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HomeMy WebLinkAbout0071 SHEEP MEADOW ROAD - Health V 7,l Sheep Meadow Road k�, West Barnstable A= 109-027 I, I� i p Commonwealth of Massachusetts /0%6� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 71 Sheep Meadow Road ' Property Address py Armand Garceau Owner Owner's Name rr information is ;�;. required for every West Barnstable ✓ Ma 02668 9/13/2018 T. page. Cityrrown State Zip Code Date of Inspection ;p' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information /3�¢a.l 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 Beldan Lane . ,Q Company Address Centerville Ma 02632 Cityrrown State Zip Code » 508-658-3456, 774-2484850 SI 4522 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 16.000); 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 9/13/2018 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is West Barnstable Ma 02668 9/13/2018 required for every page. City/Town 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 dwelling located at 71 Sheep Meadow Rd West Barnstable is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 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): t5insp.do-.•rev.'7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for ever,/ West Barnstable Ma 02668 9/13/2018 page. City/Town 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 page. City/Town 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: **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 t5insp.doc•rev.'7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 1-414. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required forever}• West Barnstable Ma 02668 9/13/2018 page. City/Town 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 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 �r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of o-.cupancy: unknown Date t5insp.doc•rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts re p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 page. Cityrrown 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 Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: tank pumped at time of inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? size of tank Reason for pumping: maintenance t5insp.doc•rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form t,e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for eve.y West Barnstable Ma 02668 9/13/2018 page. City/Town 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 system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system installed 1984 per town records 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 ok, no leaks or blockages. Vented through roof t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Rcad Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 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 61f Sludge depth: 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 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" 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 was cleaned for inspection and should be done again every 2 years for proper maintenance. Tank was structurally sound. t5insp.doc•rev.7/26/2018 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 71 Sheep Meadow Road Property Address Armand Garceau Owner Owners Name information is required for every West Barnstable Ma 02668 9/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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: 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 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 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 Oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was replaced for inspection. permit#2018-292 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts +� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for evey West Barnstable Ma 02668 9/13/2018 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 ❑ 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 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for evey West Barnstable Ma 02668 9/13/2018 page. City/Town 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 fibund with 1' standing water and a stain line 3' higher. Cover is on a riser. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Read Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 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 Commonwealth of Massachusetts - = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 page. City/Town State Zip Code Date of Inspection D. 