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HomeMy WebLinkAbout0018 RED OAK LANE - Health 18 Red Oak Lane,r�1� 777 77 A = 128 - 025 i I 6 e 0 ' o 11/21/2006 TUE 15: 57 FAX 5083627103 Barnstable CTY HealthLab --- BARNSTABLE HEALTH 12001/002 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory ty y e s Report Prepared For: Report Dated: 11/21/2006 Wendy Beaulieu Prudential Premier Properties Order No.: G0638833 P O Box 200 Osterville, MA 02655 E Laboratory ID#: 0638833-01 Description: Water-Drinking Water €€ Sample#: Sampling Location 1S Red Oak Rd. West Barnstable,MA Collected: 11/20/2006 Collected by: W.B. Map 128 Parcel 1025 Received: 11/20/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.68 mg/L 0.10 10 EPA 300.0 11/20/2006 Copper BRL mg/L 0.10 1.3 SM3111B 11/21/2006 Iron $� mg/L 0.10 0,3 SM3111B 11/21l2006 Sodium 32 mg/L 1.0 20 SM 3111B 11/21/2006 Conductance 160 umohs/cm 2.0 EPA 120.1 11/20/2006 pH 7.4 pH-units 0 EPA 150.1 11/20/2006 Sodium-level is=above�lhetmaximum-c-ontaminant-level.Those.on aloes-sodium_diet_may-wish=to consult-aphysician. Approved By. 4 Director) Z5 I i U-) co t-- Ar 0 <cc ` N i> ti CD i cam: i j MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i 11/21/2006 TUE 15: 57 FAX 5083627103 Barnstable CTY HealthLab BARNSTABLE HEALTH 0002/002 I i i CERTIFICATE OF ANALYSIS �.,., Page: 1 o �'I Barnstable County Health Laboratory i `�'�geHus Report Prepared For: Report Dated: 11/21/2006 Wendy Beaulieu Prudential Premier Properties Order No.: G0638834 i P O Box 200 I Osterville, MA 02655 Laboratory ID#: 0638834-01 Description: Water-Drinking Water •. Sample#: Sampling Location: 18 Red Oak West Barnstable,MA Collected: 11/20/2006 Collected by: W.B. Map 128 Parcel 025 Received: 11/20/2006 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Total Coliform Absent P/A 0 0 SM9223 11/20/2006 Water sample meets tl:e recommended limits for_drinking water of all the'above tested parameters. ZL ' Approved By: (La irector) / L&J Cn CD < N 9 ✓ 3 ~ O I f CD c cJ M I i i I I I I 1 ` MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 o`°F N � CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory 's�C13usx��I Report Prepared For: Report Dated: 11/21/2006 Wendy Beaulieu Prudential Premier Properties Order No.: G0638834 P O Box 200 Osterville, MA 02655 Laboratory ID#: 0638834-01 Description: Water-Drinking Water Sample#: Sampling Location: 18 Red Oak West Barnstable,MA Collected: 11/20/2006 Collected by: W.B. Map 128 Parcel 025 Received: 11/20/2006 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Total Coliform Absent P/A 0 0 SM 9223 11/20/2006 Water sample mee,!s the reeannrended limits for drinking water of all the above tested parameters. ZL Approved By: (La irector) 1-2- /l 61 w CV) -..l ca I• -cc < O (V jo Q G3 z y r MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory \�SScHtw'�^ Report Prepared For: Report Dated: 11/21/2006 Wendy Beaulieu Prudential Premier Properties Order No.: G0638833 P O Box 200 Osterville, MA 02655 Laboratory ID#: 0638833-01 Description: Water-Drinking Water Sample#: Sampling Location 18 Red Oak Rd. West Barnstable MA Collected: 11/20/2006 Collected by: W.B. Map 128 Parcel 1025 Received: 11/20/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.68 mg/L 0.10 10 EPA 300.0 11/20/2006 Copper BRL mg/L 0.10 1.3 SM3111B 11/21/2006 Iron BRL mg/L 0.10 0.3 SM3111B 11/21/2006 Sodium 32 mg/L 1.0 20 SM31llB 11/21/2006 Conductance 160 umohs/cm 2.0 EPA 120.1 11/20/2006 pH 7.4 pH-units 0 EPA 150.1 11/20/2006 _Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physician. Approved By._ ' Director) UJ C'7 a _:r m .. ' o N a> CD 4 a .xa MCL=Maximum Contaminant Level RL =. Reporting Limit Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS J DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM /a r Do2s PART A CERTIFICATION Property Address: 18 RED OAK LN W BARN r tr► r Owners Name: JOYCE r, Owner's Address: 1:11-i Date of Inspection: 12/19/0507 t ' Name of Inspector: (please print) Douglas A.Brown W r- Company Name: Douglas A.Brown Septic Inspections rn Mailing Address:P.0 Box 145 Centerville,MA 02632 Telephone Number: 508-420-4534 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 Fails Inspector's Signature*mit Date: 12/19/05 The system inspector shallpy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving, authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different Conditions of use. Tit le 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/05 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 winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: at this time system MEETS MINEWUM PASSING REQUIRMENTS B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'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 following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced 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 ' Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/0 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 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: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/0S D.System Failure Criteria applicable to all systems: 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 cesspool is less than b"below invert or available volume is less than 1/2 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. — X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 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.