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HomeMy WebLinkAbout0034 COMMODORE LANE - Health 3-;,l C C M f j O CX O r' O- L, fit., d-1 0S2- �nS 171 LLs i I'+ �C 0102—O`3—6 F Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments { w 34 Commodore Lane ' Property Address p 7 Elizabeth Driscoll Owner Owner's Name information is Marstons Mills Ma 02648 8/15/2019 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Imngoutf rms A. Inspector Information filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-48.50 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/15/2019 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form ,e a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 34 Commodore Ln Marstons Mills is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 1000 gallon precast leach pit. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is Marstons Mills Ma 02648 8/15/2019 required for every j page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):. ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ,I **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 1. Title 5 Official Inspection Form 1la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <f 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every- Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address. Elizabeth Driscoll Owner Owner's Name information is Marstons Mills Ma 02648 8/15/2019 required for every � page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7/2019Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is Marstons Mills Ma 02648 8/15/2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No i Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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 )and a owner system co of latest Y PY inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: original system installed 10/26/1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:' years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons .Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should done every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet baffle intact and in good condition. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. r G ease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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: it gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found level in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 E c� Commonwealth of Massachusetts Title 5 Official Inspection Form (rt Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: / Type: ® leaching pits number: 1 x 1000 gallons ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was video inspected and was found with approx 6"standing water with a stain line approx 2' higher. Pit walls were clean, no sign of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I i Commonwealth of Massachusetts ra = Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 34 Commodore Lane Property Addross Elizabeth Criscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form !� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection M System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately O A 2 7'6 r 33 3 AZ 3 0- �? 3G.e �3 � M l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F 34 Commodore Lane Property Address Elizabeth Driscoll Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/15/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 J)P TOWN OF BARNSTABLE LOCATIONL 01 %L� C4AI(hddafe _ J SEWAGE # ?744-f' �ILLAGE / q 4 re' f pru_S /Vl f I ASSESSOR'S MAP & LOT tr) 06INSTALLER'S NAME & PHONE NO., SEPTIC TANK CAPACITY 1000 - LEACHING FACILITY:(type) t1'�-� tl Pl (size) NO. OF BEDROOMS RIVATEA�WELL>R PUBLIC WATER BUILDER OR OWNER 6[Z$e i7 'OX id I Xe 1.) (U�P. DATE PERMIT.ISSUED: 16j, ,l� DATE COMPLIANCE ISSUED: ®- 7 VARIANCE GRANTED: Yes No �) i i j r Y w THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 3 w .....oF........-:;9 T _ 6. ............... Xpli iration for Uiipooal Vork5 Tontrnrtion Errant Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal esystem at: ................................... tion Owner dr.S ................................. 75 J"eAddress Installer Address QType of Building Size Lot______________________ Sq. feet U Dwelling—No. of Bedrooms___..................................Expansion Attic 0A Garbage Grinder pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................................ 2� ------ W Design Flow............................. gallons per person per day. Total daily flow..................�2�_ �YJ gallons. R: Septic Tank—Liquid capacityAR.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..-------_--__.--sq. ft. Z Other Distribution box ( ) Dosingtank ( ) `" Percolation Test Result /�Performed by.