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HomeMy WebLinkAbout0045 FIELD STONE ROAD - Health 45 FIELDSTONE RD. WEST BARNSTABLE A = 111 050 r TOWN OF B�ARNSTABLE LOCATION `� ��� �/®�/ � SEWAGE # VILLAGE l(/',6///Pw ASSESSOR'S MAP 6z LOT INSTALLER'S NAME fa PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY :1,p }C£ LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C D� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �fc� , a A SI TOWN OF BARNSTABLE LOCATION S- /£L SEWAGE # VILLAGE f6 d1f/+i' ASSESSOR'S MAP LOT NAME & PHONE NO. A & B CANCO 775-6264 _SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 1h c 0/ &177- /r hlg'L Zr DATE PigltftrT t9ftffll): -0 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No F4 41 r�l' t O O �D 39 o 0 . f pF lqk :r Page: 1 CERTIFICATE OF ANALYSIS 110 "W, i Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/24/2008 Justin Jones Order No..:' G0848070 45 Field Stone Road West Barnstable, MA1 02668 Laboratory ID#: 08480 tle 0-01 Description: Water-Drinking Water Sample th Sampling Location: 45 Field Stone Rd.W.Barnstable,MA Collected: 7/23/2008 Collected by: J.Jones Received: 7/23/2008 Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested Ammonia ND mg/L 0.20 EPA 350.1 M 7/23/2008 Nitrate as Nitrogen 0.99 mg/L 0.10 10 EPA 300.0 7i23/2008 Copper ND mg/L 0.10 1.3 SM 3111 B 7i23/2008 Iran ND mg/L 0.10 0.3 SM 311 IB 7/23/2008 Sodium 11 mg[L 1.0 20 SM 3111B 7/23/2008 Total Coliform Absent P/A 0 0 SM9223 7/23/2008 Conductance 180 umohs/cm 2.0 EPA 120.1 7/23/2008 Pf] 7.6 pH-units 0 6.5-8.5 SM 4500 H-B 7/23/2008 Neater sample meets the recommended limits for drinking water a all the above tested parameters. __. Approved By• (Lab rector) 7'1--/ -k CIO Lam: �w c y, CJ; N) v CD ND=None Detected RL = R:.porting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 °F CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 724/2008 Justin Jones Order No.: G0848070 45 Field Stone Road West Barnstable, MA 02668 Laboratory ID#: 0848070-01 Description: Water-Drinking Water Sample#: Sampling Location: 45 Field Stone Rd.W.Barnstable,MA Collected: 7/23/2008 Collected by: J.Jones Received: 7/23/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 723/2008 Bromomethane ND ug/L 0.50 EPA 524.2 yn T23/2008 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 7/23/2008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,1,2-Trichloroethane ND ug/l., 0.50 5.0 EPA 524.2 yn 7/23/2008 1,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,1-Dichloroethene ND Ug/L 0.50 7.0 EPA 524.2 yn 7/23/2008 1,1-Dichloropropene ND rigs- 0.50 EPA 524.2 yn 7/23/2008 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,2,3-Trichloropropare ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,2.,4-T richlorobenzene ND ug/L .0.50 70 EPA 524.2 yn 7!23/2008 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,2-Dibromo-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,2-Dibromoetharie(EDB) ND ug/l, 0.50 EPA 524.2 yr. 7/23/2008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 7/23/2008 1,2-Dichloroethane ND ug!L 0.50 5.0 EPA 524.2 yn 7/23/2008 1,2-Dichloropropane ND ug/1 0.50 EPA 524 2 yn 7/23/2008 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524._ yn 7!23/2008 1.3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 1,3-Dichioropropane ND ug/l, 0.50 EPA 524.2 yn 7/23/2008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/23/2008 2,2-Dichlorcpropane ND uo/L. 0.50 EPA 524.2 yn 7/23/2008 2-Chlorotoluene ND ug/L OSO EPA 524.2 yn 7123/2008 