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0108 STONEHEDGE DRIVE - Health
108 bbtll Drive n R tq 317,. 41 V _ u� : •x, r ' r c y : c. u r' z , , , a W , c 4 c, v 2 y F: 0 cr .4 uJ L 9 e �ry + r 0 r a r , u : n rh No. , —33 Uf/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Dte;pOgaY *p.5tem Conztrurtten Permit Application for a Permit to Construct( ) Repair 6� Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ( l � tJ.v_ � Owner's Name ddress,and Tel.No./�/-�'' :!Ol/' Assessor's Map/Parcel 1L-aiVWA` _ 66 Installer's N e,Address,and Tel.N f�'�OtIlf�� r✓�f� Designer's Name,Address and Tel.No. ��)S i✓lr.Q dsZ s7 9� 4-WI YJ.es Type of Building: 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 Septic Tank Type of S.A.S. Description of Soil Nature Repairs or Alterations(Answer when applicable) W Date last inspected: 9 o— 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 Titl of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this d of He Signed 1 Date � L Application Approved by Date ;L)---& Application Disapproved by: V Date for the following reasons Permit No. Date Issued 7� -----------------------__—_---� -- - - - - - -- ti .. No. a Go —36.3 ,. f Fee THE COMMONWEALTH OF MASSACHUSETTS` Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes TipplicationJor 4;Mpoga1 6paem Con.5truction Permit Application for a Permit to Construct( ) Repair .Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. �LQaJ_`��{� br. Owner's Ncame ddressj and Tel No./S�%� ►��e OVze, 10 Assessor's Map/Parcel !/ Installer's 1jarne,Address,a Tel.No. b(UC..W6_4-e",- !A C Designer's Name,Address and Tel.No: /()5— {a�G dl✓I+S S'- ►3 �Svyt Type of Building: 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 t Plan Date (Number.ofsheets^? ,( Revision Date Title . Size of Septic Tankr Type of S.A.S. Description of Soil Nature,of Repairs or Alterations(Answer w n applicable) t� 4 Ccr"Ire. CO `t�,� Date last inspected: �( O 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 TJt!1pj9f the Environmental .ode and not to place the system in operation until a Certificate of Compliance has been issued by this d of 7ea)fh. }; f Signed. tt :� t�Y' Date Application Approved by - Date Application Disapproved by: Date for the following reasons Permit No. �d U—; Date Issued A -y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the n-site Z4)_ wge Disposal System Constructed ( ) Repaired X Upgraded ( ) Abandoned( )by �I LJ P (,vL�1�-,/ 14 L at 167 P)f i V f- has been constructed in accordance c with the prols}ons of Tit413 and t e for Disposal System Construction Permit No. A a ' dated 0 r 2 d Installer l y2 ww �U tt/I 1 Designer #bedrooms Approved design flow _ % gpd' The issuance of this permits 11 n�be const ed a guarantee that the system '.11 unc desig ed. !foan; s `� 0 > Date Inspector s / ; 2 � No.; �WT Fee I'�V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wi!9po5al �&p5tem Congtruction Permit Permission is hereby granted to C,nstruct ( ) Repair (x ) Upgrade ( ) Abandon ( " ) System located at I - SSt_ (��,>!c_ and as described.in the above Application for Disposal System Construction Permit.The appli nt recognizes his/her duty ' to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this. it=--, Date a 9 Approved by -��C �- ` ._ � � � .2: �='� � � �� /1 �� _�� / � - _ _ i_ _ I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Stonehed e Dr. l)(-0 Z Property Address Countrywide Home Loans Owner Owners Name information is . Barnstable MA 02630 8/09/2007 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. Important: A. General Information When filling out . forms on the computer, use 1. Inspector: only the tab key to move your Brian K. Tilton cursor-do not Name of Inspector " 7z use the return a key. The Building Inspector