__ G�f_ � �_ ` .. f._��_1- _......... Date......... .......... ............... minutes per inch Depth of Test Pit.................... Depth to ground water-.____-____-_-_____-__ .Test Pit No. 1________ _____ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W' . O Description of Soil............ ...'__. W .....(Q-----•-- = 1-... ----------•- ----------------------------------------_4 f!:4*-------l-1- ----- --------------------------------------------------------------------------------------- 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 L_''H 1 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................. / - - --- ----- ............................ .........� t Application Approved BY .. ..................•--........--- 1C1."---� .s..7 Date Application Disapproved for the following reasons:..............................................................................................................- oo Date Permit No._O-_� ....... Issued_____________________________ ..--•--•---...--•� --•------•---------- ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appiiratiou for M-4poaa l Works Tnnitrnrtinn 1hrmit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at ................ �../ I t r C x✓ €�` �� �� ? ... -....-- -..-.....•.-....----••-•••--•----•--•-•-•---_. Location A d ess ' or Lot No. o — f ' 1.. .. ....s...� ,k •/� Owner `� �f -Jy E Address ...............t -------------------------- . .......... - _�.............................---- ---........-----------------------......-•-- a ,. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---.,,:..................................Expansion Attic Ab) Garbage Grinder (110 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures = . Design Flow.............................!��� ,_--.gallons per person per day. Total daily flow____........._._._._..__O gal W -------------- Ions. 9 Septic Tank—Liquid capacity/1%_AA.gallons Length................ Width................ Diameter................ Depth................ - Disposal Trench—No. .................. Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results_` i�Performed by.../&� 1._�`:��:��s�f`I °�"��¢ � Date.-_._____ 4 Test Pit No. 1-_-.__-1�-_-minutes per inch Depth of Test Pit.................... Depth to ground water----_-.-__--_-_-___..--. (4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____....._......_.' --- _-- O Description of Soil .---�........���c � = '.? - -_ x -•-••-•••----•------•--------------•--------- 1 �� � W ------------------------------------------- = )4-------- UNature 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 TTT Z 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. 1 � Signed............... ----------- -------- ----- .......... Ye /- Application Approved By-••••-••.�r-- ----`^'*..... .._ — /10--=--.. �. Date` Application Disapproved for the following reasons_____________________________________________•___.__.____._________.____.________.__________.__._________.._..... ....----...-•---•--•-----------•-•-•--•-...._._...-•------------------------------------••••--------••••.---...--------...•-•-•-••-•---••------•------•-----------•--------•--•---••••---------...._.._. Date PermitNo.-p.].......i�G.a------------------------_ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .t`.1 .............OF........... .......................................................... ................................. Tn#ifiratr laf TompliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) ..... .Installer l �at........ • i�.____ C ?.has been installed in accordance with the provisions of TILT— 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ -.. .�_.. dated-....................................---------- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FU C I ATISFACTORY. DATE............. ..}_.. ..................................... Inspector-------------V �A------------------------------------------------------- t f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH {� 7 J� �"...................O F..... .,� 7'� -'..:..� .. �.� ................... ti o. . FEE.,��Cr .—. - - Disposal Works Tnnitrnrtion rranit Permission is hereby granted. == . ......-_ . ..... :�---------------------------------------------•--.........---•----.......••--- to Construct ( # ) or Repair ( ) an Individual Sewage Disposal System _ , 7at No.... . 1 . ................. �. f •-- . ............... Street r, as shown on the application for Disposal Works Construction Permit N _ �-1___ Dat .....(. 1. ... ........... 2f Board of 7Health DATE............... 4`� ?. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS q n Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT L WELL LOCATION Address 1_OM✓ILL D C 0 re- 4411 IQ— City/Town f�►2S )'-D NS G.S.Quadrangle Map K o Grid Location Owner �rs2£�AV 616A r4— �(]2yz�o�]MN�t f�e r A— Address J8OY WELL USE CONSOLIDATED WELL Domestic.N Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled rlyq,, r 1) From To 2) From To Date Drilled 9"61A— 7 3) From To 4) From To CASING Depth to Bedrock Length Diameter o? 1 Type /OIl(L UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface_ Sand: fine❑ medium❑ coarse Date measured 9�.