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 p Z L3 3Z �3 sY �I v � t I /u� 31 30 t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sheep Meadow Read Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wel s 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: L ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation 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 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sheep Meadow Road Property Address Armand Garceau Owner Owner's Name information is required for every West Barnstable Ma 02668 9/13/2018 page. Citylrown 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 I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i CERTIFICATE OF ANALYSIS ¢. - .. Barnstable County Health Laboratory (M-MA009) i "CH"?"' { Recipient: Arthur Caiado Order No.: G18110401 Century 21 Cobb Real Estate Report Dated: 10/17/2018 1550 Rte.28 Falmouth Road Submitter: Arthur Caiado, Realtor Centerville, MA 02632 Description: RE Kit- Laboratory IN: 18110401-01 Matrix: Water-Drinking Water Sample M. Sampled: 09/28/2018 11:30 By: AC Collection.Address: 71 Sheep Meadow Rd.W.Barnstable Received: 09/28/2018 12:05 By: PatmerP Sample Location: Turn Around: Standard s Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED TIME Nitrate as Nitrogen 3.3 mg/L 0.010 10 EPA 300.0 LAP 09/30/2018 10:64 Copper ND mg/L 0.10 1.3 EPA 200.8 CL 10/0312018 16:58 Iron 0.16 mg/L 0.10 0.3 EPA 200.8 CL 10/03/2018 16:58 I pH 6.7 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 09/28/2018 14:42 Sodium 26 mg/L 2.5 20 EPA 200.8 CL 10/03/2018 16:58 Total Conform 0 CFU/100mL 0 0 SM 9222B RG 09/28/2018 18:00 Conductance 290 umohslcm 2.0 EPA 120.1 DCB 09/28/2018 14:42 i Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. Attached please find the laboratory cartified parameter list. Approved. B (Lab Director) a i ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508.375-6606 Page: 1 of 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) Recipient: Arthur Calado Order No.: G18110401 Century 21 Cobb Real Estate Report Dated: 10/17/2018 1550 Rte.28 Falmouth Road Submitter: Arthur Calado,Realtor Centerville, MA 02632 Description: RE Kit- Laboratorv.ID#: 18110401-01 Matrix: Water-Drinking Water' Sample#: Sampled: 09/28/2018 11:30 By: AC I Collection Addr: 71 Sheep Meadow Rd.W.Barnstable Received: 09/28/2018 12:05 By: PaimerP Sample Location: Turn Around: Standard , Analyst: yn Method: EPA 524.2 Dilution: 1 Date Analyzed: 10/01/2018 @ 9:23 EPA 524.2 - Volatile Organics by GC/MS LL Parameter Result ug ugjL Parameter u�gu/L uult �g/L�? u DL Dichlorodiflucromethane ND 0.50 Chloroethane ND 0.50 Chloromethane NO 0.50 Chloroform ND 80 0.50 Vinyl chloride ND 2.0 0.50 cis-1,2-Dichloroethene ND 70 0.50 Bromomethane ND 0.50 cis-1,3-Dichloropropene ND 0.50 1,1,1,2-Tetrachlomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1 Trichloroettkane NE, 200 0.50 Dibromomethane ND 0.50 1,1,2,2-Tebmchioroethane ND 0M Ethylbenzene ND 700 0.50 1,1,2-Trichloroethane ND 5.0 0.50 Hexachlorobutadiene ND 0.50 1,1-Dichioroethane ND 0.50 Isopropyibenzene ND o.so 1,1-Dichloroethene ND 7.0 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichioropropere ND 0.50 Methyl-tert-butyl ether ND 0.50 1,2,3-Trichlorobenzene ND 0.50 Naphthalene ND 0•50 1,2,3-Trichloroprop3ne ND 0.50 n-Butyibenzene ND oso 1,2,4-Trichlorobenz--ne ND 70 0.50 n-Propylbenzene ND 0.50 1,2,4-Tdmethyibenzene ND 0.50 p-Isopropyltoluene ND 0.50 1,2-Dibromo-3-chloropropane ND 0•So sec-Butylbenzene ND 0.50 1,2-Dibromoethane P;EDB) ND 0.50 Styrene ND 100 0.5o 1,2-Dichlorobenzene ND 600 O.so tert-Butyibenzene ND 0.50 1,2-Dichloroethane ND 5.0 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Dichloropropane ND 0.50 Toluene ND 1000 0.50 1,3,5-Trimethylbenzene ND 0.50 Total xylenes ND 10000 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichloropropane ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichloroethene ND 5.0 0.50 2,2-Dichloropropane ND 0.50 Tdchlorofluoromethane ND 0.50 2-Chlomtoluene ND 0.50 Compound _ %Recover!j!