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles ................... inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level .. Adjustment factor ................... Adjusted ground water level . Percolation Test Date: Time: ....... Observation Hole # Depth of Perc Start Pre-soak Z 4� End Pre-soak v 1Zr55 � Time at 1 Z" CIO Time at 9" �cc Time at 6" 4 n\ Time (9"-6") Rate Min./Inch Site Suitability Assessment: Site Passed U Site Failed ❑ Additional Testing Needed: Performed By: v/�v%o �'� ��ii Certification Number: Witnessed By:...... Comments: BEN' NETTA" 01 ILLY, Inc. 17 ngineering & Environmental Services 84 Underpass Road P.O. Box 1667 O Brewster, MA 02631 508-896-6630 SOIL TEST REPORT CLIENT: ASSR'S MAP: DATE OF TEST: AGENT: — PCL: TYPE OF TEST: ENGINEER: D. 0,cWAINCT STREET: 176- DEEP HOLE: _ HEALTH REP: -- - ('s3��a L.�/ PERC TEST: EXCAVATOR: A--w, ewll TOWN: (✓rs: L'yr/212s;7Y[ BORING: SOIL LOGS SKETCH OF LOT (not to scale) TEST TEST D N I ' 4 PROPERTY INFORMATION r DEPTH TO GROUNDWATER: WATER SUPPLY: PERCOLATION RATE: SITE FEATURES: TEST RESULTS: AIVrWli&. ��1✓l� RU3;S:.c/T /IV T.y�A�:- re6, PURPOSE OF TESTING: �oLr"� `/G(_ c►P�S��fl�� . , C`C�.c/ y�T�/��Hitle /`�xTl.�.c/T Gt= Ccr?xi nrb , •a�,2rs G�c_c_ CERTIFICATION: WE HEREBY CERTIFY THAT THE ABOVE TESTS WERE PERFORMED AND THE RESULTS ARE AS SHOWN ON THIS REPORT. "� ? Q't"« — of is?9•,y� y 1 v Ask ^e -- 1 -TPI Pfl S IN TEST HOLE LOG • DATE:"10,47'Z,/9 ,-, l.By SOIL EVALUATOR:-p WITNESS::._,!aa PERC RATE: 'c 1-!i-/,//NC-41 -*/ 2z /aZ' O~ J•D A e-, �" G, 5 '� 99 zo<cus� �- pe2c CZ 72" i�y2s/y 4.0 .sue cZ � � .S•a.uv i /6yle /3Z" Y • �/o G�,ai�,� E.�J�c�v ti1TE.JZE,a /z ,= �� ✓�E�./ DESIGN DATA DAILY FLOW: (y�DRMS.1c 110 GPD= y7o GPD SEPTIC TANK: 4, DGPD i 200%=B8 o GPD USE:/Soa GALLON PRECAST SEPTIC TANK LEACHING FACILITY: USE: (3)S x Z"-I- Soo 0,2�u/EGGS CAPACITY: In, Z75 IV As SIDEWALL: 9•�X Z O.�/r /,37 BOTTOM: 13'x 3.; ' 'QnLj .,L32z.3 TOTAL: ' ,ZH OF Mgs�gc •' O DAN" ' y Of M BRAMAN N ava 'No.32686C h - W. RUM ' �PFF C/ST NOTES: ssl y SLAVE GT 1. ALL PIPE TO BE 4"DIA.SCH 40 PVC. ro 2. PIPE TO BE LAID LEVEL FOR V OUT OF DISTRIBUTION _ ,4 • BOX. 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6"OF FINISH GRADE 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL. S. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED ON A 6"LAYER OF STONE 6. INSTALL GAS BAFFLE IN OUTLET TEL 7•LAYER OF 3/8•PEASTONE OVER 314•-1 In•WASHED STONE ALL AROUND TOP OF FOUND. @ EL Yav,So to* 14• / Pz 93 9�.�0 9a.zs y�•90 SEPTIC SYSTEM PROFILE SITE — SEWAGE PLAID GENERAL NOTES FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR Gp�f' �• ��, 3g�JcJ� TO ANY EXCAVATION OR CONSTRUCTION. /75,�711 c.,5o� 4:',�J, �, .�3AlZ.�///S7f16C E- 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH PREPARED FOR 310 CMR 1100:TITLE V. / 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE ST�v� ��US7��C GLI DETERMINATION. DATE: SCALE: y ..3C� 4. ALL DISTURBED AREAS TO LOAMED AND SEEDED. 5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS. FT WELLER & ASSOCIATES FALMOUTH ROAD CENTERVILLE, MA. 02632 EL: (508)775-0735 FAX: (508)775-0754 AppRQW-V_RY: -- ! i �s ins y � OC j2Z, \ ! 17.