of Cape Cod Company Name PO Box 307 CD � y I Company Address Eastham MA 02642 �f07 City/Town State ip Code " r- 508-255-9343 S14392 m Telephone Number License Number B. Certification All I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r 8/09/2007 1" pector's Signature +� Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 108 Stonehedge Dr.t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is Barnstable MA 02630 8/09/2007 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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: B) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts N y W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 5 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 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. 108 Stonehedge Dr.t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4c^M 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: The septic tank is leaking and needs to be pumped and repaired. Effluent level is 1' below bottom of invert. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® 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. 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 _ every page. City/Town State Zip Code Date of Inspection D. System Information 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): 336 gpd Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: 7/06 Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Not pumped since '02 installation Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 8/7/2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town Water feet Comments (on condition of joints, venting, evidence of leakage, etc.): no evidence of leaks or clogs. Septic Tank(locate on site plan): 1'6" Depth below grade: 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: Sludge depth: 15" Distance from top of sludge to bottom of outlet tee or baffle 15" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 1' (tank is leaking) Distance from bottom of scum to bottom of outlet tee or baffle 1'6" below invert How were dimensions determined? Accusludge,Baffle stick&Tape measure 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees in place, tank is leaking and levels are one foot below the outlet invert. Tank needs to be pumped and leak found and sealed. 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.): 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): 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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.): D-box is 4' below grade with no riser, Viewed D-box with "MYTANNA" sewer camera, equal flow to two outlets, no evidence of solids carryover, backup or leaks. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2/500 gal. W/2.5' stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Lawn over top with no evidence of break out or hydraulic failure. 108 Stonehedge Dr.t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 . every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A 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.): Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 108 Stonehedge Dr.t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 �q I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A [}welling 4 B C NOT TO SCALE 5 - 3 0 1 B1=25'6" C:1=31'6" B2=29' C2=356" � W A3=41' B3=21' A4=376" B4=26'6" 51n W 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 �w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C1M , 108 Stonehedge Dr. Property Address Countrywide Home Loans Owner Owner's Name information is required for Barnstable MA 02630 8/09/2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 114 No water encountered 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: 8/7/2002 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: System design plans on file with BOH 108 Stonehedge Dr.t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 . 