4-Ch!orotoi'uene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Benzene ND ug/1- 0.50 5.0 EPA 524? yn 7/7.3;2008 Bromebenzene ND ay/l.: 0.50 EPA 524.2 yn 7/23/2008 Bromochloromethane ND ug/L 0.50 EPA 5<44.2 yt, 7'23 2008 Bromodichloromeihane ND ❑g/L. 0.50 EPA 524.2 yn 1/23/2008 B,romoform ND :,e/L 0.50 EPA 524.2 yn 7/23/2008 ND=None Detected RL - Reportirg Limit MCL- Maximum Contaminant Level Superior Court House, PO, Box 427, &-unstable, MA 02630 Ph: 508-3-75-6605 CERTIFICATE OF ANALYSIS Page: 2 Barnstable County Health Laboratory Re�tcrrt Prepared For: Report Dated: 7-24i2008 Justin Jones Order No.: G0848070•''• 15 Field Stone Road Vest Barnstable, MA 02668 Laboratory ID#: 08480/7 O-OI Description: Water-Drinking Water Sample#: Sampling Location: 45 Field Stone Rd.W.Barnstable,MA Collected: 7/23/2008 Collected by: J.Jones Received: 7/23/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/23/2008 Chlorobenzene ND ug'L 0.50 !0o EPA 524.2 yn 7/23/2008 Chloroethane ND ug/L 0.50 EPA 524.2 yP 7/23/2008 Chloroform 0.94 ug'L 0.50 80 EPA 524.2 yn 7/23/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn N23/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Dibromomethane ND ug/L 0.50 EPA 52.4.2 yn 7/23/2008 Ethylbertzene ND ug/I- 0.50 700 EPA 524.2 yn 7/23/2008 I-lexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 Isopropylbenzene ND ugrL 0.50 EPA 524.2 yn 7/23/.2008 Methvlene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/23i2008 Methyl-tert-butyl ether ND up'L. 0.50 EPA 524.2 yn 7/23/2008 Naphthalene ND ugiL 0.50 EPA 524.2 yn 7/23/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/23/2008 n•Pr6pylbenzene ND ug/L 0,50 EPA 524.2 yn 7/23/2003 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 7/2312008 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7./23/2008 Styrene ND ugrL, 0.50 100 EPA 524.2 vn 7/23/2008 tert-Butyibenzene ND ugiL 0.50 EPA 524.2 po 7/23/2008 Tetrachlo oethene ND nYit- 0.50 5.0 EPA 534.2 yn 7/23/2008 Toluene ND ug/L 0.50 1000 EPA 524.2 yn ii23'2008 Total xyle.nes ND ug./L 0.50 10000 EPA 524.2 yn 7/23'2008 trans-l,'2-Dic:hloroethel;e ND ug/L u.50 !00 EPA 524.2 vn 7/23/2008 trans-l,3-Dichloropropfnie ND .le/L: 0.50 EPA 524.2 vrt 7/23/21008 TrIchlorof-thene ND us'i.. 0.50 5.0 EPA 524.2 y<, 7/23/2008 Tri4hkrfrofluorometl;tne. NT6 uglL ti.5o EPA 524.2 yn 7/2`3/2008 Wate, .saarple neemthe recot.rntended lhn,Us•fnr erinlung water of all lire obove tested l xrwn;ters. Approved �. c- ND=Ncne Detected RL = Deporting Limit MCI,=`4aximinn Contaminant.Level Superior Court House, I'O. Box 427, Barnstable, MA 02630 Pit: 508-3 75-6605 'I f �IL/ COMMONWEALTH OIL MASSACHUSETTS x x EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION O„H p ye• - 350 MAIN STREET WEST YARMOUTR,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner's Name: MICHELLE MCDEvfrr FEB 0 7 2001 Owner's Address: 45 FIELD STONE ROAD WEST BA.RNSTABLE,MA 02668 TOWN OF BARNSTABLE Date of Inspection I'EBRUARY 2,2001 1 HEALTH DEPT. Name of Inspector:(please print) JAMES D.SEARS Company Name: A c&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT - I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority 1 Fails Inspector's Signature: Date: 2-2-01 The system inspector sliall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing Qiis 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 sliall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot lie buyer,if applicable,and the approving authority. Notes and Conunents ****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. Title 5 Inspection