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — _ the system is within 400 feet of a surface drinking water supply _ 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered yes'm Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 RED OAK LN W BARN Owner: JOYCE Date of Inspection: 12/19/05 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? _ 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)on the site 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 Cis at issue approximation of distance is unacceptable) [310 CMR 15.302(3 ))(b)] 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection. 12/19/0 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: Does residence have a garbage grinder(yes or no): — Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): — Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): WELL Sump pump(yes or no):_ Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy —Shared system(yes or no)(if yes, attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 1993 BRIAN KISSLING Were sewage odors detected when arriving at the site (yes or no)? NO i i Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/OS BUILDING SEWER(locate on site plan) 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 on site plan) Depth below grade: 3' 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: 1500 gal Sludge depth: 'TRACE Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: TRACE Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: 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 LOOKS STRUCTUALLY SOUND AT THIS TIME GREASE TRAP:_(locate on site plan) 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.): i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/05 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: e€1Ions/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.): PUMP CHAMBER: (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.): Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/05 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: I OOC> C,� cc I.v a.' 0� 5 l,►�y� 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.): 2PITS OPENED ONE LIQUID LEVEL AT ABOUT 2 FT FROM BOTTOM STAIN LINE HALF WAY 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 or no): 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.): L Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: W BAN AK LN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/05 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Gc,rc%e J `at rr�r I 1 0 Df\00 0C., A 3 _ 73 J A. 3` Si/ r v °J' - C'. C° �` Q� C 11 CIIN OOF C . �.�•_LC7c7C t r Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 RED OAK LN W BARN Owner's Name: JOYCE Owner's Address: Date of Inspection: 12/19/05 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water' 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: 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: /'a 7 -a;z FS Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection ,Tofu, Grad One winter Street,Boston,Ma. 02108 D.L.P. Title V Septic Inspector Uq P.O. Box 2119 Teati 02536 y WILLIAM RWELD 1 Governor ARGEO PAUL CELLUCCI IQ� Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORE _, OFGt Ike, PART A CERTIFICATION `3 '47,9 w ",st 9� Property Address: 18 Red Oak Lane�arnstable Address of Owner: i OFD ��cr Date of Inspectlon: 11/25/97 /\ (If different) N Linda Brown Name of Inspector: John Graci I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) � Company Name,Address and Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X_ Passes This Inspection Is based on criteria defined In Title V code 310 CMR 16.303.My findings are of how the system is _ Conditionally Passes perfonningat the time of the inspection.My Inspection does not Needs Fu Evaluation By the Local Approving Authority septic sysany tem an warranty of componearantee nts useful life the — septic system end any of its components useful Itfe. Fails Inspector's Signature: Date: 1212197 The System Inspector shall lubit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N,pr ND). Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revisedO M91) One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Red oak Lane Bamstable Owner: Linda Brown Date of Inspection:91125197 _ Sew.acte backup or.breakout or hioh.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 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 protect the public health,safety and the environment. stem is failing to p system g p i 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE pRD IN AOF HEALTH (AND PUBLICMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. _ The system has aseptic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet or a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15,303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in facility or system component due to an 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 — cesspool. SAS is in hydraulic failure. (revised 04117197) f Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Red oak Lane Barnstable Owner: Linda Brown Date of Inspection:11125197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS.or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 