1 fy TOWN OF BARNSTABLE U6(�_-,'AT1DN 10-5 S'J�d ����, ZV- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. t-01-IM 4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) JOO (size) /Z NO. OF BEDROOMS 3 BUILDER O WNER >' PERMITDATE: `7-,?y:6� COMPLIANCE DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist) / on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by /1g)ti I' — — 1 �s� ,a� �b�� ,i .« .,��' r` h ,, �p/.� TOWN OF BARNSTABLE LOCC F'ION 1 D 8 S'V AP h e e �r• SEWAGE # V), .L IAGE IRar n 54 a h LQ- ASSESSOR'S MAP & LOT 3 Olo b� NAME&PHONE NO.�f'�� k•T 16^ ' 5o8-25'-43y, �'n5 2c f5 . SEPTIC TANK CAPACITY 1500 6i4L LEACHING FACILITY: (type) Z- -5V0*/(Z' w15—/9Xe-(size) NO.OF BEDROOMS 3 BUILDER OR OWNER . PERMITDATE: COMPLIANCE DATE: 8f'��Z007 Separation Distance Between the: 5� Maximum Adjusted Groundwater Table and 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) can Feet Edge of Wetland and Leaching Facility(If.any wetlands exist within 300 feet of leaching facility) N Feet Furnished by_1l+t "/CV tge/oG Cad C , Al o T To ScA�E 3 2 R 2 25► a2: 35'�'� cq 3�'b'� c s. � No. �O F ., Fee 5b_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pp[ication for Migpogat *pgtem Cottgtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade(iV)Abandon( ) ❑Complete System lLXlndividual Components Location Address or Lot No./ J�,�� Owner's Name,Address and Tel.No. Assessor'sMap/P E I ,yp gj:2 ,,v Installer's Name,Addres ,and Tel.No. / l/ Designer's Name,Address and Tel.No. C®Xyr &14117 Ca�� ��• W- Type of Building: Dwelling No.of Bedrooms .3 Lot Size Z019 Ile sq.ft. Garbage Grinder(� Other Type of Building OCR 2 4Ce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 30 gallons. Plan Date O Number 9f sheets �� s���w9Revision ate�� Title w! � � O Size of Septic Tank _Ozp Type of S.A.S. Description of Soil 1K ff;e E S t5 �£ g r Nature of Repairs or Alterations(Answer when applicable) % /tn X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Board o eal > Signed Date l Application Approved by L S Date Application Disapproved for the following reasons Permit No. oe2- 3 \ Date Issued a C� LOCATION _/21 SEWAGE # 00�- VILLAGE v3�a6� ASSESSOR'S MAP & LOT. INSTALLER'S NAME&PHONE NO. 41aS'Y9,�G I SEPTIC TANK CAPACITY /SbOG�G LEACHING FACILITY: (type) -EdO Ca/ (size) x�- NO. OF BEDROOMS 3 BUILDER O WNER , PERMITDATE: `7-a y I5� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by g. . i • 3o s II 7 °� S i I ,I 11 1 �i /h \ h 3 / _o 6 . * z, i No. - .�c�` X, d Fee 4THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: Yes j PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Z[Pprication for ]Digpool *p!tem Con.5truction 3dermit Application for a Permit to Construct( )Repair(. )Upgrade(V)Abandon( ) O Complete System ®`ndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. /oS �7eAel e�' � Assessor'sMap/Parcel. AV /�S�a� �( Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 7 Dwelling No.of Bedrooms J . Lot Sizes W sq.ft. Garbage Grinder(1-051 Other Type of Building PS/ R Z1 _& No.of Persons Showers( ) Cafe-feria( ) Other Fixtures �9 Design Flow ��l/ gallons per day. Calculated daily flow .3?e gallons. Plan Date j 7 IeZ Numberpf sheets RevisioinDate Title 1 Size of Septic Tank CGS Ci'D' '' - Type of S.A.S. Z S�d.f / ��. S�i7 a. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t e. 'Pr (.1,,09/Dz� y1a /�®GYM/rf' _.• a Date last inspected: Agreement:,, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d Heal A. Signed r �-6 � - " Date 7I /elZ Application Approved by Q e..]