Form 6/15/2000 1 f Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 C. Further Evaluation is Required by the Board of Health: N/A _ 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 45 FILED STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVTTT,MICHELLE Date of Inspection: FEBRUARY 2,2001 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in pits is less than 6"below invert or available volume is less than''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H 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 is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVTTT,MICHELLE Date of Inspection: FEBRUARY 2,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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(3xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 2668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x 4 of bedrooms: 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): WELL WATER Sump pump(yes or no) NO Last date of occupancy: N/A COMMERCIAL/INDUS TRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: PUMPED AFTER INSPECTION—FEBRUARY 2,2001 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1987 NEW D-BOX FEBRUARY 2,2001 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVTTT,MICHELLE Date of Inspection: FEBRUARY 2,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 44" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 24" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16 How were dimensions determined: ASBUILT AND 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.): MAIN TANK AT WORKING LEVEL,INLET TEE,INLET COVER 19"BELOW GRADE.OUTLET TEE, OUTLET COVER 44"BELOW GRADE. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspecfion)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (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.,): D-BOX IS NEW"X15",5'BELOW GRADE.COVER 4"BELOW GRADE. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Tide 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 02668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 2 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) TWO 1,000 GALLON PRE CAST PITS.PITS ARE 4'BELOW GRADE.COVERS ARE 15"BELOW GRADE. BOTH PITS HAVE 30"WATER,NO HIGH STAIN LINE. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionxlocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N./A (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.) Title 5 Inspection Form 6/15/2000 9 o Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 FIELD STONE ROAD WEST'13ARNS'I'ABLE,MA 02668 Owner: MCDEVfiT,MICIIELLE Date of Inspection: FEBRUARY 2,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pernianent reference landmarks or benclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r O � 3r y� O Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 FIELD STONE ROAD WEST BARNSTABLE,MA 20668 Owner: MCDEVITT,MICHELLE Date of Inspection: FEBRUARY 2,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 62 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) X 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: G.I.S. AT HEALTH DEPARTMENT Title 5 Inspection Form 6/15/2000 11 No. �,2oozngk:� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprtcation for ]Digool *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(16 Upgrade( )Abandon( ) ❑Complete System ErIIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. /h C. D£lo/ Assessor's Map/Parcel InstLall s 1]pn,Add ,and Tel.No. rev Designer's Name,Address and Tel.No. IA.-' " Type of Building: F Dwelling No.of Bedrooms Lot Size sq.