�BL—�� Gravel: fine❑ medium❑ coarsen Screen: GRAVEL PACK WELL Slot# /0 ength�3 from e00 to/03 Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# lenqth from to Chemical ❑ Biological Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 d/E✓Yl CI d / s LEE" P / O 4W DRILLER Drillin d 1 Firm r�p� ` c4L6 Gc�2 AddressT.Q. Box 4!30 �3 City So. -%mok�h. MN 02664 Registration No. perator s Signature Please print irm y CU$T_OMER COPY 15M-2 84-176471 ' og• Number: 7175 Bottle # 704 Date: Sept. 25, 1987 BAR�',ra BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT �j SUPERIOR COURT HOUSE V BARNSTABLE, MASSACHUSETTS 02630 AS$ DRINKING WATER LABORATORY ANALYSIS PHO NE: 362-2511 Ext. 337 Client: Greenbriar Development Cor�pllector: F. Clifford Mailing Address: P. 0. Box 510 Affiliation: well driller Centerville, MA 02632 Time & Date of Collection: . 9/24/87 8:40 a.m. Telephone: Type of Supply: well _ Sample Location: Lot 16 Commondore Lane Well Depth: 63' Marstons Mills, MA _ Date of Analysis: 9/2.4/87 1:00 P.M. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 PH_. Conductivity (micromhos/cm) 65 500.0 Iron ( m) 0.3 Nitrate-Nitrogen ( m) 10.0 Sodium ( m) 6 20.0 I . x Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked- below: A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. 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 checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: The Bnrncgabla c'e�y6,ty Health and FnvirnMngugal Department shall not endorse any statements, interpretations or conclusions made by anyone :else concerning these results without written.consent. CC: Barnstable Board of Health CC: Clifford Well DRilling 1 /7/85 Laboratory Director /6 ' - Explanation of.Test Results .Total Coliform.Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason, it would be advisable to retest any well water that is not approved. pH . pH is the measure of acidity oralkalinityof the water. On the pH scale,the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity , Conductivity is'a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are generally -. considered unacceptable and may have a laxative effect upon users. Iron The presence,of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper r fit; � Cod copper tends t o leach from pipes. This normally does not Due to the acidic nature of the-water on Cape pp p p Y present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the,water supply has more than 20 ppm sodium,it is up to the people who are on such a diet to find another source of drinking water or contact their,doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm 7 , ny rail )`c v;, .�Ie,:iJ. �`i _ indicate that there may,be,oce'an water or road salt runoff water getting into the well. � e No--------------- ---- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion-*r Well Congtruct ion Permit -- -- —(;) 2-0-plcuy— Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: -39----- s2r __L ck,-" J'!A-e"r s-r PLYI ► _ 1 -----�!"!1_ Location — Address Assessors Map and Parcel -�-ri. cA l---- - --- --— - _ cs. - - - ---- ---- ----- - Owner Address l, a 1" � 1' ►-n_ eaha•1_ c- li �s�_11 - 3� -RQs�.r�� �— � -a - Installer — Driller Address Type of Building `��`� ' Dwelling -— © ` - _--------------------------------- Other - Type of Building ------ No. of Persons---------------------------__—__________ Type of Well— ---- - -----__—- Capacity---- - ---- ---- - -—— Purpose of Well---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Co p ' e has beerx issued by the Board of Health. Signe - - --- e���- ----- date Application Approved By — -- ------- date Application Disapproved for the following rea s:-- -------------------------------------------_—____—_ date l (� Permit No. ---- Issued--�L -- - --- - -- ------ _-__ d e — BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance 2 ►C&ce-d THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) byf�3�1 — atL-1 c�we r1at®t`� �_a —►'�'1G�r� �n_S_- - 1 � --- -e-�-- has been installed in accordance with the provisions of the Town of Barnstable B?arq of HeealthTrivate Well Protection lt Regulation as described in the application for Well Construction Permit No. II Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -- - Inspector--- --------_-_ —_ —_ L- No. No. ---------- ---- � r - Fee------ --------- BOARD OF HEALTH TOWN OF BA'RNSTABLE _•,. •'+W " ation r0ell ConitructioriW Application is hereby;,made.for-a 7 permit to Construct.( ),'Alter ( ),`or e'p' ',. ,„ )yan-individual_Well at -�- _ , - At ='Cocat�on Address. t *u> Assessors Map and P.arce, , t . 