�l_ Date —2 2ct C�7 Application Disapproved for the following reasons Permit No. Date Issued —————————————————————------------------ THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certif irate-of_Com Nance THIS IS TO CERTIU, that the On-site Spew ge Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by ® "_5 at D g S 1 # Z / D'1'M /~!�' - has been constructed in accordance i with the provisions of Title 5 and the for Disposal System Construction Permit No.20t�Z'_2j dated :t 2 41 It 2l Installer Designer , The issuance of thig perrAit shall not be construed as a guarantee that the sfstedi will functi� s des l ned. 1�y Date `7 ��� Inspector_ �-`_ w, --------------------------------------- 1, No. ouZ`-,�_a ` Fee -�)o i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS W5pool *pztem Con5truction Verntit Permission is hereby granted to Construct( )Repair�(f )Upgrade(Abandon System located at /� S Zee and td ��• �t�}/'a/S/��°�fG� s and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to 'i comply with Title 5 and the following local provisions orspecial conditions. Provided:Construction mus•be completed within three years of the date of this p� t. ` (� Date: /2`� f�'� Approved by �r �L`� lLS i ' r i I , L.000TION ' v f7` SEW&CGE PERMIT UO. VILLAGE IMSTQLLER 5 U&ME ADDRESS j BUILDER 5 Q / MF- ADDRESS DNTE PERMIT 155UED DATE COKAPLI &KiCE ISSUED ; L4 ---. � ,, .. a r T ^4 . ``^\) O ,y . . � ��, �r. FRic � i ...:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH i _.... . ..... _...-._.........OF................. ...-.- ................................................... Appliratiurt -fur BWVoiial Works Tomitrurtiutt Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: G6k--` _T a--- ...........................�y-----••---• -- •---------•••---------------•--...----•--••.. �. t .................... ......` -.---7----�--- h--.. ...No. x �" /.�L_ocation•Addre -hi' �4.. 1!J'.(U�.(_SL.._P S.._. Gv (✓ / or, of v Y /�T!!� << / Owner Address WT rl 'L. ' `_.•••-•-----•--•-•••--•-•-••••----•- --- Installer A7ress d Type of Buildin ` d v rJ 1 g Size Lot_-_.�:...,t_____________Sq. feet Dwelling `—'No. of Bedrooms_-_.__-3______________________________•.Expansion Attic ( ) Garbage Grinder (,c') aOther—Type of Building ............................ No. of persons-------_.................... Showers ( ) — Cafeteria ( ) dOther fixtures - ---------------------------------------------------------------------------------------------------- IF-D W Design Flow_...______ _--------------------------gallons per person per day. Total daily flow_.._...._...®_!?.......................gallons. WSeptic Tank-LLiquid capacity_1SP.o.gallons Length________________ Width................. Diameter-----__...... Depth................ x Disposal Trench—No. ................ Width.................... Total Length..................._ Total leaching area....................sq. ft. Seepage Pit No------I------------- Diameter!y0�?__.J.-z/-- Depth below inlet.................... Total leaching area-----.------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ��. �� ✓_ `- �"' aPercolation Test Results Performed by-------- -------------------------------------------•----------_.____.__._ Date____------------------_-- ----------- Test Pit No. 1................minutes per inch Depth of "Pest Pit_-________________- Depth to ground water---___---__-_-___-_-..-. GTq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water._----_--__-___-_____-.. G ----------- ------------------------------------ ---- 1 -- ' '-----------------_----- Descrt Description of Soil_ e� IU. e� -:� � • �g `�To J c P t l = x j -------- W 2 - ....................-------------- ---- -------------------------- V 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 Article XI 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. c J Date Application Approved By-------- �� Gs- __ Application Disapproved for the following reasons_____________________________ b Date _________________________________________________ ....