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 Type of S.A.S. 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 is by this Board of Heal �7 Signed Date o2 _P7- ®� Application Approved by Date Application Disapproved for the following reason Permit No. 06-Z Date Issued z No. c>l00/'O w� = Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLES MASSACHUSETTS �.. ZIpprication for Migooar 6potem Construction Permit Application for a Permit to Construct( )Repair O Upgrade( )Abandon( ) ❑Complete System C"tl Individual Components Location Address or Lot No. --_ �,,p�. Owner's Name,Address and Tel.No. S,q 8 + 3 r Assessor's Map/Parcel + p�p a NE Gt,•,�is7/J°ti Installer's Ua�Address, d Tel.No. p^a Designer's Name,Address and Tel.No. 3 S o �/liN w- �qiP Type of Building: F Dwelling No.of Bedrooms �", 5 Lot Size sq.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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ' C 9,-7 f t,7— 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 is_ Y by this Board of Heal Signed Date o2 Application Approved by - Date Z S Application Disapproved for the following reasons Permit No. Zay 06</ Date Issued Z --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE TIFY that the On-site Sewage Disposal System Constructed( )Repaired(.N)Upgraded( ) Abandoned( )by 41(9 C0141 C O 35 G 0,41A, r T Z--o - f.Wl< at -3 1' t L-9 Q C o',) w " "IPA.- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. GG e/ dated ZJS �U Installer Designer The isslr&e of this permit sha}}1 not be construed as a guarantee that the system w',kfunctiomes designed. Date ?_/1 /d Inspector G ---� —�---,�/--------------------------------- No.,>"/— 06/ Fee J / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS lio pooaf 6potem Construction Permit Permission is hereby granted to Construct( )Repair(.4')Upgrade( )Abandon( ) System located at 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. r�M t Provided:Construction must be completed within three years of the date of this Dernut. Date: Approved by 0 . s TOW ARNSTABLE L0CA'rION,&l"SO Y5 EWAGE # 8 7- q_/ f VILLAGE �a�wa S c6 � 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)� tEo�� a (size) PO NO. OF BEDROOMS . 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,_/` �I< op h�ouS£ 1 �' Ib04�g1}. �if THE COMMONWEALTH OF MASSACHUSETTS Appli5pion is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal -0 .. -1111% ...wl*,-*-,-,.. ..... .....rAt.......... ner Add Installer ress Dwelling—No. of Bedrooms .......................Expansion Attic Garbage Grinder'kV)O Septic Tank—Liquid...c'apacit Ions e?n;19 z Other Distribution box Dosing tank: Percolation Test Res erformed b, 4d............;;;;;,................... Date.;O�.. ..... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAN U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_- ___' __-0---__--__ It Application Approved Bv------ --��� --- -_-'------ -______ - - - mate Application Disapproved for the following reasons:.....................................................................................'....................... ----'-----'------'-----------'--------'------------'--'----'---'--------'--'------------'---------- Date Pero Date L ~~~~~~~~~.~^-~.~~--------------------------------------------^----------------------------- THE COMMONWEALTH OF MASSACHUSETTS Fss. BOAR WTH 1/6 -14-- ------_--------------0 . ...........-----.._.......