-4 N TOP FNDN, AT EL. 52.2' SYSTEM PROFILE TEST HOLE LOGS .., ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN / ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: DAVID C. BENNETT, RS MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 52 0' WITNESS ED BARRY : ... , 2" DOUBLE WASHED PEASTONE DATE: 5/2/96 -I qrf ELEV. 50.35' RUN PIPE LEVEL �q FOR FIRST 2' < 5 MIN INCH EXISTING 1500 3 MAX. PERC. RATE _ / 3 HGH sr. �p GALLON SEPTIC 48 9'f* 49'0' CLASS I SOILS P#t8684 LOCUS3 TANK (H- lO ) GAS 0QOQ O Q � � � ". BAFFLE 48.53' �� 48.36' 48.17' p p p p p C7 � I. 0 " 4' AROUND C01EN µGEu 6" CRUSHED STONE OR MECHANICAL 0 0 � M � ED � � 0 COMPACTION. (15.221 (2]) $g 2' a a C� 0 0 a ED C3 0 0 46.17' Q ELEV. 1V2-1 a� DEPTH OF FLOW 4' ( 1 SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE �" 56,C 0" Sli TEE SIZES: A A INLET DEPTH = 10" LS LS ,.OUTLET DEPTH 14 410YR 4/4 4„ 10YR 4/4 LOCATION MAP NTS ` FOUNDATION EXIST. LEACHING B B SEPTIC TANK 29' D' BOX 21 ASSESSORS MAP 1 10 PARCEL 28 FACIL ITY 5' LS LS , 6 "THE INSTALLER SHALL VERIFY THE 33" 1OYR 6/6 53.25' 19„ 1OYR 7/ 53.4 LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS Cl PRIOR TO INSTALLING ANY PORTION OF 59. a NOTE: DH3, DH4 AND DH5 ARE SEPTIC SYSTEM �:� SHOWN ON SOIL SUITABILITY SANDY LOAM UNSUIT. ��. ASSESSMENT PERFORMED 8Y C BENNETT & O'REILLY. ALL 37 0, 10YR 5/4 59 INDICATED FILL WITH NATURAL SAND 72" 49.0' 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 9.14 SAND UNDER AND NO WATER TO PERC AROUND PERIMETER OF LEACHING FACILITY, 8,48 15' (ELEV. 37.0'f) 10YR 7/3 DOWN TO SUITABLE SOIL LAYER. REPLACE 8.1 TH C2 WITH CLEAN MED. SAND. ENGINEER TO INSPECT AND CERTIFY REMOVAL 5� 9,0 54. + SAND SS S EXIST. F ED SAS 10YR 7/3 EXIST. SEPTIC SYSTEM �, 58.44 BENCHMARK: USE TOP OF 144" 1 44.0' 132 44.0' IS SHOWN AS PER DIMENSIONS \ ` \\ FOUNDATION AT CHIMNEY - - NOTES ON INSTALLER'S SKETCH \ \ \ AT EL. 52.2' NO GROUNDWATER ENCOUNTERED 4 .2� 52.4 e SEPTIC DESIGN: , (GARBAGE DISPOSER )S N6T ALLOWED ) 1. DATUM IS ASSUMED a v +49. pH DESIGN FLOW: 4 BEDROOMS ( 110 GPD) = 440 GPD 2. MUNICIPAL WATER IS NOf AVAiUhBLE +51.67 58.01 USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. (Uv (R T. ST .35 SEPTIC"" TANK: 440 GPD ( 2 ) = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 I + .9 5. PIPE JOINTS TO BE MADE WATERTIGHT. OPEN SPACE �9� 51.16 USE A 1500 GALLON SEPTIC TANK (RE-USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 44. 1 DHHS 28 51.59 DH4 7 LEACHING. - ENVIRONMENTAL CODE TITLE V. SIDES: 2(42 + 12.83) 2 (.74) - 162 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT *51.20 52 TO BE USED FOR ANY OTHER PURPOSE. + 8.6 51.0' 1•80 BOTTOM: 42 x 12.83 (.74) 398 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. PATIO +51.80 51.08) DECK TOTAL: 757 S.F. 560 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 51.19 USE (4) 500 GAL. LEACHING CHAMBERS WITH 4' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED S0, FROM BOARD OF HEALTH. 5}-2*51.31 S?v 4E ALL AROUND EXIST. 51.1 -' 10. PUMP & REMOVE FAILED SAS DWELL. 11 . NO KNOWN POTABLE WELLS WITHIN 150' OF SAS TF 52.2' k 50.84 1 0.26 \� ` 51.03 EXIST. WELL LEGEND TITLE 5 SITE PLAN 50.29 -I"o 100.0 PROPOSED SPOT ELEVATION OF 175 CARLSON LANE - LOT 9 \+,,50a3 -�50.79 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: EXIST. WELL 43,561 SF \� 50.78 100 PROPOSED CONTOUR (WEST) BARN STABLE �- e:eo �•so.4o 100 EXISTING CONTOUR 11a6 030 �a�9.9�0 _ �,�.�•so.26 PREPARED FOR: BORTOLOTTI CONSTRUCTION/ABBOTT �. Z5 0 .r-=39 U3 30 0 30 60 90 o tY•' � BOARD OF HEALTHlv - - -• MA SCALE: 1 " 30' DATE: MAY 15, 2004 O APPROVED DATE RL -116.19 C A off 508-362-4541 i fox 508 362-9880 OF 14,gss9c ANN$ �o� AR H y�N �•, down cape engineering, inc. OJALA 0 ��IwA U IL N CIVIL ENGINEERS N , 040 4 LAND SURVEYORS ,710 y 04- 130 939 main st. Yarmouth, ma 02675 ARNE H. OJ_4LA, P.E., P.L.S. DATE