__._---_ -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---------- Date ��- � "all,t No......................................................... Issued.... ---Date-•-•--•-----•^--------...._ 76 No.. .............. FEs........L..�....' � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH _....... .... ...........OF................... ...................................................................... Appliration -fur Bwpoutt1 Vorkfi Tonfitritrtion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1�__`w�s ---!on =Add -..ress ----- ..........................-...................................................................... Locati • or Lot No . • .e. ---. ...... W - l �G u f ✓�OW7t/ o ����12 ��._/.f 4 r•= j= caress. �-'......-••-------- ----------•------------- - - _ Installer Address Q Type of Building Size Lot...... feet Dwelling—`No. of Bedrooms...-.-._... _ Expansion Attic ( ) Garbage Grinder ( >c) ---------- aOther—Type of Building ............................ No. of pet-sons......--.................... Showers ( ) — Cafeteria ( ) 0.' Other fixtures ---------------------------------------------------- W Design Flow............�7�.........................gallons per person per day. Total daily flow.............]o.J......................gallons. WSeptic Tank 1 Liquid capacity---0�-Kgallons Length---------------- Width................ Diameter-_-- .......... Depth---------------- x 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 ( ) Dosing tank ( ) ®//_ /�G'/,fd 3" A—7 L W Percolation Test Results Performed bY.......................................................................... Date....-•-•------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to -ground water__...._-------------.._. rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water wa terf..-------------- -----. --------------- -------•--------GDescription of S = .. .__ c� / W VNature 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 Article XI 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. tgne ... ............ = ✓¢fie f �� �6 / Date Application Approved BY ,�' -- ---------� }....._.... ��..-_.7 C,� Date Application Disapproved for tlae following reasons:.... ----------•----•--•-------•-----•--•------------------------------------------••--- ------------------------------------------------- ....................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH / I.�+-. .......OF............................ ........................................................ uprrtifiratr of T"IMphaurr TH I )TQs C�TI Y T1 the Individual Sewage Disposal System constructed ( r Repaired ( ) by....... ( "" // !/ / �. . .... Installer . ..... 1 has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION.SATISFACTORY. ! DATE - Inspector ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F/HHE�ALTH No......................... FEE./d........... Dinpugal lVarkqnuu tr r,"uflt lrrutit Permissio i hereby granted............ ._- ........ ......d. '. ..-•------ to Construct ) or Repair ) an I ivid al Sewage Di sal System at No.-_- -_ r--- Street as shown on the application for Disposal Works Construction P,v6i No.... �.,D,at/ed,......................................... ------------------ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 124, oo 5 q 4.2 LoT �oj� W ND o 3q ` 44 I �Z • 9� CERTIFIED Ae67' li�,4/V BARNST4SCCI MASS. SC.9GF /'--'30' DfTT�' �"fyRCH 22,7976 fG9N 2E 8cty& Z,/ *14 so owm 4o'wtOE YWHITE M, P- om A P441V FAX F%OMAT X, wili?E 4No-ToMnl 5. 