18 Red Oak Lane Barnstable Owner: Linda Brown Date of Inspection:11125197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,t_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — unacceptable)[15.302(3)(b)] (revised 04127)871 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 18 Red oak Lane Barnstable Owner: Linda Brown Date of Inspection:11125197 FLOW CONDITIONS RESIDENTIAL: Design flow: "0 g•p•d./bedroom for S.A.S. Number of bedrooms:4 Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nla Last date of occupancy: nla OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection: (yes or no)N,a, If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date installed(if known)and source information: 1992 Sewage odors detected when arriving at the site: (yes or no) No (revised 04127)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 Red Oak Lane Barnstable Owner: Linda Brown Date of Inspection:11125197 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Polyethylene_ ) Material of construction:x concreate_metal_FRP_ other(explain If tank is metal, list age 0 . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: t.e'e-'H57'w4'10^ Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:25" Scum thickness:g Distance from top of scum to top of outlet tee or baffle:e" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years. GREASE TRAP: (locate on site plan) Depth below grade: Na Polyethylene_other(explain) Material of construction: _concrete_metal_FRP_ Dimensions: nla ` Scum thickness:nra Distance from top of scum to top of outlet tee or baffle:rds Distance from bottom of scum to bottom of outlet tee or baffle: nia Date of last pumping;,ia Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 2:e-• Material of construction:_,cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line's Diameter: V_ Qeinments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04)27)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 Red oak Lane Barnstable Owner: Linda Brown Date of Inspection:11125197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: We. Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nre Capacity: nra gallons Design flow: nia lklalrm n working order?_Yes_No Alarm level:_nra g Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,sic.) nra DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom of pipe Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) The D•box Is structuraly sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)—yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1E Red oak Lane Barnstable Owner: Linda Brown Date of Inspection:1111125197 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: 2.1,000 gallon leach ptta leaching chambers, number:Na leaching galleries,number: He leaching trenches, number,length: Na leaching fields,number, dimensions:rda overflow cesspool,number:Na Alternate system: rda Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pits are structurally sound and funcUening property,the pa B had 1'In It and the pit C had 1'of water In It CESSPOOLS: (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: rda Depth of solids layer: Iva Depth of scum layer: Na Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na inflow(cesspool must be pumped as part of inspection) Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: rda Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na (revlaed 04I27)87) u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 18 Red Oak Lane Barnstable Linda Brown 11125197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) L rya Dec 0 Poo v � 1 U O Wij AC gib. 0 y (revbod04r17197) Page f of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 18 Red Oak Lane Barnstable Linda Brown 11125197 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts I� (rev1aed04)2T19T) 711041 10 of 10 A= THE COMMONWEALTH OF MASSACHUSETTS FEBI�� BOARD OF HEALTH V TOWN OF BARNSTABLE Appitratiall for Mipasal urk �gtts r Application is hereby made for a Permit to Construct rttlln Prruti# System at: ( ) or Repair ( ) an Individual Sewage Disposal ................__,1$ RED OAK LANE -_..................... 12 ....... _ �tLocation-Address •'"""""- .........•-•-..._.... ...TTQR',],'.Q.R.E or Lot No. w z�z�o..._.......-•-•....... ........14_.LI,A�I...LtQ�r� Owner q U.l.... ._ -� K.UBLI-INTO.................................... �7 Address V ��,t "•••-^••- Installer •-^.....9 7...rXQNN...8.&QQ.K...RQ�I ----.I�.t�RM.QU.TIj........_. U Type of Building 4 Address 44,450 '-� Dwelling—No. of Bedrooms.............•--_---.-• Size Lot...-.....••_•_•- a Other—T -• Expansion Attic O Sq. feet Other—Type of Building -IV/A•- (N ) Garbage Grinder (TO) -- No. of persons.........._Other fixtures ........ /A Showers ( ) — Cafeteria ( )Design Flow................55 . •---------------gallons per person per day. Total dailyflow......._._--.----440--- W Septic Tank—Liquid capacit _100Gallons Length 6" 4 x Disposal Trench—No......N..A . Width_.....'-10" gallons. Width............. •••. Diameter._..N/A Depth._5.'4" Seepage Pit No........2...-_.�_. Diameter................... Depth below inlet_..__...._...._._._. Total lea 6 'Q -'.. Total Length.................... Total leaching area _ Other Distribution box ' " . . s f P 6 O q t. Dosing tank ( ) Ching area.._5.33-,0-sq• ft. t Results Performed by........ R. GIFFORD 12-21 Percolation Pit No. 1------6-------minutes per inch Depth Date.................-84 Test Pit No. 2----N/A P of Test Pit.__.._6.'......._ Depth to ground water................ -•-----....minutes per inch Depth of Test Pit-................... Depth to ground water94 ....___......__......... Description of Soil....___---.----- , -LpAM AND SUBSOIL/ 4,0-6.0 '" x 0 0 40 ' ' .0-12.5 ' MEDIUM SAND SILTY SAND W . ..SAND x U Nature of Repairs or Alterations—Answer when applicable..._..._..N............Agreement: ...................................................................... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a the provisions Of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the hoard of health, g accordance with Signed -- ' ...Ga.` . y�73 Application Approved B -. .................. ................. Dare . ........................ .. Application Disapproved for the followingreasons: -•....-- " ................. .......... ...................................... .. re ...................................... .................................................................................. .................... Permit No. �- ........... ...................�................. ............................. ............ Issued �`.�... �... te THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t TOWN OF BARNSTABLE (grr#iftrUf.V of C�ul< PRUnre THIS IS TO , at th, n dividual Sewage Disposal System constructed ( v) or Repaired ......... Q / ..... ............................ at ........ . �i. alley At as been installed in accordance with the provisions of TITLE 5 of The St E vir nmental Co a ..........e.:........ the a lication for Disposal Works Construction Permit No.THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A ti � SATISFACTORY. GUARANTEE THAT THE DATE Inspector ......... .... THE COMMONWEALTH OF MASSACHUSETTS V BOARD- !OF'-HEALTH No......................... TOWN OF BARNSTABLE - Fs$........... ts�rlasttt urk� 'fin Permission is hereby granted..................... � � mutt 4 to Construct ( ) Repair ) Individual System .... or p ( an I ....---• at No.. ............................... ............ Sewage Disposal-System :............._. ..................................-- -•-•-- -••••-•.--- . Street ,. ......_._. . as shown on the application for Disposal Works Construction Permit No............:.::..... Dated. ATE ......................... .......... ._... :.. .. . ................................... . ........................................: Board of Health..... .. FORM 365oe HOBBS Q WARREN„INC.,PUBLISHERS TOWN OF BARNSTABLE E , c LOCATION / ��� p,¢,f/ l,4,.c/E' SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. o�.� SEPTIC TANK CAPACITYfog a mac, 6 LEACHING FACILITY:(type) (size) loop fo4 0 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER WC4L BUILDER OR OWNER /yrt:h fee 7-,o4C LC� DATE PERMIT ISSUED: I Zz f, DATE COMPLIANCE ISSUED: 2ZS/ 93 - VARIANCE GRANTED: Yes No i� ��� �� ��� � , ../ �� �, I �use ' (off` __Y.___ � t ..� 1 �► a � � �o � `_' n h �,° / , _57 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allp iratiou for Disvviia1 Vaarkii Ta nstrurtuau Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 18 RED OAK LANE 12 ................_................................................................................ ....................................................-•-----------------------------...------------ Location-Address or Lot No. ..................... ...................... ........1A...LAN...RQ.,U.i...aMDX1.C:H.............................. Owner Address BR Ali...5.];SS .i�.Q.................................... ........9-2.�ON[I�I B.l3QQ ...RQ.U......Y&RNlQU1Ii.--------- Installer Address 44,450 Type of Building 4 -�, Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic (NO) Garbage Grinder VO) aOther—Type of Building .Nl_A__________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........N/A--------------------•-•••......•-- W Design Flow................55.......................gallons per person per day. Total daily flow____.___.._..--__440-•................gallons. WSeptic Tank—Liquid capacity..1000�allons Length---$.'6....,Width...4'10-"Diameter-___N/A... Depth..5-!411 x Disposal Trench—No. .....N._A...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------2----------- Diameter------- Depth below inlet.....6.'.O Total leaching area...533-.O.sq. ft. Z Other Distribution box V/ Dosing tank ( ) '-' Percolation Test Results Performed by......................R.__ GIFFORD...._....________.____.. Date...12-21-84.............. Test Pit No. 1____--6_____--minutes per inch Depth of Test Pit------- Depth to ground water . LL, Test Pit No. 2....N/? ...minutes per inch Depth of.Test Pit.................... Depth to ground water........................ W 0 Description of Soil.... .0-40 ' , LOAM AND SUBSOIL, .4.0-6.0 - SILTY SAND - -------------------------------------•------------------------------------------------------------------------------------------•------------------ 6.0-12.5 ' MEDIUM SAND V W ---•--------------------------------------------------------------------------------------------------••-----••••-••------•----...•-•---------•--•••--------•----•--------•------....