---•-----•------ Appliratiun for Disposal iarkks' Tonstrurtiun rnmit Appli tion is hereby made for a Permit to Construct (; ) or Repair ( ) an Individual Sewage Disposal Syst � . �d�;,E _ -= --•--- ---- .. --- .. .... ............. ........... .... .. --- -- Lo ion-. - or Lot No. -. ............................................. Owner Address W ..... .... .................................. n..............-...-- �`Installer I r(����.�„} Address UType of Building -I e Lot .,261 •......Sq. fee Dwelling—No. of Bedrooms. _.__...-• ..............................Expansion Attic ( Garbage Grinder aOther—Type of Building _____________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixture-......----------------•-------------......................------------------------------------ --------- ---------- --------------------- Desi Flow.................... .i�....... .___._gallons per person per day. Total dail flow_...____.:_._� ° gallons. W g P P P Y ---•--------------------- W Septic Tank—Liquid capacity`4_gallons Len Septic _'/-..... Width�r _.... Diameter................ Depth. .-........... x Disposal Trench—Now................ Wid .................. ..._.........__.... Total Length.__._xx---------____ Total leaching area.._�.__...._....__.sq. ft. Seepage Pit No____________ iameter.__ . . Depth below inlet..4............... Total leaching area} :+/e.. i �� ...sq. ft. { Z Other Distribution box ( Dosing tank - ) z r W Percolation Test Results Performed by_____________ ..../V.-.............-.____,__.__._::"`_.... Date . 4 ._........__. Test Pit No. 1...... .__.minutes per inch Depth est Pit•/.�''.�...... Depth to ground water-/t/P............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pG .....•••••-•••••----•---•---•••.....................•-•-••-•••--•-•----•--••....._............---••-......................................................... ODescription of Soil....................................................................................................................................-................................... W ----------------------------------------------•-•-----------------------------------------------•-------------------------------••-•-•---•-•-•••••..........•--...._..................--••.._......... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------•------------------------•-.....---------------------------------------------------•--......-------•----------------------------------.....--------------------------..._•-••-•.._.._......•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........ - ..................................•. .......................... Application Approved By.....-••---•y�-��-�y = V� Date Date Application Disapproved for the following reasons:--•----•-------------------------•-•----.....................----•-------------.........._.........-••-........ ---•---••-----•---------------------------------•-------•---..........-......----•-------................. .........................._,------------------------------------------------------•-------- Date PermitNo...... ...............L1 1-9..--------•--------•--. Issued.............•.............----•----•-••---•---......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH......................................... (Intifiratr of faumplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by......_.. - --•- --------------------------------------------------•--------.........-----._......---- at •---Installer ; has been installed in accordance with the provisions of TITL'E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.2 7 t.A.f.j_V.