8C7W G,M, AND RECo-,P&P /N of V B,C: 226 PG. 3, /"-vrn ZSo AL.: 99 Z��"RTiFy TN4T Tt/EFou✓DgTon/ � ��`' =��' 51-low" onI �'H/$ PCAn/ /S. GoCATED `°J '.i 10, oN 7"HE e^rRouNa AS sNo�rilV NiQEoN � o AND THAT /T Comp'kMS To THE Zo W& LAWS of THE T,,✓n/ of B,gRNST.96`Gf An/p i3 M7� /A/ Tz/E FLocvD hL�r�.v Zon/E. � ° . rjAN 29 i y 74 SSo�. — �'EG �D Scu,1�/ yot- .�1CA8C�" per/T/t�.Vt"�, TOP FNDN. AT EL. 33.1' SYSTEM PRO 1LE TEST HOLE LOGSACCESS COVER TO WITHIN 6 OF SIN, GRADE (NOT TO SCALE) / ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST /f WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 31.0 W TNESS BARNSTABLE HEALTH DEPT. o I 2' DOUBLE WASHED PE P DATE: STON. 1976 EL. 30.9' RUN PIPE LEVEL I B -- FOR FIRST 2' 3' MAX. PERC. RATE - < 2 MIN/INCH EXISTING _ GALLON SEPTIC ! 12 28.0' x TANK (H- 1O ) GAS t r CLASS I SOILS ROUTE 6A RE-USE BAFFLE 2$.17' ooc�o 28.0 0 27.17' Cl C] Cl [� Q C:] CD � CDCIC7 0 QCI 6' CRUSHED STONE OR MECHANICAL C1 m C7 0 Q Q ED C7 C� COMPACTION. (15.221 [23) MIN 2' 7 1 C] C=7 0 C] C7 C m 0 r.3 � 25.17' v [� ELEV. x Locus DEPTH OF FLOW = 4 ( 3.4 / SLOPE) ( % SLOPE) r o 3/4 TD 1 1/2 DOUBLE WASHED STONE TEE SIZES: LOAM " wF+i oR 10 INLET DEPTH = 12" - OUTLET DEPTH = 14" SAND LOCATION MAP NTS IDATION--- EXIST SEPTIC TANK FACILITY 5.17 DENSE 39' D' BOX 16' 24" ASSESSORS MAP 317 PARCEL 68 LEACHING MATERIAL VERIFY 4' NATURALLY OCCURRING PERVIOUS 36" BENCH MAR HYDRANT ON TAG MATERIAL AS SHOWN IN TH 1 BETWEEN ELEBOLT #140 EL. = 31.1' FACl/LITY..ATIO REMOVENANY4UNSUITABLEACHING COARSE SAND MATERIAL ENCOUNTERED AND REPLACE WITH CLEAN MEDIUM SAND WITHIN 5' OF 72's PERIMETER OF LEACHING FACILITY ' 20.0 DENSE LAYER _. 84" FINE SAND 24.0' + 29.7 _I. + 29.5 + 31.2 72 NOTE: LEACH PIT MAY BE IN COARSE 31.1 124.00 AREA OF PROPOSED NEW SAND IN r 9,o LEACHING FACILITY Cu a LOT 14 + I " /+aa9 20,0401 SO, FT. 132" 20.0' ry 16.7 - - 0.46t ACRES NO WATER ENCOUNTERED NOTES: GROUP OF I + 3 WILD CHERRIES I . AP PROXIMAT_E.D. FR V,�QUAD 3 .6 _ DAI TH + 10' DIAM. SEP"IC �. _._....-..._ ....._._ _- ._;_. DESIGN (GARBAGE DISPOSER IS NOT ALLOWED > g, '~ RHODODENDRON - 2, MUNICIPAL WATER IS EXISTING 3 (110 GPD) - 330 GPD FLOW: BEDROOMS G D • �7 a DESI'3N _ y � 3. MINIMUM PIPE PITCH TO BE 1/8 PER F'DDT. �•., I 32.1 USE A 330 GPD DESIGN FLOW 10 A 4. DESIGN LOADING FOR ALL PRECAST. UNITS TO BE AASHD H- I N + 31. SEPTIC TANK: 330 GPD ( 2 ) = 660 5, PIPE JOINTS TO BE MADE WATERTIGHT. 00 __. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 10 USE A 1500 GALLON SEPTIC TANK (RE-USE EXISTING) ENVIRONMENTAL CODE TITLE V, LEACHING; 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT I 2 .6 12" PLE 33.1 SITES: 2(30 + 9.83) 2 (,74) = 118 TO BE USED FOR ANY OTHER PURPOSE. ►� !� 30 x 9,83 (,74) = 21$ S. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. N O+ 3 31i�:4 BOT'.�DM: 1 �. EXIST. DWELL. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TF - 33.1' ~ ! 1 TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED I� + 3 9 DECK ( USE (2) 500 GAL, LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH, + 3ao �`" I J EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT 29.9 11, WATER TEST D'BOX FOR LEVELNESS BETWEEN _UNITS W 3>.�------ L E N D TI TL E 5 SITE PLAN 4 \ 100.0 PROPOSED SPOT ELEVATION OF I + 31.8 \P� 108 STONEHEDGE DRIVE 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: _ loo PROPOSED cONTauR 31. B A R N S TA B L E ( VILLAGE) + � 30. i I o 100 --- EXISTING CONTOUR PREPARED FOR: B4ORTOLOTTI CONSTRUCTION/CALI 30.6 I ( \ n IPAVED I 30.1 I DRIVE 1 ©2 20 0 20 40 60 Z + 31.7 I I 0, � BOARD OF HEALTH \ I � o �fi\ MA SCALE: 1" = 20' DATE: JULY 12, 2002 APPROVED DATE oc \ 2 off 508-368-4541 I I O Pax $08 362-9880 \ \ QS I I 11A OF �tH OF \ dOWn cope engineering, Inc, a� ARNE ARNE �k 29.6 \ Vi OJALA G H. ALA CIVIL_ ENGINEERS � NoC30792 o No 28 Q LAND SURVEYORS A��� /STERE% 02-- 1 79 +2 U 939 vain st. yarr�outh, rya 02675 AR 1V OJALA P.E., P.L.S. DATE �I- ,3_ -� _+ 29.1