----...._......... U Nature of Repairs or Alterations—Answer when applicable..........N/A -------------------•-------------------------------------------------------•--•-------•------------•-•--------------------------------•---------------------------------------••-----••------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliancehas been issued by the oard of health. ` Signed ...... yR3.... - --- ---- --------------------------- -------.. ....-- ............. Date Application Approved B . ....--- -- .... t Application Disapproved for the following rea.ronr- ..................................................T--------------------------------------------------------------------------------- .................................................................................................. .......................... ........ .................................................. ............ ...................................... Permit No. ......�s���' �� r Issued ................�'� -°� e� Date No................-....... Fim............._............... THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispotial Workii Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 18 RED OAK LANE 12 ................_................................................................................ ...............---•................•-----.....------------------..........................•----... Location-Address or Lot No. ..................... . ...................... ........1.4...LAN... .............................. Owner Address W > zm 515.Lq...K-I. uG..--.....--••-•----•-•-•-•-•--......• ........9.7.�Qk1lq._.13.E3QQ}{...RQA�2_�_... A,RMQUTIi.......... a Installer Address 44 450 P� U Type of Building 4 Size Lot......... 1..................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (NO) Garbage Grinder �O) Other—Type of Building .N/A.................. No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .......N/A................. • - W Design Flow................5.5_.....................gallons per person per day. Total daily flow.._............._44Q..................gallons. c� Septic Tank—Liquid'ca.pacit _100(,�allons Length...$.'6 Width...4.'_10_"Diameter....i`?�A._. Depth..5.!.4" W }}'' x Disposal Trench—No. ...... l-A...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........2........... Diameter......6.�.D fit... Depth below inlet...... ...0...... Total leaching area...533•,O.sq. ft. Z Other Distribution box Dosing tank ( ) rix Percolation Test Results Performed by......................R._ GIFFORD Date...12_-21_-84.............. Test Pit No. I......6....._.minutesperinch Depth of Test Pit........'........ Depth to ground water........................ Test Pit No. 2....N/A...minutes per inch Depth of Test Pit.................... Depth to ground water........................ •• •-••••••-••••--•-••--........--•-•-----•--•-•- .......................................................... 0 Description of Soil.._0...0740 ' LOAM AND SUBSOIL,....4.0-6.0 ' SILTY SAND x 6.0-12.5 ' MEDIUM SAND ---------------------------------------•--------------------------•---••.........••••••............._...........--•---------......•......••-•••--•-•-•-•-•-••---•-...................•-•................ UNature of Repairs or Alterations—Answer when applicable...........N/A ........-•-•••••----•-•-•-•••••-•--•--•---•--•-•••..................................•••---••---•---•-•••-•--•-•••••••-••......•-••-•••---•-••-••••••••••••••••.•••••-••..................------........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 ............................................................................................................ ........................................ Date ApplicationApproved By ...................................................................................................................................................... ....................................... Date Application Disapproved for the following reasons: ........................................................................................................................................ ................................................................................................................................................................................................................ ........................................ Date PermitNo. .................................................................... Issued ...............................------------............---.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C11extifirate of (11-ontlatiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................................. ......V w. ...............................................................................................................................:........................ Installer at ..................... .... . a tit.......LN............... I`,------ ..........................................------------------........................ has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....�a.'.. ...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �I Cj. DATE...............��.. ....LJ.....r'......f......�.. .........---.......................... Inspector ................... .:... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / .��j TOWN OF BARNSTABLE t..... FEE....-..