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®,AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............� ................................ Inspector...._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nd�7 f�rti.,.................OF........ - ' ..................... FEES ........ Disposal Works Tunstrurtiun rprmit Permission is hereby granted...../4/ °-----.4e:V' .............-......-................................................................. .. to Construct ) oar,DRepair (, a1} ndividual Sewag Disposal System atNo.••L - i l/.; .._ �-.,r..r =J : .................................... Street as shown on the application for Disposal Works Construction Permit 1 7-_y1�---;-. Dated.......................................... /C 7_ _- oard of Health DATE ----------------------•--------••••-•••••-•-••••••--...... FORM 1255 A. M. SULKIN, INC., BOSTON , 1000 38 �iTyiN /l03 2O � ���.•SI-SZE 38 38 3(p Sq VA" OF OF -a \ q�y\ nG U tHRISTO �R �. `CC 0.814 , `q�STER�� / supV � SCA�C,� : Uf'�ERCAf?E E'it/�I�(/EEI�/.VG ,rd6 A/D. P.O• o fe/ � DATE SHEET / OF Z TOP OF FOUNDATION ' . CONCRETE COVERS CONCRETE COVER e 4"CAST IRON 12"MAX. r� OR SCHEDULE 40 12"MAX. i P.V.C. PIPE ' 4 / ER. , SCHEDULE 40 PV.C.(ONLY) PITCH 14"P PIPE - MIN;' FT PITCH I LEACH 14 PER.' FT \—INV RT PIT _ PRECAS `•0 LEACHIN �'- SEPTIC INVERT INVERT _ ° w �? o;; PIT. OR ° INVERT EL, ins DIST. ELy�. EOUIV GAL INVERTl3oX ?x � EL`1/• INVERT \9 0 w :•�; 3/4':T0 11, WASHED /0 /U —v- w �• STONE PROFILE OF - — - - GROUND WATER TA©LE;_ SEWAGE DISPOSAL*' SYSTEM NO SCALE SOIL LOG WITNESSED 8Y •, OATE� O. "� ��.... TIh1E. . ... . . . . . . (�:�', . �;��/.��.�-/.1'�t/• . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ELEV. .`�3:���. . . ELEV. .. .. . . . . . . 1/�. . ENGINEER y •TOP me • n1'77 Z DESIGN DATA : •• SAni 4 NUMDER OF DEDROOMS 5� TOTAL ESTIMATED FLOW GALLONS/.DAY $ i . . . CCEI� 1 007 TOM LEACHING AREA J'vxZ=/00 SO.PT, /PIT � a � EiD SIDE LEACHING AREA !S/, SC Z•=43a Z SO.FT./ Pli' ,. 31•%5 ,2 ' GARDAGE DISPOSAL AC). (50 % AREA INCREASE) TOTAL LEACHING AREA . . 9, SO,FT P[.iRCOLATION RATE :fib. , , , • MIN/INCH /�/O,WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .. . . ... SQ.FT NUMDER OF LEACHING PITS APPROVED . . . . . . 130ARD OF HEALTH S/D .°��� G•a7�(2/ DATE. P O/0!y . ��'2= J rO7-A S/z7 DID PcR P,T AGENT OR INSPECTOR / '�'vOTE YGG VA,7� TU `C 4E7C'1/ s,/ClA11__) 1/•% 14N y co 0. PETITIONER AA , t 5290 BOG ) Date:September 13, 1985 dg FNumber: Bottlt BARNSTABLE COUNTY HEALTH AND'ENVIRONMENTAL DEPARTMENT SUPERIOR COURT MOUSE Q � r . p Rf ARNSTABLE, MASSACFIUSETTS 02a30 DfoITT J 'Ass DRI.NK.ING; 9x I r. sa WATER LABORATORY ANALYSIS �Howc: . �z Client: Nabil 'C. Bogh6t Collector: :Joseph J. Petron Mailing Address: 3 Tamarack Terrace Affiliation: Stoneham, 0218 _ Time. 6 Date of 438-8480 Collection: Telephone : Type of Supply: we . Sample Location: i treet' ' Well Depth: West Barnstable. Date. of Analysis: '' PARAMETER SAMPLE RE UL MM N ' L M Total Coliform. Bacteria 100 ml0. 0 . • H 15.5 Conductivity micromhos/cm 84 500.0. Iron m .4 0.3 Nitrate-Nitro en m < .l 10.0 Sod'i um m 8 '20.0 1 , I Water sample meets the recommended limits for drinking of all above .tested parame II . XX Based only on results of -the parameters tested for this sample, the hater is suitable for drinking butmay present the problems checked •beldw: av ra e ;levels of Nitrate.. Future monitoring is A. Water sample has higher than e g , recommended (2-3. times per year.) to establish any upward trend's. B. The low pH of the water may shorten the useful life of the hou.se's •plumbi.ng. C. X Water may present aesthetic problems (taste, odor, staining) 'due to h' h. iron p Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III . Due to one or more of the .reasons checkedibelow, this water. sampl'e is unfit for human consumption: A. Iigh Bacteria B• High Nitrates 9 , REMARKS: . , o€ S�mRle ��olle tion. Results may be incopc.