�70 imits(%} lorotoluene ND 0.50 1,2-Dlchlorobenzene-d4 106% 130 Benzene ND 5.0 0.50 p-Bromofluorobenzene 100% ) 70 130 Bromobenzene ND 0.50 Bromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND 100 0.50 Attached please find the laboratory certified parameter W. Approved By. (Lab Director) ���� ND None Detected RL = Reporting Limit MCL= Maximum Contamfi nt Level 319S Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-37S-660S Page 1 of 1 COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION ' I Certified Parameter List as of:01 Jul 2018 M-MA009 BARNSTABLE COUNTY HEALTH&ENV DEPT, BARNSTABLE, MA Ana es Methods for NON-Potable Water Methods for Potable Water ALUMINUM EPA 200.8 EPA 200.8 ANTIMONY EPA 260.8 EPA 200.8 ARSENIC EPA 200.8 EPA 200.8 BARIUM EPA 200.8 ' BERYLLIUM EPA 200.8 EPA 200.8 CADMIUM EPA 200.8 EPA 200,8 CHROMIUM EPA 200.8 EPA 200.8 COBALT EPA 200.8 COPPER EPA 200.8;SM 3111B EPA 200.8;SM 3111B IRON SM 3111B LEAD EPA 200.8 EPA 200.8 MANGANESE - EPA 200.8;SM 31118 EPA 200.8 MERCURY - EPA 200.8 NICKEL EPA 200.8;SM 3111B EPA 200,8;SM 3111B SELENIUM EPA 200.8 EPA 200.8 SILVER EPA 200.8 THALLIUM EPA 200.8 EPA 200.8 VANADIUM EPA 200.8 ZINC EPA 200.8;SM 3111 B PH SM 4500-H-B SM 4500-H-B SPECIFIC CONDUCTIVITY EPA 120.1;SM 2610B HARDNESS(CAC03),TOTAL SM 2340B CALCIUM SM 3111B MAGNESIUM SM 3111B SODIUM SM 311113 POTASSIUM SM 3111E ALKANIL1TY,TOAL SM 23209 SM 2320E CHLORIDE EPA 300,0 FLUORIDE EPA 300.0 SULFATE EPA 300.0 EPA 300.0 NITRATE-N EPA 300.0 EPA 300.0 NITRITE-N EPA 300.0 TURBIDITY EPA 180.1 AMMONIA-N EPA 350.1 KJELDAHL-N EPA 351.2 TOTAL CYANIDE EPA 335.4 EPA 335.4 TOTAL DISSOLVED SOLIDS SM 2540C SM 2540C NON-FILTERABLE RESIDUE(TSS) SM 2540D TOTAL ORGANIC CARBON SM 5310B QHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 5210E TRIHALOMETHANES EPA 524.2 VOLATILE ORGANIC COMPOUNDS EPA 524.2 PERCHLORATE EPA 314.0 HETEROTROPHIC PLATE COUNT SM 9215B TOTAL COLIFORM MF-SM 9222B TOTAL COLIFORM EPA 1604 TOTAL COLIFORM ENZ.SUB.SM 9223 FECAL COLIFORM MF-SM 9222D MF-SM 9222D• E..COLI EPA 1603 EPA 1604 E.COLI , EPA 1103.1 NA-MUG-SM9222G E.COLI MF-SM 9213D ENZ.SUB.SM 9223 ENTEROCOCCI EPA 1600 EPA 1600 Effective Date:01 July 2018_Expiration Date:30 Jun 2019 TOWN OF BARNSTABLE LOCATION "7 ( S 1'1.e-E e SEWAGE#d O VILAGE C, 2Sk O c�,rt%S fi,,'uIL,ASSESSOR'S MAP&PARCEL 109 INSTALLER'S NAME&PHONE NO. 5�o c� (=�„�►� S�b' `l 6 b _i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)' x�0 NO.OF BEDROOMS p/,,,N OWNER C, GrC-C rvv PERMIT DATE: I Q 1 COMPLIANCE DATE: / Q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ° Feet �• , 't FURNISHED BY _ t4T Ll GOA fro r%k C,�c1 0 rjo lip . r No. V "- �01� • Fee e:THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: %4� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLation for Disposal &pstrm constrULtion permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete SystemdIndividual Components i Location Address or Lot No. 5���p Q R� Owner's Name,Address,and Tel.No. Assessor's Map,ParceP`o p '� ``�j1ll@ J A`;,r--s t G(p �M � 1.7rRr C e V Installer's Name,Address,and Tel.No. `J Designer's Name,Address,and Tel.No. �13 0 ka 01 i ej v-,;k_ oozy IN Type of uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(: ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of S-.ptic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) k C C.Q. PP ) (� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. C� Signe Date / 2O If Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2G Date Issued v----------------------------------------------- �J /'u No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 33isposaY *pstem Construction Permit Application for a Permit to Construct( ) Repair(" ) Upgrade( ) Abandon( ) ❑Complete System e Individual Components Location Address or Lot No. tqt4dOUi R J Owner's Name,Address,and Tel.No. Assessor's Map/Parceli o� - 1 e JA �,rns{ c- Installer s-Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L�o GCc.�vC k 13 OW \/c,r 1, CJk 2j Type of uilding: ` �\ Dwelling No.of Bedrooms 'v' Lot Size sq.ft. Garbage Grinder( ) e of Building T Other T t No.of Persons Showers YP g l ( Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. III Description of Soil� y • 4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date /,aO I f A ApplicationApproved.by ; Date o / Application Disapproved by ( 4 r Date f for the following reasons ff Permit No. 2 G ( � Date Issued ()v r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r1�X on l/ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(j/) Upgraded( )' Abandoned( )by Ir at '1 S It..e t 0 Me4 6 a W (S"^SkC\§as-een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. u f F'.2V dated C�1.2 Installer ✓ Designer ner M g #bedrooms Approved design flow ti gpd The issuance of this permit'sshalhnot be construed as a guarantee that the system will function as designed. Date t ! Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. O .2 01 2- r. . Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal �&pstetn Construction Permit Permission is hereby granted to Construct( ) Repair(,,/) Upgrade( ) Abandon( ) System located at'"fit 1 ,p r1(,h�o,0 Rt} and as described in tie above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must bT ompleted within three years of the date of this permit. Date c l �) u ,� Approved by ! i LOCA1J,ION SEWAGE PERMIT NO. vILI, Ac f INST LIL 'S AM.E A ADDRESS , "Ole B U I L D E R OR OWNER QVTE PERMIT ISSUED g ¢ DA E COMPLIANCE ISSUED v �i �\ 9 I NX� 9 tl� I /Op NoK!-------- ------ Fes$....J� .... R 1 T E COMMONWEALTH OF MASSACHUSETTS i �� _02 BOAR®, F HE L 1 9............OF..... ..:.... .........-.. ----------------------------------- ApOliratilan for Disposal Works Tnnstrnrtiun rnmit Application is hereby made for a Permit to Construct ( or Repair ( ) an In ' idual Sewage Disposal System at: ... .. .... .... Loca, o Adds r N .....................• ... ---. ............. h ---•-- ...... ........ .!.._....._. _........ .................................. yj( er It Address Installer AddressPQ Type of ilding Size Lot... ,._ _ 1L.Sq. feet Dwelling—No. of Bedrooms. _._... . Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ... --- ----------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtur ._ W Design Flow..................... . ..........gallons per person per day. Total daily flow____ .Q•......................gallons. WSeptic Tank—Liquid capacity gallons Length..... Width..._...... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.._Z---U.?>...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) est Percolation t I... minutes Performed inch Depth of Test Pit.-/_. / Depth to ground water__ Test Pi No. _____________•----._-. (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________------_.-_-_ � . • •---•• C...O Description of So' .-• --•.// . ........... ...."- `.... V -------------- �} UNature of Repairs or Alteratidns—Answer when applica le.._...___ _________________________________________________............................. ------------------------------------------------•--------------•--------------------------------------------------------------------------------------•--------------------- --•-------•-•----........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 5 of the State Sanitary C4b, The ers' ed further agrees not to place the ste in operation until a Certificate of Compliance has b n o d of health. Sig le Date ApplicationApproved By............................ ...........•........------••--•----.......-----------------•------. ••--•--•••-............................ Date Application Disapproved for the following reasons----------------------•----------•------•--------------------......-------------------------------------------•-- ....-•----•----------------------------------------•----••-•-•-•••--••----••-----•--...••---•-------•---.._.....---------------••--•-------••-•-•-----•---------•-----•------------•---•---•---•...--•-•- Date Permit No.. ..... 3 ...................._. Issued--•--. '` -$ ..................... Date f __ __—-------W_----------------------�------- Nil._.....9.._....... Fn$... .........._ E COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL/T Appliration for Disposal Works Tontrnrtinn umit Application is hereby made fovea Permit to Construct (101 or Repair ( ) an In idual Sewage Disposal r System at: ................. �`"'.. � !/C .d1t1 l G'c ' chi * ft1. J ..... -- ��t+_Lpolt�„(1esw. - "`�;__ _ :...:..t" .I'.::4w .................................. . -- .. •.I ............................................... ......._ ............. Installer - Address U Type of ilding Size Lot__ . t ! S q. feet :. �-, Dwelling—No. of Bedrooms - Expansion Attic ( ) ''. , Garbage Grinder ( ) aT Other— ype of Buildi g _,1 -- -_:... No. of persons__ ... ..._______ Showers' ( ) — Cafeteria ( ) dOther fixtur -----------------------••---------••••-•.....•------••--••----•---- -•------- ----•-••-••----------••--••-•-•-••• Design Flow................ g P P Y Y _._..__.____gallons per person da Total daily flow.__.. ._ ... W l � •;............gallons. WSeptic Tank—Liquid capacit/ -gallons Length___- ..... Width.../e........ Diameter-------- "Dep h.... _ ....... x Disposal Trench—No......................Width...:......_..__...__ Total Length.................... Total.leaching area. ._ ._._sq. ft. Seepage Pit No..................... Diameter.....................