�a........... �i��rla�ttl nrk� �nn�tr�trtilan .ermit Permission is hereby granted.................DO-%. _ ......... . _ - �t.............-----...............................-----:................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at No Street ( q as shown on the application for Disposal Works Construction Permit No.� 1�Dated.......................................... ��.-..- ------------------------------------------------ Board of Health DATE.......................•-------................................................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS No........................ Fns............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFation for Uhipoii al Workii Tnnstrartion rrtnit Application is hereby made for a Permit to Construct ('4.) or Repair ( ) an Individual Sewage Disposal System at: Y..-�-• . rrr Location-Adddress or Lot No. e 4 w C .......................•-�^ ^• .............................................. ---........•••••.......---•-•--•---••---•--•-.............._..-••••-.............................. y Owner Address W Installer Address 1. d Type of Building Size Lot....t) ;.��r r••------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( Garbage Grinder ( � Other—Type of Building t i. No. of persons............................ Showers — Cafeteria Otherfixtures ------------------------ � 11'--•----•-•--•-••...•••----------••-•--••••-•---•-------------------•.......••--•-•........--••-•............--•••- W Design Flow............. '`±-'............_..___.gallons per person per day. Total daily flow...............�-'��.................._gallons. ..1 . 9 Septic Tank—Liquid capacity.- LLf'gallons Length_f .'- Width... - Diameter----!LAI a-_.. Depth..... .: �:r Disposal Trench—No........ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........... Diameter.... :'.r..... Depth below inlet.... _#_ "... Total leaching area.... 7 _sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed b - -.,.*........................�~ �.. •.. Date......i�._'.��:"�►��.......... ,aa Test Pit No. l......Z.....minutes per inch Depth of Test Pit----__)_ ._........ Depth to ground water... !' 44 Test Pit No. 2.......?-.....minutes per inch Depth of Test Pit.......U........ Depth to ground water............. ........ R+' ------------------------------------.-------------------------------------.............................................................................. 0 Mi .... - -C•C —Z-0. h--.c 41��:� Fs.a-, e..—S_4L 1t-, e- 7 .G - 11.0 OLI./ 'r- A-era J+.—it,j t-.^ t x Description of Soil...............:....................... r U ............................ --------------•------------•-•--------.....--•-•--•-------•------........ --------•------•---•-----------.....---------------........----•------------.....---•-•-----•-----••--•---•---- W ...... 1 ... .....r ...-.. UNature of Repairs or Alterations—Answer when applicable____-_•-. 0A............................................................................. ---------------------------------------------------------------------------------------------•-•-••---•••-•--••-•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The under og ed further agrees not to place the system in operation until a Certificate of Compliance has been issued by e Hjar4.of health. Signed --------------------- ------------------- -----......-...........-------------------- --------......-------------------------- Date ApplicationApproved By .................... ...................................... ...... ......... -------------- Date Application Disapproved for.the following reasons: ..... .. .................................... --- -- -- -------------------------------------------------- ------------------------------------- ----------- -------------------------------...... Date Permit No- ------- ------------------ -- ...... Is ed Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ertifiett#e of C�omplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............................................. ............................ Installer at ...................................... ............................ ... ..................:....................................................................--------------.............................--------...................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------- ------------------------------------------------------------------------------- Inspector ...............-----------...............---...............:---------------.....---------------... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ nrk� C�lan�trnrtilan lerntit . Permissionis hereby granted...--------•--....---•--•---.._...-•........................•••••-•--.......••-••-•-•••••••-••-•-••-............••--.............-•---...... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo..........................................................................._.................................................................................................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -------------------------------•------------------------------------......•-••-•......•-•-.....-••....._ Board of Health DATE................................................................