�usive due to unknown tirrieTf .g( tg,� :•,;: ,::._ : :'.,;:- Deporhr.c;i shod n.c i c.­...: c:•.y , interpretations or eorcl ;ie^'s, m66 a uy en; CC: Barnstable Board of Health ',e co ruing eie! " L:lts wi!hout writ'an cc CC: a rat j lrec 1 /7/Dal _ rr' m rpm•,t P.-.i: tMUJ:ht�.t r:!r::�•:n.+p, BENCH MARK : 40 - 9 ; 'E-7I- dV 3 3. li 2. .G, .VD' TEST HOLE ( RESULTS P 'i DATE : �` lie, W I T N E S S E D BY xl� J f o /'1"7 . "re/ 7' a N y r3 P� /A /�.� v fl t_ f-1 a'Lr") c� RAT h' �, be T CO F' 3 (o,, loo3 M 'ED/um /�(� �J'Z� r:_'} >�11. 1� _._ _. �,L /,�__..__-a.• ._ :,rJ S / W/S c7rrt E EG1J2, 2 C4_,6- ` - 1� 7-0 I'-O t - 4ra � ! ` /N� 7-0 tV O W.:=4 7" /Z MANHOLES AND COVER TO BE 'BUILT TO ELEV. TOP OF FOUNDATION `-WITHIN 12�r OF FINISHED GRADE FINISHED GRADE MIN. 2 % SLOPE PE f� ��,/ � ',_•` / 1\� ;.. 4 DIA. ---- ----P I P E 4�� DIA. PIPE FIRS 2~MI : ,H, t �� _r vlk. MIN.PITCH FT 2 LEVE f MIN. 2 LAYER OF MIN. PIT _ • • I�g_..i 2 PEAST0NE ,�• b 14 F T. /60 ca ^'""i_ 1 120 S GALIL N INVERT swrw INVE 0 AI, • / Y ,Y a � �O - ,o' \� INVERT '. C21.� '� � DN T. RT �� ® �N� m+ 11 , EPTIIC TANK �' / ! be > . � INVERT INVERT 80X 1 19.Q0 ;.61 ,� t'�i� mom, ,.,, 4 �2 DIA. 2 s INVERT ., w WASHED STON E PLA C E ON. . L� Y ALE AROUND a / / y r {d r;,-, c =o2 � � � / / <r l :, /0 FIRM BA S f: (�_ a o T"'a c.erNTr / �ti l '� 8 1 MI 1' 7 . M. BOTTOM AT ELEV. //,5;.5 { n/ T -�- 3r. .5 r,���c 2 0 � � / / 3:3 NO GARBAGE . ovS � a T � , � 20 MIN.) f/ _ - _ GRINDER C� . H $ 2. n PR O F I- L E OF :GROUND WATER TABLE 3El0w - - - P SANITA-RY D I Sf OS A L SYSTE M � s ( NOT TO SCALE DESIGN DATA CONSTRUCTION OF SANITARY DISPOSAL 3 BEDROOMS i SYSTEM SHALL CONFORM TO THE MASS. ENVIRONMENTAL CODE TITLE 3t DESIGN FLOW 3._ GALAY Q (REVISED . 7- 1-77 ) _ AND T+1E TOWN OF LEACH RATE - �' 2 MIN/ NCH r O HEALT' H REGULATIONS. REQUIRED LEACHING CAPACITY : 3�� • SEPTIC _ � ' PTIC TANK, DISTRIBUTION BOX AND LEACH PROPOSED ' GA AY ING UNIT TO BE OF REINFORCED CONCRETE : MIN. CONCRETE STRENGTH 3000PS.1. R QUIRED SEPT C TANK • / OGOQ C04, MIN. STEEL STRENGTH • 20,000 P.S.I. MIN. -DESIGN LOADING : H-/Q PROPOSED SEPTIC TANK : • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND FITTINGS TO 8E WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. . HEALTH AGENT APPROVAL, DATE SITE PLAN . SHOWING PROPOSED CONSTRUCTION ZONING DATA LE G E N D LO CAT FO N : (W �--S —) s - . FOR : o ne sP.�c,�- .� 1� TEST HOLE LOCATION DATE 1 ZONE 2. _... _ P��H of M R E F E R E N C 0 7- '.s .S w� 0/y •. s�o� E L-- � �c� REVISIONS �--- REQUIRED AREA : (.¢� ,0� �90 EXISTING ' SPOT ELEVATION 17.6 �oNX, cRarG�ss9�.� �� 37,5 m - I ` REQUIRED FRONTAGE :._ :._.0 EXISTING CONTOUR SHORT c REQUIRED FRONT SETBACK {,-tn} 30L An PROPOSED C ONTO UIT - 16 ' �� R CALF : REQUIRED SIDE SETBACK : �� © PROPOSED WATER ' SERVICE -W `'roNR� EN� er<orz 4zG PG 4G -' � 8 REQUIRED REAR SETBACK : i5' J.5 PROPOSED GAS SERVICE G- _ C Pe r^ P/an on, - L3 car-t� S1 v 87 ✓c t � / .�'' PROPOSED - ELEC. a TELE .. . E QT R Gl � l R . SHORT , P. E . PROFESSIONAL CIVIL EN 01 N E E R ` BU I L D I NG INSPECTOR APPROVAL31 DATE I OLD R0`U`TE- 132 , HYANN Is , MA. 02601 FILE NO. ./ rFLE. » 2 9 411) ^] SHEET r OF e y . t ' If Ili