3 Owner Address4 ' Cdo�ro _ r`'t_�e_e lean _ �Q,In-.� -'c� !l„ a)1►,� _3 f fQ_ _e_-�l_ ® -8©_ t r Installer Driller 4 Address , A as 3 M Type of Building f1 JJ � C Dwelling - --. ��.. Other - Type of Building-----------'=---------------- No. of Persons------------------------ ----------- Type of Well- "4 _ _ — Capacity — __. ... l.. s .., � �- . '� �' 1..z�� t a` sc � _s,#� �„*ems-=.' ..�•.'-;� �._aG�.�-�'r�� f-v..-'�,�•'-- T,Purpose'of Weil�; `` , '. - =- -'=. .. .._ '� 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 Co li- a has bee issued by the Board of Health. Si ne ��� - •o�a__ Q date Application Approved BY _-- -- �.- datet Application Disapproved for the following reasons: date --- • 1�/1/• �/,/,IF. ` ---' -- ---`�'_-- -- s Permit No. � Issued __-- ---€--�---------___-- # da e �liN.9000'3:1t.4HbtiTG9eoi�vTGlelilili4.�d.�4e�b?iK!'n+!4t<i�i+'i•1a'Ji4GT8llrV:Sl6'ae`4?eS6l.S.sloSeli/ilRol2ti�i?o!a$ts7eevai�lpalaii9oE2,9s'GE:iTvbCaTa.9G1�s�se7M1iM?ms6l4lslile±iMm± t BOARD OF HEALTH TOWN OF B) A R N S`T A B°L E _r` •__ . �:Yti--:.:5: qa.:.-�_ n;-r+., ^'�1.,. .... _._. ,-:: �..3";.-. .::.=,v' :�9 '3` �-.t` «. t::,:..._ E, Certificate Vf Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (- ) by Installer at 3�I c�►. ,Ntq�I©�E' l�Q n�r_4.* c,�:� -tQ1� - -1v1 I = Q=-=---has been installed in accordance with the provisions of the Town of Barnstable Boar f eal �rivate Well Protection ,Regulation as described m the application for Well Constructron Permit No. ---- --r- - Dated=---- THE ISSUANCE OF THIS'CERTIFICATE SHALL NOT.BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM.WILL FUNCTION SATISFACTORY: , DATE------- Inspector-- ------ - --- —- ---- i1'4!N.d?*}'liT.ihiRiTi'lb�ili!GNG?rliSi�!FltiSi/ilitititiil.i'1Pi�il.Ili@Gfli9i4i@i`Si'9il6lYl1'>litifGR6lGl6!1G1G11ilGliiliimOAiClitSll,.�ili9ikf.5!i'Ri°!i!'iNi�i4i.Arai+i'�i!K!d!!J!i9i!IGOGT4?i4G�i�6°. BOARD OF HEALTH TOWN. OF BARNSTABLE Co No. Fee -- Permissio 's hgg. eby ranted ' (.lax to Construct ( , Alter ( ), or Repair ( ) an Individual Well at: k, -- - ��17- - - `. Sheet a as'shown on e ta�p}plicat ca?or a Well Construction PermitNo /Aq n. Date - - _--- � ---- ---------- f � � �J r Board oAealth �- 1 DATE -!!! -- Y t R { Y TOP OF FOUND. 20 FT. MIN. EL. _ 2, 10 FT MIN. SOIL TEST DATE OF SOIL TEST CONCRETE WITNESSED BY 4�� SCH. 40 P C PIPE GLEAN SAND COVERS MIN. PITCH 1/8�y PER FT. PERCOLATION RATE Z z MIN./INCH OBSERVATION HOLE I OBSERVATION HOLE 2 CONCRETE 12 2 LAYER OF ELEV. = ELEV.=4" CAST IR N PIPE COVERS 4 ,OR EQUAL MIN. y I/8 I/2" WASHED To q PITCH / PER FT. STONE _ -_- _ E v 3 0' Z_ i E V 6 p', FLOW LINE _� E�- ' � ' `� MIN. .r..i d• CUAR5C 5AWD _, EL.-- E L ' 7 20 ref - �� -� � LEVEL _ z E L, I Ev 14 DIST. EL = o y BOX eo 0 0 > w O WATER AT EL.= � WATER AT -- EL.= 3/4"- 1 1/2" v •o° b o 0 0 �) GALLON WASHED STONE •%o ° w • u 0 DESIGN CALCULATIONS SEPTIC TANK W s° � EL.= PRECAST .LEACHING NUMBER OF BEDROOMS BASIN OR EQUIV. 7 GARBAGE DISPOSAL UNIT! } ,� Z 6 DIAM. Z TOTAL ESTIMATED FLOW 1 SEWAGE DISPOSAL SYSTEM PROFILE F i,ANI ( LC) GAL./BR'/DAY z BR.) GAL./DAY NOT TO SCALE REQUIRED SEPTIC TANK CAPACITY = GAL. ACTUAL SIZE OF SEPTIC TANK I GAL.( REG BOTTOM OF TEST HOLE = /7, LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE EL.= -- SIDEWALL AREA 6AL./S.F. JV �; BOTTOM AREA } . J GAL/S.F. LEACHING CAPACITY ( BOTTOM SIDEWALL) 549 GAL. LEGEND: EXISTING SPOT ELEVATION OOxO RESERVE LEACHING CAPACITY � _7 GAL EXISTING CONTOUR — —— -00---- --r-- FINAL SPOT ELEVATION NOTES FINAL CONTOUR I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. f SOIL TEST LOCATION UTILITY POLE -d.. TITLE 5 AND THE TOWN OFF T RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. / TOWN WATER W ===W 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO ~ &ZCATCH BASIN WITHIN 12" OF FINISHED GRADE . 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. LEA` H Plrt ,. -- < w, 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPAIBLE OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER Out 4- WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING; MIN. FRONT SETBACK SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARWING. MIN. REAR SETBACK S• ANY MASONARY UNITS USED TO BRING COVERS TO GRADE - ! MIN. SIDE SETBACK- ..� SHALL BE MORTARED IN PLACE. 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO, ir OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. APPROVED BOARD OF HEALTH 5; � t l� -• t,/ B ram, {y DATE AGENT r 7 „. PF OCATION /T A N D S E P T I C `' r -- '� - ; /�/ POS D S M PLAN,. LOT , � i I6 7y �.ANE 13ARNSTACiLE MA 4, f 1 1 I^ , tL r M E FJT A/ L L Lev E dredge & Wagner TA ,�� y, I Associates Inc,. t + -- ,. ., �. w.r '~•--�...,��,� Engineers landscape Architects Planners Land Surveyorls , V 77 889 West Main Street Centerville Mo. 02632 - L 't n ,_• ' A i LEVY Joe No. LOCATION MAP J _: SHEET OF R