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No. Fee------------=-42� BOARD OF HEALTH TOWN OF BARNSTABLE 21ppritation-for VrIl Conotructioll Permit Application is hereby made for a permit to Construct ( ), Alte '( ), or Repair (X)an individual Well at: .-- ------- --------------------------------- Location — Address Assessors Map and Parcel `e— uti-- —/__6_ � — s —---------------------- 6v� r Add -------------------- - --- = =-��---------------------------------------- Installer_ Driller Address Type of Building Dwelling - Other - Type of Buildin -- No. of Persons------L/----------------------------------- Typeof 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 Certificate of Compliance has been issued by the Board of Health. Signed ----------— -- - - - �( Application Approved By- ---------------- - ��-`--- -"'-— date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- �,p/ date Permit No.­ ' =-``----�--'�--------- ---------------- Issued--------- -'` �`r- date a, BOARD OF HEALTH TOWN OF, BARNSTABLE Certificate Of Compliance THIS IS TO CERBTIFY, That the Individual Well.Constructed Qe), Altered ( ), or Repaired ( ) by-D- _�J_S� --- -- - -- —- - - - ----- ---------------------------------------------------------------------- Installer at—l y/J "'�=k �-- — `�----------------�r �� — -- — 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 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ----- -- - - -- Inspector--- -- --—---------- - ------------------------ No.-� /� Fee— BOARD OF HEALTH TOWN OF -BARNSTABLE ZppYitation-*r Vell Construction permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (>()an individual Well at: ---------------- ------- Location — Address Assessors Map and Parcel Owner ��/ / Andress -------- �_� ���a E/�'+ —------------------------ ----,�c--=--4� Ia - -------------------------------- Installer — Driller Address Type of Building - Dwelling- % --�? ------------- Other - Type of Building ___ No. of Persons- _- --------- Type of Well--------- ------------------------------------ Capacity-----------------------------------------_ --__--- ---- Purpose of Well------------= ---- -- - - Agreement: l� 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 Certificate of Compliance has been issued by the Board of Health. l Signed Ay ------------- - L - ' btate Application Approved By- .—- - --------------------- ---------------------- " Application Disapproved for the following - ------------------------------------ q date Permit No. ,/1.��... -"-----4o -------------------- Issued--------------ee---­- -`= -—- — -- __a__________�_____ _ y__ __�___ date J Yl( 3 BOAaD,,,bVF1,HIEALrTH IK� TOWN OF BARNSTABLE� t —Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (k), Altered ( ), or Repaired ( ) -^ � ----------------------------------- ---------------------------------- ------------------------------------------------------------------ Installer a ----——---------�-- &-------------------------—------------------------- 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 ` ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -DATE ------ -- to -�� " Inspector--' ------------ ----------—-----____ -- ----_ `6 BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con5truct ion Permit No. -------------------- 'T y Fee Permission is hereby granted- — =v= "a ------�1' .!_/1� -�'� ---------------------- Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: p No. -------y --ram- - �a - _--'-� - r✓'P_-= �+ -- � f ri-u• r,-- -- - F- y ✓�' / lam". p r r r- a.v ..• ew fr•` S r � Street as shown on the application for a Well Construction Permit No.-- .1- =' -�� -'�------------------------------ Dated - P e ,r - ------ -= --------- `------------ __ / Board of Health DATE----.! i --- +- -'`"d--— - --- ENVIROTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 - (508) 888-6460 CLIENT: Art Dolaoff LOCATION: 18 R d Zak t\ ADDRESS: P.O. Box 355 W. lalhs eU W. Hyannisport, MA El 5 �q COLLECTED BY: D.A. Scannell SAMPLE DATE: 1a-92 ME: �??JOAM DATE RECEIVED —92 w R ID: ET 929 JOB #: New well WELL DEPTH: 0 - RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 mi (MF Method) 0 0 pH pH units 6.0-8.5 6.33 Conductance umhos/cm 500 82 Sodium mg/L 20.0 9.8 Nitrate-N mg/L 10.0 0.08 Iron mg/L 0.3 c0.05 Manganese mg/L 0.05 Hardness mg/L as CaCO, 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria EPA 601 /602 ttgfT, Chlnrnfnrm 2 COMMENT: * See attached. ''o NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PA ETERS TESTED. ZRX ❑ (� DATE/ �� �2.C"v:d'u�1AT^R ANALYTICAL Y� GROUNDWATER ANAL YTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: ET929 Lab ID• 4.327-01 Project: Dolggoff/18 Red Oak Batch ID: VHA-1121-W Client: Envirotech Sampled: 12-28-92 Cant/Prsv:. 