`B,*h below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) f..I a .♦. �. Percolation Test Results . Performed by...._.____............................ ....... ° Date........................................ -- ,�a Test Pit No. 1.. ':..._minutes per inch Depth of`Test Pit./3.......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water'....................... a . ... ----•- --- �..}...... O Descri tion o= S �..�.-f U U Nature of Repairs or Alteratibns-Answer when applicable ......... ......... ......... .......................................................... --------------------------•--••------••-••-••---•-•----••••-•-•-•--••--••--•••---•---•-•-•••----•---•-•-•••.....-•---•--•-------•-......=--•••-•-•---......•••.........-................................ Agreement k The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State 'Sanitary Code Th ers' ned further agrees not to place the st in operation until a Certificate of Compliance has ben ' ed b d of health. Signe .............. . •_.... _--- -•-•- Date Application Approved BY..........................-- '......-•----------..... Date Application Disapproved for the following reasons-------------------------------------------------------------•------------------------------•--•--......•------ --••-•..........................................•-•----------------------.....---------......-------••----••-•-•--••--•.....•---•-------•--------•-•--•---------•••--•-•-••-••••---•••--••••....._------ Permit No..... - -------•--.....----•-.. Issued-.....4..-.L....--`�_4 ..-----Dau...•.. Date COMMONWEALTH OF MASSACHUSETTS BOARD HEAL ......... .......................OF. ............................:.......... ;.......................... �rr#ifirtt�e of �unt�li�anrr .:. THIS IS 7'0jURWFY. t divldual Sewage Disposal System constructed (. or Repaired ( ) by----------------------- - -•-----•---------------- _.-•---•------ ..._.._..........._.__............... . taller fI ate+} has been mstaled in accordance with the provisions of T F 5 floe State Sanitary Code as described in the application for Disposal Works Construction Permit No. '_. �i................. dated_................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT�.THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........1.- 9 �dZ ......................................... Inspector..... s-„ f1 COMMONWEALTH OF MASSACHUSETTS BOARDP. FHE AL,P'H ... .... ........OF......... No. ....................... ... FEE: ................. Disposa anti# Permission is eby granted.•.... ------------------ -----------------------------• :.. to Construct ( ��?rq:�R par ( ) Individual S ge Dis a Sy / at No..... I11. ! Street as shown on the application for Disposal Works Construction Permit No._ `�`'_._. .. ed.... .-�.-�i¢.............. F =^ ...................... .... - ...................................................... 4 _— 4 rd of Health DATE. --------•--..--•.............•-••.......--- FORM 1255 A. W SULKIN, INC., BOSTON S " y. i f j _ b0 �. p "7 i f i i r .. v 1 - _ _ C /�/�Atv N L 7-O �X D ® FIt�l5+� 69^VW• /AI►J. 2'* -- W I't`N 1 K ONE. F OCl'T OF Fi til l S H C•a RAP E p V E 9 L EA G H A R E.A ; OF PEA STONE FOR MPERVIOO s C.vV�+�- TD 24 PIA, CO+� r , �� 80x 5r +' rfZeVet4T Ftt`!B5 F M 2 I.F VOL 4:� I tit F I t?�Z ATi r.Ya rd E• nnlnt� tN, p Y 4�GA�C�Ra� 2 M1n1. 4 GI I 1 HT i2"NV�. - f OK ,40a,�n ZIrJE t=ooT �_ Mi y � � `4 F�oT i;;. << ,4 �a�•� � vw. Nv6(�T' Pl I T, r ors E r • L 1 GALLON 4 M�ty. � ►�� I RChjt�D , CAPACITY �' / A PVC f r- — cc ��WATEl�s� �rr' p,9 6 AR B��. G RI fQ`QSR 20 x r g q ' q -- - T- -- ----- - -�►..� —' pE�1 C4 1� j, _ Y�Dos�� � , _ , 5EP"fi G SYSTEM CON 5TR uc-r' ©ri CON FO R/v\ TO 71-4E MASS• N ,�!! R O NM E TA t< COPS B -,-a TL E• � �' 6•-�' r.-0\A/ ' — - --- — o w 00AfZ0 of NSAL-11fi 145C LL LATioN� j - --_ TR Cho �� �? Gi-�. v tC , ��s ► P-OTi co N1 ' . L eA GAPA G ITY — �. _ ,ter �,� - - - i 1 7 � - � ANra LEACN INL� err -t'o t3� o� — — _ '— ' '� � RE►t.iFoK•G�t� �.oNC-RATE ' K F: ✓, �i t�.00 �� `� M!(J CONGRE.T'E �RC�P05�D I.�AGI-}G'AP/4cG1TY - — r. — T TN�TN 300o P� �f 5'TF.E.N D LDA D I CaAA sr — ! / ` \ r � CRAIG No. 27463 � -_ . ALA Pr PEra --0 43e WAT�'r� �T sal —i � • 5 F RAF ,�N C { I � g/ �i REO. OF VEFOS t�'E ail F��M �a1a,5E � PaARNS. , 1I� M P9S-CAST - _ IC, ,� ENGINEERING C. R. DESIGNING BUILDING 4 Tf::� p FAUN ALi�-r APP90VAc- DENN6, MASS385 - 2831_j� SHORT Al-©ANENE t'" 10 5455 ARCHITECTS' STANDARD FORM