40ml V0A Vial/NaHSO4 Cool Received: 12-28-92 Matrix: Aqueous Analyzed: 12-29-92 PARAMETER CONCENTRATION REPORTING LIMIT . . (u5/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL I Bromomethane BRL 6 1 Chl'oroethane Trichlorofluoromethane BRLBRL I I 1,1-Dichloroethene Methylene Chloride BRLBRL 1 1 trans-1,2-Dichloroethene 1,1-Oichloroethane BRLBRL 1 I cis-1,.2-Dichloroethene * 2 BRL Chloroform 1,1,1-Trichloroethane BRL 11 Carbon Tetrachloride BRL 1 Benzene BRL 1,2-Dichloroethane BRL 1 Trichloroethene BRL 11 1 1,2-Dichloropropane Bromodichloromethane BRL I 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene 8RL I Toluene 1 BRL cis 1,3-Dichloropropene BRRL 1 1 1,2-Trichloroethane 1 Tetrachl.oroethene BRL Dibromochloromethane BRR I L 1 Cllorobenzene 1 Ethylbenzene I m+p-Xylene * BRL o-Xylene 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene 1 1,2-Dichlorobenzene BRL BRL 1 1 QC SURROGATE COMPOUND SPIKED --MEASURED RECOVERY QC LIMITS Bromochloromethane 30 27 88 % 83 - 117 % Fluorobenzene 30 30 101 % 87 - 113 % BRL - Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). I ENVMOTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Art Dolhoff LOCATION: 18 Red Oak Trail ADDRESS: P.O. Box 355 W. Barnstable, MA W. Hyannisport, MA COLLECTED BY: D.A. Scannell SAMPLE DATE: 12-23-92 TIME: 11:OOAM DATE RECEIVEDJ2-23-92 SAMPLE ID: ET 929. JOB #: New well WELL DEPTH: 140 RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.33 Conductance umhos/cm 500 82 Sodium mg/L 20.0 9.8 Nitrate-N mg/L 10.0 0.08 Iron mg/L 0.3 c0 05 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria EPA 60i1 /6n2 * ug f I Ch1 nrnfnrm 2 COMMENT: * See attached. M NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PA ETERS TESTED. lax ❑ DATEI �� Rr GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: ET929 Lab ID: 4327-01 Project: Dol9off/18 Red Oak Batch ID: VHA-1121-W Client: Envirotech Sampled: 12-28-92 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 12-28-92 Matrix: Aqueous Analyzed: 12-29-92 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 2 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2=Dichloroethane BRL 1 Trichloroethene BRL 1 r 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethene BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+p-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 27 88 % 83 - 117 % Fluorobenzene 30 30 101 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). IA TURNING MILL CONSULTANTS, INC Designed by : SCALE DATE ENGINEERS AND CONSTRUCTION MANAGERS Drown by 171 ROUTE 149, UNIT-B Checked by MARSTONS, MILLS, MA 02648 Approved by : 1" = 50' 09-19—02 PHONE: (508) 420-7244 - FAX: (508) 420-7388 1/O 00 G � Lm i o LOT 12 L 2'3TQL�sty rn Kc 0 O Z . 1 1} 31 0 SITE PLAN SCALE:I"=50' A-1 SITE LOCATION Sheet of 1 1 M RL'D O.A/Y LANE 18 RL'D 0.4/Y LAYF BARNST.4BLX MASS BARNSTi1BLE MASS JOB NUMBER MFJ 2.Of f EXT'G EL.= 57.0 P - 20` LEACHING TOP OF YVVNDAffoN PITS CD- EL.= 45.0 PMH 7/4• Pl+R FI i r C>+ .R=3p - CO1►OUTE coVE'Rs - level 21A%ER OF LOT 1 F COVERS WAS! STONE 44,45O.f sf 4' CAST IRON ,44 , , OR SCHEVULE 40 43.0E I (� P.V C PIPE i < s=0. �8 4' SCEMULE 40 P.V C D P1PE - AaN. INVERT Fzow LM s=0. �04 PITCH 118' PM? ox s=0.03 65 . 46.19 i 19' IN"VER s$CRIM2Mp�,, `c IP�s aa:8,8:8 INVERT �i 0 EQUIVALENT 4 o, 40.99 EL. :° g 0 l INVERT - 40. 74 EL.=40.21 0 6, o C 1 1 g/4 1-1�z- t SEPTIC TANK '.0 WASHED STt�NE 1000 caccoNs EL.=`40.38 EL.=40 00 0 : Oc reserve e1=34.0 4 \ areas w 01 tp �-- DIAN. . \ � Cz ?YLo LEACH PIT o IJ 10" --4p Tj� PROFILE OF ' / I 46.S �z SEWAGE DISPOSAL SYSTEM OBSERVED WATER TABLE ( / / ) EL=_nae � l jleaching � � �' � encoun e ed pit l 9' c� NOT TO SCALE The contractor shall ecavate m to elevation 29. 0 and then notify Q, _ - 44 ALL ELEI TIONS ASSUMED the engineer in writing to inspect Y. 1� 9 SOIL LOG the soil conditions. GAR 0 �. P No. 3888 c�. • o- septic WITNESSED BY: R. - GIFFORD 12 21 � / � \� �6'p � •� �� 65 tank DATE' _ ��84_ HEAL TN OFFICER S5\0 o TEST HOLE 1 TO of BARNSTABLE PRO. _ - � -` - 0 EL. 49.0 ENGINEER JOHN LANDERS_CA ULEY !I :HSE. ' 0 Q to _ 6 0 PERCOLATION RATE _ _ MW INCH O- top and - , subsoil DESIGN .DA TA.' P os , �O• �` - 4.0 45 0 e1 � . : FOrrR / test silty sand NUMBER OF BEDROOMS 55\0 cr \ ` APPROVED. BOARD ©F' HEALTH 6.0 43. 0 rn \ hole GARBAGE DISPOSAL NONE. medium DATE AGENT sand TOTAL ESTIMATED FLOW 440 GPD o , ( _110 _GAL/BR/DAY x 4 B .) �, N \ ►.. 12.5 36.5 49 of P SEPTIC TANK CAPACITY \, \� �, \ � r1, ,��`'�H of MRssq�y o�����, `����� LEACHING AREA REQUIREMENTS total= 550 PAUL � JOHN A. ® N�EFW�� ' COUNTERED SIDEWALL AREA 188� GAL/S.F. 188.5x2x1.25-47,2 33 MERITHEW CIVIL 78.5 GAL 78.5x.2x0.5 78 \ ext g well BOTTOM AREA _ - /S/F e No. Q No. GISTERti� �,�` � �� '°F�`p p�Q tf, LEACHING CAPACITY ( BOTTOM & SIDEWALL) 550 _ GAL rb RESERVE LEACHING CAPACITY GAL GENERAL NOTES -- 1. THIS PLAN IS FOR CONSTRUCTION OF A SEWERAGE DISPOSAL SYSTEM. PROJECT LOCATION I ext g ,2 PLAN REFERENCE.' BOOK 398, PAGE 64. LOT 12, OSTERVILLE- W BARNSTABLE RD driveway BARNSTABLE, MASS 3THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO REP APPLICANT.ART DOLGOFF BUILDING-REMODELING a /1 TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 508-775-6532 �p d FOR THE SUBSURFACE DISPOSAL OF SEWAGE. h / 5. ALL COVER TO SANITARY UNITS SHOULD BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. YANKED SURVEY CONSULTANTS 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE R 0. BOX 265, 143 ROUTE 149 f / SAME UNLESS NOTED BY FINAL CONTOURS/ � MARSTONS MILLS; MA. 02648 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 508 428-0055 FAX 508 420-5553 / OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING / Ix ` / SHALL BE USED UNDER OR zPr 10' OF DRIVES OR PARKING. SCALE. 1"=30' DATE. cp0 �'HIN NOV.13,1992 „0 UNLESS NOTED. 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. Rom'• DEC. 2, 1992 REV. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO .IOB NO. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LOCATION MAC' 5024-2 1 SHEET 1 OF Z